New @StateDept Bureau to Take $26 Million, Plus 98 Staffers From the Medical Services  Bureau

Updated 1:24 pm PDT 
We just learned that the Under Secretary for Management Brian Bulatao is pushing for the formation of a new bureau called Crisis and Contingency Response (CCR) under the Management umbrella. This would expand the “M” family to 14 bureaus and offices (including a more recent creation called Office of Management Strategy and Solutions (M/SS). 
We understand that Mr. Pompeo has formally signed off on this new office.  CCR will reportedly take $26 million funding from the Bureau of Medical Services (MED). It will also  pull 98 positions from MED and it will share EX and IT services with the Medical Services bureau.   
We also learned that the “7th floor loves Dr. Will Walters” because he and his Directorate of Operational Medicine are reportedly not only “providing OpMed flights during COVID, repatriation flights, logistics flights, but have also provided the Secretary with medical support during his travels.”
“Very sexy stuff, whereas what MED providers do is the more mundane day-to-day care of diplomats and their families overseas.”
Many medical providers are said to be up in arms about the rapid formation of this new Bureau — which happened in a span of just four months — with apparently no input from the field.
“Medical services to diplomats and their families abroad may suffer.”
We asked what are the potential consequences to MED and its patients, and we’re given a quick rundown by Sender A:
    • Since MED and the CCR Bureau share EX and IT, there is widespread concern that MED staffing and funding will be given short shrift in this new configuration.
    • What might happen is fewer FS medical providers whom MED is allowed to hire, leaving positions overseas unfilled.
    • Other critical “back office” functions in MED, if not supported by the new shared EX, might become understaffed.
    • If sections such as MED Foreign Programs (authorization and funding of Medevacs and hospitalizations, referrals to WDC medical providers) do not have sufficient staffing and funding, service to FSOs and EFMs abroad will certainly be noticed in terms of delayed or denied authorization and funding cables.
    • If the MED/GSO section does not receive sufficient funding/staffing, delivery of essential medications and vaccines will be delayed or nonexistent.
Our source said that a town hall was held last week concerning this new bureau.  Many medical providers reportedly submitted questions ahead of time, but “the vast majority of the one-hour time slot was taken up my monologues from Bill Todd and Will Walters.” 
Source added that “both were very good at smoothly blowing by the concerns raised by MED.”
We understand that Todd did not explain why a separate Bureau was being created, but almost everyone in MED apparently viewed this as “the ultimate bureaucratic power play.”
Bill Todd is the Deputy Under Secretary for Management (formerly Acting M, Acting DGHR going back to Tillerson’s fun times in Foggy Bottom).  He is awaiting committee and Senate vote to be the next U.S. Ambassador to Pakistan. Time’s running out. 
Dr. William Walters’ February 2020 bio posted in congress.gov says that he is a member of the Senior Executive Service (and former US Army medical officer). His bio says he is the Acting Deputy Chief Medical Officer for Operations and the Acting Executive Director for the Bureau of Medical Services. Further, it says that “As the Managing Director of Operational Medicine, Dr. Walters is responsible for the Office of Protective Medicine and the Office of Strategic Medical Preparedness and manages the care of the Secretary of State and traveling delegation while traveling abroad.”
The MED Bureau was last inspected by State/OIG in mid 2000 and the OIG issued a report in June 2006. So it is due for a new review. According to OIG, in 2006 (lordy, that’s 14 years ago!), MED had the following:

“192 health units in embassies and consulates abroad. MED’s direct-hire overseas staffing includes 45 regional medical officers (RMO), who are physicians, 16 regional psychiatrists, 72 health practitioners, 10 laboratory technicians, and three regional medical managers, supplemented by 250 locally employed staff. […] Overseas, MED serves patients from 51 U.S. government agencies. This patient population includes approximately 50,000 direct-hire employees and family members who are full beneficiaries of the program and about 70,000 locally employed staff, for whom MED provides treatment for on-the-job injury and illness. In 2004, there were 230,000 health unit visits and MED facilitated 635 medical evacuations to the United States and 350 medical evacuations to overseas centers.”

We understand that current staffing includes 250 Foreign Service Medical Specialists ( RMO, MP, RMLS, RMO/P) plus LNA nurses and Social Workers in some posts. MED’s workforce reportedly also includes around 1000 LES staff who work in health units abroad. This staffing number does not include the Civil Service employees working for MED in Washington, D.C.
Under current staffing, how many employees will be left at MED after 98 employees are pulled to staff the new CCR bureau?
What will be the direct consequences of gutting MED’s fund by $26million in order to fund the new CCR bureau?
What is the rational justification for creating a new bureau like CCR separate from MED? Why now? Is this a case of strike now why the iron is hot, there may not be another mass evacuation due to a pandemic soon?
What is the issue with keeping the Directorate of Operational Medicine as the arm for crisis and contingency response under MED? 
Why are they calling this the Crisis and Contingency Response (CCR) Bureau and not the Medical Crisis and Contingency Response (MCCR) Bureau, hmmmn? Will this new bureau be headed by an assistant secretary level appointee subject to Senate confirmation?
Hey, wait, wait a minute –is some hombre considering this new bureau as the crisis and contingency response lead in medical and non-medical crisis? The name is kind of a tell.  We’d like to hear the big picture, tell us more.
You know, we’ve heard of the Crisis Management and Strategy arm that’s operating out of Ops Center for decades. They do great work. We’ve never heard those folks start a new bureau.
Update 1:24 pm PDT: 
It looks like the State Department needs to send Congressional notification to create a new bureau. In May 2019, the State Department merged the Bureaus of Public Affairs (PA) and International Information Programs (IIP) to create the new Bureau of Global Affairs. That merger did not happen overnight:
“In the summer of 2018, a task force of PA and IIP colleagues collaborated with bureaus and offices Department-wide to design a proposal for the new merged bureau. Extensive consultation with Congress as well as key leaders and organizations both inside and outside of the Department continued throughout 2018 and early 2019. Following State Department approval and congressional notification, the new Bureau of Global Public Affairs became a reality in May 2019.”
So how fast do you think State can do all that and its congressional notification obligation for this new entity? 
It’s 13 days, 8 hours, 31 minutes to Election Day. Go VOTE!

How @StateDept Handles Domestic Violence Overseas: One Example and Some Questions

 

In the many years that we’ve watched the State Department, or asked questions about assaults, harassment, or domestic violence, we seldom see a public accounting of how the agency handles these cases, particularly overseas.  State had such a case in 2018. And we’re only seeing it now because the case landed in the U.S. Equal Employment Opportunity Commission.  The EEOC case came from a complainant who was previously assigned to an overseas post in the Bureau of Near Eastern Affairs (NEA).
On November 7, 2018, Complainant filed an EEO complaint alleging that the Agency [State Department] subjected him to discrimination and a hostile work environment/harassment on the basis of sex (male), status as a parent, and in retaliation for “whistleblower activity”. The EEOC notes that “With respect to Complainant’s allegations on appeal of violations of the U.S. Constitution, whistleblower protection laws, criminal laws, and tortious laws not addressed by EEO laws, these laws are not within the purview of the EEO complaint process.”.
The State Department concluded that Complainant failed to prove that the Agency subjected him to discrimination as alleged. On March 13, 2020, the EEOC issued a decision which affirmed the Agency’s final decision. Excerpt from Appeal No. 2019005790:
The Agency accepted the complaint as to the alleged basis of sex and conducted an investigation, which produced the following pertinent facts:
Complainant was assigned to the Agency’s facility [/], accompanied by his spouse (“Spouse”) (female) and children. He and his family resided in U.S. government-supplied housing.
On September 21, 2018, Spouse reported an incident of domestic violence to the Deputy Regional Security Officer (Deputy RSO), alleging Complainant assaulted her. The alleged assault occurred on September 9, 2018, while they were on vacation in Poland. Deputy RSO attested that, based on Spouse’s report, it was reasonable to believe that domestic violence had occurred, and he reported the situation to the front office and the Office of Special Investigations (OSI), as required by Agency policy.
The Agency’s Family Advisory Team (FAT) was advised of Spouse’s report of domestic violence and they recommended that, in the best interest of the family, Complainant and Spouse be separated for a cooling down period. One factor in the decision was Spouse’s comment that she was afraid of Complainant’s finding out that she made the report. Members of the FAT recommended the separation out of concern for further violence, without a determination as to the veracity of Spouse’s allegations, until a decision could be made as to the next steps. The Deputy Chief of Mission instructed that Complainant be removed from the residence, pending further deliberations by the FAT.
On September 21, 2018, Deputy RSO and two other Agency employees went to the residence Complainant shared with his Spouse and their children and informed Complaint that he was being relocated to a hotel. Complainant and Spouse were instructed not to contact each other until a decision was made about the alleged domestic violence incident. Complainant cooperated and was escorted to a hotel.
On September 25, 2018, Complainant reported to Deputy RSO that Spouse was the aggressor in the domestic violence incident. Deputy RSO instructed Complainant to communicate with OSI, as they had jurisdiction.
In the instant complaint, Complainant alleged sex was a factor because he was required to leave the residence, while Spouse remained in the home with their children.
On September 26, 2018, Complainant met with a Human Resources Officer (HRO) and Agency security personnel and was informed that he must immediately leave the post and return to the United States. He was given the choice of voluntary or involuntary curtailment. He was informed that the issues facing his family could not be addressed locally and resources were not available to manage his family situation. Complainant agreed to a voluntary curtailment because the official reason would be classified as personal and there would be no discipline. He also attested that he selected voluntary curtailment because, even though he was the victim of Spouse’s assault, he did not believe he would have any support at the post.
HRO explained that when there is a conflict between two members of a household and one or more of the individuals are direct hires, the Agency policy is to curtail the direct hire. She further explained that this approach is preferred as there is an unwillingness to involve the local police in a potential domestic violence situation. She explained that the post cannot adjudicate claims and make a determination, as that authority rests with OSI. She explained that the post has no authority to require a family member of a direct hire to leave the country and the only viable option is to require the direct hire to curtail, which then will require the spouse or other family member to vacate the government-supplied housing.
The Deputy Chief of Mission attested that she made the decision to curtail Complainant, as this was the third occasion of serious behavioral incidents involving Complainant since he arrived, less than a year ago and, based on the advice from FAT, she instructed that he be given a choice of voluntary or involuntary.
On September 28, 2018, Complainant returned to the United States. Spouse and their children remained behind to pack their belongings and arrived in the United States on October 17, 2018.
Upon his arrival in the United States, Complainant was informed by Diplomatic Security that an update for approval of his security clearance had been initiated “for cause.” Complainant’s security clearance was not scheduled to expire until June 2021. Complainant alleged that the review of his security clearance was initiated by the post to support their decision to remove him from [post].
The Office Director of DS/SI/PSS explained that he was, in part, responsible for the investigation and adjudication of security clearances for the Department and Complainant was subject to an “out of cycle” investigation regarding his security clearance because of the reports received from a Diplomatic Security investigation alleging potential misconduct. He explained that the investigation was “for cause,” non-routine, and pursuant to regulations.
With respect to the alleged harassment, Complainant attested that, on November 7, 2018, the Agency notified him that he was the subject of an administrative inquiry into allegations that he was a harasser.
He explained that he learned that, during a social setting, he made a comment about Spouse that might have been considered a distasteful joke but did not rise to the level of harassment. He also alleged that, during a meeting with the American Foreign Service Association and Human Resources, a Human Resources representative asked him when he anticipated retiring.
[…]
The Agency explained that, following Spouse’s report of domestic violence, the Agency felt it in the best interest of the family that Complainant and Spouse be separated for a cooling down period, pending a determination as to what steps were next. The Agency further explained that there is an unwillingness to involve local authorities in such matters and it lacks the authority to adjudicate such matters. The Agency explained that in such situations involving a direct hire employee and an accompanying spouse, it is the Agency’s policy to curtail the direct hire, which would then cause the spouse and family to be required to vacate the government-supplied housing. The Agency also explained that Complainant was subject to an “out of cycle” investigation regarding his security clearance because of the reports of alleged potential misconduct. We note that, although Complainant and Spouse disagree as to who initiated the domestic violence, Complainant does not deny that the domestic violence occurred. We find the Agency’s actions of separating the spouses, sending the employee back to the United States, and subjecting him to another security investigation to be reasonable under these circumstances. Therefore, although Complainant has alleged discrimination, he has not established by a preponderance of the evidence, that the legitimate, non-discriminatory reasons articulated by the Agency were a pretext for unlawful discrimination or motivated by some unlawful discriminatory animus with respect to any of these claims.
The links to the related regs are below. In this case, State told the EEOC that “there is an unwillingness to involve local authorities in such matters and it lacks the authority to adjudicate such matters.” And yet, 3 FAM 1815.2 says:

d. If the initial report is substantiated, action may include one or more of the following: (1)  Post may call upon local authorities or resources in certain cases; […] (5)  Post may be asked to call upon shelter and child protection resources or find alternative shelter within the post community for the victim and any children.

Seriously though, why are these options decorating the FAM if they are never real options? In certain cases? Which cases would there be a willingness for post to call upon local authorities to settle a domestic violence case?
Perhaps the most striking thing here — well, a couple of things. 1) “Complainant agreed to a voluntary curtailment because the official reason would be classified as personal and there would be no discipline”; and 2) the Agency’s point that “the only viable option is to require the direct hire to curtail, which then will require the spouse or other family member to vacate the government-supplied housing.”
And then what?
The spouse and children returns to the United States. To where actually? To get back with the spouse? To a halfway house? To a homeless shelter? What actually happens to the family upon return to the United States following a report of domestic violence overseas? Folks do not always have houses in the DC area, spouses may be foreign born with no families in the DC area. In most cases, the household effects and those on storage are also under the employee’s name only (unless the spouse made prior arrangements).
So what happens next? Could ‘what happens next’ be one of the main reasons why folks do not report these cases?  

Related items:
3 FAM 1810 FAMILY ADVOCACY PROGRAM (CHILD ABUSE, CHILD NEGLECT, AND DOMESTIC VIOLENCE)
3 FAM 1815  DOMESTIC VIOLENCE