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? 
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