NASA has established rigorous medical standards for the selection of new astronauts, space mission assignments, and medical and behavioral health to ensure that astronauts can adequately carry out missions in space. As of April 2010, NASA had 83 astronauts eligible to be assigned to a space mission and 9 astronaut candidates in training to become eligible for a mission. Prior to going into space, astronauts receive an average 6 years of training for a Space Shuttle mission and an average 8 years of training for an International Space Station (ISS) mission. The Astronaut Corps is supported by 21 medical and aerospace physicians, 2 psychiatrists, and 3 psychologists who provide routine health care, annual physical and behavioral health examinations, and support during training exercises and space flight missions.
The arrest of a NASA astronaut in February 2007 for personal actions that were the subject of criminal charges led to a number of internal and external reviews related to health care services provided to members of the Astronaut Corps. The first review, performed by Johnson Space Center (Johnson review) between February and June 2007, focused on Johnson's practice of behavioral medicine and included recommendations to improve Johnson's behavioral health care services for NASA astronauts.
A committee of Federal behavioral health care and aerospace medicine specialists commissioned by the NASA Administrator performed the second review, which focused on Johnson's overall astronaut health care program. That committee issued a report in July 2007 (Committee review) with recommendations to improve medical and behavioral health care provided to astronauts and their dependents, communication and coordination between NASA's medical providers and the behavioral health providers, and Astronaut Office operations.
A third review by NASA's Office of Safety and Mission Assurance (Safety and Mission Assurance review) in July 2007 focused on allegations of alcohol misuse by astronauts. The Office of Safety and Mission Assurance issued a report in August 2007 concluding that allegations of alcohol impairment or misuse by NASA astronauts were not substantiated; however, the report contained recommendations pertaining to alcohol policies within the Astronaut Corps and at the Centers as well as suggested revisions to the disciplinary policy for the ISS code of conduct.
We conducted this audit to assess NASA's actions to implement the recommendations contained in these three reviews to improve the medical and behavioral health care provided to the Astronaut Corps. We assessed whether NASA Headquarters and Johnson had taken corrective actions that (1) met the intent of the recommendations in the reviews and (2) whether the actions were implemented. We did not, however, test the effectiveness of NASA's implementation efforts nor did we validate the reviewers' findings. See Appendix A for details of the audit's scope and methodology.
We determined that NASA had taken steps to implement 36 of the 39 recommendations contained in the three reviews. We also found that NASA had not completed or taken action on 2 recommendations because no NASA official had been assigned responsibility to address one of the issues and because the program addressed in the other recommendation had been suspended. Finally, NASA was unable to take action on 1 recommendation because the recommendation requires determining whether changes to the astronaut selection process were useful, which cannot be done yet.
NASA Took Actions to Address 36 Recommendations. We determined that all 3 of the recommendations from the Johnson review were addressed, all but 2 of the 30 recommendations from the Committee review were addressed, and 5 of the 6 recommendations from the Safety and Mission Assurance review were addressed.
The three recommendations in the Johnson review sought to improve the behavioral health care provided to astronauts and astronaut candidates. We found that NASA officials took actions that met the intent of the three recommendations. Specifically, the Johnson Space Medicine Division Chief issued new guidance (SD-09-021, "Annual Astronaut Behavioral Health Exam," March 23, 2009) to address the recommendation that a 30-minute behavioral health assessment be conducted in conjunction with annual medical flight physicals and the recommendation that behavioral medicine flight assessments be performed on Shuttle crewmembers. The guidance includes a requirement for the behavioral health providers to institute annual behavioral wellness evaluations for all astronauts regardless of flying status and a requirement for a psychiatrist to determine whether the astronaut is qualified for active flying status. In addition, NASA organized a working group that made recommendations to improve the astronaut selection process to address a recommendation that NASA enhance the assessment of an astronaut's fitness for flying duty.
Further, we determined that NASA took actions to meet the intent of 28 of the 30 recommendations issued by the Committee commissioned by the NASA Administrator. Specifically, NASA established or revised 21 policies and procedures to address 14 Committee recommendations related to Privacy Act information, alcohol misuse, behavioral health care, independent reviews of the behavioral health clinic, medical records, credentials, standard operating procedures for the behavioral health clinic, attendance and structure of the Aerospace Medicine Board, an Astronaut Code of Professional Responsibility, and astronaut performance evaluations. NASA took additional actions to address 8 other Committee recommendations related to the psychological evaluation of applicants to the Astronaut Corps, medical testing of the Astronaut Corps, reporting safety concerns, continuity of health care, privacy of medical information, supervisory training, and surveying the Astronaut Corps regarding issues identified by the Committee. These actions included increasing behavioral health providers' involvement during the astronaut hiring process, providing training on topics such as privacy of medical records and supervision, hiring additional behavioral health providers, improving the explanation for medical testing, encouraging the reporting of safety concerns, and surveying the Astronaut Corps and flight surgeons about their knowledge of policies and procedures, the relationship between astronauts and flight surgeons, and allegations regarding astronauts misusing alcohol. In addition, NASA provided us evidence of existing policies that satisfied the intent of an additional six recommendations. For example, NASA already had policies and procedures in place that addressed the Committee's recommendations regarding selection of crewmembers and the need to identify and share human factor concerns among all organizations involved in astronaut activities.
Finally, we found that NASA officials at Johnson and Kennedy Space Centers met the intent of five of the six recommendations made in the Safety and Mission Assurance report. The recommendations related to procedures on launch day, alcohol use by crewmembers, and conduct of crewmembers on the ISS. Specifically, Johnson revised an internal policy to include the risk of drinking to excess, finalized an internal policy on alcohol use in astronaut crew quarters, and provided NASA's disciplinary policy to the Multilateral Crew Operations Panel, an international body that makes policy decisions about the ISS. In addition, Johnson uses a flight surgeon's checklist, which includes a visual assessment of the astronauts up to 9 hours before launch, and an April 2008 policy that states that the mission-assigned flight surgeon, astronaut supervisor, and other managers are required to stay in Kennedy's astronaut crew quarters prior to launch. These actions satisfied the intent of the report's recommendation related to procedures on launch day. Finally, in response to the report, Kennedy officials issued a new policy on alcohol consumption in astronaut crew quarters.
NASA Had Not Taken Actions to Address Two Recommendations. At the time of this review, NASA Headquarters had not addressed the recommendation from the Safety and Mission Assurance report to implement a NASA-wide alcohol testing program because no NASA official had been assigned responsibility to address the issue.
In addition, NASA Headquarters had not addressed whether astronauts should be included in NASA's Personnel Reliability Program, as recommended in the Committee report. The Committee found that NASA civil service and military astronauts were not required to report illnesses, injuries, or medication use so that the responsible NASA entity could determine whether the astronauts were fit to perform their assigned duties. Even though the NASA Office of Protective Services suspended NASA's Personnel Reliability Program on June 10, 2009, we determined that including astronauts within NASA's Personnel Reliability Program would not address the Committee's finding that astronauts were not required to report illnesses and non-NASA care. Therefore, to address the Committee's finding, NASA should require astronauts to certify that they will report all health care, to include mental health care, they receive from providers not affiliated with NASA when assigned to a mission and continuously report such non- NASA care until the mission is completed.
NASA Was Unable to Address One Recommendation. NASA was unable to address a Committee recommendation that it fully integrate behavioral health information derived from psychological testing evaluations into the final selection process of astronaut candidates if the information is found to be useful. Although NASA hired nine astronaut candidates in May 2009 using psychological testing evaluations in their selection, NASA officials said they cannot yet determine whether the behavioral health information they used was helpful, because the candidates have not yet successfully completed the training and evaluation period prior to becoming an astronaut. Additionally, it can take up to 8 years from the time NASA hires an astronaut candidate to when the astronaut returns from his or her first long-duration mission. Therefore, to determine whether the behavioral health information collected during the hiring process was useful, NASA officials said they will need to observe the performance of the new astronauts for a period significantly longer than the year that has elapsed since their hiring.
The Assistant Administrator for Human Capital Management should issue policy establishing a NASA-wide program to test NASA astronauts and other employees for alcohol. We also recommended that Johnson's Space Medicine Division Chief issue a policy requiring newly assigned mission crewmembers to update any medical and behavioral health conditions and treatments received from non-NASA sources since their last annual NASA examination.
In response to a draft of this report, the Assistant Administrator for Human Capital Management nonconcurred with our recommendation to issue an Agency-wide alcohol policy. The Assistant Administrator said that given the press of other priorities, the Administrator and Deputy Administrator have not yet been briefed on the legal issues and complexities involved with establishing an alcohol-testing requirement for NASA civil service employees. However, the Assistant Administrator also said that NASA will "work toward staffing a final Agency decision on alcohol testing of civil service employees."
In light of the Assistant Administrator's pledge to reach a final Agency decision regarding testing NASA employees for alcohol, we are resolving the recommendation. We will close the recommendation when management issues a final decision on the matter.
The Assistant Administrator concurred with the intent of our recommendation to issue policy requiring astronauts to report all medical care received from non-NASA sources. However, rather than issue policy, the Space Medicine Division and Astronaut Office added a requirement to the annual family history form requiring astronauts to acknowledge that they must report to the Flight Medicine Clinic or Behavioral Health Clinic all instances of non-NASA health care that they receive.
We obtained and reviewed the revised annual family history form and have determined that this action is responsive to our recommendation. Accordingly, the recommendation is closed.