Pentagon plans draft of medics

WASHINGTON - The Pentagon is firming up a plan to draft thousands of doctors, nurses and other health-care specialists in the event of a worst-case crisis.

The Selective Service System is dusting off its plan for a "health care personnel delivery system," which has been on the shelf since Congress authorized it in 1987 to cope with military casualties from a large-scale biological or chemical attack.

At the Pentagon's direction, the agency also is examining whether that plan for a "special skills" draft could be adapted to address critical shortages that might arise for military linguists, computer experts or engineers.

"We're going to elevate that kind of draft to be a priority," Lewis Brodsky, acting director of Selective Service, says.

The plan would be needed if an attack on U.S. troops overwhelmed the capabilities of the military to care for its wounded.

The president would issue a proclamation ordering an estimated 3.5 million health-care workers to register for a draft within 13 days. Congress would quickly enact legislation authorizing the draft for health-care workers 20 to 44. For the first time, a draft would include women.

The Pentagon would tell Selective Service how many people it needed in each of 62 specialties. A separate draft lottery would be held for each of those needs.

For example, if 300 orthopedic surgeons were required, Selective Service would choose birthdays in a random lottery and order those dates from 1 to 365. Notices would go out to the surgeons, starting with the first birthday drawn, until 300 had been called.

The Pentagon expects that within several months of the crisis, Selective Service could deliver surgeons, nurses, dentists, X-ray technicians, etc. -- up to an estimated 80,000 in all -- through the Military Entrance Processing Command.

"If you were to ask 10 doctors, maybe one might have heard something about it," said Dr. Marybeth McCall, chief medical officer at Crouse Hospital in Syracuse, N.Y., and an Air Force veteran.

McCall said she was confident that health professionals would volunteer their services in the event of a large-scale emergency, much as they did during Operation Desert Storm and the Sept. 11 attacks.

"I would say it would be ill-advised to force a draft," she said. "Health-care personnel commit to a life of service. We're going to take care of patients wherever they happen to be."

Congress ordered up the plan in the late 1980s, thinking more about Cold War dangers than about an Iraqi dictator who might unleash weapons of mass destruction against U.S. troops. Pentagon officials say they see no need for a conventional draft of young men to be soldiers.

Brodsky said the plan has moved to the front burner because of recent signals from the Pentagon and conversations with military leaders.

Selective Service maintains 2,000 active draft boards around the country that would handle appeals for exemptions, deferments and postponements.

Members of those draft boards can expect to be trained in the near future on a special "essentiality" exemption that health-care workers might seek, Flahavan said. A doctor might be able to show, for example, that he or she is essential to a community and should not be drafted.

Are Health Care Professionals Subject to the Draft?

Questions and Answers About The Health Care Personnel Delivery System

In response to Department of Defense concerns about potential shortfalls of health care personnel, legislation was introduced in 1987 to register medical specialists. That legislation was soon replaced with instructions for Selective Service to design a Health Care Personnel Delivery System, PL 100-180, which amended the Military Selective Service Act in December 1987.

The Health Care Personnel Delivery System (HCPDS) would be an annex to the regular conscription system under the Military Selective Service Act. It is a very different proposal from the Doctors' Draft, which expired in 1973.

Selective Service first published the first HCPDS concept paper in August 1989. That proposal has now been reissued in greater detail and with a few changes reflecting the critique Selective Service received in 1989. The concept paper is not yet law, though changes in the proposal are not likely without strong leadership from the medical community.

There is no draft operating now. Although the statute and regulations for a draft are in place, the President's induction authority expired in July 1973. The only part of a draft which is currently operating is draft registration, which is required of young men between the ages of 18-25.

At this time, Selective Service has no statutory authority to draft medical personnel. That authorization would be provided by legislation to be introduced and passed in Congress at the time of a national defense mobilization. That "M-Day" legislative package has not been made available for public comment or Congressional debate.

Can Selective Service start registering and drafting at any time?

No. The proposal is not yet law. It would require authorizing legislation, as well as implementing regulations. Selective Service says it will be kept "on the shelf" to be implemented when needed.

Are all medical personnel vulnerable?

Yes. The Health Care Professionals Delivery System would register and conscript sixty-two categories of medical specialists. They range from orthopedic surgeons to animal care technicians—doctors, nurses, medical specialists of all types.

Can I be drafted if I am fifty years old?

Yes. In this concept, Selective Service projects taking people through age 55.

Are students in the health care professions subject to the draft?

When students complete their qualification for their specialty, they will be required to register and will be subject to this medical specialists draft. In the meantime, if they are subject to the regular draft they could be inducted or deferred under the regulations already in place.

Are women included?

Yes. Selective Service proposes that women be included, since the service they provide is non-combatant. The current exclusion of women from the draft would be amended in the statute.

How likely is it that this proposal will ever be implemented?

It depends on how long and how big a war is, and how many casualties are predicted or eventuate. CCW believes that medical specialists will be called well before they ever get around to a general draft. During the Gulf War, health care specialists in the reserves were mobilized first, along with the logistics personnel who got them in place.

If I am registered for the draft already, will I need to register again as a medical specialist?

Yes. The separate register of Health Care Professionals will supersede the other registration. You will be required to provide information about the highest skill level in the health care professions that you have attained. You will still be subject to the regular draft, though you will almost certainly be beyond the age for call-up in the prime selection group of men who turn twenty in the calendar year.

Will there be deferments and exemptions?

As in the regular draft, there will be deferments, but the physical standards for acceptance will be lower.

Who decides who goes?

Selective Service System local draft boards and administrative offices staffed by reservists will decide all claims for postponements, deferments, and exemptions. Physicians’ claims that they are "essential" to their community will be evaluated by advisory boards.

Will there be provisions for conscientious objectors?

The same criteria for conscientious objectors would apply as in the regular draft.

Do conscientious objectors have to be wary of particular problems for health care professionals?

Potential applicants need to be alerted to the fact that during the Gulf War it was especially difficult to gain approval for CO claims by military doctors.

Will alternative service be required of conscientious objectors?

Yes, but the alternative service program for medical personnel is not defined yet. Selective Service says it needs to monitor it more closely than the regular alternative service program, but does not explain what this close monitoring would entail. Selective Service intends to reassign health care COs to fields in which there is a short supply of health care givers. Health care specialists should be aware that they will probably have a right to present their own proposal for the work they would do in alternative service.

What other problems are there with the proposed system?

There are many:

It is unfair that male health care personnel will be subject to liability under both conscription systems.
The proposal does not explain how adequate public notice of the requirements of the system will be given.
The proposal is too vague regarding which occupational deferments will be allowed. Without detail, a proper assessment cannot be made.
Similarly, not enough is said about how SSS will register the various specialties and then respond to DoD calls by particular specialty. The differential rates for differing specialties, combined with random sequence selection, and youngest first requirements implicit in the regular draft, do not seem to be resolved.
Selective Service says it cannot meet the worst-case scenario proposed by DoD. CCW has some sympathy with this view, since it is predicated on all-out nuclear war.
The system is a "mobilization style" draft, which CCW believes to have no statutory authority. Since Congress has explicitly rejected such a system, legal challenges on this basis can be expected.
CCW does not see the need for lower physical standards for health care personnel, as if their service would be any less vigorous and less demanding than that which other draftees would have to undergo.
SSS claims to have coordinated the proposal with other government agencies, though this cannot have been done with the officials in the present administration.
Is my professional association fully aware of this proposal?

SSS is misleading in claiming to have consulted with the affected professions. As in 1989, CCW does not believe that this has been done sufficiently nor with sufficient publicity to allow proper consultation.

Write to your association and ask for its analysis and position on the HCPDS.

What next steps should be considered?

The proposal should not be kept on the shelf, to be included with the special legislation authorizing U.S. participation in hostilities. Instead, this proposal should be discussed by the public and by the affected professions, and hearings should be held in Congress to determine whether or not such a conscription system is necessary.

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