The Foreign Service Journal, September 2010

S E P T E M B E R 2 0 1 0 / F O R E I G N S E R V I C E J O U R N A L 19 signment would be curtailed, and she would be sent to the United States or another post where treat- ment was available. Once that hap- pened, the patient would no longer be eligible for per diem to cover ho- tels or meals, and would have to cover the cost of all medical treat- ment not covered by her insurance. This past spring, the American Foreign Service Association asked members to share their opinions about the Office of Medical Services as part of a general survey of active-duty State Department members. While most respondents said they had received high-quality treatment, many raised concerns about MED’s dual role: providing health care treatment to Foreign Service mem- bers while at the same time evaluating their fitness for duty. They contend that this creates an untenable conflict of interest. “The bottom line is that MED’s portfolio combines functions that should not necessarily be com- bined,” says Daniel M. Hirsch, the State Department vice president for the American Foreign Service Association. “Ultimately, the Office of Medical Services has exactly one patient: the U.S. Department of State. Where your health care needs coincide with keeping the Department of State healthy, they are there to take excellent care of you. But where your health care needs are perceived as making State unhealthy, one of MED’s roles is to tag you for removal. It’s a very un- clear line, and it’s very subjective.” As Hirsch notes, some agencies —with comparably im- portant jobs — do things differently and, in his view, bet- ter. The Central Intelligence Agency, for instance, maintains two separate groups of psychiatrists: one to treat F O C U S Do you have Earn reward points when using an SDFCU Credit or Debit Card*. Visit www.sdfcu.org/flexpoints to learn more. *Signature transactions only. Points? The number of Foreign Service employees evacuated from posts for medical reasons has doubled from 600 in 2002 to about 1,200 last year.