“Who let you transfer here?!?”

[John1513]

have you ever had a service member with a very severe medical condition transfer to your MTF from a large MEDCEN?

Somehow, they have eluded the LIMDU/Profile/MEB system.

Somehow their Detailer had no idea.

As a .mil doctor, do we have any right to request that this service member be sent back (for saftey reasons at least), after their household goods and all are already a done deal?

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[ArmyTiger]

This is a frequent question at my current OCONUS station with limited medical resources. In my experience, we have two courses of action.

1. Medical curtailment: this involves discussing the soldier with their command, and agreeing that a transfer back to a MEDCEN or near appropriate civilian facilities is appropriate. Then it's an administrative process between that command and HRC to cut PCS orders. Unfamiliar with the admin side of things, but medically it's just a memo.

2. MEB: if the soldier truly has a severe medical condition, you probably should consider whether they are fit for duty. For the Army, the reference is AR 40-501. The new diagnosis of many chronic medical conditions should prompt an MEB, which is frequently overlooked by the diagnosing physician because they aren't familiar with it. An MEB can (and in this case, should) prompt a medical curtailment to a WTU for completion of the MEB. The weight of the MEB should make that curtailment move faster.

Hope that helps.

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[militaryPHYS]

Very common OCONUS. Active duty members and dependents of active duty. Despite us recommending a solid "NO" when overseas screening inquiries come across our desks, ultimately the line side decides despite our recommendations.

There are avenues to submit these instances back up to HQ, but they often fall on deaf ears. Currently we are tracking each individual case to provide objective evidence to hospital and line leadership on why disregarding medical recommendations can have horrible outcomes.

 

[ArmyTiger]

On a related note, please let your patients know that EFMP is not there just to make them miserable. If you take a family member who should be EFMP OCONUS where they shouldn't be allowed to go, you're making a headache for their new doc who gets to explain that there aren't any resources there to help them. I've seen that plenty too.

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[Kingfisher]

have you ever had a service member with a very severe medical condition transfer to your MTF from a large MEDCEN?

Somehow, they have eluded the LIMDU/Profile/MEB system.

Somehow their Detailer had no idea.

As a .mil doctor, do we have any right to request that this service member be sent back (for saftey reasons at least), after their household goods and all are already a done deal?

For the Navy

In order for members to execute orders to an operational or overseas command they must go through an overseas/sea duty screen process. This means someone has to see them and review their medical record and approve them for transfer. Per the instruction, almost any chronic medical condition that requires ongoing treatment requires the gaining command to be queried. This means you (gaining SMO) should have gotten an email or phone call presenting you with their overseas/sea duty screen packet to review yourself. You should have had input as to whether you have the resources to take care of the patient or if they are not stable to transfer. If you say UNSUITABLE the losing command medical should take that into consideration and if there is a discrepancy, they should consult with your TYCOM or with PERS (this process sometimes changes).

If this process fails and the screening provider does not follow the instructions, patients who shouldn't be at your command will show up. Once you have identified them you will need to review AHLTA to find out who did their screening. You will need to get your chain of command involved since the cost of sending them back will be incurred by your command. Your CO should know which medical center/command sent you the patient so they know whom to direct their "feedback". What I also do is find out which specific provider did the screening so I can send them and their department head some "feedback" of my own.

Another scenario happens when the process goes through appropriately and they still end up at your command. This could be because PERS pulled their "Override" powers and sent them to you despite gaining and losing command finding them UNSUITABLE. If this happens and the patient needs to be sent back to the states or MEDEVAC'd off your ship or out of your AOR, make sure you provide your COC the information they need to communicate to PERS so they can review how they reviewed the patient.

Still another scenario is where a dependent just pops in despite being found unfit by all parties. This is common for dependents overseas in nice locations. If they were found UNSUITABLE they are NOT eligible for care in an overseas clinic. If something has to be done involving sending them home emergently the service members COC needs to be involved as the service member can be held accountable.

 

[Gastrapathy]

Had a guy show up in theater with his 6 mo Embrel supply on dry ice “just looking for a fridge”.

 

[HighPriest]

Never saw it with a soldier. Had a 3 year old with a tracheostomy and subglottic stenosis and a laundry list of other problems show up to my clinic at a 12 bed MEDDaC with no ICU, no inpatient peds, and no peds ICU within a 1 hour helicopter flight. The NP sent him over to find out if I thought he still needed a trach. And all I could think was “who the hell let this happen? This kid should never, ever be this far away from a peds hospital...”

 

[d2305]

SNM used to have to be fit for worldwide deployment to be on active duty.

 

[DD214_DOC]

It's a broken system. To share some insight onto this problem, I actually was dx with a DQ medical condition almost 3 years ago, and still do not have a profile and have never been referred for an MEB.

I get new family-member patients all the time who should never have been allowed to PCS here due to limited resources, but were able to because nobody ever bothered to do the EFMP enrollment. I have also had families who were enrolled but showed up anyways, because the family members moved to the area and the sponsor remained at some other duty location. You can't stop dependents from doing what they want.

 

[Dr. Wexler]

nobody ever bothered to do the EFMP enrollment

That is on the service member. And I have little sympathy for them in that case.

What I see much more often is a family gets PCSed, and are unhappy with the new duty station. "You know we shouldn't have been able to come here" when in fact our installation is well within the EFMP travel radius for almost every medical specialty under the sun. And then I'm being asked to fill out a memo for a compassionate assignment action for a service member who clearly has not read the regulation. Because the reg says nothing about moving ADSMs to get their dependent closer to medical care.

The place I am is not a sought-after assignment but it is firmly located within civilization and is a fair representation of the "access" a large part of our nation has to medical care.

Them: uggh, .mil keeps moving us to places where it is hard to get medical care
Me: ahh, yes, well you could always quit and then move anywhere you like
Them: we can't do that
Me(feigning confusion): ...
Them: well, he has X (where x=at least several) years left until he can retire
Me(internally): ok, so there you go