Iraq Transition: The Civilian Medical Support Services on Paper

I have posted previously about the transition to a civilian-led mission in Iraq. The planned 17,000 civilian personnel (including personal security contractors) will be a lot less than what DOD has in country right now, but it is larger than the entire Foreign Service which has approximately 6,500 Foreign Service Officers and 5,000 Foreign Service Specialists.

Think about it, a workforce larger than the entire Foreign Service, deployed to one country alone.

I’ve posted previously about the transition and the medical support function here, here, here and here.

U/S Patrick Kennedy during his appearance at the Commission on Wartime Contracting last June 6 states that “a medical contract was awarded to Medical Support Services – Iraq on May 15, 2011 for $132 million for five years.”

I don’t know why there is a discrepancy in the amount and the name of the contractor but according to FedBiz the medical support services contact number: SAQMMA11D0073 is in the amount of $61,427,699.00 and has been awarded to CHS Middle East LLC, a company based in Reston, Virginia on May 19, 2011.

I went digging for the solicitation in FedBiz to see what to expect. Excerpts below on what the medical support services look like on paper. Excerpted from the publicly available statement of work:

C.1 Purpose and Objectives

This is a non-personal services contract to provide for Health Service Support to U.S. personnel and authorized foreign nationals serving for the United States in Iraq. The Contractor will provide trained and certified health care professionals and administrative service support to U.S. and U.S. sponsored beneficiaries working and residing in Iraq. The Contractor will staff, operate, equip, and supply health care facilities in locations prescribed by the Department of State to meet operational requirements as identified in this Performance Work Statement. Mission capable status (all sites listed in table C.1) is 1 December 2011. Mission capable means able to perform all requirements under this PWS.

C.2 Background

The health care support mission will transition from the U. S. Department of Defense to the U. S. Department of State over a period of time as denoted in Attachment A. Transition Timeline, beginning on or about June 2011 with complete transfer completed by December 2011 coinciding with majority of the U.S. forces’ departure.

After the U.S. military forces withdraw from Iraq, the U.S. Embassy and constituent posts and sites will be comprised of approximately 14,000 to 17,000 U.S. Government personnel under the U.S. Ambassador which includes U.S.G. civilians, military and local national employees; and supporting Contractors (U.S. third country, and local national). All U.S. and third country personnel will require medical care (local nationals only in emergencies or work related injuries).

The Department of State will establish a network of Contractor operated facilities in three regional support areas (see Attachment B for map of the facility locations and support regions) consisting of seven Health Units (HU), one large Diplomatic Support Hospital (DSH), and three small DSHs that provide patient care. A description of the capabilities required of each of the three types of facilities may be found in the Scope of Work of this PWS.

Health care facilities will be in secure compounds within each of the three geographical support regions with general logistics, utilities, and housing support provided by separate contracts.

The Contractor will be responsible establishing facilities as indicated in Table C.1 below:
Table C.1 Facility Type, Locations, and Population Supported

C.3.2 Health Unit (HU) Capabilities.

The Contractor shall provide on-site primary, urgent and initial emergency care for general medical, surgical, orthopedic, gynecologic (GYN) and mental health conditions; triage, stabilize and evacuate patients to the next level of medical care; and keep up to two patients in the HU for up to 24 hours until stabilized or medically evacuated. Staffing shall be continuous and uninterrupted; coverage for illness and vacations shall be the
responsibility of the Contractor.

The Contractor shall designate a medical director for appropriate medical oversight at each facility. This medical director shall be named in the resultant task orders. Routine care shall be provided during regular working hours, and on an emergency basis after normal working hours based on COM requirements. At least one physician with expertise in all aspects of emergency care shall be available 24 hours daily. All providers shall be licensed to US or equivalent standards and physicians shall be qualified by US or  equivalent specialty boards. All primary care providers (Physician(s), Physician Assistants, Nurse Practitioners) shall hold current credentials in trauma care (e.g. ATLS, CALS or equivalent) and cardiac care (ACLS or equivalent).

The Contractor shall also provide the following supplies and services at each HU facility:

• Medical and medical emergency equipment.
• Basic formulary and vaccines to include, but not limited to:
• Thrombolytic therapy.
• Medical supplies.
• Laboratory equipment and supplies and maintenance thereof,
• Clinical Laboratory Improvement Act (CLIA) waived lab capabilities to include, but not limited to: basic hematology, blood chemistries, urine analysis, cardiac enzymes, d-dimer testing.

C.3.3 Small Diplomatic Support Hospital DSH Capabilities.

In addition to the capabilities outlined above for a HU facility, the Contractor shall establish a medical/trauma care hospital with the following capabilities:

• Basic x-ray, diagnostic ultrasound (to include Focused Abdominal Sonogram for Trauma (FAST) Right Upper Quadrant (RUQ), renal, OB (tubal pregnancy), GYN, testicular, and Deep Vein Thrombosis (DVT) evaluations).
• Appropriate number of trauma bays in the emergency medical and trauma unit for care and stabilization.
• Overnight bed capabilities for up to four patients (8 beds total ( 4 ICU beds + 4 regular beds))
• Post operative / intensive care capabilities for up to four patients to be stabilized until medically evacuated
• One operating room table with anesthesia and supplies.
• Laboratory with blood bank.
• Computerized Tomography (CT) Scanner with the capability to conduct non-contrast, contrast (oral and IV), and the ability to do PA-grams (ideally with venous run-off).

Staffing shall reflect that necessary to manage a single surgical patient with the required operating room (OR) techs, nurses, anesthetists and the possibility of multiple injured or ill patients. The professional staff, when time permits, shall be integral to all aspects of the facility. Physicians, surgeons, anesthetists, OR tech, EMTs, laboratory technologist and nurses shall meet the requirements outlined below in the Staffing section.

C.3.4 Large Diplomatic Support Hospital (DSH) Capabilities.

Sather Air Base will have the same common items as the Small DSH facilities and Health Units, but will have:

• staffing that reflects the requirements to manage two surgical patients and the possibility of multiple injured or ill patients
• staffing to include competency in performing and interpreting ECG stress tests
• possess a total of 2 OR tables with anesthesia and supplies
• overnight bed capabilities for up to six patients (12 beds total (6 ICU beds + 6 regular beds))
• post operative / intensive care capabilities for up to six patients to be stabilized until medically evacuated
• It is anticipated that full occupancy would be a rare occurrence.

According to the solicitation, which has now been awarded, the US Government estimates the following staffing: Health Units-5, Small District Support Hospitals-16, Large District Support Hospitals -31.

If I got my math right, and I’m atrocious at math — this comes out to 1 medical support provider for every 326 of the deployed population.

Related info:

1-21-2011 PRE-SOLICITATION CONFERENCE final.pptx (1,054.90 Kb)
January 21, 2011 slides from Presolicitation Conference(FedBiz)