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ACCESS TO CARE
BEYOND THE COLD WAR
The Army's efforts to raise the standards expected of medical soldiers and to update doctrine, equipment, and systems were tested in a series of deployments in the post-Vietnam era. One of the first followed Israel's withdrawal of its occupation forces from the Sinai in 1982, when the United States agreed to maintain one infantry battalion there as part of a United Nations peacekeeping force. MSCs were part of that effort, and 2d Lt. John B. Witmer, MSC, medical platoon leader in the 101st Airborne Division (Air Assault), died in December 1985 along with 255 other members of his battalion when their plane, returning from the Sinai, crashed in Gander, Canada-the greatest disaster in military aviation history.1
The first sizable American combat operation after Vietnam was the invasion of Grenada. In 1983 the Caribbean "isle of spice" seemed well on its way to becoming a satellite of Communist Cuba, as Cuban military advisers and workers moved in and began to construct a 12,000-foot airstrip, apparently intended for use by Soviet military aircraft. The situation deteriorated in October when Grenada's prime minister was executed by leftist rivals. Nearly eight hundred American medical students attending school on the island made an attractive target for hostage-taking. The prospects were especially alarming to President Ronald Reagan's administration, which had moved into the White House in 1981 on the heels of President Jimmy Carter's bitter experience with Americans taken hostage by Iran.2
Under presidential orders, the invasion began in the early morning of 25 October with a combat jump of two Army Ranger battalions and an assault by helicopter-borne marines. By the next evening the Ranger and airborne battalions of the 82d Airborne Division, Fort Bragg, North Carolina, had evacuated the medical students. The United States reported 19 killed and 115 wounded; it estimated that 70 hostile Cubans and Grenadians had been killed in action and 394 wounded.
Lt. Col. Edward B. Wilson, MSC, remained in command of the 82d Airborne's 307th Medical Battalion. Other medical units included elements of the 5th Combat Support Hospital, which deployed to Grenada from Fort Bragg on 2 November under the command of Lt. Col.Joseph J. Costanzo, MSC. Aeromedical evacuation was provided by the 57th Medical Detachment, commanded by Maj. Arthur W. Hapner, MSC. Lt. Col. Joseph P. Jackson, MC, headed the advance party of the 307th, and his medical team received casualties through 2 November when hostilities ended. The team's experience highlighted a basic lesson in medical logistics as their operations were initially jeopardized because the detach-
ment's materiel had at the last minute been bumped from its place in the air transport queue at Pope Air Force Base, Florida, when the division ordered in more combat soldiers than originally scheduled. Also relearned was the requirement for medical support of refugees and enemy prisoners of war, and Col. James Rumbaugh, MC, the XVIII Airborne Corps surgeon, organized a medical civic action program before the hostilities ended.
Lt. Col. Hugh M. McAlear, MSC, and Capt. William B. Andrews, MSC, both sanitary engineers, along with Capt. John B. Czachowski, MSC, were members of the preventive medicine team that assembled on the island. Czachowski, an environmental science officer from Womack Army Hospital at Fort Bragg, came under sniper fire while inspecting water points. His arrival was a welcome event for Lt. Col. N. Joe Thompson, MC, the first preventive medicine officer on the island, who was "never so happy in his life as when Czachowski showed up." McAlear, assigned to the U.S. Army Environmental Hygiene Agency, Aberdeen Proving Ground, Maryland, left for Grenada on a 24-hour notice. Riots and a garbage strike prior to the arrival of the American forces, coupled with a water shortage caused by a loss of electricity for pumping, combined with the island's heat to create sanitation challenges. The lackadaisical attitude of some soldiers toward sanitation required command intervention to compel them to adhere to basic field sanitation principles.3
MSCs at all levels of the intervention in Grenada quickly shifted from support of combat operations to support of the transition to peace. As in previous
U.S. military engagements, their actions were especially valuable in restoring sanitation and providing health care to POWs and the civilian population. They were active participants in the Army's role in civil-military operations, the creation of a democratic government, and the departure of U.S. forces.
Disorder in Latin America was not ended, however. Increasing troubles in Panama caused by the regime of dictator Manuel Noriega subjected Panamanians to brutal oppression and threatened U.S. citizens and interests in the Canal Zone. The crisis began in mid-1987 as Noriega, faced with an outpouring of dissent, moved toward armed repression, turning his army against both Panamanians and Americans. Violence escalated and the situation became increasingly chaotic and untenable. The United States increased its troop presence in 1988 as the situation deteriorated and Noriega continued his anti-American tirades. In 1989 Noriega nullified national elections held in May, and he survived a coup attempt in October. In December his forces killed an American Marine lieutenant at a roadblock and later abused a Navy lieutenant and his wife. Thereupon President George Bush ordered an invasion with the purpose of securing the Panama Canal, restoring the Panamanian government to its elected officials, protecting U.S. personnel, and turning Noriega over to U.S. officials to stand trial on a drug-trafficking indictment.
In the early morning hours of 20 December a joint force of about twenty-six thousand U.S. military personnel under the command of General Maxwell R. Thurman, the U.S. Southern Command commander, began a complex operation against targets in twenty-six locations. In short order the American forces captured Noriega, secured the Panama Canal, disarmed the Panamanian military, and restored Panama's government to the country's elected leaders. The intervention was over in a matter of days. The United States had 23 combat deaths; Noriega's forces lost 314, and the Catholic Church estimated the civilian death toll at 655.4
A joint force of 7,000 military including elements of the 82d Airborne Division and the 16th Military Police Brigade from Fort Bragg, North Carolina; the 75th Ranger Regiment from Fort Stewart, Georgia; and the 7th Infantry Division from Fort Ord, California, flew from the United States for the attack. In Panama they joined the 193d Infantry Brigade, based in Panama, which had been joined previously by elements of the 5th Infantry Division, Fort Polk, Louisiana; the 7th Infantry Division; and additional support forces. Corps-level medical support was provided by units led by Col. Jerome V. Foust, MSC, commander of the 44th Medical Brigade, Fort Bragg. The 142d Medical Battalion, under the command of Lt. Col. David W. Foxworth, MSC, moved 233 patients by ground ambulances. The 5th Mobile Army Surgical Hospital (MASH), under the command of Lt. Col. Stephen H. Johnson, MSC, and the 56th Medical Battalion, commanded by Lt. Col. Ira F. Walton III, MSC, set up two forward surgical teams that established a 22-bed facility on the airfield of Howard Air Force Base in the Canal Zone. The establishment of a mobile surgical capability forward in
the combat zone was reminiscent of the 25-bed World War II portable surgical hospital that augmented clearing stations of task forces or divisions, especially in jungle or amphibious operations.5
Unit-level medical service was provided by the medical platoons of the maneuver battalions under the direction of their MSC platoon leaders. The medical platoon leader of the 5th Infantry Division's battalion task force, 1st Lt. David W. Roberts, MSC, set up his platoon's aid station in Balboa High School. There they treated 140 casualties, receiving their first patients fifteen minutes after the shooting started. Division-level medical support was provided by the medical clearing companies of the 7th Division, the 82d Airborne Division, and the 193d Infantry Brigade. MSCs in special operations, air evacuation, and preventive medicine, as well as those assigned to Gorgas Army Hospital in the Canal Zone and to other units, contributed to the medical support of the combat operations.6
The Panama invasion taught several medical lessons-fundamentally the necessity of employing the complete military medical team in support of combat operations. The absence of MSC medical logisticians from the operational planning caused deficiencies in medical supply. In part because the deployed treatment unit included no MSC patient administration officers, the casualty reporting system was unable to meet the demands made upon it, and some wounded soldiers called home before their families were officially notified. Ground ambulance support was inadequate, and the planners were handicapped by the Army's deficien
cies in doctrine for conflict resolution-especially the necessity of planning for early transition to humanitarian relief missions. For example, most of the casualties treated by Lieutenant Roberts' aid station were civilians, and within a short while after the fighting ceased his platoon was deluged with 5,000 refugees who had fled to the security of the American soldiers. The medics handed out blankets, medical supplies, and food and delivered two babies.7
The Persian Gulf
Despite the instability in Latin America, the most dangerous spot in the contemporary world continued to be the Middle East. Grenada and Panama were eclipsed when on 2 August 1990 Iraq's President Saddam Hussein seized his neighbor, the tiny monarchy of Kuwait. On 7 August President Bush, in response to a request from Saudi Arabia, ordered United States military forces into neighboring Saudi Arabia to head off the danger of an invasion by Iraq, which might have given the dictator control of 40 percent of the world's oil supply. Within thirty days the United States had deployed 41,000 troops to an area located 7,000 air miles and 12,000 sea miles from the continental United States. The 82d Airborne Division and the 1st and 2d Marine Expeditionary Forces, the first combat forces into the region, established an immediate defensive capability for Saudi Arabia. They were followed by the 101st Airborne Division (Airmobile), with its Apache helicopter tank killers and airmobile infantry, and the heavier forces of the 24th Infantry Division (Mechanized), the 1st Cavalry Division, and the 197th Infantry Brigade (Mechanized). MSCs in unit- and division-level medical organizations were part of that rapid deployment. A medical platoon leader in the 24th Infantry Division, 2d Lt. Christopher A. Hutchinson, MSC, was one. He found himself "caught up in an adventure not quite my own, preserving a brittle peace on the front lines of a distant desert."8
By 15 August thirteen nations had aligned against Iraq under a United Nations mandate, and the multinational force assembled in Saudi Arabia included 110,000 troops. The United States began calling up reserve and National Guard units and deployed the 2d Armored Division and the 3d Armored Cavalry Regiment. By 13 October the United States had 200,000 troops in place. Those forces were insufficient to provide the allies an offensive capability, and on 8 November the Pentagon announced the deployment of the VII Corps and elements of the V Corps from Germany, adding to the growing array the heavy forces of the 1st and 3d Armored Divisions, the 1st Infantry Division (Mechanized), and the 2d Armored Cavalry Regiment. Equipment, materiel, and personnel continued to pour into the Persian Gulf; by the end of the year about 300,000 United States troops were in Saudi Arabia awaiting the call to action. In January 1991 Congress voted Bush the authority to use armed force to expel Iraq from Kuwait. At mid-month a coalition force of 680,000 troops from twenty-four nations were preparing for war. The United States was the dominant presence in the coalition, and American troops numbered over 415,000, with 4,200 tanks, 2,800 infantry fighting vehicles, and 3,100 artillery pieces. They faced 540,000 Iraqi soldiers armed with 7,000 tanks and armored vehicles and 3,000 artillery pieces.
Operation DESERT SHIELD became DESERT STORM on 17 January 1991 as the United States unleashed an unremitting air campaign aimed at disrupting Saddam's command and control apparatus and eliminating key targets, especially antiaircraft radar and missile sites and nuclear, biological, and chemical weapon production facilities.9 The 1,000-hour air war ended on 24 February when the allies launched a ground assault. Over the twelve-day period leading up to the attack, General H. Norman Schwarzkopf, commander in chief of the U.S. Central Command (CENTCOM), had shifted two corps with a combined strength of over 200,000 troops to the west at distances of up to 300 miles. In a celebrated maneuver, the coalition forces outflanked and routed the Iraqi Army in 100 hours. The United States had deployed 541,000 military, but suffered only 145 killed and 357 wounded.10 Iraqi casualties were estimated in the tens of thousands, and Schwarzkopf's forces were swamped with enemy prisoners of war. Lieutenant Hutchinson's medical platoon saved the lives of many Iraqi soldiers who were brought to his aid station.11
MSCs at all levels of the military establishment were important contributors to Operation DESERT STORM, and over 1,350 active component officers deployed to the theater of operations. The full range of administrative and clinical specialties was essential, from handling "paperwork" (which increasingly meant the flow of electrons) to serving as essential members of the preventive medicine team that controlled and prevented the spread of disease.12
MSCs figured prominently in the command structure of units at corps level and echelons above corps (Table 5). Colonel Foust remained in command of the 44th Medical Brigade as it deployed from Fort Bragg to Saudi Arabia to support the XVIII Airborne Corps. Eight medical groups deployed to the theater of operations, six of which were commanded by MSCs.13
Col. Benjamin M. Knisely, MSC, CENTCOM's deputy surgeon and the senior MSC on the CENTCOM staff, deployed with that headquarters from MacDill Air Force Base, Tampa, Florida. He made national news in November when he appeared on the ABC program Nightline. An earlier broadcast had alleged that CENTCOM was not prepared to support combat operations, principally because of inadequate medical equipment and a lack of medical preparedness. Knisely assured the viewing audience that conversion of the hospital units to Deployable Medical Systems (DEPMEDS) sets was proceeding well and that CENTCOM was assembling a fully capable medical support apparatus.14
Anticipating heavy casualties, the United States sent a robust medical force of sixty-five hospitals to the Middle East. The Army deployed 198 medical units, which included the organic support units of 8 divisions and 44 hospital units (16 from the active components and 28 reserve) with 13,580 beds.15 General Schwarzkopf praised the Medical Department for performance during the buildup that "was nothing short of spectacular."16
Preparing for War
The U.S. Army Health Services Command (HSC) undertook the challenge of multiple missions in support of the deployment. First, it designated its six stateside medical centers as primary casualty receiving hospitals and made over ten
Echelons Above Corps
3d Medical Command (AC)-Col. Demetrious Tsoulos, MC
173d Medical Group (USAR),
Chicopee, Massachusetts Col. Douglas A. Stephens, MSC
202d Medical Group (ARNG),
Jacksonville, Florida Col. Spessard Boatright, SC
244th Medical Group (ARNG),
Brooklyn, New York Col. Thomas P. Meany, MSC
332d Medical Brigade (USAR)-Brig. Gen. Michael D. Strong, MC
30th Medical Group (AC),
Col. Jesse K. Fulfer, MSC
127th Medical Group (ARNG),
Ashland, Alabama Col. Dalton E. Diamond, MC
341st Medical Group (USAR),
Mesquite, Texas Col. Robert G. Smith, MSC
XVIII Airborne Corps
44th Medical Brigade (AC)-Col. Jerome V. Foust, MSC
1st Medical Group (AC),
Fort Hood, Texas Col. Eldon H. Ideus, MSC
2d Medical Group (AC),
Fort Lewis, Washington Col. William E. Ethington, MSC
Source: John R. Brinkerhoff, Ted Silva, and John Seitz, Office of the Chief, Army Reserve, Rpt, sub: U.S. Army Reserve in Operation Desert Storm: Reservists of the Army Medical Department, 23 Sep 1993, p. 50, PL.
thousand beds available for that purpose. Second, it provided clinical officers, principally physicians and nurses, for the U.S. Forces Command units deploying to the Gulf. This was achieved with the Professional Filler System (PROFIS), a program established in 1979 when mobilization exercises had demonstrated that the peacetime personnel requisition system was not fast enough to meet the needs for rapid deployments or mobilization. PROFIS was designed to provide officers to the gaining units within seventy-two hours of notification (forty-eight hours in certain cases). Over twelve hundred officers in HSC units were deployed to units in the Persian Gulf through this mechanism.17
However, a third mission had been unanticipated. The command's task became vastly more complicated when the Army chief of staff ordered that HSC would not curtail its care for family members, retirees, and other beneficiaries during the mobilization. Lt. Col. Ralph E. Bradford, MSC, chief of HSC's Personnel Management Division, handled the intense coordination effort as PROFIS underwent a severe test. Bradford, who had signed into HSC on the day before it was alerted to the Persian Gulf requirements, found himself on a roller coaster of frenzied activity, working 22-hour days. "I was astounded at what humans can do when the adrenalin starts flowing." Mobilization planning had assumed the sus
pension of care for other than active duty military, and the chief of staff's order meant that Colonel Bradford and his team would have to find replacements for the officers deployed to the Gulf under PROFIS. It was made even more difficult when HSC had to come up with eighty-seven clinical officers to backfill units deploying from Germany.18
Their first source for replacing the PROFIS officers was the pool of officers remaining in HSC. Other sources included the units of the reserves and individual reservists who volunteered for temporary active duty tours. PROFIS worked "amazingly well" according to one report, but the unforeseen requirement to keep HSC hospitals running at full capability for all beneficiaries caused an enormous amount of work for MSC personnel officers.19 The deployment brought into focus the need to make major improvements, including intensive management of the supporting automated data base and the establishment of a means for the automatic replacement of PROFIS officers through the individual mobilization augmentee program of the reserves. For Bradford, though, it was the experience of a lifetime. "Everyone should have the chance to do what I did."20
The deployment placed large demands on Army medical facilities in the United States and Europe. For example, MSC optometrists assigned to eye clinics and optical fabrication laboratories were hard pressed to meet the demand for the more than 112,000 deploying soldiers who did not have the appropriate spectacles or protective mask inserts.21 As another example, family support efforts received strong command emphasis as senior leaders demanded the establishment of support networks for the families of soldiers sent to the Persian Gulf. This was even more important for families in Europe who were already isolated
by being overseas. MSC psychologists were valued contributors to those programs, including planning for the special needs of children. Nearly every student and teacher in schools on military installations had family members or close friends deployed for war. Psychologists who assisted the schools in responding to the deployment dealt with the possibility that up to twenty children in any one classroom might lose a parent.22
The 7th Medical Command in Germany sent 12 units, 1,300 soldiers, and 17 DEPMEDS hospital assemblages while supporting the deployment of 70,000 soldiers from Europe.23 It tripled its operating capacity and designated its three largest hospitals as primary receiving facilities, setting aside 1,820 beds for combat casualties. The 7th MEDCOM was replenished by Army Reserve and National Guard units called to active duty. The 3,000 soldiers from those units who backfilled 7th MEDCOM units prevented the collapse of the Army's health care system in Europe, which continued to support the force remaining in Europe and the family members of the soldiers deployed to DESERT STORM. The reserve component soldiers were a welcome addition to the medical force in Europe. For example, an Army National Guard unit from Maine, the 112th Medical Company (Air Ambulance), received special commendation by General Crosbie E. Saint, the USAREUR commander who said it "established an outstanding reputation providing medevac support to the theater."24
One of 7th MEDCOM's Dustoff units, the 45th Medical Company (Air Ambulance), commanded by Maj. Richard S. Ellenberger, MSC, flew twelve Black Hawk helicopters 3,500 miles from Darmstadt, Germany, to Dhahran, Saudi Arabia, in late August. The trip, which was spread over five days, took the
crews south from Germany, through Italy, Greece, Cyprus, and Egypt, and into Saudi Arabia-the longest self-deployment of the Black Hawk ever attempted. It challenged their resourcefulness. One crew repaired a rotor blade skin separation by drilling holes in the blade with a hand drill and injecting glue using syringes from their medical supply kit.25
Once in the Persian Gulf the crews dealt with the ever-present elements of heat, sand, desert navigation, and flying with night-vision goggles. Capt. Randall G. Anderson, MSC, a pilot with the 57th Medical Detachment of the XVIII Airborne Corps, said his crew of four found that the Black Hawk helicopter was a multipurpose vehicle in addition to being an ambulance. The constant requirement for mobility necessitated keeping all their personal effects with them at all times, and they used every nook and cranny of the aircraft for storage. They found that the four-litter carousel support device in the cabin afforded the crew an excellent place to sleep. The helicopter's main rotor blade served as a hanger for a shower bucket and, despite the fact that bathers were covered by blowing sand by the time they dried off the shower made them feel (and smell) clean. So equipped, Anderson's crew evacuated four thousand patients during the operation, including over a thousand enemy prisoners of war.26
MSC commanders took their hospital units to Saudi Arabia and then stepped down from command to serve as executive officers, in accordance with a standing Medical Department doctrine that would be strongly criticized after the war. Lt. Col. Scott Beaty, MSC, commander of the 47th Field Hospital, deployed his unit in August from Fort Sill, Oklahoma, sixteen days after he was first alerted. The 47th set up in a former British compound in the far northeast corner of the tiny island country of Bahrain. The temperature soared to 130 degrees during the day, making the use of air-conditioned shelters essential. Once the unit was operational, Beaty was replaced as commander by a physician in accordance with the existing Army doctrine. Reverting to duties as the 47th's executive officer, Beaty coordinated the unit's use of a hospital set that had been pre-positioned in that region some twenty years earlier. Much of the stored equipment was obsolete and some had deteriorated-a World War II lesson relearned. The experience taught Beaty that going to war "is never going to be the way you thought it was going to be."27
Maj. Tommy R. Hancock, MSC, deployed as the executive officer of the 159th Mobile Army Surgical Hospital, a Louisiana Army National Guard unit. The 159th crossed the Iraqi border on 25 February and was operational for a little over two weeks, during which time it received 300 patients, a third of whom were enemy prisoners of war. Lt. Col. Joseph H. Cohen, MSC, was executive officer of the 403d Combat Support Hospital, a reserve unit in Phoenix, Arizona. His unit, which was activated the day before Thanksgiving, had just completed training with DEPMEDS equipment at Camp Pendleton, California. It was good preparation for what they faced in Desert Storm.
The medical logistics effort was a noteworthy performance. The 32d Medical Supply, Optical, and Maintenance (MEDSOM) Battalion, commanded by Lt. Col. Ray G. Brueland, MSC, arrived in Saudi Arabia on 8 August. Col. Philip E. Livermore, MSC, arrived at the end of the month as the senior medical logisti
cian for the Army component of CENTCOM (ARCENT). The 32d MEDSOM was joined by the 47th MEDSOM in September; they were combined into a single organization and designated the U.S. Army Medical Materiel Center, Saudi Arabia, under the direction of Lt. Col. Richard L. Ursone, MSC, commander of the 47th. It functioned as the joint medical logistics organization for the theater. The 980th MEDSOM, a reserve unit from California commanded by Lt. Col. Jeffrey Gidley, MSC, replaced the 32d, which then relocated to support the XVIII Airborne Corps. The newly formed materiel center processed over 200,000 customer requests for over $200 million in supplies and equipment-an average of sixty-five air line of communication (ALOC) pallets daily.28
Two more MEDSOMs arrived in December: the 428th, commanded by Lt. Col. Clarence R. Wills, MSC, deployed from Germany with the VII Corps, and the 145th, a reserve unit commanded by Lt. Col. Gene Johnson, MSC, deployed from Texas to the western region of the theater. The 7th MEDCOM's U.S. Army Medical Materiel Center, Europe, located in Pirmasens, Germany, under the command of Joseph J. Costanzo, now a colonel, provided the communications zone medical supply support for DESERT STORM. Its workload skyrocketed; it shipped to the theater 5.6 million pounds of medical supplies valued at $56 million, and at one point had 1,606 ALOC29 pallets awaiting unloading for further distribution throughout Europe and Saudi Arabia. It sent seventeen DEPMEDS hospital sets, and its optical section filled nearly 71,000 orders for spectacles and protective mask inserts.
Deployed hospitals were retrofitted with DEPMEDS equipment, an enormous undertaking that converted twenty-eight units in Saudi Arabia and upgraded equipment in all the Army hospitals. The work was accomplished by a modernization team of twenty personnel headed by Maj. John T. Harris, MSC, supported by a staging facility at the port of Ad Dammam headed by Capt. Jettaka V. M. McGregor, MSC. The teams delivered over two thousand military vans (MILVANS) and international shipping overseas (ISO) containers of medical equipment to the field units in the largest medical force modernization ever conducted. Capt. James A. Signaigo, MSC, had the task of expediting transportation of the equipment from the port to the field sites. By January the heavily trafficked two-lane Tapline road, which headed northeast 500 kilometers to Hofar al Batin near King Khalid Military City, became essentially impassable for Captain Signaigo's trucks. He arranged for the use of a flatcar railroad train and put together an 800-kilometer combination train and truck route to the same destination. Signaigo's train ran daily, and he had to fend off efforts to steal or borrow it for other purposes.30
In the Gulf War American forces faced their first serious chemical threat since World War I. The genuine potential for Iraqi use of chemical agents sent the military scrambling. Scientific specialty MSCs of the U.S. Army Medical Research and Development Command (USAMRDC) were again revealed as a national resource, in this case for their expertise in chemical agent protection. One of the command's tasks was to provide training to the medical clinicians who would handle any chemical casualties. That mission was executed by the U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), whose
deputy commander, Lt. Col. George C. Southworth, MSC, coordinated the logistical support for the effort and served as the institute's acting commander throughout this period as its teams provided the Medical Management of Chemical Casualties Course for 6,600 health care providers, principally physicians and nurses, in the United States, Germany, and Saudi Arabia.31
The threat of chemical weapons necessitated the protection of aircrews who were issued an aviator version of a new protective mask. Unfortunately, the mask could not accommodate spectacles, so the surgeon general approved aircrew wear of contact lenses on a voluntary basis, expanding an earlier program for Apache and special operations crews. Lt. Col. Morris R. Lattimore, Jr., MSC, of the U.S. Army Aeromedical Research Laboratory at Fort Rucker, Alabama, directed a protocol that outfitted 349 aviators, using a team of eleven optometrists in the United States and Germany who did the contact lens workups. The project established aviator wear of contact lenses as a viable alternative to spectacles and determined that fears of eye injury from desert sand conditions were unfounded.32
Of perhaps even greater concern was the potential for Iraqi use of biological weapons. A United Nations inspection team after the war confirmed that Iraq had the capability of producing, at its biological research facility in Salman Pak, fifty gallons weekly of anthrax, Clostridium perfringens, and botulinum toxin, amounts sufficient to kill thousands of people.33 Defense against those agents also fell to the USAMRDC, whose MSC researchers and administrators were part of the team that constituted a defense against this lethal threat. One of the potential agents, botulism, was the most potent bacterial toxin known, and USAMRDC accelerated the fielding of a highly purified equine antitoxin. Lt. Col. Michael A. Balady, MSC, a U.S. Army Medical Materiel Development Activity immunologist, coordinated with the manufacturer and provided oversight for testing schedules, and, with Lt. Col. Gregory P. Berezuk, MSC, the command's human use review officer, secured its approval by the Food and Drug Administration (FDA) for use as an investigational new drug. Maj. William R. Cline, MSC, of the U.S. Army Medical Research Institute of Infectious Diseases, handled its distribution. Other MSC researchers contributed to gaining similar FDA approval for use of pyridostigmine, a nerve gas pretreatment.34 In addition, the U.S. Army Medical Research Acquisition Activity, commanded by Lt. Col. John L. Chaffee, MSC, executed an emergency procurement of centoxin, required for treatment of septic shock, and ciprofloxacin, a broad-spectrum antibiotic necessary for defense against biological agents. Chaffee's organization awarded the $45 million contract for the drug within forty-eight hours of being notified of the requirement.
On the Ground
Women were a sizable presence in the United States military force deployed for Operation DESERT STORM. Maj. Carolyn A. Albanese, MSC, executive officer of the 350th Evacuation Hospital, deployed with her 400-bed reserve unit from Ohio to King Khalid Military City. Albanese, an associate professor at the University of Akron, believed her gender had no effect on her ability to carry out her duties. "I have the position because I earned the position, and I have the respect of my staff for that particular reason."35 Lt. Col. William C. Long, MSC,
executive officer of the 86th Evacuation Hospital (and the hospital's commander when in garrison at Fort Lewis, Washington), found no difference in the performance of male and female soldiers in his unit. A patient administration officer with the 173d Medical Group, 2d Lt. Melissa A. Gagnon, MSC, was representative of many female MSCs at all levels of the command. Lieutenant Gagnon was on duty in the group's tactical operations center 25 February 1991 when a Scud attack on Dharhan killed twenty-eight soldiers and wounded ninety-eight. She coordinated the evacuation of casualties from the incident, which accounted for one-third of all American deaths in the war.36
MSCs were challenged and tested by the deployment, and there were lessons for medical operational planners. There was common agreement that medical supply was more responsive than the other classes of supply; some essential commodities (such as Class IX, spare parts) never functioned at the required level of performance. An enormous logistical problem for the hospital units was the lack of sufficient organic transport, which made moving an arduous task. "Over here there ain't no trains, there ain't no boats," said one captain. Priority of transportation assets went to movement of tactical units and, as MSCs found out, "if you weren't a fighter or if it wasn't bullets or food, you just didn't get trucks."37 United States forces were heavily dependent upon Saudi vehicles; Colonel Foust went to war in a Toyota.
The DEPMEDS sets received praise, but the deployment made plain the immobility of DEPMEDS-equipped hospitals and the deleterious effect of fielding the sets to the hospitals in Europe without all their equipment (a problem when those sets were pressed into service). Foust believed DEPMEDS was outstanding, but much too heavy.38 He reduced his combat support hospitals and MASHs to a size that could be moved by their organic vehicles so that they could keep up with the combat units. Generat Strong agreed. He said that DEPMEDS was "a wonderful system for providing medical care, but a terrible system to try to move."39
As in Vietnam, the hospitals were not authorized any fuel trucks. Capt. Steven R. Gilreath, MSC, S-4 of the 86th Evacuation Hospital, had a 36,000-gallon fuel storage capability, but "had I not been able to bootleg a 5,000-gallon civilian tanker we'd never have been able to support ourselves. Once the battle was under way there was no way we could get tanker support from anyone."40 The 47th Combat Support Hospital deployed with MUST equipment and converted to DEPMEDS in Saudi Arabia. Capt. David O. Hill, MSC, the hospital's logistics officer, estimated the daily fuel requirement for its MUST set at 7,000 gallons, an unsupportable rate under combat conditions, especially without its own fuel truck.41
There were other problems in medical support. Col. James A. Martin, MSC, head of the Walter Reed Army Institute's research psychology team in Germany, did an assessment of corps and division mental health support in the Gulf before, during, and after the ground war. He found that mental health teams, with some exceptions, were not sufficiently prepared to handle their combat missions, and he concluded that this would have led to unnecessary evacuations from the theater if the conflict had produced heavy casualties or had been prolonged. He was particularly critical of a general unpreparedness for handling combat stress casualties,
and he emphasized the need to implement lessons that had been painfully learned and relearned since the Civil War. As Colonel Martin put it, "One of the most important roles for any mental health officer in the combat theater is to curb the tendency of line and medical leaders to evacuate [stress] casualties out of the theater of operations as quickly as possible."42
MSC patient administration officers had other challenges and headaches. The chief of patient administration for the 47th Combat Support Hospital, 1st Lt. Damon T. Mathis, MSC, said the evacuation system was effective once the ground war started, but prior to that had been "a gnarly mess."43 In Panama and DESERT STORM, war was covered by live television for the first time, and patient administration officers were faced with the overwhelming expectations of families and commanders that medical information should be superior in timeliness and accuracy to that provided by the omnipresent news media. The Surgeon General's Office received over sixty thousand phone calls a day on a hotline it set up for families to call. None of the DOD systems was able to meet the insatiable desire for information. Patient data were contained within four different computer systems that operated independently of each other. Col. Fred R. McClain, Jr., MSC, commander of HSC's Patient Administration Systems and Biostatistics Agency, recommended formation of a joint patient tracking and information system as a solution for this difficult problem.44
The Gulf War, like the operations in Grenada and Panama, demonstrated the need for MSC administrative and scientific specialty officers as part of the military medical team in the posthostilities medical care of enemy prisoners of war (POWs) and refugees. The extent of those requirements tended to catch planners off guard, and their resolution required a variety of MSC skills to handle. As an example, hospital units of Col. Douglas Stephens' 173d Medical Group admitted 6,225 patients during its deployment from December 1990 to April 1991. Over a third were POWs and refugees and, as in previous wars, hospital personnel cared for tired and hungry patients who were infested with lice. Support provided by the 173d to United States POW camps was inspected by a team of the International Committee of the Red Cross who communicated with their home office in Geneva with a microwave transmitter, an example of the increasing electronic sophistication of the twentieth century battlefield.45
And as in other times and places, soldiering in the Persian Gulf had a uniquely human dimension as the GIs accommodated to foreign places and customs. Lt. Col. Philip K. Schenck, MSC, the executive officer of the 173d Medical Group, reported that his staff took advantage of the local laundry in the Dharhan area until their own washers and dryers arrived. They quickly discovered that the laundry's one-hour service sometimes took two weeks, that buttons disappeared, and that clothes shrank two sizes in the first washing. After about a month in tents, they moved into a large housing complex. There they found that because Saudis did not use toilet paper, the building drain pipes were of a smaller diameter than those in the United States. This necessitated placing diaper pails in each bathroom for disposing of the used paper. Schenck and his comrades at arms lived with the incongruity of plastic pails gaily decorated with teddy bears and little cherubs.46
As MSCs had been challenged by the deployment, so were they put to the test in the redeployment once hostilities ceased and the Army turned to getting soldiers and materiel shipped home. National Guard and reserve soldiers returning to civilian life were required by law to have a physical examination, principally in order to assess future disability claims against the government. A hearing test was part of the examination, but the field medical facilities were not equipped for that procedure. In response to this need an audiologist, Lt. Col. Richard W. Danielson, MSC, led a group of 11 MSC audiologists, 1 noncommissioned officer, and 39 enlisted technicians to Saudi Arabia where they located with the 47th MEDSOM. They brought with them ten 32-foot trailers that were specially equipped for hearing testing. Danielson broke his group into teams of one officer and two soldiers who then fanned out to the evacuation hospitals. They tested over twenty-nine thousand soldiers, and in so doing speeded up the return of the soldiers to the United States. A different sort of homecoming was handled by MSC social work officers at Walter Reed Army Medical Center who served as case managers for five American prisoners of war repatriated by the Iraqis after the conflict. These were the first POWs since Vietnam.47
Soldiers learn in basic training that they have to clean and put away their equipment when they come in from the field. For the medics this required rebuilding thirty-five DEPMEDS-equipped hospital sets so that the equipment could be returned to their home stations in a condition that was redeployable. MSC medical logisticians managed the project for both reserve component and active component units, and by August 1993 they had rebuilt the equipment in 610 ISOs and MILVANs. Some 426,000 items had been returned to inventory for reissue, and 4,600 pieces of equipment had been repaired. MSCs also helped Kuwait put itself back together. Maj. John T. Watts, MSC, a health facilities planner, went to Kuwait in 1992 to assess the damage to the country's medical facilities and to identify rebuilding requirements.48
Overall, United States military leaders were pleased that the doctrine, equipment, and staffing changes of the post-Vietnam period had worked. General Thurman, one of the architects of the modernized Army, believed DESERT STORM proved that high-quality people with good quality equipment, training, and leadership could do almost anything. The United States had moved half a million military personnel halfway around the world in six months, the fastest deployment for a force of that size in America's history. In Europe, an entire forward-deployed corps had redeployed 77,000 military personnel and all their equipment in forty-five days, leaving their family members overseas-an unprecedented action.49 Lt. Gen. Frank F. Ledford, Jr., General Becker's successor as surgeon general in 1988, said the Medical Department had "performed superbly" in a deployment that had tested the department's preparedness "to its limits." Once on the ground in the Gulf medical personnel had handled over 20,000 hospital admissions and over 200,000 outpatient visits.50
A lot of things had been done right in Panama and Iraq. The effects of the Goldwater-Nichols Act of 1986 were evident. The Services had worked together, and General Colin Powell, the chairman of the Joint Chiefs of Staff, was the undisputed senior military leader.51 President Bush had clearly stated the objec
tives in both operations and had effectively marshaled the support of the American people. The United States employed overwhelming combat power, gave authority to the military command structure, and made the care of family members a matter of constant attention at all levels of command.52
A Time of Change
The Army Medical Service Corps remained an important national asset in United States military planning for the twenty-first century. MSCs were essential leaders in the Army's health care system, which at the beginning of the last decade of the twentieth century numbered over 200,000 officer, enlisted, and civilian personnel in all the components of the Army, including 91,000 in the active component. MSCs provided administrative and scientific expertise for a medical enterprise that was funded at over $3 billion annually and operated 50 hospitals and 544 health and dental clinics for nearly four million beneficiaries. The fixed plant, complemented by a large field medical apparatus, constituted most of the United States military capacity for meeting medical contingencies. The Academy of Health Sciences (which in 1991 became part of the newly organized U.S. Army Medical Department Center and School) was training more than 35,000 officer and enlisted students per year in the largest military medical training institution in the world. The U.S. Army Medical Research and Development Command was also the largest organization of its kind. But with the end of the Cold War, the most momentous world events since World War II began to influence the Army's medical establishment. As the Soviet Union neared collapse, the challenge would be to preserve the specialties of the MSC as part of the military medical team of the future.53
Elements of the 5th MASH arrived in Europe in November 1989 from Fort Bragg for the annual Return of Forces to Germany (REFORGER) exercises while ecstatic Berliners danced on the Berlin Wall to celebrate startling changes on the Continent. Eastern Europeans were pulling the Iron Curtain open, and thousands of little smoke-belching Trabant and Wartburg automobiles were pouring through the openings to clog the autobahns of West Germany.
Those pitiful cars on western European roads were happy evidence of the change. Soviet President Mikhail Gorbachev's policies of glasnost (openness) and peristroika (restructuring) had unleashed the exuberance of freedom. The phenomenal changes under way in the Soviet Union came to a brief halt with an abortive Communist coup in August 1991, but resumed with renewed vigor shortly afterward. The Soviet empire and its ruling party were nearing collapse and by the end of the year had ceased to exist. The events of 1990 and 1991 made it plain that the course of international events could confound the wisest pundits. The West had won the Cold War.
Exhilaration over the defeat of the Soviet Union was soon followed by the sobering reality that great instability continued to trouble the world and that universal peace was not assured. Yet United States military doctrine had enshrined containment of communism as its centerpiece; suddenly it was swept away, and no one was certain what would take its place. United States military actions on the heels of the Persian Gulf war in deployments to Turkey, Croatia, Somalia,
Rwanda, and Haiti illustrated the changing nature of the nation's role in the post-Cold War era. A measure of the Army's response to diverse and continual deployments was its awarding of over seven hundred Purple Hearts in the period from the collapse of the Soviet Union to the beginning of 1993. A major revision in 1993 of the Army's fundamental war-fighting doctrine, Field Manual 100-5, Operations, recognized those changing realities to the extent of including a new chapter on operations other than war.54
Some argued that one of those missions, humanitarian and disaster assistance relief, should move to the forefront of the Army's planning. Saddam Hussein provided an opportunity to demonstrate the U.S. military's capability for humanitarian assistance immediately after the Persian Gulf war when his persecution of the rebellious Kurdish minority in Iraq resulted in the flight of over 1.4 million refugees to neighboring Turkey. A European Command combined task force of 21,000 personnel from twelve nations under the command of Lt. Gen. John M. Shalikashvili provided humanitarian assistance in Operation PROVIDE COMFORT. The U.S. involvement that began in April included about one hundred soldiers of the 7th Medical Command who deployed principally for the preventive medicine effort as the command's U.S. Army Medical Materiel Center, Europe (USAMMCE), shipped emergency lifesaving supplies. Lt. Col. Stuart A. Mervis, USAMMCE's head of materiel management, described those shipments as the largest humanitarian assistance effort in the unit's history.55
Shortly afterward Mother Nature provided an opportunity for the military to demonstrate its capability for disaster relief at home. In August 1992 Hurricane Andrew, one of the worst storms of the century, struck near Miami, Florida, with 140-mile-an-hour winds, leaving hundreds of thousands of people without shelter, water, and power and causing damage that was still being repaired two years later. The Florida governor's request for federal assistance brought in 17,000 active component soldiers, principally elements of the XVIII Airborne Corps, headquartered at Fort Bragg, North Carolina, and 7,000 soldiers of the Army Reserve and Army National Guard. MSCs in various specialties were part of the effort. Maj. Dale R. Brown, MSC, a health facilities planner, went to the hardest-hit area, Homestead, Florida, where the wind gauge at Homestead Air Force Base had broken at 216 miles per hour. Brown assessed the damage to civilian hospitals as part of the effort to restore essential services. He found that while the buildings were structurally intact, unprotected windows had broken and inadequate roofing had torn apart. This enabled the storm's wind and water to ravage the interior of the facilities. Roof-mounted components, such as air-conditioning equipment and vents, tore off in the high winds, and Major Brown warned that those items should either not be reinstalled on roofs or should be adequately protected.56
First Lt. Timothy G. Bosetti, MSC, a sanitary engineer, also went to Homestead where he had firsthand experience with reestablishing a public water system after a natural disaster. He encountered the frustrating complexity of dealing with local, state, and federal officials who had conflicting roles in the matter. Bosetti had to deal with the political ramifications attendant to the restoration of basic public services, especially the pressure to remove an order to boil drinking
water that had been imposed in the several jurisdictions throughout the area hit by the hurricane. Elected officials, who desired to stay in office, were feeling the heat from their constituents to restore normal service, no matter what the consequences. They released areas from the boil-water notice in spite of Bosetti's objections that this was premature in some cases due to positive coliform tests in samples taken by the Army at different points in the distribution system.57
The next crisis again directed America's attention overseas. The breakup of Eastern European communism unleashed ancient animosities in regions previously dominated by the Soviet Union. A bloody civil war erupted in the former Yugoslavia, and the United Nations dispatched a peacekeeping force to the area in an attempt to moderate the hostilities. In October 1992 Col. Charles G. Stevens, MSC, commander of the 68th Medical Group in Wiesbaden, Germany, was appointed commander of Joint Task Force PROVIDE PROMISE and placed in command of all European Command elements in Croatia. Stevens deployed elements of his command, principally the 212th MASH, to Croatia as the first six-month rotation of a series of Army, Navy, and Air Force field hospitals supporting the 22,000-member U.N. protective force. The 212th set up on an airfield in Zagreb. Much of the surrounding area had been mined by the Yugoslavian National Army before its withdrawal from the separatist province. The hospital's dental clinic became the busiest section, as word of the availability of modern American dentistry quickly spread among the U.N. troops, especially the Eastern Europeans.58
Humanitarian assistance soon included aid to Russia as well. In 1992 Lt. Col. Edward P. Phillips, Jr., MSC, took a team to Soviet Georgia to set up a 1,000-bed
contingency hospital in the capital city of Tbilisi. The following year MSC medical logisticians transferred $28 million worth of medical equipment from two 1,000-bed hospitals that had been in storage during the Cold War to eight hospitals and a dental clinic in Moscow.59
At the end of 1992 the threat of starvation in Somalia as the result of a bitter civil war among competing warlords prompted President Bush, in the last days of his administration, to dispatch his final humanitarian relief effort. Col. Ian L. ("Red") Natkin, MSC, commander of the 67th Medical Group, Fort Lewis, Washington, moved elements of his command to Somalia where he was also appointed the joint task force surgeon. The United States involvement ended in March 1994 when Bush's successor, President Bill Clinton, pulled out all United States troops after the relief operation turned into combat operations that produced two posthumous medals of honor.60
Among those in Natkin's command was entomologist Capt. Steve Horosko III, MSC, commander of the 485th Medical Detachment that deployed to Somalia in January 1993 to assume the vector control mission of the preventive medicine team. Horosko reported that the human side of war had not changed. The availability of one five-minute phone call each week for his soldiers after the unit had been in Somalia for six weeks proved to be an enormously important morale booster for soldiers feeling very far from home.61
Lieutenant Bosetti, on the heels of his experience in Florida, had another opportunity for a preventive medicine mission as the executive officer of the 485th Medical Detachment, an entomology team that deployed to Somalia in January 1993. His team's primary mission was pest control, with additional capabilities for water testing, mess inspections, and sanitation services. They used several pieces of equipment for the pesticide dispersal operations that made them a welcome presence for the marines operating in Bardera, an area threatened by malaria and dengue fever, and for the soldiers of the 10th Mountain Division in Jalib, a malarious area. Bosetti said the insects were so bad in Bardera that when they sprayed "the sky would rain dead bugs." Bosetti's water-testing mission took him throughout the country to certify potential water sources for quartermaster water production companies, the final product of which he found was superior in quality to most of the imported bottled water. One of his more eerie moments occurred when he had to test the water in a 50 by 100 by 200 foot above-ground tank. He climbed down inside armed only with his 9-mm. pistol, a flashlight, and two sample containers. "It was so humid in there it was actually raining."62
Other military deployments to Third World countries benefited from the talents of MSCs. In July 1994 civil war erupted in Rwanda, resulting in an estimated 500,000 deaths in the largest mass murder since the Khmer Rouge pogrom in Cambodia in 1975. The slaughter was of such ferocity that in a matter of days over two million Rwandans fled westward into neighboring Zaire, creating a dreadful refugee situation that was unprecedented for its size and speed. The refugees principally concentrated in the cities of Goma and Bukava, described by Newsweek magazine as a "bleak landscape teeming to the horizon with a solid carpet of refugees," where they were subjected to a deadly cocktail of crowding, contaminated water, starvation, and filth.63 The United Nations responded with humani
tarian aid to ward off an explosive disease situation that included outbreaks of cholera, typhoid, and dysentery. With thousands of people dying, President Clinton ordered the European Command to provide a joint task force to conduct a humanitarian relief mission in Rwanda resembling the earlier mission to aid Kurdish refugees in northern Iraq. About 2,300 Americans were dispatched to Rwanda. MSCs were in the first deployments as members of the 71st Medical Detachment (Sanitation) and a forward distribution team detachment of the 37th Medical Logistics Battalion.64
Similarly, MSCs were valued members of the 20,000-member U.S. joint task force (including 17,500 soldiers) sent to Haiti, a desperately impoverished country, in September 1994 to intervene in a chaotic, violent situation that had intensified with a military coup in 1991 against Haiti's elected president, Jean-Bertrand Aristide. An estimated three thousand people, mostly Aristide supporters, had been killed in the intervening period, principally by government forces. The U.S. military oversaw the removal of the military regime and the return of Aristide to power. Soldiers patrolled the outlying areas, restored the country's infrastructure, and disarmed hostile elements. Medical personnel included medical assessment teams that assisted civilian hospitals and relief agencies. Maj. Arthur P. Lee, MSC, a sanitary engineer, was a member of the preventive medicine team charged with establishing the prevention measures that would keep soldiers healthy in a
country with widespread conditions that spread infectious disease. Lee conducted environmental assessments of Haitian hospitals, including one in which chickens were walking around one of the wards. Dale Brown, now a lieutenant colonel, headed a health facility assessment team that completed reports on ten hospitals and clinics. They also provided designs to expand two hospitals and a plan to convert a hotel to a hospital. Brown's team found that in spite of many deficiencies, mostly due to the lack of resources, the rudiments of a system were present. For example, he noted after his visit to St. Catherine's Hospital in the Port-au-Prince area that "for where it is located and what it does it is not in bad shape." In one of the more unusual assignments for a Medical Department officer, Capt. Berthony Ladouceur, MSC, a native French and Creole speaker, served as the personal interpreter for the U.S. joint task force commander, Lt. Gen. Henry H. Shelton.65
In such a rapidly changing world, the future of the United States military was uncertain. The planned pullout of U.S. forces from Europe and the overall reductions in strength were both temporarily halted by the war with Iraq. But both resumed in 1991 as the Army began the drawdown of its active duty force from eighteen to ten divisions, complemented by six National Guard divisions. The active duty strength of the Army in 1989 was 780,000; it peaked at 863,000 in 1991 with the call-up of Army Reserve and Army National Guard soldiers for the Persian Gulf war. By the summer of 1993 the active duty number had dropped to 575,000 as the Army drew down in earnest; in a twelve-month period it had
moved 400,000 soldiers and released 177,000 (many of whom were veterans of Panama and Iraq) from active duty. The Army was the smallest it had been in forty-four years, since the year before war broke out in Korea. By July 1993 there were more soldiers on the retired rolls than on active duty for the first time in the history of the Army. The number on active duty fell to 540,000 at the end of fiscal year 1994 and was projected to drop to 495,000 in 1996. The United States brought home its overseas cold warriors in droves. It deactivated VII Corps in Germany in order to cut the number of soldiers stationed in Europe from 183,000 in 1990 to 100,000 by 1995, and from 1990 through 1994 closed over nine hundred overseas military installations. Further reductions were planned.66
In the aftermath of the Cold War, the Medical Service Corps braced itself anew for the inevitable cuts. The Medical Department was a sizable portion of the Army, and it accounted for 20 percent of all Army officers. This was a prominent target as reductions got under way on a trajectory that would decrease the department's total active component numbers 37 percent through 1997. The number of officers was programmed to drop from 18,478 in 1991 to 14,793 in 1998, a reduction of 20 percent. MSC strength, which had remained relatively constant at 5,000 officers during the post-Vietnam period and numbered 5,080 in 1991, was at 4,571 (see Appendix M) in 1994 and was projected to fall to 4,041 in 1998, an overall reduction of 20.5 percent.67
Various programs were used to reduce the Army through voluntary and involuntary means that had not been available for the military during previous drawdown periods. These eliminated the need to conduct a reduction in force (RIF) in the MSC, as after the Korean and Vietnam Wars. Younger officers who were not eligible for retirement were offered a variety of attractive bonuses as incentives for separating from active duty. For example, a captain with six years' service could collect a onetime bonus of $32,350, or elect to receive annual payments of $5,390 for twelve years.68
The most painful of the drawdown programs were selective early retirement boards (SERBs), which forced officers into involuntary retirement and contributed to an atmosphere termed by the Army Times as "the blue mood of the officer ranks." SERBs of MSCs in 1987, 1990, and 1992 through 1995 forced out 250 officers. The odds of being selected were high-23 to 28 percent of eligible colonels were selected each year; in effect, retirement-eligible field grade MSCs were serving on year-to-year contracts. Believed to be an essential mechanism for drawing down the Army while maintaining promotion opportunity, SERB was an agonizing process for those involved in its management. The Medical Department SERB became such a malignant undertaking that by 1995, 95 percent of the MSC colonels selected for forced retirement were rated by the Personnel Command in the top two categories of officers, the result of the unrelenting winnowing of that group each year. Further, although the entire Medical Department was drawing down, by 1995 the MSC by itself accounted for nearly 47 percent of all of the department's officers hit by the SERB since it began. The effect on morale was predictable. While selected officers left active duty with full retirement benefits, their unceremonious departure in this way made for a bitter ending to the careers of a group that included many Vietnam veterans who had
gone through two Army drawdowns, had demonstrated superb talent, and had contributed to the dramatic rebuilding of the Army after Vietnam. Army officers remaining on active duty no longer believed that promotion to colonel was a reasonable aspiration. Captains believed their horizons had diminished and now viewed a successful career within the limits of promotion to lieutenant colonel and retirement after twenty years of active duty.69
The shape of the MSC for the future was a subject of intense debate. Efforts in 1991 and 1992 to decide how to apply the cuts that were necessary to achieve the drawdown targets produced a draft plan that entailed a drastic reduction of selected MSC specialties. This was particularly true with the more technically complex fields and especially the scientific specialties. Some would have been entirely eliminated, including health facilities planning, research psychology, podiatry, physiology, and biochemistry. Others, such as comptroller, information systems, audiology, and immunology, would have been nearly eliminated. Relief eventually came at the end of 1992, when the MSC figures were adjusted upward and some specialties previously slated for elimination were retained (see Appendix J). However, there were no guarantees for the future. Brig. Gen. Jerome V. Foust, promoted and appointed chief of the corps in September 1992, predicted "some tough years ahead of us in regards to the downsizing." To assist him in planning for the future of the corps, Foust formed a board of directors comprising the assistant corps chiefs and eight senior MSCs in a variety of key positions, selected to widen his sources of advice.70
As in previous postwar reductions, the future of uniformed scientists in the Army was especially cloudy. The same pressures that had appeared in previous drawdowns predictably reappeared in the post-Cold War period, and questions again were raised as to the viability of the MSC scientific specialties. Indeed, those statements of concern could have been taken verbatim from the transcript of the 1948 meeting on the medical allied scientists. MSC scientists such as Lt. Col. Wilbur K. Milhous, MSC, a microbiologist, worried out loud that the Army could end by losing a valuable asset-the uniformed scientist-who brought to the research mission rapid deployability, focus on military relevance, and individual talent and experience. Often, Milhous argued, medical problems that were of great importance to the military were of no interest to the civil sector. For example, he warned that infectious diseases such as malaria and leishmaniasis remained a worldwide threat to U.S. military operations. However, without the military's support and sponsorship there would be no development of the drugs and vaccines necessary to defend soldiers against those disease threats. His concerns for the future were echoed by the Army's scientific community at large, prompting pledges of support for "green-suit" scientists by Army senior leaders.71
There were other concerns. Some senior officers worried over the best way to ensure the proper development of MSCs for the varied settings and challenges they would face in their careers. The MSC Management Study, completed in 1990, attempted to mold a leader development pattern to qualify senior officers for specialty-immaterial assignments. Another aspect was the old issue of alley cats and house cats, the challenge of developing officers with experience in both
the wartime and peacetime components of the health care system. Over the years efforts had been made to reward officers who pursued field assignments, and yet some specialties still tended to shield their officers from a mix of assignments between garrisoned and operational medical units. In 1993 Col. Timothy Jackman, MSC, argued that difficulties arose when garrisoned field units deployed to the Persian Gulf, where they were joined by their full complement of clinicians. MSCs in leadership positions whose careers had not included assignments to operational medical units were disadvantaged at that point by a lack of understanding of the clinical mission and of the clinicians themselves. Jackman said this caused organizational stresses at different interpersonal, cultural, and management levels. He noted that his observation would be controversial to some, "especially those who have prided themselves on never having been assigned to a hospital." His solution was to require officers who desired those leadership opportunities to have assignments to operating medical units, such as hospitals, as part of their leader development pattern.72
During the early nineties, the Army Medical Museum at Fort Sam Houston, Texas, sold maroon T-shirts emblazoned with the MSC silver caduceus and the motto, "So Others May Live." The MSC would take that credo and the lessons from its history into the next century. Time and again, the United States had found in wartime that it needed medical administrative and scientific specialties. The evolution of the MSC from its precursors into a permanent corps was evidence of that need. After World War I the Medical Department had attempted to capitalize on its experience with the U.S. Army Ambulance Service and the Sanitary Corps, but World War II was needed to show once and for all that the military could not afford to dispense with the contributions of the Medical Administrative Corps and Sanitary Corps. A permanent Medical Service Corps emerged in 1947, and the new corps proved itself in Korea, where it was a source of strength. It demonstrated impressive maturity and cohesion with its own internal leadership during the difficult drawdown period after Korea. Its lifesaving work was in evidence throughout Vietnam. MSCs again showed their courage and expertise in the Persian Gulf, only to face once again the challenges of a postwar drawdown.
An estimated $898 billion bill for U.S. health care in 1993, accounting for 14.3 percent of the gross national product, and an unsuccessful yet high-priority attempt at health care reform by the Clinton administration kept the cost of health care in the news. DOD's annual cost of over $15 billion also attracted attention.73 Rising concern by Congress over costs pressured the Department of Defense into further consolidation along the lines of a "purple suit," or amalgamation of the Army, Navy, and Air Force health care organizations.74 The changes at the top of the military health care system would affect the structure of the Army Medical Department and the form its Medical Service Corps would take in the future. Army MSCs would be instrumental in designing that formulation as well as key players in its operation, but the department would most certainly
have to resist more attacks on the MSC. Since the American Revolution, the periods of greatest growth of the MSC and its precursors came during wartime; regression occurred as funds dried up and the appreciation for the full dimension of medical support for combat operations was forgotten. Such periods had been characterized by direct assaults on individual MSC specialties as well as on the continued existence of the corps itself, and these attacks could be expected to reoccur under similar circumstances.
The process was evident in 1990 when the Army undertook Project VANGUARD, a study intended to find ways to cut the Army. Brig. Gen. Bruce T. Miketinac, the chief of the corps, believed it was the department's task to convince the Army Staff and others of the Army's need for MSCs in the various specialties. For example, in the case of resource managers the Medical Department had to communicate its requirement "to train MSC officers to be comptrollers, not comptrollers to be MSCs." The Medical Department resembled other specialized organizations that required their own unitary structure of people, units, equipment, and doctrine to execute their missions. In a similar vein, another effort to move medical logistics away from medical control was put to rest in 1993. The technical complexity of medical logistics, its time sensitivity for the user, and its pivotal role in the delivery of health care had not changed.75
Expertise remained a key to the corps' future. The MSC and its precursors had contributed to modernizing military medicine, principally by giving the Medical Department access to new technologies. The inclusion of experts in varied technical fields changed doctrine, equipment, and clinical practice, and the presence of scientific expertise-such as that embodied by Colonels Cavanaugh and Angel during the Vietnam War-was genuinely a national resource. Modernization extended to the administrative specialties as well. Improvements to the evacuation system were pioneered by administrative specialty officers skilled in the pioneering automotive technology of the World War I era, a time also marked by the first American attempts at developing a system of aeromedical evacuation.
The need for modernization was evident in the post-Gulf War period as well. As General Thurman insisted, the United States had to begin preparing immediately for the next war because every element of its military force had been exposed to the view of all countries, friendly and unfriendly.76 Military medicine had to modernize as part of that process. Accordingly, the Academy of Health Sciences undertook a series of lessons-learned sessions. Problems that had surfaced in Panama and Iraq had to be identified and solved, and much more had to be done to improve joint operations. The Medical Service Corps would be a source of innovators who would develop the new technologies, doctrine, training, and equipment necessary to position military medicine for future challenges.
An example moved to the forefront in 1991. Lt. Col. Fred Goeringer, MSC, had over a several-year period personally shepherded the Medical Department's development of filmless radiology from its early days as a project of the U.S. Army Medical Research and Development Command. Goeringer, a medical logistics officer and institutional entrepreneur, organized an imaging system that combined computer applications with advanced phosphorous plate technology. His
project promised to revolutionize military medicine with computer technology that had the potential of billions of dollars in applications in both military and nonmilitary settings. Goeringer oversaw a spinoff of that technology in a successful test of teleradiology in the Gulf War in which scans from a computed tomography (CT) scanner were transmitted via satellite and telephone links to Brooke Army Medical Center in San Antonio, Texas. Goeringer's effort expanded into a network of computer-based systems, called the Medical Diagnostic Imaging Support System (MDIS), that tied together a variety of systems such as CT, ultrasound, magnetic resonance imaging (MRI), and computer radiology. In 1991 the Army awarded a $209 million contract to Loral Corporation for the MDIS project. In 1992 Goeringer was recognized with a Federal 100 Award by an industry journal, the Federal Computer Weekly.77
Goeringer's efforts formed the Medical Department's core of visionary technology called telemedicine that was strongly championed by Lt. Gen. Alcide M. LaNoue, appointed as surgeon general in 1992, and was demonstrated in 1994 at the Advanced Warfighter Experiment at the National Training Center, Fort Irwin, California. In September 1994 telemedicine became a tri-service effort with the Army as its executive agent under the auspices of the assistant secretary of defense for health affairs. Goeringer, by then a colonel, said that the joint effort was an opportunity "to redesign the process of diagnostic imaging in the military."78 LaNoue said it provided "the ability to virtually project the skill mix and clinical capabilities found in our medical centers, totally independent of real time and distance limitations."79
Another example of a pioneering advance led by MSCs was found in Col. Henry C. Beumler's work as the Health Services Command's (HSC) chief of coordinated care during the period in which the Army's direct health care system evolved into a system called Gateway to Care. This was an expansion of a demonstration project mandated by Congress called Catchment Area Management that began in the Army at the Fort Carson, Colorado, and Fort Riley, Kansas, hospitals in 1989. It represented a major shift in the demands placed upon hospital commanders, who were now required to account for the management of all military health care within the catchment area of their hospitals, including expenditures by the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), the military's health insurance program for family members. Primary care providers for beneficiaries enrolled in the program would arrange and approve all care for patients as a means of ensuring quality and controlling costs. As implemented in eleven hospitals in 1992, Beumler's Gateway to Care enabled HSC to demonstrate savings in its health care delivery. In 1994 it was subsumed in a DOD regionally controlled program called TRICARE.80
A principal theme of the MSC history is opportunity, the lifeblood of a vibrant corps. Opportunity for education, positions, and promotions has everything to do with the Army's ability to retain its best and brightest officers, because it defines the horizons of their aspirations, goals, and ambitions-in a word, their hopes. While the story of MSC opportunity is an evolutionary one, it is also the story of adversity. Nothing that MSCs enjoyed in the late twentieth century was achieved without the vision and struggle of officers who had gone
before. Often, visionary Medical Corps officers had provided the leadership for that progress.
Educational opportunity advanced after World War II with graduate education programs and the establishment of the Army-Baylor Program in Healthcare Administration. Military training also opened up, with opportunities for staff college, senior service school, and other military courses that prepared MSCs for greater responsibilities. Position opportunities expanded with MSC replacement of and substitution for physicians and others in such senior positions as commanders, hospital executive officers, and command chiefs of staff. Promotions improved with the repeal of the 2 percent cap on colonels. MSCs could look forward to promotion opportunities through that rank and, beginning in 1966, a chance for brigadier general.
There continued to be good opportunities for Army MSCs in the post-Cold War era. Educational opportunities remained excellent; in fact, two programs were added in 1994. A study directed by the Army chief of staff of branch-immaterial command in medical units held the promise of new position opportunities. And throughout the drawdown the MSC maintained its promotion opportunity close to the goals of DOPMA and sometimes better than that afforded officers of other Army branches.81
While young MSCs in the 1990s benefited from the legacy of those who had gone before them, this did not end the evolution of their corps. The talent, skill, and ambitions of MSCs continued to outstrip the Medical Department's willingness to fully accommodate their aspirations. For that reason, some talented officers continued to transfer to other branches or left the Army for better opportunities elsewhere. MSCs could certainly go farther in the 1990s than before, but hope for the future comes from a conviction that tomorrow will be better than today. The challenge to the department's leaders was to provide that hope to officers who had served it faithfully. The removal of obstacles to opportunities for education and training, promotions, and assignments to positions of increased responsibility had strengthened the Medical Department over the years. The imperative was to eliminate the remaining elements of institutional discrimination that continued to block the department from using the full potential of MSCs and officers of other branches and accepting them as full members of the military medical team.
The Army Medical Department began the last decade of the century with the process of transformation incomplete and with some barriers to opportunity still in place. A fundamental theme of the MSC history is the repeated demonstration of a need for a corps of officers who specialized in administrative skills-beginning with control of "paper work"-that surfaced repeatedly in the Revolution, Civil War, Spanish American War, World War I, and World War II. The need for specific medical management skills-for example, medical logistics-was a lesson often relearned. By the time of the Korean War the benefit of a permanent MSC was accepted.
The handmaiden to the evolution of the MSC was pressure from sources outside the Medical Department, such as the War Department and political groups in World War II, who forced modernization and the adoption of modern business
practices upon the management of military medicine. Individual MSC specialties had been greatly affected by the demands of professional guilds, especially for professional recognition. Pharmacy from the period after World War I through the formation of the MSC in 1947 was an example. Optometry, sanitary engineering, laboratory sciences, and health care administration were other specialties whose outside practitioners affected the military role.
The pressure to use MSCs to substitute for physicians in administrative positions could be expected to ease in the early 1990s, as American medical schools produced a surfeit of physicians. The federal coffers for the financing of health care opened in 1965 with the advent of Medicare and Medicaid, and the number of physicians expanded to meet the federally funded demand. Some states built new medical schools, existing schools added capacity, and the federal government got in the act with the construction of its own school, the Uniformed Services University of the Health Sciences. The number of graduates from American medical schools more than doubled from 1965 to 1980, peaking at over 16,000 in 1984 (declining slightly after that to 15,499 in 1991). The number of physicians per 100,000 population increased 59 percent over the same period, going from 139 in 1965 to 237 in 1990. The greatly increased physician supply had lessened the department's problems in recruiting physicians, improved the quality of those on active duty, and increased the department's willingness to use them in administrative positions rather than for clinical duties. Political pressure to capitalize on the clinical training of physicians, while perhaps muted for the moment, would undoubtedly return in the future as the supply of physicians changed, as national pressure increased to reduce costs in health care, or if the United States again drafted physicians for military service.82
The command issue remained unsettled and unsettling, and
there were still those who argued against using MSCs as commanders.83 Yet bright
spots existed. The U.S. Army Medical Research and Development Command (renamed
the U.S. Army Medical Research and Materiel Command in 1994) continued to be an
exception to the department's policy, routinely appointing officers based on
their individual qualifications, and MSCs commanded USAMRDC laboratories,
activities, and field research units. Further, at least one surgeon general did
not object to MSCs commanding hospitals. General Pixley, in a 1984 interview,
said that he believed MSCs could command the smaller community hospitals
(although he did have reservations about their commanding operational field
In 1991 the Senate Appropriations Committee continued to challenge the Army to follow the lead of its sister Services in appointing nonphysician commanders of medical facilities.85 By 1992 MSCs commanded 18 of 109 Air Force treatment facilities and 21 of 44 Navy hospitals and clinics.86 In Grenada and Panama-as in Korea and the Dominican Republic-MSCs had remained in command of operational medical treatment units and medical battalions in spite of the rule that called for the relinquishment of command to a physician. In the Gulf War, MSCs remained in command of a medical brigade and all the medical groups they commanded in garrison. However, Medical Department policy dictated the designation of PROFIS commanders for operational treatment units, and MSCs
were required to turn over the command of those units as they deployed, often to officers with little if any training and experience to prepare them for that duty. The commanding general of the Medical Department's Center and School believed there was "an inherent fallacy" in this policy.87 The question to be answered in the 1990s was how the department would act in light of its experiences in recent crises. Would it take the initiative to unharness the talents of MSCs in a new system of free competition? Or would it remain chained to its past?
By 1994 it appeared that the Army was prepared to open up command of medical units to officers of any Medical Department corps. General LaNoue launched a series of revolutionary changes upon his appointment as surgeon general, including the formation of a three-star U.S. Army Medical Command that replaced the Health Services Command and merged a number of organizations under his command (with Henry Tuell, now a colonel, as its first chief of staff). Subordinate units included eight regional health service support areas commanded by the medical center commander in each region. LaNoue sought to appoint Brig. Gen. Nancy R. Adams, the chief of the Army Nurse Corps, as one of those commanders.88
Coincidentally, the failure of the PROFIS command policy in the Gulf War, continued congressional pressure to reduce the number of clinicians in administrative roles, and political pressure by the Defense Advisory Commission on Women in the Service forced a review of the Medical Department's command policy. The issue catalyzed when the 212th MASH deployed to Zagreb in December 1992 and underwent a PROFIS change of command from MSC to MC. This resurfaced the complaints about last-minute changes of command that had been voiced by line officers during the Gulf War, and in January 1993 the assistant secretary of the Army for manpower and reserve affairs directed the surgeon general to review the Medical Department's command policy. In June, LaNoue wrote the Army chief of staff, General Gordon R. Sullivan, of his intent to implement Medical Department branch-immaterial slating of medical unit commanders. General Sullivan concluded that the Medical Department's leader development program was not sufficiently developed to support this change, and he suspended action on General LaNoue's request until the department developed a program that would enable any of its officers to prepare for command. Sullivan directed the formation of a formal study that would report its recommendations to him. That effort was under way as this book went to press. The indications were that the Army would approve some form of branch-immaterial command of selected medical units.89
Such a change would be a major advance in the opportunities open to MSC officers. Throughout their history MSCs had petitioned the department's leaders for an opportunity for fair and open competition for the largest challenges.90 It was their hope that, when records were thrown on the table to select officers for the highest positions in the Medical Department, the records of MSCs would be on that table as well, so that their capability, training, and experience would be fairly considered. The hope was that if the Confederate hospital commander, Capt. Sally Louisa Tompkins, were alive in 1995, she would have a fair shot at the job she had performed so well 133 years before.
1Gander: Rice, a first lieutenant commissioned directly from civilian life, processed the death records of Lieutenant Witmer, who as a fellow student in the officer basic course at Fort Sam Houston had taught Rice how to polish her boots just a few months before. Notes of interv, 1st Lt Beverly J. Rice, MSC, with Lt Col Richard V. N. Ginn, Pentagon, 16 Jan 86, DASG-MS.
2Grenada: After action rpt, Lt Col Jack R. Roden, MSC (ACSOPS, 44th Med Bde), sub: 44th Medical Brigade, Operation URGENT FURY, 15 Mar 85, hereafter cited as Rodin, Grenada rpt; Roden to Ginn, 28 Mar and 28 Apr 86; Press release, sub: Award of Combat Medical Badge to Maj. Arthur W. Hapner, MSC, and Capt. Kevin J. Swenie, MSC, 44th Med Bde, XVIII Abn Corps, 18 Jan 84; Notes of informal intervs, Ginn with Lt Col Jack Crabtree, Inf, (S-4, 82d Abn Div in Grenada), Brussels, Belgium, 10 Feb 88, and with Lt Col Edward B. Wilson, MSC, OTSG, 25 Apr 86; Notes of discussion, Col Joseph E. Herndon, MSC, Ch, San Eng Sec, MSC, with Ginn, 23 Apr 86, hereafter cited as Herndon notes, all in DASG-MS; Lt Col Joseph P. Jackson, MC, to Cdr, USACMH, 23 May 85, USACMH; Richard Gabriel, Military Incompetence: Why the American Military Doesn't Win (New York: Hill and Wang, 1985).
3Sanitation: Roden to Ginn, 28 Mar 86, and Roden, Grenada rpt; Herndon notes. Quoted words: N. Joe Thompson and John B. Czachowski, "Preventive Medicine in the Grenada Intervention: Detained Personnel and Civilian Populations," AMEDD Journal (November/December 1991): 5.
4Panama: Rpt, WRAMC, sub: Casualty Data Analysis, Operation JUST CAUSE, 11 Jan 90; Briefing, Col Jerome V. Foust, MSC, Cdr, 44th Med Bde, sub: Operation JUST CAUSE, presented at MSC mtg, Garmisch, FRG, 14 May 90, author's notes, hereafter cited as Foust, Operation JUST CAUSE; Briefing, Maj Jay Harmon, MSC, sub: Operation JUST CAUSE, 7th MEDCOM Ambulatory Patient Care Conference, Garmisch, FRG, 15 Oct 90, author's notes, all in DASGMS; Donna Miles, "Operation JUST CAUSE," Soldiers (February 1990): 20-24; Kenneth J. Jones, The Enemy Within: Casting Out Panama's Demon (Panama: Focus Publications, 1990), p. 145; Lawrence A. Yates, "Joint Task Force Panama: JUST CAUSE-Before and After," Military Review 71 (October 1991): 59, 70. United States deaths were twenty-one killed in action plus two who died of wounds later. About 54 percent of the 150 casualties air evacuated on 20 December were jump injuries from the very low (500 feet) combat jumps. Civilian casualty estimates were disputed. They were principally in the Chorillo slum district surrounding the Comandancia, Noriega's headquarters.
5Medical operations: Foust, Operation JUST CAUSE; Info paper, Maj Paul E. Bluteau, MSC, sub: Medical Support for Operation JUST CAUSE, 1 Mar 90; Briefing slides, Lt Col Susan McCall, ANC, Chief Nurse, 5th MASH, sub: JUST CAUSE Medical Operations, presented to HQ, 7th MEDCOM, Heidelberg, FRG, 30 Jan 90, all in DASG-MS. Lessons learned are in after-action reports assembled by the 44th Medical Brigade, in Memo, Lt Col Gerald A. Palmer, MSC, COS, 44th Med Bde, for Cdr, 1st COSCOM, 10 Jan 90, including: Maj Ted A. Martinez, Dep ACOSLOG, 44th Med Bde, undated; Lt Col Robert C. Leeds, DC, Cdr, 257th Med Det (DS), 9 Jan 90; Capt Talford V. Mindingall, MSC, Cdr, HQ and HQ Co, 44th Med Bde, 8 Jan 90; Capt Robert J. Yates, ANC, 8 Jan 90; Maj Priscilla M. Alston, MSC, Acting Cdr, 28th Combat Spt Hospital (CSH), 9 Jan 90; Lt Col Elwood L. Stephens, Cdr, 32d MEDSOM, undated; Lt Col Ira F. Walton III, MSC, Cdr, 56th Med Bn, 9 Jan 90; Maj Lee A. Porisch, ANC, 7 Jan 90; Maj David E. Rivera, MC, 1st FST, undated; and Lt Col Muench, MC, FST, 30 Dec 89, all in DASG-MS. Forward surgical team (FST): The FST handled 129 casualties and performed 73 operations, 22 of which required general anesthesia. The portable surgical hospital, which it resembled, was developed in the Pacific and adopted by the Army as T/O 8-572S "to furnish definitive surgical care in areas where it is impractical to use larger, more specialized units." Military Medical Manual, rev. October 1944 (Harrisburg, Pa.: Military Service Publishing Company, 6th ed., 1945), pp. 643-44.
6Roberts: Tom McNiff, "Remembering Days of War," Palatka [Florida] Daily News, 24 March 1990.
7Logistics: Foust said the problem was "unbelievable." Foust, Operation JUST CAUSE. Refugees: McNiff, "Remembering Days of War"; Notes of discussion, Capt David W. Rogers, MSC, with Ginn, Alexandria, Va., 11 Jul 94, DASG-MS. Only 34 of the 140 casualties treated by the aid station were American soldiers.
8Control of oil: Robert Woodward, The Commanders (New York: Pocket Star Books, 1991), p. 206. Woodward cited Nicholas Brady, Bush's secretary of the treasury. Iraq had 20 percent of the world's supply, as did Saudi Arabia. DESERT SHIELD: "'A Line in the Sand'-A Chronology," Stars and Stripes (S&S), 31 December 1991; "Our Deployment into the Persian Gulf," essays by Generals Glenn K. Otis, Frederick J. Kroesen, and Louis C. Wagner, Army 40 (November 1990): 14, 16. Quoted words: Christopher A. Hutchinson, "Dispatches From a Distant Desert," Duke 77 (February-March 1991): 10.
9Buildup: S&S, 10 January 1991; United Press International (UPI), "More Than a Million Troops with Vast Arsenals Face Off" and Associated Press (AP), "Congress Vote Gives Bush Power To Wage War in Gulf," S&S, 13 January 1991; "Chronology," in special issue, "The Gulf War," Military Review 71 (September 1991): 65-78. The vote in Congress was 52 to 47, Senate, and 250 to 183, House. Forces: AP, "Pentagon Braces for Word To Go," S&S, 16 January 1991; "Operation DESERT STORM," S&S, 28 January 1991; John Barry and Evan Thomas, "A Textbook Victory," Newsweek 121 (11 March 1991): 38. Operations: Association of the United States Army (AUSA), "Special Report: The U.S. Army in DESERT STORM" (Arlington, Va.: AUSA, June 1991), DASG-MS.
10Ground assault: Schwarzkopf said, "We're going to go around, over, through, on top, underneath and any other way it takes." Ron Jensen, "Land War Launched To Liberate Kuwait," S&S (25 February 1991). Casualties: "Medicine in the Gulf War," U.S. Medicine 27 (August 1991): 6, hereafter cited as "Gulf War," U.S. Medicine. General Ledford testified to the Senate Armed Services Committee that CENTCOM had predicted thirty to forty thousand casualties, including fifteen thousand KIA. "Army Anticipated 15,000 Gulf Deaths," U.S. Medicine 27 (June 1991): 1.
11Iraqi casualties: Barry and Evans, "Textbook Victory," p. 38; Ltr to the editor, Hutchinson, Duke 77 (June-July 1991): 33. "I was surprised at my own lack of feeling as we rolled over the charred remains of bodies and half-bodies recently killed."
12Medical support: Discussion of the medical support for Operations DESERT SHIELD and DESERT STORM is based principally on the following documents: USACMH intervs in the Persian Gulf; Capt Donald E. Hall, MSC, with Lt Col Joseph H. Cohen, MSC, USAR, XO, 403d CSH, 19 Mar 91; Col Jerome V. Foust, MSC, Cdr, 44th Med Bde, 29 Mar 91; Col Harold C. Schade, MSC, XO, 114th Evac Hosp, 7 Mar 91; Brig Gen Michael D. Strong, CG, 332d Med Bde, 21 Mar 91. USACMH intervs in the Persian Gulf (interviewer not identified) with Capt Steven R. Gilreath, S-4, 86th Evac Hosp, 12 Mar 91; Maj Tommy R. Hancock, MSC, Capt Randall L. Gaines, MSC, and Capt Paul Arbour, MSC (all Louisiana Army National Guard), 159th MASH, 8 Mar 91; Lt Col William C. Long, MSC, Cdr (XO during operational status), 86th Evac Hosp, 12 Mar 91. USACMH intervs in the Persian Gulf; Col Richard A. Bowman with Maj Carolyn A. Albanese, MSC, USAR, XO, 350th Evac Hosp, 6 Mar 91; Lt Col Scott Beaty, MSC, XO, 47th Fld Hosp, 23 Feb 91; 1st Lt Damon T. Mathis, MSC, Maj Robert J. Meyers, MSC, and Capt David O. Hill, MSC, 47th CSH, 8 Mar 91. XVIII Airborne Corps interv, Maj Robert B. Honec III, and SSgt LaDona S. Kirkland with Lt Col Roger R. Sexton, MSC, XO, 62d Med Gp, 26 Feb 91, all in USACMH; Intervs, Cols Robert P. Belihar, MC, USAF, and Benjamin M. Knisely, MSC, USA, in "Gulf War," U.S. Medicine, pp. 45-56; Interv, Ingeborg Sosa with Maj Gen Michael J. Scotti, Jr., Cdr, 7th MEDCOM, in AMEDD Journal (January/February 1992); Interv, Sosa with Lt Gen Frank F. Ledford, Jr., TSG, in AMEDD Journal (March/April 1992). Also see Memo, Maj Gen William L. Moore, Jr., Cmdt, AHS, for Dir, Special Proj Study Gp, U.S. Army Combined Arms Center, Fort Leavenworth, Kans., sub: DESERT STORM Lessons Learned Final After Action Review, 21 Jun 91, hereafter cited as Moore, Lessons Learned; Rpt, Col Philip E. Livermore, MSC, Ch, Log Div, OTSG, sub: Medical Logistics, Mar 91, hereafter cited as Livermore, Medical Logistics, all in DASG-MS; Frank F. Ledford, "Army Overcomes Combat Challenge," U.S. Medicine 28 (January 1992): 30-31; Robert M. O'Brien and Alexander M. Sloan, "Medical Support to DESERT SHIELD/STORM: The USEUCOM Surgeon's Perspective," AMEDD Journal (March/April 1992): 3-9. An especially valuable document is Rpt, John R. Brinkerhoff, Ted Silva, and John Seitz, Ofc, Ch, Army Reserve, sub: U.S. Army Reserve in Operation DESERT STORM: Reservists of the Army Medical Department, 23 Sep 93, PL, hereafter cited as Brinkerhoff; AMEDD Reservists.
13Medical groups: George A. Fisher, Howard A. McClelland, and Robert F. Griffin, "Preparing and Organizing Medical Support to VII Corps: Operation DESERT SHIELD and STORM," AMEDD
Journal (March/April 1992): 16-19; Edward K. Jeffer and Shirley L. Jones, "The Medical Units of the Army National Guard (ARNG) and Operation DESERT SHIELD/DESERT STORM," AMEDD Journal (March/April 1992): 20-22, hereafter cited as Jeffer and Jones, "ARNG Medical Units in DESERT STORM." 332d Medical Brigade: The 341st and 127th Medical Groups, both reserve units, remained operational. General Strong chose to organize all his hospitalization assets into three "vertical bands" because the distances were so great that command and control would otherwise be compromised. Rather than sticking with the doctrinal arrangement of assigning medical units behind a division to one medical group, Strong clumped his hospitals into three groups. The first level (or band), closest to the divisions, was composed of the MASH hospitals and constituted the 127th Medical Group. The 341st Medical Group commanded the second band, which had all combat support hospitals. The evacuation hospitals, which were farthest from the divisions, formed the third band and were grouped into a provisional "Task Force Evacuation."
14Knisely: "Gulf Update," Nightline (ABC News), 6 December 1990. The panel included Senator John Glenn and John Moxley, M.D., former ASD (HA). The earlier show's thesis had been that "the medical machine was struggling to catch up with the war machine." James Walker and Nancy Synderman, M.D., reporters; Peter Collis, M.D., Prin Dep ASD (HA); and John Beary, M.D., former ASD (HA), panelists, author's notes, Nightline, 20 November 1990, DASG-MS.
15Numbers: "Gulf War," U.S. Medicine, p. 6.
16Quoted words: Ltr, General H. Norman Schwarzkopf, USA, Ret., to "Members of the U.S. Army Medical Department," reprinted in AMEDD Journal (May/June 1993).
17PROFIS: Rpt, Maj Michael E. Dunn, Inf, Pers Opns Br (HSPE-MO), HQ, Health Services Command (HSC), sub: Staff Study, PROFIS, 25 Apr 91, hereafter cited as Dunn, PROFIS Study; Memo, Maj Gen Frederick N. Bussey, Dep Surg Gen, sub: Government Accounting Office Draft Report, "Operation DESERT STORM: Full Army Medical Capability Not Achieved," dated March 31, 1992 (GAO Code 393500), 16 Apr 92, hereafter cited as GAO Rpt, Operation DESERT STORM, 1992; Notes of telephone interv, Lt Col Ralph Bradford, Ch, Mil Pers Div, HQ, HSC, (HSPE-M), with Col Richard V. N. Ginn, 25 Jul 94, all in DASG-MS; "U.S. Hospitals Scramble to Backfill," U.S. Medicine (August 1991). Quoted words: Dunn, PROFIS Study.
18Quoted words: Bradford, Ginn telephone interv.
19Quoted words. Dunn, PROFIS Study. The personnel officers made it work, but at a cost. "Previous mobilization exercises, such as PROUD EAGLE 90, had wished away all the mundane, routine work associated with transporting fillers to their TO&E [Table of Organization and Equipment-i.e., field] units and moving backfill health care providers to the MTFs [medical treatment facilities] in need." Ibid.
20Quoted words: Bradford, Ginn telephone interv.
21Optometry: Memo, Maj David J. Walsh, MSC, Pgm Mgr, Developmental Eyewear, U.S. Army Medical Materiel Development Activity, sub: Trip Report, Natick Research, Development, and Evaluation Command, Natick, Massachusetts, 7 Oct 91, DASG-MS. The number represented 44 percent of those who wore glasses.
22Psychology: Roger Lehman, Jefferey E. Hansen, and Harry L. Musinger "Crisis Management of Children During DESERT STORM," AMEDD Journal (January/February 1992): 39-41. Planning extended to establishing death notification procedures.
237th MEDCOM: Crosbie E. Saint, "War Adds New Dimensions to Europe's Role," Army 41 (October 1991): 91. The 7th MEDCOM provided the U.S. Army, Europe, portion of the U.S. European Command requirement to provide 5,500 contingency beds. O'Brien and Sloan, "Medical Support to DESERT STORM," p. 3.
24Quoted words: Jeffer and Jones, "ARNG Medical Units in DESERT STORM," p. 22.
25Dustoff: Rpt, 45th Med Co (AA), sub: Darmstadt to Dhahran: Self-Deployment to DESERT SHIELD, 25 Dec 91, DASG-MS; Rosemary Sawyer, "Chopper Ride to Gulf Gives Medical Unit Some Hot Times," S&S, 6 September 1990.
26Anderson: Randall G. Anderson, "Forward Aeromedical Evacuation," in Perspectives on the Gulf War (Arlington, Va.: Association of the United States Army Institute for Land Warfare, August 1993), pp. 49-52, PL.
27Criticism of command policy: See Brinkerhoff, AMEDD Reservists, p. 53; Moore, Lessons Learned. Quoted words: Beaty, Bowman interv.
28Logistics: Livermore, Medical Logistics; Rpt, AHS, sub: AMEDD Stockholders Report, 27 Jul 91, pp. 4-5, DASG-MS; O'Brien and Sloan, "Medical Support to DESERT STORM." General Scotti, 7th MEDCOM commander, said the medical logisticians "deserve great respect for having accomplished this monumental task." Scotti, Sosa interv.
29Pallets: These were model no. 463A air line of communication (ALOC) pallets.
30Train: "Gulf War," U.S. Medicine, p. 44.
31USAMRICD: Frederick R. Sidell, "The Medical Management of Chemical Casualty Course in CONUS and Europe During DESERT SHIELD," AMEDD Journal (March/April 1992): 10-12. Sidell was pleased with the outcome. "I believe that at the onset of DESERT STORM, the U.S. military medical personnel were as well prepared to deal with chemical agent casualties as any military medical personnel have ever been." Ibid., p. 12.
32Contact lenses: Morris Lattimore et al., "Contact Lens Use by U.S. Army Aircrews on Operations DESERT SHIELD/STORM," AMEDD JournaI (November/December 1993): 13-17. Maj. Francis L. McVeigh, MSC, in unpublished paper, U.S. Army Command and General Staff College, sub: The History of Army Optometry: The Battles, Triumphs, and Future Challenges, June 1993, DASG-MS. Aviator use of Forward Looking Infrared Night Vision Goggles also dictated the issue of contact lenses. Optometrists also issued selected soldiers Ballistic-Laser Protective Spectacles.
33U.N. team: Bernie Ankney, "Iraq Possessed Large Biological Research Program, U.N. Team Says," U.S. Medicine (February 1992).
34BW/CW defense: USAMRDC News (monthly newsletter), August 1990-July 1991, DASGMS; "Gulf War," U.S. Medicine, pp. 13-14; Notes of conversation, Walter E. Brandt, Ph.D., Dir, Biological Systems, U.S. Army Medical Materiel Development Agency, with Col Richard V. N. Ginn, Fort Detrick, Md., 22 Oct 91, DASG-MS.
35Quoted words: Albanese, Bowman interv.
36Scud attack: Rpt, Lt Col Philip K. Schenck, MSC, XO, 173d Med Gp, sub: The 173d Medical Group and the Gulf War, 12 May 91, DASG-MS, hereafter cited as Schenck, After Action Report.
37Quoted words: Bowman intervs with Maths, Meyers, and Hill.
38DEPMEDS weight: Foust, Hall interv. Also see "Army Identifies 'Lessons Learned' from DESERT STORM" (interview with Brig. Gen. Ronald Blanck), U.S. Medicine (February 1992): 3.
39Quoted words: Strong, Hall interv.
40Quoted words: Gilreath, USACMH interv.
41Fuel requirement: Bowman interv with Mathis, Meyers, and Hill.
42Quoted words: James S. Martin, "Combat Psychiatry: Lessons from the War in Southwest Asia," AMEDD Journal (January/February 1992): 44.
43Quoted words: Bowman interv with Mathis, Meyers, and Hill.
44Patient administration: Col Fred McClain, Jr., Cdr, Patient Administration Systems and Biostatistics Agency, Ft. Sam Houston, Tex., in AHS, AMEDD Stockholders Rpt, pp. 5-10. The four systems were the Automated Quality Care Evaluation Support System (AQCESS), Comprehensive Health Care System (CHCS), Theater Army Medical Management Information System (TAMMIS), and Defense Medical Regulating Information System (DMRIS)
Phone calls: Maj. Gen. Ronald R. Blanck, Director of Professional Services, OTSG, in U.S. Medicine (February 1992).
45Enemy prisoners: Schenck, After Action Rpt; Notes of telephone conversation, Schenck with Col Richard V. N. Ginn, 14 Jun 94, DASG-MS. Of the 6,225, 4,136 were American patients, 1,138 were enemy POWs, and 951 were in other categories. The Red Cross representatives were pleased with the quality of the American medical support for the enemy POWs.
46Diaper pails: Schenck, After Action Rpt.
47Audiology: Richard W. Danielson, "Deployment of Audiologists: Forward to the Troops," AMEDD Journal (November/December 1993): 50-52. Repatriated POWs: Robert H. Gemmil and Calvin Neptune III, "Social Work Service to Army Repatriated Prisoners of War at Walter Reed Army Medical Center," AMEDD Journal (January/February 1992): 45-48.
48DEPMEDS rebuild: Richard I. Donahue, "Rebuilding Deployable Hospital Readiness," AMEDD Journal (November/December 1993): 9-12. Kuwait: MSC Newsletter, December 1992, DASG-MS.
49Satisfaction: Speech, Gen Maxwell R. Thurman, USA, Ret., to the Annual Meeting of the Army and Air Force Mutual Aid Association, Fort Myer, Va., 9 Apr 91, DASG-MS, hereafter cited as Thurman Speech.
50Quoted words: Lt. Gen. Frank F. Ledford, Jr., "Army Overcomes Combat Challenge," U.S. Medicine 28 (January 1992): 30. Numbers: GAO Rpt, Operation DESERT STORM, 1992.
51Changes: Editorial, John G. Roos and Glenn W. Goodman, Jr., in Armed Forces Journal (April 1991): 5.
52Lessons learned: Thurman Speech.
53Numbers: Rpt, DASG-PTZ, RQTDEC91, 11 Feb 92, DASG-MS. The active component numbered 18,171 officers, 37,550 enlisted, and 35,171 civilians. Scope: Msg, Lt Gen Quinn H. Becker, 261330Z Mar 85, sub: Early Appraisal-Becker Sends no. 1; Becker, statement before the House Subcommittee on Defense, Committee on Appropriations, House, 99th Cong., 1st sess., 16 Apr 85, both in DASG-MS. There were also 275 health clinics and 269 dental clinics.
54New doctrine: Department of the Army, FM 100-5, Operations, June 1993. Chapter 13, "Operations Other Than War," includes thirteen missions, including noncombatant evacuation operations, humanitarian and disaster assistance relief; nation assistance, and peacekeeping operations. For background on this revision see James R. McDonough, "Building the New FM 100-5: Process and Product," Military Review 71 (October 1991): 12. Purple Hearts: General Gordon R. Sullivan, CSA, statement to the House National Security Committee, DCSPER electronic mail msg, 24 Feb 94, DASG-MS.
55Operation PROVIDE COMFORT: "EUCOM Plays Supporting Role: PROVIDE COMFORT," U.S. Medicine (August 1991): 87-88; "A Record of Misery," Newsweek 124 (1 August 1994): 37.
56Facilities: Frank Sabatino, "Hurricane Andrew," Hospitals 66 (20 December 1992): 26-30.
57Water supply: MSC Newsletter, December 1992; Info paper, 1st Lt Timothy G. Bosetti, MSC, sub: Disaster Relief-Water System Reconstruction, 3 Nov 93; and Memo, Bosetti, sub: Sanitary Engineering Support of Operation Andrew and Hurricane Disaster Relief, 15 Sep 92, all in DASG-MS.
58Croatia: Steve Vogel, "First U.S. Army Unit Arrives in War-Torn Yugoslavia," Army Times, 23 May 1992; Vogel, "MASH Provides Aid to U.N. Troops," Army Times, 10 May 1993; Harry Noyes, "U.S. Medics Serve U.N. in Croatia," U.S. Army Health Services Command newspaper Mercury, August 1993; Presentation, Col Gregg S. Stephens, MSC, to Health Svcs Div, OPMD (TAPCOPH), PERSCOM, Alexandria, Va., 7 Oct 93, author's notes, DASG-MS.
59Aid to Russia: MSC Newsletter, December 1992, DASG-MS; "U.S. Hospital Supplies Sent to Moscow," Washington Times, 11 July 1993.
60Somalia: Jack Lancaster, "Combat in Mogadishu," Washington Post, 20 October 1993.
61Entomology: Rpt, Capt Steven Horosko III, sub: After Action Report, Operation RESTORE HOPE, 10 Apr 93, DASG-MS.
62Quoted words: Rpt, Capt Timothy G. Bosetti, MSC, sub: Preventive Medicine in Somalia: 485th Medical Detachment, 28 Jun 94, DASG-MS.
63Quoted words: "A Race with Death," Newsweek 124 (1 August 1994): 26. Dr. Florence Parent, a relief worker, said: "We can't do anything, I'm afraid. They just die and die and die, and they keep coming and coming and coming." "1994 Perspectives," Newsweek 124 (26 December 1994): 70.
64Rwanda: Briefing slides, Health Care Opns Div (DASG-HCO), OTSG, sub: Rwanda Refugees, 22 Jul 94; Briefing, Col Rick Erdtmann, MC, and Maj David S. Heintz, MSC, sub: Rwanda, 22 Jul 94, author's notes; Msg, DASG-HCO, sub: DASG SITREP no. 3 Rwanda Relief Operations (Operation SUPPORT HOPE), 28 Jul 94, all in DASG-MS; Thomas W. Lippman and Rebecca Fowler, "U.S. and U.N. Rush Relief to Rwandans," Washington Post, 22 July 1994; Thomas W. Lippman, "U.S. Sends 4,000 Troops to Help Relief Efforts," Washington Post, 23 July 1994; "Army Units Help Ease Tragedy in Rwanda Refugee Camps," Mercury (September 1994), DASGMS; Thomas W. Lippman, "U.S. Troop Withdrawal Ends Frustrating Mission to Save Rwandan Lives," Washington Post, 3 October 1994; Steve Harding, "Hope Comes to Rwanda," Soldiers 49 (October 1994): 13.
65Haiti: Memo, Togo D. West, Jr., Sec Army, for Sec Def, sub: The Weekly Report, 4 Oct 94, DASG-MS; Douglas Farah, "Haitian Police Attack Crowd; U.S. Troops Watch," Washington Post, 21 September 1994; Evan Thomas et al., "Here We Go Again," Newsweek 124 (26 September
1994): 20-24; Don Kirkman, "GIs Get Warning on AIDS in Haiti," Washington Times, 1 October 1994. Assistance efforts: Rpt, Lt Col Dale R. Brown, MSC, Ch, Health Facility Assessment Team, 44th Med Bde, sub: Final Report Assessment and Design Concept, extracts in DASG-MS; "Haiti's Bugs Defy Health Care," Army Times, 17 October 1994. Quoted words: Soraya S. Nelson, "U.S. Medics Pitch in at Haitian Hospital," Army Times, 10 October 1994.
67Numbers: Briefing slide, Manpower Div, OTSG, sub: Revised Five Year AMEDD Capability Plan, 12 Oct 94; Briefing slides, AMEDD Personnel Proponency Dir, AMEDDC&S, sub: FY 96 AMEDD Corps Breakout, 4 Oct 94, both in DASG-MS. The total authorized numbers by fiscal year end strength were as follows:
69Quoted words: Bernard Adelsberger, "As Officer Cuts End, Uncertainty Begins," Army Times, 26 December 1994. SERB: Briefing slide, DASG-PTM, sub: SERB History, undated (1994); Memo, DASG-PTM for DCSPER, sub: AMEDD FY95 SERB, 16 Sep 94; Rpt, TAPC-OPH, sub: AMEDD SERB Background, 15 Dec 94, all in DASG-MS. The 250 total included 109 colonels, 120 lieutenant colonels, and 21 majors.
During this period the Army SERBed a total of 538 Medical Department officers. In addition to 250 Medical Service Corps officers, there were 113 Army Nurse Corps, 99 Medical Corps, 68 Dental Corps, and 8 Veterinary Corps officers. No Army Medical Specialist Corps officers were SERBed. Quality of officers: PERSCOM used four rankings to evaluate officer efficiency reports based on a comparison of each officer's overall file with those of his or her peers: A for above center of mass; P for center of mass, top half (plus); M for center of mass, bottom half (minus); and B for below center of mass. The schema is depicted in Adelsberger, "As Officer Cuts End, Uncertainty Begins." Ninety-five percent of the MSC colonels were rated A or P. This was in contrast to the Medical Corps colonels selected by the same board, 96 percent of whom had M or B files. Rpt, TAPC-OPH, sub: FY95 AMEDD SERB, 30 Nov 94, DASG-MS. Captains: Briefing, Lt Col Ernest R. Morgan III, sub: Army Leadership Study, 20 Sep 94, PERSCOM, Alexandria, Va., author's notes. The study team interviewed 1,625 captains worldwide (including 80 Medical Department officers).
70MSC reductions: Briefing slides, APPD, AMEDDC&S, sub: MSC Downsizing FY94 and FY96, undated (Dec 92); Memo, Col Frederick J. Manning, MSC, Research Psychology Consultant, for Research Psychologists, sub: Rumors of Your Demise, undated (Dec 92), both in DASG-MS. Quoted words: MSC Newsletter, August 1993, DASG-MS. Board of directors: The membership included the chief of the MSC; assistant chief of the MSC; chiefs of the four MSC sections; chiefs of staff of the Health Services Command, U.S. Army Medical Research and Development Command, 7th Medical Command, 18th Medical Command, and AMEDD Center and School; director of health care operations, OTSG; chief of the MSC Branch, Health Services Division, OPMD, PERSCOM; and a representative of the Surgeon, U.S. Forces Command. Memo, Lt Col Michael D. Wheeler, MSC, Asst to Chief; MSC, sub: MSC Strategic Planning Conference, 4 Nov 92, DASG-MS.
71Concerns for scientists: Memo, Lt Col Wilbur K. Milhous, MSC, for Lt Col George C. Southworth, OTSG, sub: The MSC Soldier/Scientist, 22 Apr 92, DASG-MS; Ralph E. Hay, "The Uniformed Scientist-An Uncertain Future," Army Research, Development, and Acquisition Bulletin (July/August 1989): 17-19. Support: Lt. Gen. William G. T. Tuttle, Jr., CG, U.S. Army Logistics Center, Fort Lee, to Editor, Army Research, Development, and Acquisition Bulletin (July/August 1989): 45.
72MSC Study: Briefing slides, William J. Leary, Jr., MSC, sub: Medical Service Corps; Building for the Future, undated (Mar 90); Memo, Gary L. Tonniges, Ch, AMEDD Pers Proponent Div, AHS, sub: Recommended Changes to Military Occupational Classification Structure, 29 Jan 90, both in DASG-MS. Quoted words: Jackman, Operations Newsletter.
73U.S. costs: "A Checkup for Health Care," U.S. News and World Report (13 June 1994): 63. DOD costs: Speech, Katherine Ladd Railey, Ofc of the Asst Sec Def for Health Affairs, sub: Internal Accountability, presented at the Federal Day of the annual meeting of the American College of Healthcare Executives, Chicago, Ill., 2 Mar 92, author's notes, DASG-MS. Costs included military personnel and construction.
74Pressure: Andy Pastor, "Military Medical System, Beset by Budgeting Ills and Riddled with Waste, Needs Some Doctoring," Wall Street Journal, 26 August 1991.
75Project Vanguard: MSC Newsletter, 20 November 1990; Rpt, Col Richard V. N. Ginn, MSC, IG, 7th MEDCOM, to Ch, MSC, sub: Historical Perspectives on Project Vanguard with Special Emphasis on Two Administrative Specialties: Aeromedical Evacuation Officer and Health Services Comptroller, 26 Sep 90, both in DASG-MS. Medical logistics: Memo, Gene A. Markel, U.S. Army Logistics Evaluation Agency, New Cumberland, Pa., for DCSLOG, sub: Medical Logistics Policy Proponency Study-Decision Briefing, 1 Oct 93, DASG-MS; Philip E. Livermore and Angel Cintron, "Medical Logistics: Pillar of Health Care Delivery," Army Logistician (March-April 1994): 9-11.
76Thurman: "If your weapons, doctrine or tactics went to war, you can assume it has been [sic] compromised." Thurman Speech.
77Teleradiology: Michael A. Cawthon, Fred Goeringer, et al., "Preliminary Assessment of Computed Tomography and Satellite Teleradiology from Operation DESERT STORM," Investigative Radiology 26 (October 1991): 856. MDIS: Larry D. Cade et al., "Project Management in Military Medicine: The Medical Diagnostic Imaging Support System (MDIS) Project," AMEDD Journal (November/December 1993): 18-20. Goeringer headed a team that included seven MSCs with a variety of specialties. Award: Federal Computer Weekly 6 (March 1992).
78Telemedicine: Nancy Tomich, "Telemedicine: 'Off-the-Shelf' Phenomenon," U.S. Medicine (July 1994); Donna Miles, "Medicine by Monitor," Soldiers 49 (October 1994): 32-34. Quoted words: Nancy Tomich, "MDIS Will Proceed 'Tri-Service,'" U.S. Medicine (October 1994).
79Quoted words: Memo, Lt Gen Alcide LaNoue, TSG, sub: Telemedicine, 1 Nov 1994, DASGMS.
80Gateway to Care: Rpt, Rand Corporation, Santa Monica, Calif., sub: Evaluating the Catchment Area Management Demonstration, Jun 90; Rpt, Ann L. Price, Manpower Div, OTSG, sub: Army Management Initiatives, Demonstrations, and Alternative Health Care Delivery Systems, 20 Apr 93; Harry Noyes, "Gateway to Care Shows Medical Future" and "Local Control Is Key Part of Gateway Program," in flyer, sub: Gateway to Care...the Army's Coordinated Care Program, undated (1992), extracted from Mercury; Harry Noyes, "DOD Orders Active-Duty TRI
CARE Enrollment," Mercury (September 1994), all in DASG-MS; "Catchment Area Management Found Effective in Reducing Health Costs," U.S. Medicine (October 1991); Frank F. Ledford, "Army Overcomes Combat Challenge," U.S. Medicine 28 (January 1992): 31; Harry Noyes, "TRICARE: The Parable of the Genie and the Guru," Mercury (August 1994), DASG-MS.
8176. Opportunity in the 1990s: Interv, Brig. Gen. Jerome V. Foust with Ingeborg Sosa, in AMEDD Journal (November/December 1993). The new offerings were master's programs in marketing and health care economics. Promotions: Briefing slides, Mil Pers Mgmt Div, OTSG, sub: Promotions and Loss Management, 4 Dec 92, DASG-MS. The DOPMA goals consisted of selection opportunity rates of 50 percent for colonel, 70 percent for lieutenant colonel, and 80 percent for major. The opportunity rate was calculated based on the entire population eligible for selection, i.e., officers considered for the first time, plus those previously considered and not selected, plus those selected from below the zone (early promotions).
82Numbers: American Medical Association, Physician Characteristics and Distribution in the U.S. (Chicago: AMA, 1991); annual education issues of the Journal of the American Medical Association, 1965-1991; Karen Sandnick, "U.S. MD Glut Limits Demand for Foreign Medical Graduate Physicians," Hospitals 62 (5 February 1988): 67.
83Opposition to MSCs: Edward K. Jeffer, "Medical Units: Who Should Command?" Military Medicine 155 (September 1990): 413-17. Actually, Jeffer's apparent purpose was to defend the use of physicians as commanders. This is an entirely valid position in the author's view, but not at the expense of denying the opportunity to everyone else. The problem comes in denying the validity of utilizing officers with other specialty backgrounds as commanders no matter what their individual capability. That denial was the underpinning of Jeffer's analogy of the physician as the only conceivable "quarterback" of the health care team.
84Pixley's view: Pixley, Ginn interv, 1 Nov 84. In an earlier interview he stated that "the most qualified member of the health team should assume command." "Improving Manpower: Pixley's Early Days," interv in U.S. Medicine 17 (15 September 1981).
85SAC: Draft rpt, Senate, Appropriations Committee, Department of Defense Appropriations Bill, 1992, 102d Cong., 1st sess., September 1991.
86Navy command: Memos, Lt Col Larry K. Hammerbacher, AMEDD Ctr and School, sub: Command of Navy Medical Treatment Facilities, and Command of Air Force Treatment Facilities, 19 Oct 94, both in DASG-MS.
87Quoted words: Moore, Lessons Learned. Colonel Foust thought it a significant problem. "We had some very bad experiences with physicians taking command." Foust, Hall interv.
88Medical command: HQDA GO 20, sub: Organization of the United States Army Medical Command (MEDCOM), 10 Aug 94, PL. The order redesignated HSC as the MEDCOM and assigned to it the U.S. Army Medical Department Center and School, U.S. Army Medical Research and Materiel Command, U.S. Army Environmental Hygiene Agency (AEHA), U.S. Army Dental Command, U.S. Army Veterinary Command, U.S. Army Health Service Support Areas, all medical centers and medical activities, and the medical installations at Walter Reed Army Medical Center, Fitzsimons Army Medical Center, and Fort Detrick, Maryland. AEHA was soon thereafter redesignated the U.S. Army Center for Health Promotion and Preventive Medicine and placed under the command of General Adams. Adams: General Adams was an outspoken advocate of changing the command policy in order to provide members of her corps with the opportunity to command. "Army nurses are qualified and ready to be commanders." Ltr to the editor, Brig. Gen. Nancy R. Adams, "Nurses Ready to Lead," Army Times, 14 November 1994.
89Command opportunity: Lt Gen Alcide M. Lanoue, TSG, to Gen Gordon R. Sullivan, CSA, 23 Jun 93; Memo, Lt Gen John H. Tilelli, Jr., DCSOPS, sub: Leader Development Decision Network (LDDN) to Study Implementation of Branch Immaterial Army Medical Department (AMEDD) Command Opportunities, 2 Feb 94; Memo, Lt Col Larry K. Hammerbacher, MSC, Ch, Officer Pers Proponent Div, AMEDD Pers Proponent Directorate (APPD), AMEDDC&S, sub: AMEDD Immaterial Command LDDN Council of Colonels, 7 Sep 94, including Rpt, sub: AMEDD Command Leader Development Action Plan; Council of Colonels, AMEDDC&S, Fort Sam Houston, Tex., 18-19 Oct 94, author's notes, all in DASG-MS. The Tilelli memo established a requirement for quarterly briefs by TSG to the CSA and review of the three "pillars" of leader development: institutional training, operational assignments, and self-development.
90Petition: Michael J. Tolk, "Who Should Command Medical Units," Army (December 1993): 12-13.