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By Carol Rados
There's a little-known secret about the Public Health Service (PHS): its Commissioned Corps is one of the seven uniformed services that protect the United States. But unlike the Army, Navy, Air Force, Marine Corps, Coast Guard, and National Oceanic and Atmospheric Administration Commissioned Officer Corps, the PHS Commissioned Corps' all-officer organization is composed entirely of health professionals who, though unarmed, fight an often elusive and deadly enemy.
For more than a century, men and women of the PHS Commissioned Corps have served on the front lines of the nation's health defenses, alongside their military counterparts, safeguarding a fundamental aspect of national security--the public health. Commissioned Corps officers regularly participate in international relief efforts as well, having battled everything from infectious diseases such as smallpox through massive vaccination campaigns, to infant mortality on Indian reservations through the education of expectant mothers. Officers recently have assisted in developing a new health care system in Afghanistan.
Today, Corps officers from eight PHS agencies, including the Food and Drug Administration, are battling AIDS, cancer, drug abuse, product tampering, and other health issues requiring specialized skills. This kind of combat requires officers to use their professional training in medicine, dentistry, sanitation, social work, and other health disciplines in the fight to promote good health and minimize disease and suffering.
"Some of the best people we have today in FDA are in the Corps," says Acting FDA Commissioner Dr. Lester M. Crawford. In addition to ensuring safe and effective drugs and medical devices and educating the public about health matters from their offices at FDA headquarters, this medical militia is ready to respond to public health needs anywhere in the United States or around the world in times of war or other emergency.
"Deploying members of the Corps was a big part of what the Department of Health and Human Services and the FDA contributed to the aftermath of 9/11," Crawford says.
The PHS can trace its origins back to 1798, when Congress passed an act to provide for the care and relief of sick, destitute merchant seamen. The result of the act was a network of hospitals that eventually came to be known as the Marine Hospital Service. In 1870, the service was reorganized with its headquarters in Washington, D.C., and the following year the first Supervising Surgeon--now called the Surgeon General of the United States--was appointed.
In 1889, Congress established the Commissioned Corps to ease health care personnel shortages in the nation's hospitals. Officers were commissioned as a nonmilitary service with a distinct uniform and insignia, and with titles, pay, and retirement systems that corresponded to those of the military services. Eventually, members of the Commissioned Corps became a mobile force of health professionals subject to reassignment in order to meet the needs of the PHS.
Originally, the Corps was composed only of physicians. Over the years, as the functional responsibilities of the PHS and the Corps have broadened, so has the range of health professions represented. In addition to medical doctors, the PHS currently commissions 10 other categories of health professionals: pharmacists, dentists, nurses, engineers, scientists, veterinarians, environmental health officers, dietitians, therapists, and health service officers. The health service officer category includes social workers, optometrists, computer scientists, and medical records administrators.
The responsibilities of the service expanded in the late 19th century to include public health measures such as quarantine and the medical inspection of immigrants. The Marine Hospital Service became the Public Health and Marine Hospital Service in 1902, and a decade later, the name was changed to the Public Health Service. With the expansion of its public health activities throughout the 20th century, the PHS today is a principal part of the Department of Health and Human Services (HHS) and a major health agency within the federal government.
Currently commanded by Vice Adm. Richard H. Carmona, M.D., M.P.H., surgeon general of the United States, the Commissioned Corps is an elite group of expert, diverse, and flexible public health professionals who can respond quickly, on the surgeon general's activation, to both immediate and long-term health needs. Some of those needs include increasing preparedness for public health emergencies, reducing health disparities, and developing strategies to prevent or reduce the incidence of chronic diseases.
Their uniforms and their readiness for immediate deployment are what set Commissioned Corps officers apart from the other doctors, nurses, dieticians, and scientists who are their civil service counterparts at the FDA and other PHS agencies.
Drawing on the expertise of PHS officers like Rear Adm. Marlene E. Haffner, M.D., M.P.H., an assistant surgeon general and director of the FDA's Office of Orphan Products Development, Carmona says, "I rely on the breadth and depth of experts like Marlene. And, no matter what issue confronts me," he adds, "I can pick up the phone at any time and talk to the world leaders in public health."
Rear Adm. Steven K. Galson, M.D., M.P.H., an assistant surgeon general and acting director for the FDA's Center for Drug Evaluation and Research, says that the Commissioned Corps, for him, has been "a great career developer." The beauty of the Corps, Galson says, is that it has enabled him to move from job to job over the years "on one piece of paper"--indicating the ease with which an officer can transfer. "You're considered to be a stronger officer if you've had a lot of mobility," he says.
The choice to enter the Commissioned Corps instead of the civil service system depends on a number of factors, including type of assignment, needs of the program in which the assignment is located, and a health professional's personal interest and desires, training, and experience. All told, the PHS has about 6,000 Commissioned Corps officers and 51,000 civil service employees.
Rear Adm. Mary Pat Couig, chief professional officer for the nursing category and also an assistant surgeon general, advises Commissioned Corps candidates to "make sure that the Corps explains the expectations of being an officer in a uniformed service, and that it is a good fit." Potential officers, she says, "need to be willing to accept response-readiness," a now-mandatory requirement for Corps members to be trained and then available to act on a moment's notice. Couig is assigned to the FDA's Office of Orphan Products Development.
About 700 of the FDA's 10,000 employees wear the PHS Commissioned Corps uniform, continuing the long tradition of promoting the public health in the United States. Officers today wear uniforms that closely resemble those of the Navy--but with a unique Corps insignia--and hold rank similar to that of naval officers, such as lieutenant, commander, captain, and admiral.
In July 2003, HHS embarked on an ambitious, ongoing process that Secretary Tommy G. Thompson called "the biggest and most sweeping transformation in the history of the Corps." Anticipating that Corps members would be needed to respond to the challenges of the 21st century, Thompson said the plan includes scholarships to recruit as many as 1,000 nurses and 100 doctors per year to work in medically underserved areas. Additional short-term duty missions to address presidential and HHS initiatives, such as childhood immunizations, diabetes detection, terrorist attacks, and the recruitment of several hundred new officers to support the Indian Health Service, also are part of the plan.
The transformation phases out the former Commissioned Corps Readiness Force structure that consisted of mostly voluntary deployments, and replaces it with a revised system designed to bring the status of the Commissioned Corps to a mandatory 100 percent deployability by the end of 2005.
"As we stare into an uncertain future of possible terrorist attacks, natural disasters, and emerging infectious diseases, the president and the American people must know they can depend on their Public Health Service to aid them in times of need," Thompson says. And they will be ready to act on a moment's notice. Thompson also stated that no one is better suited to respond to such needs than the officers of the Commissioned Corps. "The Corps has always been able to adapt to the urgent needs of each generation."
While most people agree that modernizing the Corps is important, some worry that the transformation may jeopardize the essential work that the PHS agencies do on a daily basis. Deploying health officials who hold key positions in science-based agencies such as the FDA, according to some in Congress, could thin the ranks of experts needed to combat health threats within the United States, or take away resources from tasks like new drug reviews.
Carmona has assured critics that "no officers would be deployed to achieve mission objectives that are not congruent with the officer's skills, competencies, and physical capabilities." He also advocated a process of transforming the Corps that is inclusive, open, and transparent. Carmona calls the transformation a work in progress. "We're triaging right now because we don't have enough officers," he says. The transformation means "we're defining jobs that are unique and specific to the PHS offices and their needs."
As of September 2004, more than 2,000 officers had met the basic readiness standards established for an immediate response.
Cmdr. Hung Trinh was the last to arrive in Guam and the last to leave the island in the western Pacific, accompanied only by a laptop strapped to his back and a small suitcase by his side. A biomedical engineer, Trinh was deployed in January 2004 in response to a request by the island's governor, who had declared a state of emergency at Guam's only hospital.
An unusually high number of premature births over a five-day period had overwhelmed the resources of the neonatal intensive care unit (NICU) at Guam Memorial Hospital, which was still recovering from a recent typhoon. Health care providers at the hospital found that nearly half of the mothers from Guam and the neighboring Northern Mariana Islands had not received a prenatal evaluation when they arrived.
"They literally showed up at the door at delivery time," says Trinh. Although the U.S. Navy on Guam and Okinawa was able to provide some support, the military lacked adequate resources to properly address the needs of the hospital.
The hospital's NICU was designed to accommodate only six babies. But 11 of the 16 premature infants delivered at that time needed life-saving ventilators. "What impressed me the most was the resourcefulness of the staff," Trinh says. The island is far removed from land, and acquiring services is a constant challenge. In addition, the prospect of rebuilding from typhoon damage every year, he says, is very real. Out of necessity, the Commissioned Corps members and hospital staff that made up the biomedical team developed in-house expertise to conduct many of the services that normally would be done elsewhere. "It gives me great pride to be able to serve as a Public Health Service officer," he says.
After nine days in the NICU, just three of the 16 premature babies remained, while the others were either transferred or sent home because they had improved. By the end of the PHS mission, new prenatal monitors, incubators, and ventilators had been installed, successfully tested, and calibrated. And the capacity of the NICU at Guam Memorial Hospital had been doubled.
Trinh was nominated for a Crisis Response Service Award for his work in Guam. "But the real unsung heroes in my mind are the hospital staffs that take on adversities with such a great positive attitude," the FDA project officer says.
After Washington, D.C., and other U.S. cities were placed on heightened alert status in August 2004, Lt. Lori Garcia, a regulatory project manager in the FDA's Center for Drug Evaluation and Research, was deployed to the HHS Secretary's Operations Center (SOC) in Washington, D.C., to assist the regular staff.
The SOC functions as an information and operations center that provides a focal point for information collected, analyzed, and shared; command and control; communications; and specialized technologies for all HHS agencies under emergency and non-emergency conditions.
"The Secretary of Health and Human Services, Tommy Thompson, is the ultimate consumer of all this information," Garcia says. The mission of the center is to ensure that the secretary is provided with the accurate high-quality information needed to gain knowledge of operations, make sound strategic decisions, and coordinate actions with other federal partners. The SOC is required to maintain a high state of readiness for a variety of scenarios, including tracking the status of chronic diseases, monitoring the spread of epidemics, and executing important emergency procedures.
Although Garcia says the recent series of hurricanes was over by the time she got to her post, "It was an excellent opportunity to observe and learn about how the Secretary's Operations Center monitors elements of potential negative impact upon public health and coordinates the Department of Health and Human Services' response to natural and man-made disasters." Garcia says she studied manuals, triaged phone calls, and simply remained prepared to act during her two-week deployment.
Lt. Phelicia Bush is trained as a pharmacist and works as an FDA drug reviewer. But she's waiting for a call to serve as a PHS liaison between state officials, non-government agencies, and HHS. In this role, Bush would provide briefings to officials at all levels and be responsible for representing the interests of the deployment-ready Commissioned Corps officers and HHS. She is currently in line for duty, and she is eagerly awaiting her first deployment.
October 2004 was her roster month, which meant that if any deployments came up, she would be one of the first to be called. "Fortunately for the country," she says, "there weren't any events requiring the activation of the Corps that month."
Bush is currently wrapping up the last leg of her training--deployment readiness--saying that it "is a way to stay in shape for the rest of your life." Besides fitness, there are Web-based training "modules" that all officers are required to complete before they can become certified and ready to deploy. The modules include lectures, slides, and exams, and cover everything from techniques to deal with stress to personal family preparedness, "in case you get a call to go in the middle of the night," Bush says.
The Commissioned Corps often participates in lesser-known relief efforts that require officer expertise, such as the recent funeral for President Ronald Reagan. Officers were on hand to head off any public health hazards for the large crowds waiting in the heat to view the event.
PHS Commissioned Corps Web site
Agency for Healthcare Research and Quality (AHRQ)--supports research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services.
Agency for Toxic Substances and Disease Registry (ATSDR)--prevents exposure and adverse human health effects and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment.
Centers for Disease Control and Prevention (CDC)--promotes health and quality of life by preventing and controlling disease, injury, and disability.
Food and Drug Administration (FDA)--assures that foods are safe and wholesome, cosmetics and radiation-emitting products won't harm people, and medicines, biologics, medical devices, and veterinary products are safe and effective. The FDA monitors the manufacture, import, transport, storage, and sale of about $1 trillion worth of products each year.
Health Resources and Services Administration (HRSA)--assures that everyone has equitable access to comprehensive, quality health care. Improves and extends life for people living with HIV/AIDS, and provides primary health care to medically underserved people.
Indian Health Service (IHS)--provides comprehensive health care services, including preventive, curative, rehabilitative, and environmental, to American Indians and Alaska Natives who belong to more than 550 federally recognized tribes in 35 states.
National Institutes of Health (NIH)--uncovers new knowledge that will lead to better health. With its 27 institutes and centers, the NIH is one of the world's foremost medical research centers and is the federal focal point for medical research in the United States.
Substance Abuse and Mental Health Services Administration (SAMHSA)--improves the quality and availability of prevention, treatment, and rehabilitative services in order to reduce illness, death, disability, and cost to society resulting from substance abuse and mental illnesses.