As the Department and the Nation begin to transition to reopening in
alignment with White House guidelines, the Military Health System continues
to focus on our mission to prepare, protect, and care for our service
members and beneficiaries. I am increasingly impressed with your endeavors
serving on the front lines, despite the unprecedented challenges our Nation
is currently facing. While many of you have had to manage changes to your
daily lives due to COVID-19, you continued to rise above those hurdles to
ensure our military, their families, and our retirees continue to get the
best quality healthcare we can provide.
Some updates on current MHS issues:
Vaccine and Therapeutics Acceleration Plan. Health Affairs is partnering
with the Joint Program Executive Office for Chemical, Biological,
Radiological and Nuclear Defense (JPEO-CBRND) in implementing a strategy to
accelerate development of COVID-19 vaccines and antibody therapeutics. This
joint effort, funded by the CARES Act, capitalizes on our enormous capacity
to develop, manufacture, and distribute medical countermeasures to the
force. Antibody therapeutics could play a vital role in supporting our
operational missions with prophylaxis measures and post-exposure treatment
COVID-19 Convalescent Plasma. The Department has launched an effort to
obtain 10,000 units of COVID-19 Convalescent Plasma (CCP) in support of
force readiness. It is critical to collect as much plasma as possible, both
for potential treatment purposes now as well as for use in research efforts
and potential use as a future therapeutic. To qualify to be a donor, DoD
personnel and their families, as well as non-DoD civilians with access to
collection facilities on installations, must have fully recovered from
COVID-19 to support this effort. To date, we have already obtained 4,367
units through a combination of procurement and individual donations at Armed
Services Blood Program donor centers across the continental United States,
Hawaii, Guam, and Germany. More on this campaign can be found here:
A special call out to Navy Medicine who, in support of the DoD CCP campaign,
sent a team to Guam and rapidly collected CCP from volunteers aboard the USS
Theodore Roosevelt. Over the course of three days, the blood donor center at
U.S. Naval Hospital Guam collected more than 200 life-saving plasma units.
This was the first of many donations as crew from the USS Kidd also
Navy Medicine is also directly involved in COVID-19 research efforts. For
the past two months, the USS Theodore Roosevelt was the focus of a public
health outbreak investigation conducted by the Navy and Marine Corps Public
Health Center in partnership with the CDC. Volunteer crew members completed
a short survey and provided two specimens for laboratory testing (voluntary
blood and nasal swab samples). This was the first CDC-published report on
this specific demographic of young adults. One of the key findings was that
loss of taste or smell was the main symptom most associated with COVID-19
infection. This joint effort furthers our understanding of this disease and
will inform future testing and mitigation strategies to ensure the readiness
of our Nation’s military force.
Force Health Protection Guidance Supplement 11. On June 11, 2020, the
Department issued new Force Health Protection guidance outlining the
military’s surveillance strategy for the COVID-19 pandemic response,
including health surveillance activities, screening, asymptomatic testing,
and sentinel surveillance testing. The Department’s surveillance and
screening strategy is designed to break the chain of disease transmission to
reduce risk to the force and to DoD missions. The full guidance can be found
COVID-19 Registry. The DHA has established a COVID-19 Registry to provide a
centralized data collection platform of COVID-19 patients. This registry,
which already includes data from 6,510 patients, will support COVID-19
clinical performance improvement and track the epidemiology of the disease.
The data will help research and medical teams, both in the DoD and the
civilian sector, provide more accurate insight into future advancements in
vaccines and treatments. The registry also will track the outcomes of
patients who receive COVID-19 Convalescent Plasma compared to those who do
not – all of which will greatly enhance efforts toward therapeutic treatment
development. The expediency of the design, implementation, and execution of
this monumental task would not have been possible without the dedication and
hard work of Col Stacy Shackelford, Chief, DHA Joint Trauma Center (JTS),
and Mr. Phil Sartin, Data Acquisition Branch Chief for JTS.
As communities begin to slowly open back up, please stay vigilant. The COVID
fight is not over. Many of you are working tirelessly in MTFs, labs, or in
supporting roles to help achieve our health system’s goals and meet the
evolving needs of the Department. Your efforts are critical to ensuring we
accomplish our mission. Please practice self-care, take time for your
families, and check in on each other. As a medical enterprise, we must
remain strong and healthy to ensure we keep our military in the fight.
Thank you for your service and selfless commitment to our troops, their
families, and to our Nation during these challenging times.
The Department of Defense continues to deliver on Secretary Esper’s
priorities during the COVID-19 pandemic to protect our people, maintain
readiness, and support the national COVID-19 response. Together, Health
Affairs, the military services, the Joint Staff surgeon, the Defense Health
Agency, and the Uniformed Services University are rising to the challenge of
managing an aggressive response to the virus.
Here are updates on issues Health Affairs is tracking.
* Testing: Major General Lee Payne, Defense Health Agency Assistant
Director, Combat Support, has been designated by the Department’s COVID-19
Task Force as the DoD’s lead to implement the Department’s tiered approach
to increase diagnostic and surveillance testing for personnel tied to
critical mission requirements. Thanks to the hard work from your teams, we
are on track to meet the operational Tier 1 requirements. We’ve completed
more than 85,000 tests and tested nearly 1,000 DoD personnel supporting the
New York City response. As we work through Tier 2 and Tier 3 requirements,
we are also looking to support sentinel surveillance testing for Tier 4
requirements. Maj Gen Payne and his team are carrying out impressive work to
spearhead testing protocols, identifying and validating Service and
combatant command requirements, managing logistics, and finalizing reporting
requirements for this massive effort.
* Advancing Force Health Protection: Health Affairs subject matter experts
are deeply involved in developing Force Health Protection guidance for the
Department, including the most recent update, Supplement 8, for protecting
personnel in the workplace. We expect new and revised guidance to be issued
shortly on Clinical Laboratory Diagnostic Testing Services; Surveillance and
Screening with Testing; Risk-Based Lowering of Health Protection Condition
Levels; and Resuming Elective Surgical, Invasive, and Dental Procedures in
Military Medical and Dental Treatment Facilities.
* Vaccine & Antibody Therapeutics Acceleration Strategy: Military Medicine
has a long history of rapid innovation and medical advances. From a
battlefield evacuation system that became the foundation for a modern
Emergency Medical Services system to advances in damage control surgery and
trauma management that have informed nationwide trauma practice, our
commitment to continuous learning and evolution of medicine has always
placed the Military Health System at the forefront. Now, once again, DoD is
out in front leveraging our world-class research capabilities and
partnerships with the Department of Health and Human Services and others to
not only develop an effective COVID-19 vaccine, but to also ensure its rapid
mass production to support a rapid national vaccination effort. This effort,
known as Operation Warp Speed, and supported through funding from the CARES
Act, is streamlining multiple research efforts both in vaccines and
therapeutics and is producing developmental strategies for the manufacturing
and distribution of a COVID-19 vaccine and treatment therapies.
The pandemic response I’ve seen from our collective MHS team has reinforced
the significant roles you play and the historic difference you are making.
Thank you for joining the fight against COVID-19 and ensuring that the MHS
is not only supporting the DoD’s response to the pandemic, but also
supporting the whole-of-government effort to defeat the pandemic.
Every year at this time, cities and towns across the Nation gather to
remember the contributions and bravery of generations of men and women who
have made the ultimate sacrifice for our country. But this year will be
different. Observances for the holiday will not look like years past because
of the pandemic, and many of the traditional Memorial Day parades and events
we are accustomed to will not proceed. While we may not be able to gather in
person this year, that doesn’t mean we cannot pay our respects to our fallen
heroes. This Memorial Day, I encourage you to pursue other ways to honor the
brave men and women who sacrificed their lives to ensure our safety and
Please stay safe and healthy!
The latest admiral is RDML(s) Cynthia Kuehner:
In addition, here is a message about Nurse’s Week from the ASD(HA):
Tomorrow marks the start of National Nurses Week. As we celebrate the long history of military and civilian nurses who have served our nation, we recognize the unique contributions nurses have made – and continue to make – to military medicine in both peacetime and wartime. This year, Nurses Week coincides with the 200th anniversary of nurse pioneer Florence Nightingale’s birth, further reminding us of the critical role nurses play in our national life.
To the dedicated nurses across the Military Health System: thank you.
Thank you for your service to the nation, working to keep our forces ready to answer the call, anywhere and anytime. Thank you for serving our 9.5 million beneficiaries – whether across our military hospitals and clinics, in our research laboratories, in our military medical classrooms, or in the office performing data analytics. Thank you for serving on the front lines in the fight against COVID-19, directly delivering on Secretary Esper’s priorities to protect our people, maintain readiness, and support the national response. Thank you for your enduring commitment to protect, promote, and improve military health care and readiness every day, building a stronger, more effective Military Health System for those depending on us.
To the MHS team: thank a nurse this week and recognize them for their efforts – big and small – that are so integral to caring for our patients and advancing our mission. Share their successes through photos, comments, or stories, on MHS social media platforms using the hashtags #NursesWeek, #YearoftheNurse, and #MHSNurses. And be sure to visit the Nurses Week spotlight page on Health.mil to learn more about how our nurses are going above and beyond the call of duty every day:
Assistant Secretary of Defense for Health Affairs
As the nation faces a historic challenge to combat the COVID-19 pandemic,
military medicine is at the forefront of the battle to protect the health of
U.S. military forces and support the national response. You are playing a
critical role to deliver on the Secretary’s priorities to protect our
Service members, their families, and the workforce, while maintaining
military readiness and supporting the national COVID-19 response. Military
medicine has been at the front lines of the national response – bringing
unique, and agile expertise and rapidly deployable resources to the fight,
including martialing medical staffing and getting them to the place where
they can do the most good: treating patients. We’re mobilizing doctors,
nurses, and medical technicians, both Active and Reserve Component.
Thank you for being a part of our team, and for the long hours you are
putting in to keep our people healthy and safe, and to support our nation in
the fight against COVID-19. I wish to share some key updates as we work
together across the MHS and the Department to tackle this virus.
The pandemic is putting unprecedented pressure on the MHS. As a result, on
April 2 the Department decided to pause the MTF transition activities for 90
days. At the 45-day mark, we’ll reassess to determine the right time to
resume these important efforts. This pause enables the system’s full focus
on the COVID-19 response.
As we direct our attention and resources to meet the increasing military
medical needs from COVID-19, the Military Health System’s agility and
adaptability remain part and parcel to our success. Health Affairs, the
Services, the Office of the Joint Staff Surgeon, the DHA, and the Uniformed
Services University continue to focus on a range of efforts to support the
Department and our beneficiaries. We’ve worked closely with senior
leadership to implement a series of Force Health Protection policies that
provide DoD Guidance on protecting personnel, patient movement and
treatment, the use of personal protective equipment, and laboratory
I issued a policy that began on March 31 directing military Medical
Treatment Facilities and Dental Treatment Facilities to postpone elective,
non-invasive, non-urgent procedures unless those procedures can be safely
performed and are deemed necessary for readiness or for a patient’s safety.
This policy aligns with actions being taken across the nation to conserve
vital healthcare resources to use in support of the national COVID-19
response. The policy has increased medical staff availability to meet MTF
demand, while supporting deployed medical assets and protecting our
patients, medical personnel, and communities from further exposure and
transmission of COVID-19.
The University’s and DHA’s COVID-19 Practice Management Guidelines,
TRICARE’s new Applied Behavioral Analysis therapy guidance, and new MTF
virtual health guidance are great examples of how the MHS is delivering for
our Service members, retirees and their families by adapting in real time to
At the same time, facilities are leveraging advanced telehealth technology
to preserve health care service offerings for patients. In fact, the number
of Direct Care visits has not changed compared to February, thanks in large
part to the virtual care our providers are now offering. On March 30, more
than 35 percent of primary care appointments were conducted virtually, and
we expect the virtual health guidance to facilitate even more virtual care
offerings in the future, in order to continue providing high-quality care to
patients, even as the COVID-19 response continues. I commend MTFs and DTFs
for working hard to execute these changes seamlessly for our patients, and
in support of the whole-of-government efforts to conserve medical capacity
Lastly, I’m pleased to congratulate the hundreds of fourth-year Uniformed
Services University medical students and graduate-level nurses who made
history being the first to graduate early. These new doctors and the nurses
who have completed advanced degrees are joining DoD’s COVID-19 response.
Thank you for your selfless commitment to serve our warfighters, patients,
and nation through military medicine. On behalf of the Military Health
System, welcome to the team!
MHS Director of Governance in the Office of the Assistant Secretary of Defense for Health Affairs – O6
Here is the advertisement for an amazing opportunity for one of our senior O-6s. A “best fit” would have some Office of Secretary of Defense (OSD)/Pentagon experience, big picture Joint understanding of Air Force, Army, Navy health care current and future priorities, and understanding of the Defense Health Agencies scope of Military Treatment Facility/Markets authority, direction and control. The person needs to be able to accurately interpret and document discussions across the Services’ SGs, DHA Director, Reform/Transition initiatives (OSD Congressionally Directed) and Health Affairs organization (Deputy Assistant Secretaries’ of Defense and Assistant Secretary of Defense four star position). Understanding of big picture and OSD organization is necessary.
Applications should be submitted to CDR Melissa Austin (contact is in the global) by 21 FEB 2020.
Happy New Year! I hope you had a restful holiday season and are back in the
swing of things. I fully expect that – like 2019 – 2020 will be a jam-packed
year for the MHS.
That starts, of course, with making progress on the reform efforts that
formed so much of our work in 2019. First is the consolidation of management
of Military Treatment Facilities. The Defense Health Agency is working with
all other elements of the system to stand up its headquarters and the market
construct that we will use to administer the MTFs under DHA. And we got an
assist from Congress, which as part of the National Defense Authorization
Act passed in December, included provisions that allow us the flexibility we
need to shift key civilian personnel in MTF management from the military
departments to DHA. We expect the first Transfer of Function-related
personnel moves to start in early February.
Second is the reexamination of our facilities footprint, a review directed
in Sec. 703 of the FY17 NDAA that asks the Department to assess MTFs to
determine if there are opportunities to resize any facilities that do not
offer a platform for maximizing ready medical capabilities. We expect that
our report outlining these plans will go to Congress within the next few
weeks, and we are prioritizing clear communications with key audiences –
especially patients and staff – to help all understand any changes and their
Third is our work to support the Military Departments’ implementation
efforts tied to their proposed repurposing of military medical billets.
Planning to implement these reductions while ensuring we meet our
obligations to patients and operational forces continued through 2019. In
that NDAA passed in December, Congress established new requirements that the
Military Departments and the Department of Defense must fulfill before
implementing these reductions, and Health Affairs, DHA and the Services are
working together to comply with this direction from Congress.
Congress included other important provisions in the NDAA with implications
for the MHS. You have probably already heard about the provision that
authorizes a new process for service members who want to file medical
malpractice claims. Health Affairs will work with the Military Departments
and DHA to develop the rules and procedures for such a process.
Related to our focus on readiness, at last month’s annual AMSUS conference I
announced that the Joint Staff Surgeon and Health Affairs had been tasked to
develop a Strategic Framework for Operational Medicine. This framework,
being developed with the Surgeons General, DHA, and the Uniformed Services
University, will provide a common goal for synchronizing DHA’s role in
health delivery with the Military Departments’ readiness and training
requirements. The goal is to better integrate the tremendous work happening
across the MHS to build and sustain the skills we need to support
operational requirements. This work gets to the heart of our system’s reason
for being and will be a focus throughout the year.
One constant in Health Affairs the last four years has been Dr. Terry
Adirim. Terry has helped the MHS navigate a host of challenging clinical,
policy, and organizational issues. For me personally, on every important
issue we’ve dealt with, she has provided invaluable counsel and support.
Terry is leaving us to take a position at the Florida Atlantic University
College of Medicine. FAU is immensely fortunate to have a physician of
Terry’s experience, skill, and dedication helping to shape the next
generation of medical professionals. The MHS’s loss is FAU’s gain. Please
join me in thanking Terry for her many contributions to our military medical
December Message to the Military Health System Team from the Assistant Secretary of Defense for Health Affairs, HON Thomas McCaffery
Earlier this month, I joined many of you at the annual convening of AMSUS (the Society of Federal Health Professionals) at National Harbor, Maryland, to discuss the status of the Military Health System: what we’ve achieved, where we’re going as an organization, and how we will get there. Directly following AMSUS, I testified before the House Armed Services Committee alongside the Military Department Surgeons General, Joint Staff Surgeon, and the Director of the Defense Health Agency. Each engagement provided an important opportunity – and critical audiences – to share our steps in carrying out reform across the military medical enterprise to better meet the Department’s needs, and to reaffirm the MHS’s collective vision for the future.
I underscored the new challenges an ever-changing security environment presents to our military and, more specifically, to military medicine – challenges requiring our organization to adapt and evolve to best serve the combatant commands and the Military Departments as we together advance the National Defense Strategy. This period of MHS reform is a time to embrace change and forge an improved system of military health that delivers on our readiness mission to ensure that troops are fit to fight, and that medical professionals are ready to support them in training and on the battlefield.
To better deliver on our mission, the MHS is laser focused on three key areas of organizational reform. First, consolidated management of the direct care and purchased care systems. Second, a reinvigorated focus on readiness within the direct care system. And third, optimizing the size and composition of the military medical force, including the recruitment, education and training, and sustainment of skills to deliver on our readiness mission. For the most current updates on our MHS reform areas of focus, I’m attaching the prepared statement that the DHA Director LTG Place and I provided to the HASC at the recent hearings.
I would like to thank Army Surgeon General LTG Dingle for inviting me to speak at the MEDCOM Leadership Lecture Series on 10 December. This event afforded me the opportunity not only to speak about my leadership philosophy and approach, but also to hear MEDCOM leaders’ thoughts and perspectives on the various changes underway in the MHS.
In the weeks ahead, I hope many of you are able to enjoy some well-deserved time with friends and families over the holidays. For those deployed or unable to take R&R due to serving our warfighters and patients: thank you for your selfless service to the Nation. Each of you across the MHS is playing a part in significant change in our enterprise – helping to inform those changes, making them real, and dedicating your talent and expertise to our mission. I am grateful for your contributions and look forward to our continued work together in the New Year.
Army Surgeon General’s Leadership Lecture Series: HON McCaffery, Assistant Secretary of Defense for Health Affairs
Here’s a link to a 1 hour video on leadership from the Assistant Secretary of Defense for Health Affairs:
On October 25, 2019, Deputy Secretary of Defense David L. Norquist signed a memo officially directing the transfer of authority, direction, and control of Military Treatment Facilities across the United States to the Defense Health Agency. While this formal directive marks an important milestone in the MTF transition process, it is only the most recent. The Military Health System’s work to date has resulted in significant progress to implement key provisions of the Fiscal Year 2017 National Defense Authorization Act. We transitioned the first phase of hospitals and clinics to the DHA last October and published more than 100 standardized policies since January 2018, with 29 more projected for publication by the end of the year. This progress reflects great momentum toward standardizing performance measures across the military medical enterprise and eliminating unnecessary variability, while moving to a more integrated system of readiness and health care delivery.
Earlier this month, I joined DHA Director LTG Ron Place and the Service medical leadership to share updates on MHS reform efforts with the Military/Veterans Service Organizations (MSO/VSO) Executive Council – a key stakeholder group that has long provided the MHS with invaluable insights into our beneficiaries’ experience within the health system. In recent months, MHS senior leadership has tackled head-on many of the issues MSO/VSOs have raised on behalf of beneficiaries. We reaffirmed to the MSO/VSO group that we’ve put in place a conditions-based, direct-support framework to ease the transition of MTFs to the DHA, which will help us to ensure we continue to provide our beneficiaries with access to quality care during this period of change.
I commend the teams across the MHS – at all levels – for your continued commitment to successfully implement the multiple reforms we have launched. Across Health Affairs, the Military Departments, DHA, the Uniformed Services University and the Office of the Joint Staff Surgeon, we recognize that success is a collective endeavor; our partnership to expeditiously solve problems, address gaps, and communicate successes and challenges remains key. A special thanks to senior leadership for forging this collaboration, and a warm welcome to Rear Adm. Bruce L. Gillingham, the Navy’s new Surgeon General and Chief of the Bureau of Medicine and Surgery. We look forward to your contributions in your new role – welcome to the team!
Outside of reform, military medicine continues to advance the Department’s three lines of effort in support of the National Defense Strategy. Earlier this month I had the opportunity to witness this first-hand when I visited the USNS Comfort in Haiti as part of its five-month deployment to provide medical assistance in support of regional partners across the USSOUTHCOM AOR. It was an honor to join USSOUTHCOM Commander Adm. Craig Faller, Task Force 49 Mission Commander Capt. Brian Diebold, USNS Comfort MTF Commander Capt. Patrick Amersbach, and the entire USNS Comfort team as they carried out this critical medical mission. This mission is a great example of the strategic role military health care plays in advancing the NDS’s focus on building relationships with our partners and allies.
Looking ahead, I anticipate seeing many of you at next month’s AMSUS (the Society of Federal Health Professionals) annual convening at National Harbor, Maryland, where I’ll join other senior leaders to discuss our progress to date implementing significant organizational change across the MHS and to outline what’s ahead for the system.
For those who are able to take some R&R for Thanksgiving, I hope you are able to spend time with friends and family and return refreshed. As I reflect on this uniquely American holiday, I’m grateful for the men and women who protect and defend our freedom and for the families who support them, and I thank all of you for what you do to sustain the health system that supports them.
As the Defense Health Agency formally assumes responsibility for management
of MTFs across the United States, I commend your continued commitment and
hard work across all levels of the MHS to ensure our warfighters maintain
the military medical combat support capabilities we provide, our patients
see no disruption of quality or access to the healthcare delivery services
they depend on, and our collective efforts to deliver on an implementation
plan to make this transition a success. You are part of an historic
transformation in military medicine – thank you for your service to the
nation during this pivotal period of change. While we have accomplished much
to date, much work remains, and I know you will continue to deliver at the
same high level as this work continues.
In addition to business reform, the MHS continues to build critical
partnerships to advance readiness and operational support. Recently, I
joined Acting Commissioner Dr. Ned Sharpless and his staff at the Food and
Drug Administration for the FDA-DoD semi-annual meeting to discuss our
continued, close partnership to ensure delivery of critical battlefield
medicine to our service members downrange. Over the past two years of
enhanced collaboration between the DoD and FDA, we’ve achieved a number of
successes to advance warfighter readiness and improve overall battlefield
trauma response. We’ve established Emergency Use Authorization for
freeze-dried plasma in initial hemorrhage control efforts as part of
battlefield trauma care, approved drugs for battlefield pain control and
infectious disease threats, and increased the Department’s access to
platelets for injured warfighters in theater. These successes are already
yielding dividends in building a better prepared, better protected, and
better cared for force, equipping the U.S. warfighter with the best possible
military medical support. A special thanks to Dr. Terry Rauch and the DoD
team for your hard work on this critical partnership – including LTC
Colacicco-Mayhugh, RADM (Ret) Carmen Maher, Ms. Kathy Berst, Mr. Nathan
Pawlicki, COL Jennifer Kishimori, Mr. Jeremiah Kelly, Ms. Emily
Badraslioglu, and Ms. Jennifer Dabisch.
Our partnership efforts within the MHS continue to develop as well. I had
the opportunity to join the National Intrepid Center of Excellence (NICoE),
the 10 Intrepid Spirit Centers (ISC), and the Center for the Intrepid (CFI)
to discuss progress and areas of focus as the MHS continues to develop the
best care and treatment for the more than 172,000 patient encounters – seen
this year alone – related to traumatic brain injury and associated health
conditions. With new improvements for treatment and care, including NICoE’s
TBI Portal – which, in collaboration with the Defense Health Agency and the
ISCs, consolidates TBI patient data to better inform clinical decision
making and treatment – the MHS is building a collaborative network of TBI
research, education, and care to enhance warfighter readiness. Special
thanks to NICoE Director CAPT Walter Greenhalgh, NCR Director Brig. Gen.
Anita Fligge, Intrepid Fallen Heroes Fund Honorary Chairman Mr. Arnold
Fisher, Walter Reed National Military Medical Center Director COL Andrew
Barr, and our talented colleagues across the University and the Defense and
Veterans Brain Injury Center for advancing the MHS’s partnership and best
practices that are putting military medicine at the global forefront to
prevent and respond to TBI.
On a final note, we bid farewell to Vice Adm. Forrest Faison as the 38th
surgeon general of the Navy, as he retires after 39 years of service to the
Nation. On behalf of the entire MHS, thank you for your passionate
commitment to the military medical enterprise and to the soldiers, sailors,
airmen, Marines, Coast Guard members and the families who the MHS supports
and cares for.