NASA - National Aeronautics and Space Administration

BACKGROUND: On July 26, the NASA Astronaut Health Care System Review Committee delivered its final report to the NASA administrator. The report gave the findings of their review of the health services available to astronauts. The committee examined current healthcare systems, medical policies, medical standards and medical certifications for astronauts. The members reviewed documents and conducted interviews with astronauts, their families and NASA health care professionals.

1. Who is on the committee? What was their assignment?
The Astronaut Health Care System Review Committee was formed after NASA Administrator Michael Griffin directed the agency's Chief Health and Medical Officer Dr. Richard Williams in a Feb. 7, 2007, memo to conduct a review of the medical and behavioral health services available to NASA astronauts at the Johnson Space Center in Houston, Texas. Eight committee members were selected from a pool of nominees provided by the senior medical officers of other federal agencies. The committee was chaired by Air Force Col. Richard Bachmann, commander of the USAF School of Aerospace Medicine. It was one of two reviews, the other being an internal Johnson Space Center review, begun in the wake of former astronaut Lisa Nowak's arrest.

2. What will NASA do with the report?
NASA is carefully evaluating all of the recommendations in the report. Many recommendations already have been accepted, including:

• Look for ways to enhance use of behavioral health data in the astronaut selection process
• Take steps to ensure that flight surgeons, trainers, and astronauts are free to communicate concerns of flight safety to senior leadership and encourage such communication
• Adopt a formal code of conduct for the astronaut corps
• Provide regular training to flight surgeons regarding behavioral health assessments
• Promote better communication from flight surgeons to all astronauts on their personal status with regard to medical qualification for space flight assignments
• Work to enhance a program of external peer review of NASA's medical and behavioral health staff
• Establish one credentialing and privileging authority for both the flight medicine and behavioral health providers, with documented processes for accountability
• Institute behavioral health assessments in conjunction with annual astronaut flight physicals

Other health-related recommendations will be reviewed and considered by the NASA Medical Policy Board. The board, which consists of senior physician representatives from NASA and other federal agencies, recommends NASA medical policy and guidance for human space and atmospheric flight. Dr. Richard Williams is the chief health and medical officer at NASA and the chairperson of the board. Other recommendations concerning astronaut corps management and communications between the astronaut corps and the flight medicine teams will be reviewed and considered by the director of the Johnson Space Center. An overall implementation plan will be provided by Dr. Williams, the director of flight crew operations, the director of space life sciences, and the director of the Johnson Space Center to the NASA administrator and deputy administrator on or before January 1, 2008.

3. The report recommends NASA establish and enforce an astronaut code of conduct. What plans are there for a code of conduct?
JSC managers, including officials within the astronaut office, have been discussing an astronaut code of conduct prior to this report. NASA accepts the recommendation and is NASA is reviewing how such a process will be collaboratively implemented. We're not going to speculate on what such a code of conduct might include.

4. What are the current policies regarding alcohol use by astronauts? Are astronauts allowed to consume alcohol immediately prior to flight?
NASA has an alcohol use policy for agency aircraft flight that historically has been applied to space flight. As a result of the report, NASA has adopted an interim space flight policy based on the agency's T-38 aircraft policy. This interim policy states that astronauts are not qualified for flight if they consume alcohol within the 12 hours prior to flight and astronauts will neither be under the influence nor the effects of alcohol at the time of launch. All astronauts will be educated on the policy. A comprehensive review of alcohol use policies relating to aircraft flight and space flight is underway.

5. Two instances were noted in the report where astronauts were intoxicated prior to flight, prompting flight surgeons and/or fellow astronauts to raise concerns to leadership. Who were the astronauts who, according to the report, abused alcohol before a flight? Will there be an investigation?
The committee received allegations regarding alcohol use that it did not attempt to confirm or verify. The committee included the comments in its report to NASA, but the committee has not provided NASA the names of individuals or flights involved in the alleged incidents.

NASA is unaware of any astronauts who were intoxicated prior to flight. However, the administrator and deputy administrator have directed an internal review, which will be conducted by the Office of Safety and Mission Assurance. Until we have more information, NASA cannot determine the veracity of these claims.

6. The report found that leadership disregarded input from flight surgeons on fitness for duty and from crew members on substandard astronaut performance. How will you fix this problem?
The NASA administrator and deputy administrator have directed an internal review of the allegations of alcohol misuse contained in the report. NASA senior leaders work to promote an environment that encourages all employees to bring safety issues up the chain of command without fear of retaliation. Such an environment helps ensure those safety issues will be given serious consideration.

7. If NASA implements the recommendations in this report, could future incidents similar to the Nowak incident be prevented?
NASA's goal is to provide the best possible health care for our astronauts. We asked the committee to review our procedures so we can improve them. The report notes that "Initial screening and recurrent psychological evaluation are not intended to, nor can they, predict a disorder of conduct or 'act of passion.' However, they can identify persons at increased risk, allowing proactive interventions which may mitigate the risk." NASA shares this view.

8. Did the medical review team examine Lisa Nowak's records?
No.

9. Why is there no psychological evaluation of space shuttle astronauts after initial selection? Will astronauts now undergo regular behavioral health assessments?
NASA traditionally has followed aeromedical guidelines for atmospheric flight in the provision of medical care for short-duration missions. In most of these models, periodic formal behavioral health testing has not been conducted. Flight surgeons are relied upon to recognize behavioral health problems and seek appropriate consultation. NASA medical and behavioral health experts have recommended that behavioral health assessments now be conducted for all astronauts in conjunction with annual flight physicals. We are prepared to implement annual behavioral health assessments of all astronauts as part of our astronaut health care program.

10. How will changes that NASA makes as a result of this report affect international astronauts?
NASA's international partner agencies that have active astronauts will be informed of any changes in NASA policies or procedures that may affect them.