TO: Col. Garrett Gordon
Director of Complaints & Resolution
78 ABW/IGQ
Robins AFB GA 31098
Mr. Jonathan Staeblein
Department of the Air Force
SAF/AAII (FOIA)
1000 Air Force Pentagon
Washington, DC 20330-1000
FROM: JC Smith, MA, DC
Smith Spinal Care Center
Warner Robins, GA
RE: #2018-08459 & # 2020-02375-F
Thank you for your letter, Col. Gordon, but let me share with you my disagreement with your decision to close this case. It appears as the 78 AFW/IG officer for the defendant 78th MDG that you are acting as judge in this case. I understand as defense counsel why you would support its side in this matter, but for you to act also as judge is outrageously unfair since your statements contained many errors, misrepresentations, and omissions that I broached in my two complaints that obviously you failed to read.
I thought once I had received the 78th MDG response to my complaint that I would have the right to respond in kind before any adjudication occurred. I never imagined the defendant counsel would make the final decision in this case based solely upon your opinion. Your response typifies my past correspondences with your group and explains why I sent my complaint to the national AFIG office to challenge the unfounded reasons for the boycott of chiropractors at RAFB considering other Air Force bases and military MTFs already have chiropractors on staff or send patients to civilian DCs.
Please now give me this opportunity to respond to your statements.
Your recent letter of 3/23/2020 basically reiterated the same position based on misinformation I’ve received for years from the 78th MDG. Your opinion alone, Col. Gordon, while it may reflect the policy of the Pentagon or specifically RAFB, it will not suffice since it is unsupported by both the law and the DoD research as I proved in my two reports, PUTTING PATIENTS AT RISK and AN APPEAL TO END THE BOYCOTT OF CHIROPRACTIC IN TRICARE & FECA AT ROBINS AFB.
Due to your apparent unfamiliarity with my complaints and supportive evidence, I’m asking Mr. Jonathan Staeblein, Department of the Air Force, SAF/AAII (FOIA), to continue with the investigation into this matter. If he is not the correct contact at the AFIG office, please refer me to whomever is. I had hoped we could settle this amicably between RAFB and myself, but it appears impossible now.
FAKE NEWS
For example, in my reports I refuted the main excuse you cited from the Pentagon, “The demonstration project reported that providing chiropractic care was feasible, but not fiscally practical.”
This is a blatant misrepresentation of the findings of the Chiropractic Demonstration Project that stated the substitution of medical spine care with chiropractic was shown to potentially save annually $26 million and 199,000 lost workdays. The TROSS ADSM patient surveys also put chiropractors’ approval rating at the top of the list of providers by over 10 percentage points above MDs, PTs, and DOs.
In fact, the real facts are clear chiropractic care is both “feasible” and “advisable,” proven to lower costs and improve outcomes as have numerous comparative studies that I noted in my two reports that show chiropractic is safer, faster, cheaper and more clinically-effective for the majority of nonspecific low back pain cases (LBP).
Indeed, the Pentagon’s position is baffling and contrary to the facts. As I discovered, its policy was not based on the findings of the actual Chiropractic Health Care Demonstration Program[1] (CHCDP) report as I indicated in my reports, but allegedly were based on the discretion of then-Assistant Secretary of Health Affairs, the late Col. (Dr.) S. Ward Casscells.
It appears Sec. Casscells unilaterally changed the intent of Congress to offer chiropractic care to the entire TRICARE community, including dependents, retirees, reservists, as well as all ADSM, not just a fraction of ADSM.
National Defense Authorization Act for Fiscal Year 2007 passed the House by a vote of 396-31 on May 11, 2006. Of particular importance to the chiropractic profession was Section 712, which calls for the Secretary of Defense to formulate a “study and plan” relating to the provision of chiropractic health care services for all active-duty military personnel, reservists, retirees and eligible dependents, and to submit a report to the House and Senate Armed Services Committees by March 31, 2007.
Later behind closed doors in the Pentagon, Col. Casscells individually re-wrote the law Congress passed to have all 9.4 million TRICARE beneficiaries covered for chiropractic care. With the lame excuse of being too costly, Col. Casscells pared this number down to only 500,000 ADSM in clear disregard of the intent of Congress to cover the entire TRICARE community, not just a fraction of ADSM.
Dr. Reed Phillips, DC, PhD, a member of Civilian-Chiropractic Oversight Advisory Committee[2] (OAC) also explained the limited coverage of TRICARE beneficiaries was an “arbitrary number chosen by the DoD not contained in the language of the federal law.”
Along with other incongruent conclusions by Col. Casscells, a case can be made the Pentagon conducted a whitewash of the law and of its own research studies on chiropractic care. This review of these baffling actions by the Assistant Secretary of Defense will explain why the civilian-chiropractic OAC asked, “Is health care prejudice involved in this opinion?” because his decision flew in the face of the law and DoD facts.
Col. Gordon, wouldn’t you agree it makes no sense Congress would pass a bill allowing only 54% of ADSM (and no retirees or family beneficiaries) and merely 15% of MTFs to enjoy the chiropractic benefit? Would Congress pass a similar bill to cover only 54% for dental care or medical care? I think not.
Although the chiropractic demonstration project showed impressive clinical and cost benefits, ironically, the DoD still obstructed the chiropractic inclusion according to Dr. Phillips:
“While politically the DCs argued for inclusion of all TRICARE recipients, the logistics and the political mindset in the military would not allow. They were attempting to do the ‘minimal’ to keep Congress off their back. They hoped the Demo Project would show no benefit with added costs and chiropractic would go away.”
This skewed DoD policy was not based on the law or research facts but upon the medical prejudice and power to keep chiropractors segregated. In my reports I have listed many untruths Col. Casscells gave in his report to Congress that were easily disproven by the language of the law and the results presented in the Chiropractic Project report itself but went unchallenged.
Apparently, either Congress was disinterested or mistakenly believed the ‘alternative facts’ given by Col. Casscells.
In Appendix B[3] of the Evaluation of the Chiropractic Care Program Implementation,[4] the OAC also accused the DoD of keeping the “chiropractic benefit a relative secret:”
It would appear as though the DoD has a desire to keep the chiropractic benefit a relative secret. This is supported by the fact that the DoD has not put any effort into educating others of the capabilities of DCs, the benefits of chiropractic care, the availability of the benefit, etc. In fact, GAO reported that only 10 of the 42 military sites (with chiropractic clinics) included the chiropractic service on their Web site.[5]
In effect, this Pentagon scheme was just another battle in the medical war against chiropractors. My investigation found beyond any reasonable doubt Col. Casscells’ manipulation of the data and the resulting Pentagon’s policy on chiropractic was a coverup lacking any legal merit or valid research data to support its discriminatory policy.
As your Commander in Chief might say, “The system was rigged.”
MEDICAL WAR CONTINUES
Unfortunately, this whitewash continues at RAFB today. For the record, Col. Gordon, let me clarify how your letter of 3/23/2020 stated many untruths:
- “TRICARE doesn’t cover chiropractic.” I believe we can put that notion to bed considering it is now covered at all three Army posts in Georgia (Benning, Stewart, and Gordon) have a chiropractor on staff at their MTF and at least 20 of the 59 Air Forces bases in the US have chiropractors (another list shows 29 bases). Here is the link to a list of MTFs with DCs @ Chiropractic Clinics in DoD Facilities.
You might enjoy this recent article in Military.com that discusses this issue: Chiropractic Care Works for Troops with Lower Back Pain, But Not Everyone Can Access It. Clearly this article disproves your assumption that TRICARE doesn’t cover chiropractic care.
- You also wrote, “Finally, to date, DoD has made no changes to its current policy regarding TRICARE benefits to military personnel at Robins AFB, which does not authorize chiropractic care. Therefore, the 78th Medical Group will continue operating under the current policy until told otherwise. Thank you for submitting your complaint and showing interest in providing chiropractic care to our military personnel in the Middle Georgia area, but again, unfortunately the care is not a TRICARE covered benefit. This case is closed.”
I am bewildered by your stance since chiropractic is already present at a minimum of 60 MTFs. As well, President Bush in the NDAA FY 2006 specifically requested the Air Force to complete implementation at 11 Air Force locations including RAFB by Sept. 30, 2006. The 11 sites identified by Congress included RAFB:
- 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
(Bases with * now have chiropractic available)
In this regard, you can understand why I believe your stance remains in conflict for not implementing a chiropractic referral program at RAFB as President Bush requested.
- You failed to answer my second complaint why FECA at RAFB also boycotts chiropractic care. My 2013 FOIA request discovered that zero of 2,512 spine-related injured patients at RAFB were referred to DCs. In my 40-year career, I’ve never had one referral from RAFB despite the fact every evidence-based guideline for acute low back pain recommends conservative chiropractic care before opioid painkillers, spinal injections, and spine surgery. The guidelines are clear on this paradigm shift in spine care that the 78th MDG continues to ignore and thereby continues to put patients at risk and thereby inflating the exorbitant medical expenses that would be greatly reduced as the Chiropractic Demonstration report found. If the goal of the 78th MDG is to reduce costs and improve outcomes, chiropractic is the best method as I listed in my full reports.
- You also didn’t answer my third complaint why the 78th MDG fails to perform the Doctrine of Informed Consent to give injured workers “practical alternatives” such as chiropractic care as required by state and federal (OSHA) laws. This oversight is not only illegal, it is unethical by illustrating the failure to “First, Do No Harm” not to offer the safest and most effective treatments for the pandemic of low back pain. The boycott of chiropractic contributed to the opioid abuse/addiction caused by promiscuous prescribers refusing to refer to DCs for nondrug care. Every evidence-based research study and guidelines today recommend conservative (nondrug, nonsurgical) chiropractic care as a frontline treatment for LBP, which also lowers the cost of medical care by avoiding expensive and inefficient spinal injections and spine surgery.
Col. Gordon, I found your response failed on all three counts to discover the truth in these matters; therefore, this case should not be closed as you wrote. Consequently, I will pursue my IG complaint # 2018-08459 to have a thorough investigation and honest adjudication of this issue.
If you take the time to read my updated complaint, let’s discuss this issue again to implement the required change at the 78th MDG. Workers at RAFB are legally entitled to chiropractic care in both TRICARE and FECA, even if they are referred across Hwy. 247 to chiropractic offices just as they are for medical care as the Rule of Reason dictates. Referring ADSM to Fort Gordon is not a reasonable solution, either. As I discussed in my report, this is just another barrier to access chiropractic and a violation of the TRICARE Policy for Access to Care.
If you and the 78th MDG want the best for injured back-pain patients, your medical staff should encourage patients to avoid addictive opioid painkillers, ineffective spinal injections, and risky/expensive back surgery.
The ineffectiveness of medical care is not only my opinion, but for your information, “usual medical spine care” has been deemed the “poster child of inefficient care” by a leading spine editor, Mark Schoene, who was quite frank in his article, “U.S. Spine Care System in a State of Continuing Decline”:
“Medical spine care is the poster child of inefficient care…such an important area of medicine has fallen to this level of dysfunction should be a national scandal. In fact, this situation is bringing the United States disrespect internationally.”
Let me add this disrespect already occurs among many ADSM who I care for in my office, disgusted that chiropractic care is not a covered benefit at RAFB knowing it is elsewhere; some had chiropractic care at their previous MTFs. The base employees have read for themselves articles such as Chiropractic Care Works for Troops with Lower Back Pain, But Not Everyone Can Access It. As this article suggests, the real question is why everyone can’t access chiropractors, especially at RAFB.
Despite the resistance by RAFB to the full implementation or referral to chiropractors, I find it interesting the DoD continues to investigate chiropractic and other forms of complementary and alternative medicine (CAM) treatments such as acupuncture, stress management/relaxation therapy, progressive muscle relaxation, yoga, biofeedback and massage.
In January 2014, the U.S. Defense Health Agency published the “Integrative Medicine Health in the Military Health System Report to Congress.”19 This report showed that 120 (29% of 421) MTFs offered 275 CAM programs. Furthermore, it showed that, during the calendar year 2012, ADSM had 213,515 CAM patient visits. The most frequent visits were for chiropractic care (73%) and acupuncture treatments (11%).
Another baffling issue, if true, is my understanding the 78th MDG presently offers acupuncture. Although this is a step in the right direction to use conservative care, are you aware chiropractic has proven to be more popular and clinically effective than acupuncture for low back pain?
CONCLUSIONS: The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication.
Col. Gordon, since chiropractic is a covered benefit at many MTFs, would you explain again why you refuse to implement this benefit at RAFB when you offer acupuncture although chiropractic is more effective and popular? Again, let me ask if medical prejudice is involved?
In August 2017, RAND Corporation released its findings on CAM treatments at MTFs and found them to be a resounding success. Complementary and Alternative Medicine in the Military Health System58 by Patricia M. Herman et al. found more than 80 percent of MTFs offer some form of CAM mainly for pain management and psychological disorders such as PTSD. This study found at those MTFs where chiropractic is offered, 59% reported a reduction in narcotic painkiller use. Col. Gordon, can you name one medical treatment that has lowered opioid use by 59%? If there were just one, it would be herald as a “medical wonder,” but when this is accomplished by chiropractic care, nothing is said. Again, is medical prejudice involved in this matter?
Dr. Herman said these treatments are “one more tool in the tool kit for dealing with issues like chronic pain, and they can offer an alternative to opioid drugs.”
MTFs cited scientific evidence as a reason to offer such therapies. Rarely did they report a lack of patient interest in these therapies or worries about their safety or efficacy as barriers to offering these kinds of care.
AFIG REQUEST
Mr. Staeblein, in light of the language of the law Sec. 712 and the intent of Congress to cover all TRICARE beneficiaries, the allegation of a whitewash, and the DoD’s research studies touting chiropractic care, I still request the national AFIG office to pursue a thorough investigation.
It is obvious RAFB will continue to deny the chiropractic benefit by ignoring the truth and laws in these matters despite the facts I’ve presented and the growing popularity of chiropractic throughout the MHS. If need be, please refer me to the appropriate contact at the IG office in Washington.
For the sake of patients, I hope RAFB finally admits to the benefits of chiropractic care, the leading conservative care for the leading military and workplace injury—LBP. It makes no sense that RAFB denies our brand of spine care while many other military installations have found great success with chiropractors as my full report reveals.
Regards,
JC Smith, MA, DC
Warner Robins, GA 31088
From: GORDON, GARRETT CIV USAF AFMC 78 ABW/IGQ
Sent: Monday, March 23, 2020 2:09 PM
To: James Smith <[email protected]>
Subject: SAF/IG Complaint – Closure letter to Complainant
Mr. Smith,
This email is in regard to your email inquiry to the Office of the Secretary of the Air Force Inspector General (IG) regarding your complaint (2018-08459), in which you indicated that you had not received a response from the 78th Air Base Wing IG Office. Let me apology for that oversight, as it was the responsibility of the former commander, 78th Medical Group, to have provided you with a response. Attached please see the complainant closure letter addressed to you.
Thank you for your interest in providing medical care to our military personnel assigned to Robins AFB.
v/r,g
Garrett Gordon
Director of Complaints & Resolution
78 ABW/IGQ
Robins AFB GA 31098
DSN 472-0818 Comm (478) 222-0818
DEPARTMENT OF THE AIR FORCE
78TH AIR BASE WING (AFMC)
ROBINS AIR FORCE BASE GEORGIA
23 March 2020
78 ABW/IG
620th Ninth St, Ste 240
Robins AFB GA 31098-5990
Mr. JC Smith
1103 Russell Parkway
Warner Robins GA 31088
Dear Mr. Smith
Ref: 2018-08459 – SAF/IGQ referred this case to the 78 ABW/IG
This letter is in response to your email to the Secretary of the Air Force Inspector General, regarding the above referenced complaint, dated March 2018, that you never received a response. First, let me apologize, as it was the 78th Medical Group commander who was charged with providing you a response, so thank you for letting us know.
After a thorough review of your complaint, to include past correspondence to you, the 78th Medical Group commander concluded that there is no boycott of chiropractic care. Chiropractic care is not a TRICARE covered benefit, therefore, the 78th Medical Group Medical Treatment Facility does not refer patients for chiropractic care because the cost will not be paid. Further, The National Defense Authorization Act (NDAA) of 1995 directed the Secretary of Defense to establish a chiropractic demonstration project for 3 years. The demonstration project reported that providing chiropractic care was feasible, but not fiscally practical. The 2001 NDAA directed DoD to design a benefit specifically for active duty personnel. The Implementation Plan was produced with the assistance of the Chiropractic Oversight Advisory Committee. Later, there was a proposed version of the 2005 NDAA that included adding chiropractic care at Robins, but it did not make the final approved 2005 NDAA.
Finally, to date, DoD has made no changes to its current policy regarding TRICARE benefits to military personnel at Robins AFB, which does not authorize chiropractic care. Therefore, the 78th Medical Group will continue operating under the current policy until told otherwise. Thank you for submitting your complaint and showing interest in providing chiropractic care to our military personnel in the Middle Georgia area, but again, unfortunately the care is not a TRICARE covered benefit. This case is closed.
Sincerely
3/23/2020XGARRETT GORDON
GARRETT GORDON, NH-03, DAF
Director Complaints Resolution
Signed by: GORDON.GARRETT.1064631485
GARRETT GORDON, NH-03, DAF
Director Complaints Resolutions, 78 ABW/IGQ
[1] https://files.acrobat.com/a/preview/7aeab451-93c0-4acc-bc16-51ccd53f97c5
[2] The Oversight Advisory Committee was renamed Chiropractic Health Care Benefits Advisory Committee (CHCBAC).
[3] https://files.acrobat.com/a/preview/6b0a2591-03cb-4dcb-8868-c73af863b50d
[4] https://files.acrobat.com/a/preview/1f5e926b-1b11-4fb8-9761-af381f3a4890
[5] Appendix B of the Evaluation of the Chiropractic Care Program Implementation, p. 21