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!

Any diplomatic posts overseas having issues obtaining proper PPE?

 

Via Briefing With Dr. William Walters, Deputy Chief Medical Officer for Operations, and Principal Deputy Assistant Secretary Ian Brownlee, Bureau of Consular Affairs On COVID-19:  Updates on Health Impact and Assistance for American Citizens Abroad | APRIL 14, 2020

QUESTION:  Hey, thank you.  Have you heard from any of the diplomatic posts overseas that they are having issues obtaining proper PPE given kind of the global shortages, particularly those who are interacting with folks who are being repatriated? 

DR WALTERS:  Yeah, it’s Doc Walters.  So with regard to PPE overseas, our – as part of our ongoing preparedness well in advance of this pandemic, the Bureau of Medical Services has small stockpiles of PPE and other countermeasures at each post.  We have supplemented that, again, well in advance of the crush on the supply chain that’s occurred.  And so our health care providers overseas and our consular officers are provided with PPE appropriate to their interaction, understanding that there are going to be times when you come into unexpected contact with American citizens and no one’s going to stop what they’re doing in helping an American citizen.

But we – as part of the safety net, both there’s the PPE side, but there’s also the small community in each of our posts that is overseen by a medical provider from the bureau, either a direct hire or locally employed, and that – that drives the statistics that I provide at the beginning of each one of these briefs, and what we’re seeing is a fairly flat curve and no ongoing employee-to-employee transmission patterns that we’ve been able to identify.

 

COVID-19 Tracker: State Department and Foreign Service Posts (April 14 Update)

Our COVID-19 tracker has large gaps in it, but we don’t have a better alternative on breakdowns as the State Department is only releasing total numbers, not locations.  We have updated our tracker to include the two confirmed FSN deaths in Jakarta, Indonesia and Kinshasa, DRC, and one confirmed FSN death at an undeclared location. There are currently two domestic deaths, one in NYC, a contractor, and one in Washington, D.C. at an undeclared office location, a Civil Service employee.

DOS Briefing 4/14/20: The State Department continues to strongly enforce and practice the appropriate social distancing and other non-pharmaceutical interventions, and that continues to be reflected in our own disease curves.  Currently there are – we’re tracking 297 overseas cases, including 182 active with 115 recovered, holding at – thankfully holding at three overseas deaths, all within locally employed staff. Domestic cases are 71 current cases, 67 with four recovered.  Important to note that we started to see domestic cases in the second into the third week of March, and so this is the point at which we would expect to see those cases start to recover.  So I would anticipate over the next week, we’ll start to see the recovery cases start to climb. I am saddened to say that we’ve had our first – our second domestic death, our first within the U.S. direct-hire population, a civil servant serving here in Washington, D.C.  And our condolences do go out to the family and to all families that have been impacted by coronavirus.”

DOS Briefing 3/23/20 “I can tell you we’re still at single digits here in the United States with cases – one each, two each, three each in Washington; Houston; Boston; New York; Quantico, Virginia; and Seattle.  So the numbers themselves are – overseas are still double-digit.  We’re looking at less than 30 scattered over 220 posts around the world, and it remains a challenge.” 

Related posts

 

 

 

 

 

 

Snapshot: @StateDept COVID-19 Cases as of April 3, 2020

The State Department updated its COVID-19 cases on Friday, April 3. 2020. From March 31 to April 3, the number of employees and family members overseas who were self-isolating went from 2,288 to 3,528, an increase of 1,240. The number of positive cases decreased from 149 to 108; while those who recovered went from 42 on March 31 to 79 on April 3, a difference of 37 new individuals recovered.
The April 3 update now includes the number of deaths. As of April 3, there were three deaths overseas from COVID-19, all three are noted as Locally Employed (LE) staffers. We learned previously that one LE staffer died in Jakarta, and another in Kinshasa. We do not know as yet, the location of the third casualty. In the April 3 briefing, Dr. Walters declined to identify the country where the third death occurred. Why? We can’t say. Obviously, the next of kin already know about the death. Co-workers at post already know about the death. We’re not sure why they’re refusing the even identify post; reporters are not asking for names. If Walters is going to cite the Privacy Act, deceased individuals and country names do not have Privacy Act rights. If there’s a real rationale for this, we’d like to know.
The April 3 update still do not include information on the number of medical evacuations (MEDEVAC), USG patients or places of origin. We can confirm at least one MEDEVAC from Burkina Faso, and that USG patient is on the road to recovery.
For domestic cases, the number of self-isolating employees went from 44 to 50 in three days, with positive cases going from 33 to 46 cases.  The report indicates that two domestic employees have recovered as of April 3, 2020.
See excerpts from April 3 briefing below.

 

As of April 3, 2020

As of March 31, 2020

 

Dr. Walters on April 3 Briefing:

Now moving on to the latest COVID-19 statistics for the Department of State, as of today, April 3rd, there are 108 confirmed cases overseas. There are 46 confirmed cases domestically, occurring in nine different cities. So far, there are no reported deaths domestically, but unfortunately there are now a total of three deaths overseas amongst our workforce.

QUESTION: Hi, thanks. I just had a question about the number of State Department deaths and a testing question. The first is: Can you give us any more information about the employee, the third person who had died or what country that was in and any other information you can give us?

And second, does State currently have a standard policy on testing? Do – for example, people who think they may be – may have the virus but are not showing symptoms, are they able to get tested? What is the standard guidance on department employees getting tested? Thanks.

MR WALTERS: So as to the first question, I can tell you that it was a locally-employed staff member overseas. I don’t – can’t really go into any further detail because it becomes easier and easier to identify individual people when you do that, so I’m afraid I can’t.

With regard to testing, domestically we all exist within a broad public health architecture. From an occupational health perspective, we have a responsibility to protect the workforce, but we live within and work within the city of Washington, D.C., or in Virginia or Maryland, and ultimately testing and contact tracing is a local and state responsibility and authority. And so we cooperate very closely with the state and local and county public health teams to make sure that we keep the workforce safe and make sure testing is used appropriately.

QUESTION: Hi, there. Thanks. Sorry, I was – I missed part of the answer to Nick’s question because of Elmo, but – (laughter) – did you, Doc Walters, say that the third death was a locally employed staffer? And is it correct that there are still no American staffers overseas who have been —who have succumbed?

And then secondly, the – how many of the more than 400 flights that Ian is talking about were commercial flights that – for which the U.S. Government did not have to pay anything? Thank you.

MR WALTERS: Thanks, Matt. I can answer the first part and then I’ll hand over to Ian and DAS Yon for the last part.

Yeah, so locally employed staff member overseas – we are not aware of any chief of mission personnel overseas who have succumbed to the illness.

Folks, we hate to do this but this is a real pet peeve for us because. Very basic.  “We are not aware of any chief of mission personnel overseas who have succumbed to the illness?” The three Locally Employed (LE) staff members who died of COVID-19 are not chief of mission personnel? Good grief!
2 FAH-2 H-112.1 talks about Chief of Mission authority to direct, supervise, and coordinate all U.S. Government executive branch employees in the COM’s country or area of responsibility.  This includes U.S. Direct Hire (USDH) employees and Personal Service Contractors (PSCs), whether assigned permanently or on temporary duty or an official visit, and; all Locally Employed (LE) Staff regardless of hiring mechanism (whether a direct hire or hired on a PSA, PSC or other mechanism by the Department of State or another U.S. government agency – see 3 FAM 7121).

COVID-19 Tracker: State Department and Foreign Service Posts (March 25 Update)

 

We originally created a tracker for COVID-19 cases for the State Department and our Foreign Service posts on March 21. We updated that post on March 22. (See Tracking COVID-19 Cases at State Department and Foreign Service Posts (Updated)).
Since Pompeo’s quip at a presser on March 17  that “We’ve had a couple of employees – count them on one hand – who have positive tests” we still don’t have official breakdown of numbers as to how many employees and family members have actually been infected, how many have recovered from the virus, or even how many were tested, or how many have been medically evacuated for COVID-19.
The last couple of days even with Senior State Department officials doing their “Special Briefing”, we still don’t have a good official count on numbers and places where there are positive, suspected, or quarantined staffers/family members due to COVID-19 cases.
On March 23, SSDO said:

“So the domestic numbers are easier to quantify just based on communications with posts abroad.  Obviously, this is a rapidly evolving situation, especially in the overseas environment. I can tell you we’re still at single digits here in the United States with cases – one each, two each, three each in Washington; Houston; Boston; New York; Quantico, Virginia; and Seattle.  So the numbers themselves are – overseas are still double-digit.  We’re looking at less than 30 scattered over 220 posts around the world, and it remains a challenge. Obviously, the – this type of outbreak, had we known earlier what the epidemiology was and had some of that data, perhaps we would have a better feel for how this was going to move across our overseas posts.  But we are keeping pace with it.  And again, the number at this point is less than 30.” 

In our updated COVID-19 tracker we are noting this info as “fuzzy math.”
On March 24, the SSDO was asked “out of the approximately 40 or so cases of COVID-positive people that you’ve got at State, how many are FSOs and how many are local staff?”.  SSDO responded:

“In terms of the cases that we’re following from the State Department’s perspective, I don’t have the precise breakdown in front of me of how many of our direct-hire employees versus local staff.  I certainly can get that information.  But again, it changes so rapidly that it’s – we just want to focus on the fact that we’re doing everything we can to take care of our people overseas, and for our local staff who are so important to our operations do what we can to facilitate their getting care in the local economy. ” 

On March 25, Dr. William Walters, Deputy Chief Medical Officer for Operations was one of the briefers and said:

So it’s important to remember that the State Department is about 75,000 – a 75,000-person workforce overseas. We’re tracking 58 current cases in our overseas workforce, spread across the – each – one to 11 cases – I’m sorry, 33 cases is the largest number in any particular regional bureau. But at 58 cases, that’s less than one in 1,000, and that’s a direct result of aggressive actions through the Bureau of Medical Services, through the chiefs of mission at post, and implementing social distancing and telework and all the things that the department has been working so hard at over the past several weeks. Domestically, we’re tracking 16 cases in five cities, the largest at just eight. So that’s 16 cases across thousands of employees. Again, the department has taken this very seriously, has implemented just the right non-pharmaceutical interventions to keep that workforce safe.

Tracker is not embeddable right now, so the links do not work; however, we have links as reference and can post separately, as needed.  The newest addition in the update below includes the cases in Madrid, which we were originally informed were 6 positive cases, and now are at reportedly 16 positive cases. Also includes the fuzzy accounting from the March 24 briefing on domestic cases, and the presumptive positive case at SA-1 per internal email on the night of March 24. After we updated the tracker, we saw the March 25 briefing with MED”s Walters and CA’s Brownlee. Walter mentions “tracking 58 current cases” with 33 cases as the highest in one unnamed regional bureau, plus 16 cases in five unidentified cities domestically (3/23 briefing notes six cities).
We think that the fuzziness is intentional. It is very likely that MED (perhaps even Ops) has detailed trackers internal to those offices and could provide a straight-forward breakdown like DOD, if they want to. We’re hearing complaints of “no central info on cases department wide”. As of March 25, based on official briefers, domestic cases went from single digits on 3/23 to 16 domestically; and less than 30 on 3/23 to 58 overseas.

 

Report: Covid19-Infected Amcits From #DiamondPrincess Flown Home Against CDC Advice

 

Via WaPo, February 20, 2020:

In Washington, where it was still Sunday afternoon, a fierce debate broke out: The State Department and a top Trump administration health official wanted to forge ahead. The infected passengers had no symptoms and could be segregated on the plane in a plastic-lined enclosure. But officials at the Centers for Disease Control and Prevention disagreed, contending they could still spread the virus. The CDC believed the 14 should not be flown back with uninfected passengers.
[…]
The State Department won the argument. But unhappy CDC officials demanded to be left out of the news release that explained that infected people were being flown back to the United States — a move that would nearly double the number of known coronavirus cases in this country.
[…]

During one call, the CDC’s principal deputy director, Anne Schuchat, argued against taking the infected Americans on the plane, according to two participants. She noted the U.S. government had already told passengers they would not be evacuated with anyone who was infected or who showed symptoms. She was also concerned about infection control.

Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, who was also on the calls, recalled saying her points were valid and should be considered.

But Robert Kadlec, assistant secretary for preparedness and response for the Department of Health and Human Services and a member of the coronavirus task force, pushed back: Officials had already prepared the plane to handle passengers who might develop symptoms on the long flight, he argued. The two Boeing 747s had 18 seats cordoned off with 10-foot-high plastic on all four sides. Infectious disease doctors would also be onboard.

“We felt like we had very experienced hands in evaluating and caring for these patients,” Kadlec said at a news briefing Monday.

The State Department made the call. The 14 people were already in the evacuation pipeline and protocol dictated they be brought home, said William Walters, director of operational medicine for the State Department.

As the State Department drafted its news release, the CDC’s top officials insisted that any mention of the agency be removed.

Read the full report below.
Anyone know if the State Department has a Task Force for Covid-19 already? It looks like U.S. citizens in Hubei Province or those with information about U.S. citizens in Hubei are advised to contact the U.S. Embassy or the State Department at the same email address: CoronaVirusEmergencyUSC@state.gov.
Excerpt from State Dept Special Briefing on Repatriation ofo U.S. Citizens from the Diamond Princess Cruise Ship, February 17, 2020:

OPERATOR: The line of Alex Horton from Washington Post has been opened. Please, go ahead.

QUESTION: Yeah, thanks, everyone, for jumping on this call on a holiday. So I was curious about when discussion with the CDC was executed to make this call. Based on their press release a few days ago, they said there would be screening to prevent symptomatic travelers from departing Japan. The press release you guys issued is very carefully worded when you said, “After consulting HHS, the State Department made the decision to allow those individuals to go on,” those 14.

So is there daylight with CDC and HHS in this decision by you guys to send them forward, and what were some of their objections that you – that you seem to have overturned?

DR WALTERS: This is Dr. Walters. What I’d say is that the chief of mission, right, through the U.S. embassy, is ultimately the head of all executive branch activities. So when we are very careful about taking responsibility for the decision, the State Department is – that is the embassy. The State Department was running the aviation mission, and the decision to put the people into that isolation area initially to provide some time for discussion and for onward, afterwards, is a State Department decision.

There is a – I think where you might see the appearance of a discrepancy is in the definition of symptomatic. Symptomatic – when we use the word “symptomatic,” we’re talking about coughing and sneezing and fever and body aches. Those are symptoms, all right? And as Dr. Kadlec laid out and I reinforced, each one of these 338 [4] people was evaluated by an experienced medical provider, and none of them had symptoms.

Once they were on the bus, we received information about a lab test that had been done two or three days earlier. But it is, in fact – it is a fact that no symptomatic patients – no one with a fever or a cough or lower respiratory tract infection or body aches, or anything that would lead one to believe this person is infected with the virus was – none of that was in place before – at the time a decision was made to evacuate these folks.