“If you’re going to sin, sin against God, not the bureaucracy; God will forgive you but the bureaucracy won’t.“
Hyman Rickover, Admiral, USN, (1900-1986)
Admiral Rickover is considered the father of the Nuclear Navy, a fleet of nuclear-powered submarines and ships he helped create. Rickover is famous for taming the Navy’s bureaucracy; finding ways around, over and under incompetence and status quoism. Frankly, our country needs more leaders like Rickover, particularly in the Military Health System (MHS), and specifically in the healthcare and family support for our Exceptional Family Members (EFM’s), military families impacted by disabilities and chronic/complex medical conditions. While medical reform for our veterans has captured the nation’s attention, reform has been slow to come to the Department of Defense (DoD), leaving our most vulnerable military children at risk.
Over the last couple of years, a small cadre of these military families, along with advocacy organizations, like those in the TRICARE for Kids Coalition, have pushed DoD to enhance its services and supports for these unique military families. Here is a brief history of just some of the issues we continue to fight with the entrenched bureaucracy of the Pentagon:
Military Families Impacted by Autism
· June 2012: Senate Armed Services Committee hearing on a host of issues related to EFM’s, with a significant focus on autism. The military family stories submitted and my testimony provide a window into our daily lives and the way our legislators can help.
· August 2012: Military families with autism win a class action lawsuit against DoD. The Court finds that the Agency’s decision to deny coverage for a recommended autism therapy as a medical benefit is “arbitrary and capricious and not in accordance with the law.” While the class action aspect is eventually cancelled, the case is remanded to DoD for correction and implementation.
· 2013: DoD implements a number of ludicrous regulations that would have halted therapy services for thousands of children with autism, forcing the families and advocates to fight back.
· 2014: DoD decides to cut reimbursement for TRICARE autism providers in half. The ensuing wait lists and access challenges cause another uproar.
· 2016: DoD cuts provider rates again, further exacerbating access to care, after which senior military leadership urgently calls on the Office of the Secretary of Defense to reverse the cuts highlighting “access to care…effect[s] both family and unit readiness” and “capacity of ABA [therapy] services cannot meet the current demand.” DoD fails to course correct, so Congress intervenes and orders the rate cuts reversed.
· 2017: DoD institutes a new set of policies requiring all children obtain a new autism diagnosis every two years and IQ evaluations to assess ongoing care. Military developmental pediatricians (experts in diagnosing autism) were not given an opportunity to provide input to the policy that directly affects their patients’ care and subsequently send a letter to the Defense Health Agency (DHA) stating the “Required testing as proposed by TOM [TRICARE Operations Manual] is not standard of care, expensive and time-consuming.” To read more, see: Military Autism Families Fear Loss of Services Amidst Policy Changes.
I believe those who review this timeline objectively will scratch their head and ask, “Who is making these asinine policy decisions, and why has this been allowed to continue year after year after year?” Simply put, the absence of sustained and comprehensive leadership oversight of essential medical care and support for military children with special needs has led to a series of public missteps that erode faith in the system and negatively affect outcomes. Families that already shoulder tremendous responsibilities feel assaulted and given the number of threats to their child’s continued services, question the Defense Department’s intent. And that is just one example.