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NEW: Download an extended provisional Table of Contents (.zip format), with juicy blurbs from the book in progress
Update: If your USAF computer is so non-functional that it can't open .zip files, here's the Micro$oft Word document version
From: (Chief anesthesiologist at the Air Force's largest hospital) LtCol 59 MSGS/MCOA
To: (senior USAF anesthesiologists, including myself)
Subject: RE: MSP/ISP (physician pay bonuses)
Date: Tue, 29 Jul 2003 14:59:33
Dear (Chief anesthesiologist in the Air Force),
Thank you for the information, disappointing as it is. I look
forward to continuing to sign on, hire, and shake hands daily with less
qualified civilians, making 2-3 times what I do, while they watch a near
constant parade of military anesthesiologists getting deployed and leaving
the service. I now know that those in power in Washington do not care, and
only want to hasten the exodus of military anesthesiologists from the
service.
(redacted)
(redacted), Lt Col, USAF, MC
Flight Commander and Chairman
Department of Anesthesiology, Wilford Hall Med Cen
(redacted)
-----Original Message-----
From: (USAF Chief Anesthesiologist/Consultant to the USAFSG) Col, 89MDG/SGO
Sent: Tuesday, July 29, 2003 2:47 PM
To: (senior USAF anesthesiologists, including myself)
The '04 plan is in draft at DoD and should be cut in the next couple of
weeks. My information is that there was not much change. Col (redacted),
Medical Corps Director, does not believe that there will be much improvement
in '05 based on the budget forecasts by Line AF and HA. Overall, the
program will probably not grow because the budget is so tight, and the
budget is so tight because the line overspent. So if one specialty
increases, then some other specialty has to take the commensurate cut.
There is guarded optimism for the 0-6 POM.
So, as far as physician retention, everyone of course will make the decision
he/she feels most appropriate for his/her personal situation. Clearly, for
those deciding to stay in, an increase in bonus money will not be a player.
(redacted)
DSN (redacted)
"Medicocrity:
It takes a lot less time and most people won't notice the difference until it's too late."
http://www.despair.com/med24x30prin.html
July 2005: After 19 years
of honorable active duty service to my country, I have decided to leave the Air Force Medical Corps, resign my
commission as a Lieutenant Colonel, and lose all retirement benefits. This essay will serve both as my explanation
and as partial catharsis of my grief over the death of military medicine and my career. I should point out that
I only have 15 years toward retirement, as the 4 years at USU, the Military Medical School, were determined by
Congress not to count toward retirement the very year I joined, in order to coerce physicans to stay in the military
four years longer in order to get the benefits they rightly earned during those years on active duty, in uniform,
and subject to the harsh rigors of the Uniform Code of Military Justice. And, yes, while still on active duty, I *did*
bring my grievances to the attention of my leaders again and again and again, to no avail.
October, 1997: The Objective
Medical Group (OMG) was implemented at David Grant, the West Coast's only Air Force Medical Center (Travis AFB,
CA). The LtCol Chief Anesthesiologist, under whom I had gladly served for three years without any major problems
or political issues, was promoted to flight commander. Even though I was a physician Major next in seniority to
him, he picked a LtCol Certified Registered Nurse Anesthetist (CRNA) as anesthesia element leader. Dr. Wrong (let
us call him) told me I was not made element leader because: a) she was more politically astute than I was (given
that she sat on her ass all day schmoozing with people via e-mail while her CRNA underlings took care of patients),
b) under Objective Medical Group rules, command assignments could be corps-neutral, so the fact that she was a
nurse (anesthetist) and not a board-certified physician (anesthesiologist) made no difference and c) she outranked
me. I was assigned the nebulous new job title of "Medical Director of Anesthesia" with no command authority
whatsoever (i.e., responsibility
without authority). Dr. Wrong told me that I would be considered the senior anesthesiologist within the element
(which I was anyway), and that I would act as the liaison between the CRNA commander and the other anesthesiologists
(signing leave forms, etc.). Dr.
Wrong also stated that I would be responsible for the medical aspects of anesthesia care, with Lt. Col. "Redacted"
as administrative head of the element.
October, 1998: A 40 year old
active duty Air Force NCO suffered obstruction of his airway after surgery. The civilian contractor nurse anesthetist,
who zealously guarded her clinical autonomy, failed to call the responsible anesthesiologist physician. She and
another nurse anesthetist placed the breathing tube into the esophagus (food pipe). When the resident surgeon begged
the "credentialed provider" CRNA to allow him to cut the patient's neck to place the breathing tube into
the windpipe, she refused, claiming that the patient needed more time for asthma medicine (administered into the
patient's stomach) to work. The patient ended up in a coma for 2 weeks, and now suffers from permanent brain damage.
During the subsequent investigation, it turned out that the nurse anesthetist's credentials to care for patients
had lapsed 2 years prior, so no "credentialing action" could be taken against her non-existent privileges.
The CRNA in charge of the anesthesia department, who was responsible for arranging for privileges of her nurse
anesthetists, had failed to renew the "provider's" temporary privileges. Both nurse anesthetists continued
to care for patients long after this incident, mainly because the hospital could not take credentialling action
against a civilian who lacked priveleges at the time of the disaster, for fear of an embarrassing lawsuit against
the Air Force (personal communication, Travis Medical Law Consultant attorney, December 1998). The subsequent JCAHO
Sentinel Event investigation committee (of which I was a member) identified lack of teamwork between anesthesiologists
and CRNAs as one of the primary Root Causes for this tragedy. The Air Force Medical Incident Investigation agreed,
and also correctly pointed out that the CRNA assigned to do the preoperative evaluation had failed to consult with
an anesthesiologist when the CRNA identified that the patient was high risk (ASA category III), in violation of
both Air Force Instructions and hospital Operating Instructions (OIs).
December 1998: A female Captain
nurse anesthetist took a patient to the operating room for brain surgery without telling the responsible anesthesiologist
physician. When the senior-ranking Major male anesthesiologist found out, he asked to speak with her in his office.
He reminded her that the "rules of engagement" spelled out in the department's official Medical Center
Operating Instruction 160-1 mandated that she consult with him before bringing a neurosurgical patient to the operating
room. Her response: "You seem pretty tense. You must not have gotten laid last night". When this incident
was reported to her superior (the same senior CRNA above) and her superior's physician supervisor (Dr. Wrong),
nothing was done.
Jan 99-Apr 99: Civil war broke
out at one of the Air Force's largest medical centers. The nurse anesthetists actively opposed what they decried
as excessive anesthesiologist "supervision", and continually undermined patient care by acting independently,
contrary to Air Force Instructions and hospital Operating Instructions. The nurse anesthetist Element Leader Lieutenant
Colonel (Redacted) stood up at a flight meeting in my presence and told the Colonel physician anesthesiologist
Flight Commander (Wrong) that she would not follow his instruction that CRNAs must consult anesthesiologists for
sick, ASA-III+ patients or children less than 2 years old, because she had already gone over his head and cleared
CRNA independent practice with the surgeon Squadron Commander. As senior physician under the Flight Commander,
I had been given the title "Medical Director of Anesthesia", which I was given to understand involved
the MEDICAL aspects of DIRECTING anesthesia care at the hospital. As such, I took steps to oppose the coup being
implemented by my titular boss, the CRNA element leader. In the end, the majority of anesthesiologists signed a
letter to the Consultant to the Surgeon General of the Air Force for Anesthesiology requesting an investigation
into this dangerous practice of independent practice by CRNAs. After a Command Directed investigation (LtCol "Tartar"
in the Salon with a Lead Pipe), the Flight Commander lost his job for dereliction of duty in enforcing good order
and discipline; the Element Leader lost her job, BUT was allowed to go off into the plastic surgery clinic to perform
anesthesia completely independently (and, frankly, illegally) until her retirement. The former pilot, U.S. Air
Force Academy alumnus Squadron Commander, who was a good buddy of my former boss, called me into his office and
told me that, unfortunately, he couldn't find anything to reprimand me for officially; however, he was disappointed
in me. He admitted that everyone knew that my O-6 Flight Commander was a poor leader, but today's Air Force under
the Objective Medical Group required physicians to assume command roles to make rank. He stated that my actions
in pointing out serious patient care problems due to lack of physician leadership indicated that I wasn't a team
player. I was fired as "Medical Director of Anesthesia"; that job was given to a low-key anesthesiologist
junior to me in rank WHO HAD BEEN MY JUNIOR RESIDENT during our military anesthesiology residency, yet who was
(correctly) seen as more pliable and far less likely to make waves or take annoying stands on ethical grounds.
May, 1999: The Surgeon General
of the Air Force told the assembled officers of the above major medical center his vision of the future: cost savings
through training of more nurse anesthetists and enlisted advanced duty nurses (ADNs), with fewer expensive anesthesiologists
and college-educated registered nurses (RNs). He stated in my presence: "My daughter is an ADN, and she can
do anything you RNs out there can do, for far less money". The front row of senior "Nurse Executives"
nearly fainted.
October 2003: Ignoring the
lessons of the 1998 Travis JCAHO Sentinel Event investigation, which pointed out the severe dangers of CRNA independent practice outside of the anesthesia care team model, Travis implemented independent practice anyway. The primary reason appears to have been that there were simply insufficient numbers of anesthesiologists to assign to cover all the OR rooms the surgeons wanted to start.
Rather than decrease the number of rooms commensurate with the anesthesiologist staffing provided by the USAF,
the Surgical Squadron leadership, with the spineless acquiescence of the remaining anesthesiologists, instituted
a policy whereby the anesthesiologists would not be responsible for patients per
se, but would only act as consultants to the CRNAs when they (the CRNAs)
requested help. From the CRNA perspective, they finally attained the victory of independent practice they had fought
for (unsuccessfully) during the Civil War of 1998-2000. Relieved of responsibility for direct patient care, the
anesthesiologists were now free to moonlight to make double or triple the money the USAF was paying them. This
turned out to be a win-win-lose proposition, with the patient population drawing the short straw. In October, 2003,
a young active duty troop suffered terminal brain damage in the recovery room needlessly after what should have been a straightforward anesthetic
and surgery, while the emasculated anesthesiologist "Consultant" stood by passively until the very end, because the nurse anesthetists didn't
ask for his "Consultative" help until it was far too late. The painful lessons of the 1998 JCAHO Sentinel Event Committee and MII investigations were completely forgotten by command staff. The subsequent response of the hospital command (60th Medical Group) to
the Air Mobility Command Medical Incident Investigation stated:
(REDACTED AT THE INSISTENCE OF AFMOA)
Sadly, by 2003, the AFMS (Air Force Medical Service) inventory of experienced "providers" was tapped
out due to deployments, lack of retention, lack of anesthesiologist training during the critical period of 1997-2001,
and, again, sheer poor planning at the highest levels of Air Force "health care", including medicine.
What they got instead (and what killed the patient) was the "blind leading the f*cking deaf, dumb, and blind,"
in the words of a senior anesthesiologist.
Between 2000 and 2002, the major Air Force hospitals on the East and West coasts were commanded by a nurse and
a pharmacist, respectively. Non-physicians stayed in the Air Force to receive far more power and money than they
could on the outside, while the best and brightest physicians, embittered by the mismanagement and maltreatment
they received at the hands of incompetent, micromanaging, and, often, non-physician superiors, did their time and
moved on to the civilian world (make sure you read the chilling yet hilarious notes by the original author...right click the link to the presentation, save target as, then open it inside PowerPoint for the full impact). To a first approximation, the only physicians who stayed in were those who couldn't
make it in the outside world, because their clinical skills had decayed from years of pencil-pushing, e-mail forwarding,
and bureaucratic ass covering. In the words of one senior CRNA at Langely AFB, VA, after the year 2000, there were
three "INs" that applied to all Air Force physicians: IN training, IN commitment (paying off their service
obligation), or INcompetent.
November 2004: I suffer a ruptured
eardrum while flying with a cold to visit my terminally-ill father-in-law. When I return, I try to make an appointment
to see a family practice doctor. I am told that I need to call the appointment line to get an acute care appointment,
as the USAF has done away with active duty sick call. The nurse on the TRICARE line tells me I have an appointment
with "Dr. S.". After waiting four hours in the FP waiting area, I finally see the "Doctor",
who is actually a Physician Assistant student. After allowing the nice but clueless enlisted medical tech to look
in my severely painful ear, the "Doctor" prescribes me what my board-certified family practice wife tells
me is an incorrect antibiotic intended for pediatric use.
The United States military has consciously decided that physicians are neither wanted or needed to provide medical
care to our troops in the 21st century. When our active duty members, retirees, and their dependents present for
medical care, their "doctors" nowadays are as likely to be physician assistants (PAs), advanced practice
nurses, nurse practitioners, or simply nurses who specialize in specific areas (diabetic nurses, nurse midwives,
etc.).
The shortsighted focus on the cost savings involved in hiring less-qualified "physician extenders" is
jeopardizing patient safety. I could go on for pages with true stories of a PA who cut out basal cell cancer on
a patient's chest in a dermatology clinic until her breastbone was exposed, requiring removal of the infected breastbone
under general anesthesia in the operating room; or of PAs failing to reduce dislocated knees after hours of trying
in the Emergency Department (ED), only to have a board-certified orthopedic surgeon accomplish the task in less
than 5 seconds in my presence. The truth is that the commanding generals in charge do not want to hear this. Beginning
in 1992, General Merrill McPeak championed the tragically demoralizing "Objective Medical Group", which
made nurses, pharmacists, PAs, physical therapists, and other non-physicians equal to doctors when determining
military command, and which implemented a new layer of uniformly clueless bureaucracy to micromanage physicians.
In 1997, the Air Force Surgeon General, Charles H. Roadman II, decided that there were too many physician anesthesiologists
in the Air Force. He slashed the training slots at Wilford Hall Medical Center, the flagship of Air Force medicine.
He forced an entire crop of newly graduating interns who wanted to pursue 4 year anesthesiology residencies to
be flight surgeons or primary care doctors. After being royally screwed by the system, these young, promising doctors,
whose only goal was to serve their country as military physician specialists, nearly uniformly gave the two finger
salute to the military, and fled to pursue civilian training in anesthesiology. Surprisingly
enough, 4 years later, after September 11 2001, the major East Coast Air
Force "Medical Center" had gone from 10 anesthesiologists to 3, of whom only 2 actually cared for patients
in the operating rooms. The department of Internal Medicine suffered similar shortfalls. The Intensive Care Unit
was staffed by between zero to one intensivist staff physician for several periods after 2001; unqualified interns
and junior family practice residents "covered" the ICU at night without "adult supervision"
from attending intensivists, to the permanent detriment of many patients. From Sept 2001 to Dec 2001, nothing was
done to lower our workload (which included 16 to 24 hour days, on call every other night) or obtain reservists
or civilians to help us until long after our morale was permanently FUBAR.
The subsequent deployments in support of Operation Enduring Freedom and the invasion of Iraq stressed the Air Force
Medical Corps beyond the breaking point. Even though we were critically short-staffed at Andrews, I was deployed
to Turkey as the only physician anesthesiologist in the country for the USAF, where I did nothing which required
my expertise in caring for the sickest of patients. Sheer poor planning had resulted in my specialty being 50%
manned after 9/11. Nearly 50 reservist physician anesthesiologists were pulled out of their private and university
practices to plug the gaps for up to a year. The risk of deployment for reservist anesthesiologists approached
100%. Any thought I might have had of leaving active duty and serving the remainder of my time until retirement
in the reserves was destroyed by the experiences of my reservist ex-colleagues, as they suffered 50%-80% cuts in
their civilian pay and long dislocations from their families due to SPP: Sheer Poor Planning on the part of Air Force
Surgeons General who had long since retired to exclusive golf courses.
It has been said that all politics is local. Similarly, the evil that oozed from the top of the military hierarchy
was compounded tenfold by the idiots those morons chose to promote to leadership roles WAY beyond their levels
of either medical or managerial competence. The virulent mismanagement committed by my Squadron Commander from
2001-2004, was a primary determinant of my decision to leave the Air Force. A surgeon and ex-navigator, he had
long since ceased to be a practicing physician, and had seemingly dedicated his career to slavish parroting of
administrative buzzwords and toxic micromanagement of his subordinates. My Flight Commander, the Consultant to
the Surgeon General of the Air Force for Anesthesiology from 2002-2004, once told me that she almost asked him
one time: "Why do you hate anesthesiologists so much?"-but was afraid she would get in trouble, given
his infamous inability to accept any feedback from subordinates whatsoever other than "Sir, yes, Sir".
I received several written reprimands from him, not for poor medical care, not for insubordination, but for speaking
out with integrity for what I strongly felt was the best interest of my patients' safety. Insodoing, I violated
the prime Air Force Core Value: "Shut THE FUCK up and don't make waves". These reprimands served both
to critically demoralize me during a period of severe stress and overwork after 9/11, and to destroy the military
career I had built over 20 years of service to my country. There was no way I would make full colonel with these
false accusations on my official Officer Performance Reports; and there was no way I could, in good conscience,
continue to serve in a system where the Wing (base) Inspector General told me to my face: "Unless you find
an e-mail stating 'I, (Commander's name), took reprisal against LtCol Jones for his continued written complaints
regarding critical patient safety issues, Signed, Your Squadron Commander', we can't do anything to help you."
The Air Force Inspector General system is a joke. When I went to the IG lawyers, I truly thought that they would
actually INVESTIGATE (a la Law and Order, one of my favorite TV shows) to determine whether my Squadron Commander
had subjected me to illegal workplace reprisal for my outspoken advocacy of patient safety. Instead, all they did
was interview a bunch of people, including this Colonel. He told them that he would have reprimanded me for advocating
medically indicated transfer of a patient, and for verbalizing my fear that a bad outcome might ensue if we didn't
follow proper preoperative procedures for a very sick patient to a surgeon with an abysmal track record of death
and permanent disability after the same procedure, even if I had not submitted multiple memoranda documenting lapses
in patient safety during the prior months. The IG folks essentially said: "O.K., sir, there you have it, thank
you for your time. Case closed." Privately, one of them told me that she thought I was reprised against, but
that the IG office could not prove it without a smoking gun. When I asked if they were going to subpoena his official
work e-mail on his official Air Force computer to look for a smoking gun, they just looked at me with something
akin to pity in their eyes for my naivete. "We don't do that," they stated solemnly. Unspoken was the
codicil: doing so would require actual work, and might embarrass a politically powerful Full Bird Colonel squadron
commander; it was far more expedient to sell the Major down the river. Any hope I had that the Air Force I had
loved and worked for since my teenage years would get me justice died that day. It became clear to me that the
military IG system is set up to short-circuit any real criminal investigation under the UCMJ, while protecting
the asses of powerful colonels and generals. Sadly, this toxic attitude contributed to the whitewashing of prisoner
torture at Abu Ghraib, Guantanamo Bay, Bagram, and elsewhere, as the American public is gradually coming to realize.
The Air Force personnel and assignments system contributed significantly to my decision to leave the military.
When I joined up, I knew that I would move around a lot as a military officer; I held no illusions that I would
be able to "homestead" for 10+ years at a plush assignment like some of the senior physicians I had met.
Since I speak several very difficult foreign languages, and learn foreign languages quickly, I actually looked
forward to being stationed overseas with my family. However, I did not count on having two disabled children with
autism born in military hospitals while I was on active duty, including one with severe asthma. Unfortunately,
the medical capabilities at overseas bases had been allowed to corrode to the point that almost none could care
for my autistic kids...and the ones that could (e.g., Lakenheath) were consistently filled with politically-connected
senior officers who wanted to spend their final months in the military touring Stonehenge. This did not mean that,
as a father of two "Exceptional Needs" children, I could count on staying in the Continental U.S. (CONUS)
with my kids. Amazingly, even 60 years after WWII, long after the post-Cold War closure of dozens of overseas bases,
the Air Force continues to cling to its antiquated and inflexible "DEROS" system (Date Eligible to Return
from OverSeas), which mandates overseas long tours. I actually tried to volunteer to take an 18 month "remote"
hardship tour in Korea or Turkey that was normally filled by a nurse anesthetist. When I begged for such an assignment,
the troglodytic drones in the Air Force Personnel Center (AFPC) replied that, as an anesthesiologist, I was overqualified
(and besides, my Air Force Specialty Code wasn't what the computer wanted to see in those slots, and no one gets
rewarded for thinking "outside the box" in the USAF). In 1999, as retribution for my role in stopping
the coup by the CRNAs at Travis, I received orders to go to Elmendorf, Alaska. Since I still owed my country 6
years of service, I had to accept the orders. When the SGH (Chief of Clinical Services) at Elmendorf reviewed my
package, saw that I had two handicapped EFMP (Exceptional Family Member Program) children, including an asthmatic,
she denied permission for me to move, given that Elemendorf had inadequate pediatric support for either autism
or severe asthma. I thought that would be that. A few months later, while my active duty staff physician Air Force
Major wife was admitted to the hospital on the Labor and Delivery deck with premature labor at 29 weeks with our
third son, AFPC issued a new set of orders which would have forced me to go to Alaska for three years without my family unaccompanied on what should be an accompanied tour. I fought this through the EFMP program; finally, Col. (Dr.) Ed Taxin, chief of special
needs for the Air Force, reversed the decision and allowed me to PCS (move) to Andrews AFB, MD. Years later, my
Flight Commander and chief anesthesiologist told me that it was not AFPC who thought up this evil assignment maneuver,
but, in fact, the then Anesthesiology Consultant, my former residency program director. She told me that he had
intended to retaliate against me for contributing to the firing of his good buddy and my former Flight Commander
and Chief Anesthesiologist at Travis for dereliction of duty, partially due to my Flight Commander's failure to
enforce good order and discipline on the CRNAs who were in open rebellion against the anesthesiologists.
Many anesthesiologists who leave the Air Force with whom I have spoken list pay as the number one reason. In all
honesty, the pay issues were not a major factor in my decision. True, I am being paid less than half of what my
counterparts make in the civilian world. True, there is no retirement plan for people who put in 19 (rather than
20) years of service. However, the risk of successful malpractice suits is lessened considerably by the Feres doctrine,
which prevents active duty military troops from suing the US government, even in cases of gross negligence and
malpractice. Derivative suits by spouses (for loss of consortium, income, etc.) are similarly barred by federal
law. Moreover, unlike the civilian world, the Air Force will not report physicians sued for malpractice to the
National Practioner Data Bank unless an internal Quality of Care review determines that the standard of medical
care was not met. These factors, combined with the multiple layers of cowardly administrators who are strongly
motivated to cover up medical errors in the name of "Quality Assurance" and "Patient Confidentiality"
(but in reality to cover their own asses in front of superiors so they can continue to make rank), serve to shield
military physicians from the financial threat of successful lawsuits.
It used to be that retirement was a great deal for military members. Retirees were guaranteed care at MTFs (Military
Treatment Facilities) without having to sign up for anything. Retirees could use the officers' clubs. Retirees
had access to commissaries, pharmacy services, and many other amenities. Moreover, retirees weren't CALLED BACK
to active duty against their wills and sent off to the desert to die. None of these can be counted on anymore.
Commissaries, officers' clubs, and many, many bases are being closed. The MTFs that are left are being "force
shaped" (the latest euphemistic buzzword) out of existence. Military physicians are being replaced with (in
many cases) less qualified and (in all cases) more expensive civilians. For anything but routine care, retirees
(and active duty and dependents) have to rely on the tragically broken TRICARE system, which combines the cuddly
warmth of penny-pinching civilian insurance companies with the naked efficiency of a bloated governmental bureaucratic
monstrosity. Any officer who retires, or who separates but neglects to resign his/her commission, can be called
up by the President and sent to war; back when we faced the Soviet threat across the Fulda Gap, this power would
have clearly been used as a last resort during WWIII. Nowadays, with the hemorrhage of experienced officers after
12, 14, or even 19 years of service, the temptation to use this "backdoor draft" tool has proven too
great for the military to resist. According to Lt. Col. Bryan Hilferty, an Army spokesman, the service has called
back 350 soldiers to active duty after retirement; about 100 are over age 60; one of them, Col. John Caulfield,
DMD, is 70 years old; he had retired from the Army twenty years prior and from the practice of oral surgery ten
years prior. After being promised that he would "backfill" a slot in CONUS for a deployed surgeon, he
was instead sent to the Army's 325th Field Hospital in Bagram, Afghanistan (formerly at http://www.marionstar.com/news/stories/20041211/localnews/1731211.html;
now see http://www.moaacc.org/fromthefront.htm). A reservist medical technician at Andrews told me that he had helped air-evac from "downrange"
an 86 year old psychologist who had been pulled out of retirement to active duty. Surprisingly, the 86 year old officer suffered medical consequences from being forced to work in the
desert in a flak jacket...imagine that! Here's the policy/law that documents the government's right involuntarily
to recall military retirees to active duty:
from
http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr;sid=2fa4ce59a0ce4b7196c66a65f3d2e376;rgn=div5;view=text;node=32%3A1.1.1.4.34;idno=32;cc=ecfr
§ 64.4 Policy.
It is DoD policy that military retirees shall be ordered to active duty (as needed) to fill personnel shortfalls
due to mobilization or other emergencies, as described in 10 U.S.C. 672 and 688. DoD Components and the Coast Guard
shall plan to use as many retirees, as necessary, to meet national security needs. Military retirees may be used
as follows:
(a) To fill shortages in, or to augment, deployed or deploying units.
(b) To fill shortages in, or to augment, supporting units and activities in the Continental United States (CONUS),
Alaska, and Hawaii.
(c) To release other military members for deployment overseas.
(d) Subject to the limitations of 10 U.S.C. 973, to fill Federal civilian workforce shortages within the Department
of Defense, the Coast Guard, or other Government entities.
(e) To meet national security needs in organizations outside the Department of Defense with Defense-related missions.
...
(2) Involuntary order to active duty-(i) Twenty-year active military service retirees. The Secretary of a Military
Department may order any retired Regular member, retired Reserve member who has completed at least 20 years of
Active Service, or a member of the Fleet Reserve or Fleet Marine Corps Reserve to active duty at any time to perform
duties deemed necessary in the interests of national defense in accordance with 10 U.S.C. 675 and 688. Retired
Regular members of the Coast Guard may be ordered to active duty by the Secretary concerned only in time of war
or national emergency in accordance with 14 U.S.C. 331 and 359.
Even retirement pay can be cut off or reduced with the stroke of the President's pen. "Congress keeps finding
ways to cut the costs (also known as the benefits) of the (retirement) program…The record of recent times stands
in sharp contrast with the practices of an earlier era, when the lawmakers' goal was to make retirement more attractive
so experienced members would stay for a full career in order to derive full benefits…Overall…the changes have reduced
the value of military retirement by about one-fourth…In USAF's 1990 poll, officers rated retirement as the fourth
highest item on a list of career 'satisfiers'. In 1994, it had slipped to sixteenth place." -Air Force: Journal
of the Air Force Association, Oct 1996
http://www.afa.org/magazine/oct1996/1096retire.asp.
Finally, unbeknownst to many retirees, retired officers remain subject to the Uniform Code of Military Justice
and potential courtmartial FOR LIFE. This means that if you do anything that the government determines to be a
violation of some arbitrary part of the UCMJ, such as Article 88, which prohibits criticism of the President, you
could be brought back to active duty against your will at age 99, court-martialled, and sent to Leavenworth. If
you don't believe me, read the law:
from: http://www.access.gpo.gov/uscode/title10/subtitlea_partii_chapter47_.html
Chapter 47: Uniform Code of Military Justice
Title 10 USC Subtitle A Part II Chapter 47 Subchapter I Para 802
802 Article 2: Persons subject to this chapter
(a) (4) Retired members of a regular component of the armed forces who are entitled to pay.
Thus, after twenty-plus years of dedicated active duty service to one's country, by accepting the retainer fee
of retirement pay (and benefits), you are agreeing to remain on call, subject to the UCMJ, for the rest of your
natural life. No one told me this when I signed up in 1981...I'm glad I found out eventually...months after I had
decided to separate without retirement.
As a result of years of sheer poor planning at the highest levels of military command, abetted by Secretary of
Defense Donald Rumsfeld's irrational attachment to his mantra of "Transformation" or "Revolution
in Military Affairs" (http://www.comw.org/rma/index.html), which really means "doing more with less" and "outsourcing", dozens
of programs and services that served as "satisfiers" to military professionals went the way of the dodo
bird. According to Maslow's hierarchy of needs, physical requirements (including safety) trump more lofty aspirations.
Accordingly, the replacement of highly trained, lethal, and young active duty Security Forces personnel to guard
military bases with overweight, rude, and old civilian rent-a-cops forced many to question whether we were being
adequately protected from terrorist infiltrators. The military finance office and personnel flights drastically
cut back on their operating hours and services due to short-staffing, thus depriving us of help with pay and assignments
when we critically needed both; sadly the base hospital couldn't close its doors at 1200 and turn out the lights
to follow suit. Skilled computer technicians were replaced by untrained individuals in Systems, to the point that
I knew thousands of times more than almost all of them about network security and computer operations. The chief
of Systems, a nurse, actually had the gall to send out an e-mail stating that we should not expect help with our
critical computer Clinical Information System (CIS) after hours or on weekends due to understaffing, even if patient
care were jeopardized as a result, given that we had no functional paper alternatives anymore. The Andrews Officers'
Club was shuttered after years of mismanagement (personal communication from a member of its advisory board, LtCol
N.); the resulting "combined club" continues to demean the proud tradition of a separate professional
military Officer Corps. Finally, to add insult to injury, on April Fools Day, 2005, the Andrews gym stopped giving
out towels (and sometimes hot water for the showers), even as the USAF implemented yet another gung-ho Army-eque
physical fitness initiative which mandated our sweaty presence at the gym for supervised Squadron-level PT every
week.
The final straw that broke the proverbial camel's back was the tragic misuse of the U.S. military against Iraq
during Operation Iraqi Liberation (sic). The military and the rest of the U.S. public were told by the Bush administration
that Saddam Hussein was poised to use weapons of mass destruction (WMD) against us. That was a lie. Our young soldiers,
sailors, and airmen were sent into a hostile country to die for a lie. The military officers and NCOs in charge
of the search for WMD (including my Flight Commander's husband) returned empty handed, demoralized and embittered,
only to be sent back again and again to hunt for a non-existent unicorn. According to my Flight Commander, Condoleeza
Rice met personally with her husband, a high-ranking Pentagon WMD expert, to plead with him to return to Iraq for
a fifth time to search for (nonexistent) WMDs in lieu of receiving a scheduled medal at the White House for his
utter failure to find WMDs during the previous 4 attempts. In truth, the invasion of Iraq appears to many to have
been part of a spiteful and petty scheme to attain revenge on Saddam Hussein for the attempted assassination of
the current President's father, George Herbert Walker Bush, by Iraqi agents in 1993 (http://www.cnn.com/2002/ALLPOLITICS/09/27/bush.war.talk/ In
a news conference 26 Sept 02: "After all, this is the guy who tried to kill my dad"). In fact, the invasion
of Iraq proved to be a bonanza for Vice President Cheney's former company, Halliburton, Brown and Root, and its
subsidiaries, which obtained no-bid contracts worth billions of dollars, and yet overcharged the military for food
and oil. Most demoralizing of all for us in the military was the repeated shifting of the propagandistic reasons
we were fed as to why our comrades had to die in the scorching sand of Iraq. Our Commander in Chief now claims
that the invasion of Iraq is part of a larger vision of a "Greater Middle East", which he intends to
reforge into his vision of a Western (and, presumably, Christian) democracy, ignoring 6000 years of Middle Eastern
history, philosophy, religion, culture, and tradition (see http://www.washingtonpost.com/ac2/wp-dyn/A24025-2004Feb8?language=printer [free registration required]). In fact, the "neoconservative" civilian chicken
hawks at DoD had called for an invasion of Iraq as part of the plan to implement a new American Empire and secure
our access to Middle Eastern oil long before Bush was elected (see the outline for empire written by the People
for a New American Century, whose members included Feith, Wolfowitz, and Cheney, here: http://www.newamericancentury.org/RebuildingAmericasDefenses.pdf,
). In the end, I signed up to serve in the United States Air Force to support and defend the Constitution of the
United States, not to support and defend a shortsighted, jingoistic, and, yes, imperialistic international agenda
which will only undermine the safety and security of my children and grandchildren.
As a student of history, it is clear that every single democracy, since and including Athenian Greece, has devolved
into dictatorship and empire. Just as in the Star Wars saga, citizens get soft, neglect to stand up for their civil
rights, fear for their safety in time of war, and thus embrace the artificial security and stability offered by
Emperor Palapatines. This is not science fiction: this is our history as a species. When American citizens are
held without charges as "enemy combatants" and tortured with the help of U.S. military physicians; when
nations are invaded on false pretexts, at the cost of tens of thousands of Iraqi and thousands of American lives;
and when the best interests of multinational corporations trump the interests of the loyal military soldiers who
raised their right hands to defend, not G.W. Bush, not Halliburton, not a flawed vision of a "Greater Middle
East", but the Constitution-- our military has now become the Instrument of Power, not of a democracy or republic,
but of an empire. For this and many other reasons, I now resign my commission as a United States Air Force Lieutenant
Colonel and senior Medical Corps officer and leave this corrupt organization forever.
Read about the Peculiar Case of the Poisoned Pizza!
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