Q&A: Rear Admiral Richard R. Jeffries

Warrior Doc
Ensuring the Best Health Care for the Marine Warrior Everywhere



Rear Admiral Richard R. Jeffries
Medical Officer of the Marine Corps

Rear Admiral Richard R. Jeffries began his naval career in 1976 through the Armed Forces Health Professional’s Scholarship Program. He earned a B.A. from Coe College in Cedar Rapids, Iowa, and completed graduate studies at the University of Colorado in secondary education, earning a State of Colorado teaching certificate. He graduated from the College of Osteopathic Medicine and Surgery in Des Moines, Iowa, in 1979.

He completed an internship and family medicine residency at Naval Hospital Pensacola, Fla., in 1982 and immediately attained Board Certification from the American Board of Family Practice. His first staff assignment was to Branch Naval Hospital Twentynine Palms, Calif. He received appointments as head, Family Practice Department, acting director, clinical services, and chief, medical staff.

In August 1984 he was transferred to the Department of Family Medicine at Naval Hospital Camp Pendleton, Calif. He served as a staff family physician, residency faculty and clinic director. In 1986 he was promoted to director, residency training. During this period, he attained Board Certification in family practice from the American Osteopathic Board of General Practice and Fellow, American Academy of Family Physicians. In 1990 he challenged and passed Board Certification for a Certificate of Added Qualification in geriatric medicine. He is a member of the American Academy of Family Physicians, Association of Military Osteopathic Physicians and Surgeons (past president), Uniformed Services Academy of Family Physicians, American Osteopathic Association, and the Association of Military Surgeons of the United States.

In August of 1990 he served in Operation Desert Shield where he was augmented to the 1st Marine Division as artillery regimental surgeon, 11th Marines. In theater he was appointed deputy then acting division surgeon. In 1991 he was permanently assigned to the 1st Marine Division as division surgeon. In December 1992 he was appointed Marine Forces Central Command and I Marine Expeditionary Force (Forward) force surgeon for Operation Restore Hope, Somalia, responsible for U.S. military forces support to the coalition health care mission.

In the summer of 1993 Jeffries was re-assigned to Naval Hospital Camp Pendleton as Family Practice Department head and Residency Program director. In 1996 he was appointed chairman, executive committee of the medical staff and he completed his tour as director, medical services. In October 1998 he reported to Marine Forces Pacific, Camp Smith, Hawaii, as the force surgeon. He was appointed to the TRICARE Pacific Executive Council and served as a military liaison to the Hawaii State Chapter American Red Cross Board of Directors. In April 2000 he assumed duties as the deputy commander for clinical services at Tripler Army Medical Center where he served until April 2003 when he assumed command at Naval Hospital Camp Pendleton. In August 2005, he reported to the Bureau of Medicine and Surgery as the deputy chief for future plans and strategies. Soon after his arrival, Jeffries was deployed as the JFMCC surgeon in support of Hurricane Katrina Relief efforts. In November 2005, he reported to headquarters, U.S. Marine Corps as the medical officer of the Marine Corps.

Jeffries’ personal decorations include the Legion of Merit with two Gold Stars, Bronze Star, Meritorious Service Medal with one Gold Star, Combat Action Award, Joint Meritorious Unit Award, Navy Unit Commendation, Meritorious Unit Commendation with one Bronze Star, Army Order of Military Medical Merit, and Artillery Order of Saint Barbara.

Interviewed by MMT Editor Jeff McKaughan

Q: Good afternoon, Admiral Jeffries. I’d like to ask you to start off with a general overview of the status of Marine health care.

A: Thanks. A few comments will help provide a foundation for the rest of the interview.

The United States Marine Corps and Navy medicine continues to do everything it can to take care of its Marines and sailors. I want to assure the families of deployed Marines and sailors that we are committed to ensuring their loved ones receive the very best medical care if they are wounded or become ill. The Marine Corps has always emphasized taking care of their own, and this is epitomized by the high priority they place on quality health services.

The focus is not only on casualty care but prevention, protection and preparedness of the force to ensure we have healthy, fit and resilient Marines and sailors at the front in our global war on terrorism.

I want to emphasize how very proud I am of our Navy medical personnel who have served or are serving today with Marine Corps units around the world. Their dedication, sacrifice, and selfless devotion to duty are making a significant difference in the lives of the Marines they serve. On Veteran’s Day this year, I ask everyone to honor the memory of those military medical personnel that have made the ultimate sacrifice for our nation. By honoring the memory of their selfless sacrifice we pay tribute to the values, character and commitment that have always set the Marine’s Doc and our other military medical personnel far above their peers.

Q: How much of Marine health care is provided directly by the USMC and how reliant on the Navy are you?

A: All health care provided in Marine Corps medical and dental units is provided by Navy medical personnel. However, the Marine Corps is responsible for determining the health services concepts, policies, doctrine, capabilities and training standards for its organic medical units.

An analogy may help to explain this relationship. The Marine Corps has chosen to obtain its medical and dental personnel from the Navy, but it determines how health services are deployed and what capabilities are required to support the Marine Corps forces. Health service support for our operating forces epitomizes the essential elements of the Navy-Marine Corps team, and is often used as an example to highlight the tremendous value this synergistic relationship can obtain. The Marine Corps relies on the Navy to provide fully trained and deployable medical personnel to staff their organic medical units, and while the Marine Corps provides the operational training, medical material and required infrastructure.

For example, Navy medical and dental personnel attend the Marine Corps’ Field Medical Service School to learn the expeditionary culture and organizational structure of the Marine Corps plus the essential skills they need to be effective in austere expeditionary environments. Senior hospital corpsman with extensive field experience with the Marine Corps are the instructors at the Field Medical Service Schools. Navy medicine considers this operational medical mission a special privilege and top priority, a bond historically forged by blood in battle for over 200 years. The Marine Corps also relies primarily upon the Navy to provide deployable theater hospitals, such as their expeditionary medical facilities and hospital ships, to support its operations. We emphasize interoperability with the Navy’s health care assets, and are jointly exploring several means to strengthen this capability.

Q: What do you see as your key challenges for the coming months?

A: Our key short term challenges include improving pre-deployment training of medical personnel and Marines, enhancing our capability to prevent casualties, and improving combat casualty care. Though Marine Corps forces supporting OIF and OEF are reporting historically low rates of disease and non-battle injuries, and high survival rates for our wounded we, can’t let up on our ongoing efforts to improve health service support.

The Marine Corps adopted the tactical combat casualty care guidelines and is emphasizing hands-on pre-deployment training for all medical personnel and designated Marines. The Marine Corps has implemented the combat life saver program to ensure Marines are fully trained as first-responders with the right skills and knowledge. The prevention of casualties is a priority of Marine Corps leadership and includes ongoing efforts to improve personal protective equipment, hardening of vehicles and development of IED countermeasures..

Just prior to OIF, the Marine Corps provided improved bed netting impregnated with permethryn, a highly effective product to protect Marines from disease-carrying insects. In 2004 the Marine Corps implemented a sports medicine and injury prevention program at its entry-level training sites, which has proven very effective in reducing the incidence and healing time of muscularskeletal injuries.

Our short-term efforts to improve combat casualty care are focused having the right health services capabilities forward deployed. We are now capturing detailed information on all our casualties in the Navy-Marine Corps Combat Trauma Registry. We constantly evaluate the health services capabilities our Marine Corps units need to provide required essential care to the injured and ill, and make adjustments based on our experiences and lessons learned. For example, we identified the need for orthopedic surgeons in our surgical companies. They deployed to Iraq in our forward surgical units, and have proven extremely valuable in treating severe extremity wounds from IEDs. Institutionalizing this successful addition by incorporating it into Marine Corps concepts and doctrine is extremely important.  Since early 2004, our deployed health services units have provided detailed information on all Marine Corps casualties in the Navy-Marine Corps Combat Trauma Registry. The ongoing collection and analysis of this information is vital to continuing efforts to improve health service support, and will ensure that enduring solutions in health services’ capabilities are based on actual outcomes data. For example, current efforts to improve our capability in the prevention of combat/operational stress reactions and the diagnosis and treatment of traumatic brain injuries are being supported by the analysis of data in the registry.

Key long-term challenges are fielding an effective DoD-wide electronic medical record, fully embracing interoperability and interdependence, and managing the complex health services issues associated with SSTRO [stability, security, transition and reconstruction operations]. Fielding a DoD-wide electronic medical record will improve the clinical care provided in-theater, and improve communication about the care provided to other medical personnel in-theater and back in CONUS. Success in fielding an electronic medical record is key to ensuring the continuity of care for our injured Marines and sailors, and to ensuring they receive all the DoD and VA benefits they are entitled. Though the Marine Corps has long emphasized joint interoperability and interdependence, several challenges still remain. The Marine Corps supports continued planning for establishing a unified medical command, largely due to the anticipated benefits from increased interoperability across all aspects of military medicine

Q: Earlier you mentioned the combat life saver program; what have the Marines done to push combat casualty care down to the lowest imaginable level with self-aid, buddy-aid and squad-level care? Is there a “what’s next”? How do you improve from where you are now?

A: The Marine Corps has always pushed health services as far forward as possible to provide Marines the best chance of survival. During OIF and OEF the Marine Corps has pushed combat care far forward fielding several improved systems and enhanced capabilities. These enhancements include a new individual first aid kit, vehicle medical kit, QuikClot, one-handed tourniquet, operational stress control and readiness [OSCAR] teams, the Forward Resuscitative Surgery System [FRSS], and new enroute care system [ERCS].

Collectively, these medical programs have strengthened the continuum of care from the point of injury to Level 3 giving an OIF wounded Marine a 97 percent chance of surviving. This survival rate matches that of the best trauma hospitals in the United States and far surpasses the rates recorded for any war or major conflict in history.

The biggest reason for this achievement is the life-saving care provided by individual Marines and Corpsmen at the point of injury, often risking injury to themselves to provide care under fire. Marines are now trained as combat life savers by their unit corpsmen, and special emphasis is given to squad- and companylevel medical support training. Casualty evacuation within minutes to far forward resuscitative surgical facilities where casualties are immediately stabilized before onward evacuation with critical care nursing support continues to save lives.

The remarkably improved military casualty care and patient evacuation system is now delivering critically injured Marines from the point of injury to definitive care in the United States within 36 hours.

Next is refining the system to improve care for certain types of injuries like traumatic brain injury and expanding far forward services as OSCAR is doing for combat/operational stress. As new technology is developed, we will strive to get it to the field for use faster.

Q: What mechanisms do you use to determine your equipment needs and the acquisition process to make sure that the best is available to the soldier at the point of injury as well as the stateside hospital? What are some of your biggest technology needs right now?

A: The Marine Corps Systems Command, with the support of the Marine Corps Warfighting Laboratory, the Office of Naval Research and the Naval Health Research Center has been remarkably successful in ensuring we have the right medical material available to support our deployed forces. The Marine Corps relies on the recommendations of the Defense Medical Standardization Board to determine the best medical equipment to meet our operational requirements.

Since the mid-1990s, the Naval Health Research Center has coordinated periodic reviews to modernize the medical material in our assemblages. Their development and innovative use of modeling tools, such as the Estimating Supplies Program, and the input of experienced subject matter experts is a real success story. Directly linking the clinical tasks performed in our health services units with the medical material in our assemblages has enabled the Marine Corps to significantly improve its capabilities while decreasing the weight and cube of medical material.

Right now our major technological focus is on IED countermeasures and injury reduction and IM/IT systems to achieve a deployable electronic health record.

Q: How do companies—both small and large—do business with Marine Corps health care?

A: Many small companies consistently do business with the Marine Corps. Our medical personnel at the Marine Corps Systems Command interact frequently with representatives from the small companies at trade shows and vendor days like Modern Day Marine.

This provides a valuable opportunity for them to see the latest offerings in medical technology and medical material from the leaders in our civilian health care sector. Most of the medical material we procure for use in our health services units are common items that can be found in most emergency rooms and trauma centers in the United States.

Procuring these commercial-off-the-shelf products, which often come from small companies, helps ensure we have state-ofthe art medical material available to support the care of our injured and ill Marines. This provides a great opportunity for both large and small health care companies to get their FDA-approved products into our deployed health service units for the benefit of the Marines and sailors we support.

Q: Are there any construction projects that will add medical facilities available to support the needs of the Marine Corps?

A: Construction projects for medical facilities on Marine Corps bases and stations are completed by Navy Medicine in coordination with the local installation and operational forces. On the horizon is a new hospital in Okinawa to support III MEF Marines, sailors and their families. There is also a medical facility being constructed to support the new Marine Special Operations Command in the Camp Lejeune, N.C., area.

Q: What mechanisms do you use to track the overall health of the Marine population to look for trends or to detect the early outbreak of problems such as SARS, the bird flu or other similar problems?

A: The Marine Corps has fielded the Medical Readiness Reporting System [MRRS] to track individual medical readiness, and to make this information available to unit leaders at all levels. Our leaders take their responsibility for the health and safety of Marines very seriously, and MRRS provides them an easy-to-use tool to monitor the individual medical readiness of their Marines. Disease surveillance is conducted at the local level in cooperation with the Navy medical facilities on our bases and stations.

In many in-garrison locations, the primary care providers for our units provide sick call information via AHLTA in the clinics to the local Navy hospital. This patient information is then screened for signs and symptoms that may indicate the outbreak of a communicable disease. We’re currently looking to expand this electronic capability to our battalion aid stations through a pilot study at Camp Lejeune by linking into an ongoing Navy medicine study in the Norfolk area.

Most of our surveillance is done by Navy Medicine or DoD. We are one of many source points for their worldwide surveillance systems and rely on their reports for most of our disease surveillance. However, our front line providers are key players in the early identification of a possible infectious disease outbreak, based on their awareness of an increased incidence of symptoms or infections in their units or the local community. Marines are always deployed worldwide and their corpsmen, battalion surgeons, flight surgeons and independent duty corpsmen document clinical findings and forward incident reports and suspicious findings up the chain and into electronic information systems. As a result, the current Marine Corps disease, non-battle injury rate remains at a historic low in southwest Asia and around the world.

Q: There was a large loss—or at best inaccessibility for long periods of time—of medical records as a result of last year’s hurricanes. Not that digital records are immune to loss, but where is the Marine Corps in terms of digitization of its medical records system?

A: The Marine Corps supports DoD’s development and role out of AHLTA—previously CHCS II—the Defense Health Program’s electronic health record and health care monitoring system. Tied with the new DHP clinical data repository and pending Theater Medical Information Program, the Marine Corps will have an electronic health record on every Marine and sailor accessible from anywhere in the world with the proper security and privacy required plus the needed interchange for casualty continuum of care and information transfer between the services and our TRICARE contractors. It will also provide much-needed epidemiological and surveillance data and reporting.

DoD is also working with the VA for a means to rapidly transmit information between the two federal health systems. The Marine Corps piloted a TMIP-Lite, Block 1 application last year in theater and is collaborating with Navy Medicine East for an in-garrison trial deployment of AHLTA at Camp Lejeune.

In addition, we have successfully fielded digital imaging systems to our deployed medical and dental units, and eliminated the hazardous materials associated with our previous X-ray units. There is much still to be done in this area, but I’m confident we’re on the right path to have an electronic medical record system available in garrison and with our deployed forces in the foreseeable future.

Q: How are your people holding up? With the deployments, OPTEMPO and everyday stresses, what are some of the things that Marine medicine is doing to look after its people in personal aspects as well as their professional services?

A: There is no disagreement that the individual Marine’s and sailor’s mettle has been tested by the increased frequency of deployments and OPTEMPO over the past several years.

To ensure that Marines, sailors and their families have access to the proper support services, Marine medicine has partnered with various Marine Corps agencies to be portals for preventive and therapeutic care. The system is extensive involving family services, Marine for Life sources, Navy chaplains and DoD-wide support services that include a new combat operational stress control [COSC] program. Operating in coordination with traditional health care delivered through the TRICARE health care plan, the COSC program provides prevention training, proactive screening, and referral for therapy before, during and after deployment. By starting before deployment, the program educates the servicemembers and their families about the subtle symptoms of stress while setting the baseline.

During and after deployment, components of the program reach out to the deployed members and to their families in response to specific stressors. Key components of the COSC program include pre- and post-deployment health assessment and reassessment processes that actively screen individuals for health concerns that have the potential to worsen over time if not addressed. Web-based technology is being employed as the program matures to bring the questionnaires to the Marine and sailor in a private environment reducing patient concerns about unwanted stigma. If treatment is indicated, therapy can frequently be delivered close to the member’s unit, reserving referral to the larger medical treatment centers for more complex problems. This is a great example of how The Marine Corps and Navy medicine are fully engaged and committed to delivering to our Marines and sailors the care and support they need and deserve for their service to our great nation.

Q: How active is Marine medicine in researching, preparing for and protecting against potential chem/bio threats both at home and deployed?

A: Although Marine medicine is well trained and prepared to provide appropriate treatment during CBRNE events, we primarily rely on the Navy and other DoD, federal, and national resources for health care research in the nuclear, chemical and biological threat response.

Q: There has been a great deal of talk about converting a number of military positions to civilian employees. Will this affect the Marine Corps medical services at all?

A: DoD’s proposal for military-to-civilian conversion of medical personnel does not directly affect the organic health services provided by the Marine Corps. That is to say, none of the medical billets targeted for military-to-civilian conversion are from Marine Corps units. The proposed military-to-civilian conversions will have a much larger impact on the other services.

However, since the Marine Corps relies on the Navy to provide medical personnel for our deployable units, theater hospitalization and for the Navy medical facilities on our bases and stations, we must work with the DoD and the other services for this support. I am concerned that converting too many military medical billets to civilian billets too quickly will negatively impact health services for our returning OIF/OEF casualties and their families that receive their health care at DoD’s CONUS medical facilities. It’s really a question of whether enough civilian medical professionals in the right specialties can be hired and brought onboard quickly enough to support DoD’s proposal, especially in some parts of the country.

Also, a recent GAO report did not find any significant savings associated with the military-to-civilian conversion of medical billets the services have already conducted, and every billet converted decreases the sea-shore rotation opportunities for our sailors.

Q: Is there anything else you would like to add?

A: There is a pressing need to maintain a sufficient numbers of fully trained and ready field medical service technicians, or Fleet Marine Force corpsmen, to support our Marine Corps operational units. Ongoing operations require large rotations of FMF corpsmen every year.

Repetitive rotations to OIF and OEF are starting to cause stress on the FMF corpsman community. Furthermore, Navy corpsmen are suffering war injuries at the same rate as the Marines they serve beside and care for. We have been working diligently with the Navy’s Bureau of Medicine and Surgery and the chief of naval personnel to ensure adequate recruitment, retention, and throughput of general duty corpsmen at our field medical service schools.

Institutionalizing our recent gains in pre-deployment training, casualty prevention and combat casualty care are needed. Though Marine forces supporting OIF and OEF have achieved historically low rates of disease, non-battle injuries and survival from wounds, we must not rest on our laurels. We are moving forward with more effective just-in-time medical training for our deploying units and expanding combat life saver training for our Marines. In addition we need a standardized way of screening, determining disposition and diagnosing/treating possible traumatic brain injury [TBI] casualties in our forward-deployed medical facilities.
 
We’re developing medical guidelines for the diagnosis and treatment of TBI casualties, in conjunction with the Defense and Veterans Brain Injury Center. Navy medicine recently held a TBI summit at our request and DoD is chartering an interdisciplinary product team for a DoD-wide improvement program. More research with the VA and civilian experts is needed and Congress has increased research support for the DoD-VA Brain Injury Center programs. ♦

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