Articles by JCS

Grips with RAFB

April 10, 2013

Maj. Gen. Robert McMahon

c/o The 21st Century Partnership


 

Dear Sir:

With a bit of déjà vu in mind, I read your comments in the Macon Telegraph article about “Coming to grips with a gripping problem at the base” (04-07-2013). To remind you of the 2005 BRAC, the most glaring problem found at RAFB had to do with Robins having the highest workers comp costs of all the ALC’s—mainly due to the high frequency rates, costs, and disability caused by back surgeries. I addressed this problem when first mentioned in 2005, but my suggestion was completely ignored by the base commander.

 The rising medical costs problem echoes the sentiments of former Secretary Bob Gates who made a plea about the “sacred obligation” to provide good healthcare to active and retired vets on one hand while admitting, on the other hand, healthcare spending in the military is “eating the Defense Department alive.” (Newsweek magazine, September 20, 2010).

 As you mentioned, your experience with the 1995 BRAC closure of Kelly Air Force Base appears to be too similar to the dire situation facing Robins AFB today. Your call, Gen. McMahon, for improvement in labor relations to bring RAFB into compliance with other ALCs is important but, aside from labor relations, there is still another huge problem RAFB faces—the escalating medical costs that once again threaten the economic viability of Robins as well as our entire country.

 Certainly this is the same paradox facing RAFB that once again I would like to address. Hopefully you will be more open minded than your predecessors since you also mention: “the 21st Century Partnership is spending $175,000 to conduct 15 studies looking at factors such as education, crime rates, and medical care.” 

 Indeed, if addressing all factors in medical care is on the table, as a health professional in Warner Robins since 1980, let me suggest a study to reduce the enormous cost of medical spine treatments both in the civilian workers’ comp program and in the military health services that previously jeopardized Robins during the last BRAC investigation. If a study is implemented on medical care at RAFB as you mentioned, I volunteer to be a member. Considering my new book, The Medical War Against Chiropractors, I feel imminently qualified to present the latest evidence-based guidelines on spine care.

 This is a huge and expensive “gripping problem” on base in regards to the epidemic of back surgeries that could be avoided if chiropractic care was used initially as the guidelines recommend and the law allows, but this solution has been ignored by the military-medical complex at RAFB due to its inherent bias.

 Certainly many spine surgeons in middle Georgia enjoy a virtual monopoly to the cash cow provided to them by their military-medical colleagues who only refer these acute low back pain cases to surgeons. The fact that my clinic has not received one referral from RAFB in over 30 years speaks volumes about the medical boycott of chiropractors considering the paradigm shift in spine care.

 Indeed, where is the free enterprise in healthcare to allow the best mousetrap at the lowest cost?

 Unfortunately, this is a good example of your statement: “There is a small number of individuals…whose personal agendas are of greater importance to them than the health and well-being of our base and our community.”

 Of course, this self-serving attitude includes the effort by military-medical complex to control all health care on base despite the fact that medical spine care has been deemed “the poster child for ineffective spine care” by a leading international spine researcher. Indeed, if given a choice, is there anyone who prefers narcotic painkillers, epidural steroid injections, and spine fusion when simple spinal adjustments work better in most cases? As Dr. Robert Mendelsohn once wrote, “anyone who has a back surgery without seeing a chiropractor first should also have his head examined.”

 To say spine surgeons have “gone wild” in middle Georgia is an understatement. It is well known that Macon has become the Mecca of back surgeries per capita due to the overuse of spine surgery. What the RAFB military-medical complex has kept secret from the employees on base is that chiropractic care that has been shown in numerous comparative studies to be more cost and clinically-effective as well as safer and cheaper than medical spine care. In 1994 the US Public Health Service deemed spinal manipulation to be a “proven treatment” as well as admitted only one in 100 cases of acute low back pain requires surgery.

 Back pain is now considered the #1 global burden in terms of cost and disability, but some intractable military-medical professionals continue to ignore the research and evidence-based guidelines that recommend the most effective and proven method for this pandemic of musculoskeletal pain—chiropractic care.

 Mr. Tom Philpott, columnist of Military Update, wrote an article in the Macon Telegraph (15-8-2000) concerning outdated Air Force medical services, “Air Force medical chief leads overhaul of health care delivery,” in which the crux of his article was posed by Lt. General Carlton: “Are we really best value health care, or are we the way we were in 1942, when we were designed?” Gen. Carlton, a surgeon, mentioned that “the ‘culture’ of military medicine is still influenced by attitudes and practices ingrained as far back as WW II.”

 This is a situation that I have encountered in the past with previous base commanders who ignored my suggestion how to reduce medical costs at Robins AFB. Like deficit spending on Capitol Hill that continues unabated despite the public rancor, unnecessary medical costs and spine surgery at RAFB continue to escalate despite the new evidence that supports spinal manipulation before drugs, shots, and disc surgery. Indeed, the 1942 medical attitude seems to still be alive at RAFB.

 Military Calls for Chiropractic

As you may know, the issue of chiropractic care in the military is not a new topic. Both former presidents Clinton and Bush signed bills into law calling for the availability of chiropractic to active military personnel and to veterans.

 As part of the Fiscal Year 2006 Department of Defense authorization bill, Congress included language to require the U.S. Air Force to complete implementation of chiropractic services at 11 sites that had not yet opened in accordance with a five-year-old Pentagon plan to make chiropractic care available to active-duty members of the military.

          Specifically, the bill calls on the secretary of the Air Force to ensure that chiropractic health care services are available at 11 facilities previously slated to offer chiropractic care, but that have not opened a clinic or made the benefit available on-base. It was also noted if the Air Force determines it is unnecessary or unfeasible to provide chiropractic health care services at any identified facility, the Air Force shall provide chiropractic services at an alternative site located off-base. The Air Force had been given until Sept. 30, 2006, to complete implementation at the 11 locations.

The 11 sites identified by Congress were:

  • Bolling Air Force Base, Washington, D.C.
  • MacDill AFB, Florida
  • Hurlburt Field AFB, Florida
  • Nellis AFB, Nevada
  • Elmendorf AFB, Alaska
  • Luke AFB, Arizona
  • Maxwell AFB, Alabama
  • Randolph AFB, Texas
  • Robins AFB, Georgia
  • Kirtland AFB, New Mexico
  • Pope AFB, North Carolina

This Congressional action came on the heels of a September 2005 Government Accountability Office (GAO) report on the status of chiropractic care in the armed forces. The GAO confirmed that the Department of Defense is not complying with current law and has failed to fully implement its own plan to provide chiropractic health care services to active-duty military personnel. Furthermore, chiropractic services continue to be unavailable at many military bases overseas–including those in Iraq and Afghanistan.

 Despite my repeated letters to the base, the only response I have ever received from RAFB on this issue was a letter dated March 26, 2010 from Col. James R. Little of the 78th Medical Group at RAFB. He wrote:

“While there is a general requirement for the DoD to provide chiropractic care to active duty military personnel, there is no specific requirement to either provide chiropractic care at Robins AFB or to refer healthcare beneficiaries to off-base civilian chiropractors.”

 Obviously Col. Little’s interpretation flies in the face of the actual language of the Fiscal Year 2006 Department of Defense authorization bill that calls for the implementation of chiropractic care at RAFB or “provide chiropractic services at an alternative site located off-base” by Sept. 30, 2006. Simply put, RAFB appears to be in contempt of Congress on this matter.

 Perhaps the most positive study on chiropractic done by the DoD was a Chiropractic Care Study touting the benefits of chiropractic care among TRICARE patients. In a September 22, 2009 letter to Congressmen from Ellen P. Embrey, then Deputy Assistant of Defense, clearly stated the benefits of chiropractic care:

“The [Chiropractic Care Study] report reveals that our Active Duty members are very satisfied with the chiropractic care they receive, and military treatment facility personnel consider offering chiropractic care to be beneficial.”

 This study also found an enormously high patient satisfaction rates for chiropractic care that ranged from

  • 94.3 percent in the Army;
  • the Air Force tally was also high with twelve of 19 bases scoring 100 percent;
  • the Navy also reported ratings in the 90 percent or higher;
  • even the TRICARE outpatient satisfaction surveys (TROSS) rated chiropractors at 88.54, which was 10 percent “higher than the overall satisfaction with all providers” that scored at 78.31 percent.[i][1]
         This Chiropractic Care Study also commented on the Unit Commanders and MTF personnel concerning chiropractic care.

“The responses were overwhelmingly a five (the highest rating available); MTFs that offer chiropractic care are pleased to do so.”

 Another revealing study was a 5-year Demonstration Project for Chiropractic conducted by the DoD in which the potential savings from implementing chiropractic care was found to be as much as $26 million and 199,000 lost work days could be saved if chiropractic care were included system-wide in the military healthcare system. 

 Marines Down

A recent example on base of this intransigence concerns the Marine helicopter squadron consisting of forty personnel who arrived at RAFB from Dobbins last year. During the first year here, already ten Marines have had back surgeries that were probably avoidable if chiropractic had been used initially as the 2006 Department of Defense authorization bill and TRICARE guideline urges. It is deplorable that 25% of these young Marines were brought down not by IEDs or combat injuries, but by the medical profession here in middle Georgia. At this rate, in three more years there will be no Marines left standing at RAFB.

 To make matters worse, many back pain patients on base are literally being railroaded into narcotic painkillers, ineffective epidural steroid injections, and back surgeries. Some patients have told me when they resist this medical railroad, their military MDs threaten to have them discharged as “malingerers” for refusing these risky procedures. In every case, these patients have been misinformed when they were not told as required by “informed consent” law that they do have the legal right to chiropractic care in federal workers’ comp, VA, and TRICARE programs.

 You may recall the tragic case regarding the suicide of an injured worker, James Sturdivant, who suffered with low back pain and failed back surgery.  The Macon Telegraph on August 15, 2005, printed a lengthy article, “SUICIDE RAISES WORKERS' COMP QUESTIONS,” about this sad situation. According to the Telegraph, Mr. Sturdivant had hurt his back in 2001 that was further aggravated by a year-long delay to approve his back surgery that adversely affected other areas of his health. As a result of his poor outcome from back surgery, he still suffered from chronic back pain then compounded by depression and impotence, occasional side-effects of failed back surgery syndrome and opioid painkiller addiction.

 This article also quoted his mother, “My son begged for relief from his pain,” and the OWC employee also mentioned, “The employee said he didn’t feel like he was a man anymore.” Without given any options like chiropractic care to control his chronic pain, he ended his life. “Sturdivant asked the director's secretary to see O'Hara then asked to see Maj. Gen. Michael Collings, the Warner Robins Air Logistics Center commander. When he was told the general was not on base, authorities said he reached behind his back and pulled out a 9mm pistol.”

 Evidence is Mounting

Certainly in this cost-conscious era of healthcare reform, one might assume responsible administrators and doctors would prefer avoiding expensive and risky drugs, shots, or spine surgery whenever possible, but this does not seem to be the case with the military-medical complex that seems willing to jeopardize the status of RAFB and its personnel.

 Fortunately, numerous recent studies now endorse chiropractic care as an effective method to avoid back surgery. A recent study from Washington state workers comp compared patients with low back pain whose first provider was a chiropractor or a surgeon determined drastically different rates for surgery—42.7% of workers who first saw a surgeon had surgery in contrast to only 1.5% of those who saw a chiropractor. Imagine the cost savings at RAFB if all back pain patients were referred to chiropractors first as America’s primary spine care providers.

 This was confirmed in 2006 by a Dartmouth University’s Health Policy Institute’s study that admitted up to 40% of spine surgeries were unnecessary. This accumulating evidence is now changing policy at many insurance companies. North Carolina BC/BS announced it will no longer pay for disc fusion if the sole criterion is a bad disc. Even the North American Spine Society in 2010 recommended 2 to 4 weeks of chiropractic care before a surgery consultation is considered.

 Tony Rosner, PhD, capsulated it best when he testified before The Institute of Medicine: “Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.” This is a fact the military-medical complex at RAFB as yet to learn.

 Freedom of Choice in Healthcare

If you, Gen. McMahon, want to come to grips with a huge and expensive problem at RAFB, you must include a freedom of choice in healthcare for every worker, airman, and Marine to select chiropractic care as they are allowed by law. Railroading patients into inefficient, addictive, dangerous, and expensive medical spine care has simply not panned out as the research has proven.

 Despite the century long defamation campaign by the AMA to discredit chiropractors, today research has concluded chiropractic care is a proven treatment helping millions and saving billions of dollars. It’s past time for RAFB to learn the value of chiropractic care. Let’s do what’s best for the troops and workers on base by giving them the best in both worlds of spine care.

Regards,

JC Smith, MA, DC

 


[i]Chiropractic Care Study, Senate Report 110-335 accompanying the National Defense Authorization Act for FY 2009; letter sent to Congressmen by Ellen P. Embrey, Deputy Assistant Secretary of Defense (September 22, 2009):2.


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