B-127166, APR 23, 1956

B-127166: Apr 23, 1956

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WAS NOTIFIED THAT CREDIT WOULD BE WITHHELD FOR $150. THE DISBURSING OFFICER WAS ADVISED. THAT MEDICAL CARE OF THE DEPENDENTS BY A CIVILIAN PHYSICIAN AT GOVERNMENT EXPENSE WAS NOT AUTHORIZED. SAYS THAT THE MEDICAL SERVICES IN THIS CASE WERE RENDERED AT AN AIR FORCE HOSPITAL AT THE REQUEST OF THE HOSPITAL AUTHORITIES AND HE INDICATES THAT THE SERVICES WERE NECESSARY TO SAVE LIFE AND PREVENT SUFFERING. HE SAYS FURTHER THAT DEPENDENT MEDICAL CARE IS AUTHORIZED BY THE ACT OF JULY 5. AS AUTHORIZING COST-FREE CONSULTANT SERVICES WHEN REQUIRED FOR DEPENDENTS WHO ARE PATIENTS IN AIR FORCE HOSPITALS. THE MENTIONED "DEPARTMENTAL POLICY" APPEARS TO BE THAT WHICH IS INDICATED IN A MESSAGE FROM THE SURGEON GENERAL TO ALL MAJOR COMMANDS AS FOLLOWS: "FROM AFCSG-34.3 ALMAJCOM 485/56 IT IS BROUGHT TO THE ATTENTION OF ALL CONCERNED THAT REQUIRED AUXILIARY MEDICAL CARE CMM AS AUTHORIZED BY THE HOSPITAL COMMANDER CMM FOR PATIENTS ADMITTED TO USAF MEDICAL TREATMENT FACILITIES UNDER THE PROVISIONS OF AFR 160-73 IS THE RESPONSIBILITY OF THE AIR FORCE AND IS PROPERLY PAYABLE FROM P478 FUNDS.

B-127166, APR 23, 1956

PRECIS-UNAVAILABLE

SECRETARY OF THE AIR FORCE:

WE WANT TO BRING TO YOUR ATTENTION A MATTER WHICH HAS COME TO LIGHT IN THE COURSE OF OUR AUDIT AT THE AIR FORCE AUDIT BRANCH, DENVER, COLORADO.

BY NOTICE OF EXCEPTION NO. 510818, DATED SEPTEMBER 23, 1954, MAJOR A.P. BLUE, USAF, SYMBOL NO. 225-064, WAS NOTIFIED THAT CREDIT WOULD BE WITHHELD FOR $150, PAID ON VOUCHER NO. 14671 IN HIS MARCH 1954 ACCOUNTS, TO HENRY C. FRECH, M.D., A CIVILIAN PHYSICIAN, FOR MEDICAL TREATMENT RENDERED THE DEPENDENT OF THREE AIRMEN. THE DISBURSING OFFICER WAS ADVISED, IN SUBSTANCE, THAT MEDICAL CARE OF THE DEPENDENTS BY A CIVILIAN PHYSICIAN AT GOVERNMENT EXPENSE WAS NOT AUTHORIZED.

IN LETTER OF FEBRUARY 10, 1956, THE VICE-COMMANDER, AIR FORCE FINANCE CENTER, SAYS THAT THE MEDICAL SERVICES IN THIS CASE WERE RENDERED AT AN AIR FORCE HOSPITAL AT THE REQUEST OF THE HOSPITAL AUTHORITIES AND HE INDICATES THAT THE SERVICES WERE NECESSARY TO SAVE LIFE AND PREVENT SUFFERING. HE SAYS FURTHER THAT DEPENDENT MEDICAL CARE IS AUTHORIZED BY THE ACT OF JULY 5, 1884, 23 STAT. 112, 10 U.S.C. 96, AND CITES CERTAIN PROVISIONS CONTAINED IN AIR FORCE REGULATIONS 160 97, JUNE 25, 1951, 160- 114A, NOVEMBER 15, 1954, AND 160-35, DATED NOVEMBER 5, 1953, AS AUTHORIZING COST-FREE CONSULTANT SERVICES WHEN REQUIRED FOR DEPENDENTS WHO ARE PATIENTS IN AIR FORCE HOSPITALS.

IN SUCH CIRCUMSTANCES, AND ON THE BASIS THAT, UNDER DEPARTMENTAL POLICY, LOCAL CIVILIAN SPECIALISTS MAY IN CERTAIN SITUATIONS BE CALLED IN BY THE HOSPITAL COMMANDER FOR CONSULTATION, AND THAT PAYMENT OF CHARGES FOR SUCH SERVICE REGULARLY HAS BEEN MADE BY THE AIR FORCE IN CASES CONCERNING DEPENDENTS, THE VICE-COMMANDER REQUESTS THAT THE EXCEPTION IN THIS CASE BE REMOVED.

THE MENTIONED "DEPARTMENTAL POLICY" APPEARS TO BE THAT WHICH IS INDICATED IN A MESSAGE FROM THE SURGEON GENERAL TO ALL MAJOR COMMANDS AS FOLLOWS:

"FROM AFCSG-34.3 ALMAJCOM 485/56 IT IS BROUGHT TO THE ATTENTION OF ALL CONCERNED THAT REQUIRED AUXILIARY MEDICAL CARE CMM AS AUTHORIZED BY THE HOSPITAL COMMANDER CMM FOR PATIENTS ADMITTED TO USAF MEDICAL TREATMENT FACILITIES UNDER THE PROVISIONS OF AFR 160-73 IS THE RESPONSIBILITY OF THE AIR FORCE AND IS PROPERLY PAYABLE FROM P478 FUNDS.

THIS FACT IS SET FORTH IN AFR 160-114 SPECIFICALLY WITH REFERENCE TO FULL REIMBURSEMENT PATIENTS CMM INTERSERVICE PATIENTS CMM DEPENDENT PATIENTS CMM EXEMPT PATIENTS CMM AND SPECIAL REIMBURSEMENT PATIENTS. THIS REGULATION STATES THAT THE INPATIENT PER DIEM RATE QUOTE COVERS ALL COSTS OF HOSPITALIZATION CMM INCLUDING SUBSISTENCE CMM EXPENSIVE DRUGS OR MEDICINES CMM FEES FOR CONSULTANTS CMM BLOOD DONATIONS CMM SPECIAL NURSING CMM AND SO ON CMM AND COVERS PROSTHETIC APPLIANCES WHEN FURNISHED INCIDENT TO THE CONDITION FOR WHICH THE PATIENT IS HOSPITALIZED. UNQUOTE IT IS REQUESTED THAT THIS INFORMATION BE EMPHASIZED FOR THE BENEFIT OF ALL MEDICAL AND FINANCE OFFICERS WITHIN ALL COMMANDS."

THIS INDICATES A VIEW ON THE PART OF THE AIR FORCE MEDICAL AUTHORITIES THAT CIVILIAN MEDICAL TREATMENT OBTAINED BY A HOSPITAL COMMANDER FOR DEPENDENT PATIENTS AND RENDERED IN THE HOSPITAL IS TO BE REGARDED AS CARE AVAILABLE AT THE FACILITY; AND, THEREFORE, THAT THERE ARE NOT FOR APPLICATION IN SUCH CASES THOSE PROVISIONS OF AIR FORCE REGULATION 160-73, AS AMENDED BY CHANGE NO. AFR 160-73A, JULY 19, 1954, TO THE EFFECT THAT EXPENSES FOR DEPENDENT MEDICAL CARE REQUIRED TO SUPPLEMENT CARE AVAILABLE AT THE AIR FORCE MEDICAL FACILITY WILL BE THE PERSONAL FINANCIAL RESPONSIBILITY OF THE DEPENDENT OR THE PRINCIPAL AND THAT CIVILIAN MEDICAL CARE AT THE EXPENSE OF THE AIR FORCE IS NOT AUTHORIZED.

THE STATUTORY AUTHORITY OF THE DEPARTMENT OF THE AIR FORCE TO PROVIDE MEDICAL CARE FOR DEPENDENTS OF AIR FORCE PERSONNEL IS CONTAINED IN THE CITED ARMY ACT OF JULY 5, 1884, WHICH PROVIDES THAT:

"THE MEDICAL OFFICERS OF THE ARMY AND CONTRACT SURGEONS SHALL WHENEVER PRACTICABLE ATTEND THE FAMILIES OF THE OFFICERS AND SOLDIERS FREE OF CHARGE."

THAT STATUTE AUTHORIZES COST-FREE MEDICAL CARE ONLY BY "MEDICAL OFFICERS" AND "CONTRACT SURGEONS." CIVILIAN PHYSICIANS AND SURGEONS ARE NOT MENTIONED. AND, WHILE MILITARY MEDICAL FACILITIES HAVE BEEN REGARDED AS AVAILABLE FOR THE HOSPITALIZATION OF DEPENDENTS, APPROPRIATIONS HAVE NEVER BEEN MADE AVAILABLE FOR THE PAYMENT OF FEES CHARGED BY CIVILIAN PHYSICIANS FOR SERVICES RENDERED DEPENDENTS OF MILITARY PERSONNEL. OBVIOUSLY, THE FACT THAT THE SERVICES OF A CIVILIAN PHYSICIAN MAY BE RENDERED IN A MILITARY MEDICAL FACILITY DOES NOT CONSITUTE SUCH PHYSICIAN A "MEDICAL OFFICER" OR AFFECT THE CHARACTER OF SUCH SERVICES AS CIVILIAN MEDICAL CARE. HENCE, TO THE EXTENT THAT AIR FORCE REGULATIONS AND DIRECTIVES PURPORT TO AUTHORIZE, AT THE EXPENSE OF THE GOVERNMENT, THE TREATMENT OF DEPENDENTS BY CIVILIAN PHYSICIANS IN AIR FORCE MEDICAL FACILITIES, SUCH REGULATIONS AND DIRECTIONS HAVE NO LEGISLATIVE SANCTION AND APPROPRIATED FUNDS ARE AVAILABLE FOR THE PAYMENT OF THE EXPENSES OF SUCH TREATMENT.

IT APPEARS THAT THE CIVILIAN MEDICAL CARE FOR WHICH PAYMENT WAS MADE IN THIS CASE WAS OBTAINED BY THE HOSPITAL COMMANDER WITHOUT CONSULTING THE DEPENDENTS AND PRINCIPALS CONCERNED. THE GOVERNMENT, HOWEVER, WAS NOT LEGALLY OBLIGATED TO PAY THE EXPENSES INCURRED, AND THERE APPEARS TO BE NO BASIS UPON WHICH WE MAY REMOVE THE EXCEPTION. APPROPRIATE STEPS SHOULD BE TAKEN ACCORDINGLY TO RECOVER FROM THE PAYEE THE AMOUNT PAID ON THE VOUCHER. ALSO, IT IS SUGGESTED THAT APPROPRIATE ACTION BE TAKEN TO PREVENT SIMILAR PAYMENTS IN THE FUTURE.