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Last Updated

07 Jul 2003

Source: Washington Post, July 4, 2003

Medical Corps to Increase, Reorganize

New Office Will Oversee Force

By Tania Branigan, Washington Post Staff Writer

The Bush administration's top health officials yesterday announced a major reorganization to revitalize the 114-year-old Commissioned Corps of the U.S. Public Health Service, the uniformed force of health professionals.

Health and Human Services Secretary Tommy G. Thompson and Surgeon General Richard H. Carmona, commander of the corps, said increasing the size of the 5,500-strong force and improving its flexibility is necessary to ensure that it can continue to cope with emergencies and help medically underserved communities.

The corps' duties range from tackling disease outbreaks such as severe acute respiratory syndrome to promoting healthy lifestyles, offering medical support in wars and providing health care workers to areas with poor access to services.

Details of many of the changes have yet to be finalized, but one of the most significant moves will be the creation of a new office to oversee corps personnel, who are scattered throughout the Department of Health and Human Services in agencies such as the Centers for Disease Control and Prevention and the National Institutes of Health.

Officers will answer to a management team under the surgeon general, allowing him greater day-to-day control of the corps.

Training and organization also will be improved to ensure that by 2004, every member of the corps has the skills and physical fitness to be deployed in an emergency, such as a natural disaster or terrorist attack. At present, 30 percent of the corps is ready to go.

"We are going to streamline the corps while increasing its size and scope to meet the demands of public health and primary care and the challenges of bioterrorism," Thompson said.

The HHS secretary has put $2 million toward the transformation plan this year and asked for a further $5 million for fiscal 2004.

HHS officials said they were unable to provide an overall budget for the corps, as many officers' salaries are paid by the agencies for which they work.

Thompson pledged to recruit as many as 1,000 nurses and 100 doctors per year to work in medically underserved areas, probably by paying for their training. That would help to address the effects of the nationwide nursing shortage.

The reforms will also introduce "warrant officers" who would be able to join with as little as two years of medical training, rather than the four to six years currently required.

Instituting regular training and standardizing call-up procedures to revive the corps's reserve component, which has effectively been dormant for many years, is another priority, officials said.

Thompson also promised to recruit at least 275 new officers for the Indian Health Service, saying many Native Americans are not receiving the health care they need.

Carmona said the corps had a tradition of compassion and quoted the observation by Thomas Jefferson that "[t]hough we cannot relieve all the distressed, we should relieve as many as we can."

The surgeon general said the Public Health Service had helped to lead the antibiotic revolution and the war on cancer, and had provided medical support in every war since World War I. More recently it has dealt with anthrax, SARS and the Sept. 11, 2001, terrorist attacks.

But the existing structure of the Commissioned Corps dates back decades and is no longer suitable to help it meet the demands made upon it, Carmona said.

"Our challenge is that the service that has taken us in so many directions has also left the Commissioned Corps fractured and decentralized," he said.

Thompson has been publicly discussing his intention to restore the corps since last spring, but yesterday's announcement offered the first detailed proposals for change.

"The discussions began before 9/11, but that certainly added an urgency," Carmona added. "With anthrax, SARS, monkeypox -- you step back and say, 'There's a whole new world out there.' "