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Interview: Vice Adm. Mike Cowan, MC, USN (Ret.), AMSUS Executive Director

 

 

Dr. Cowan began his Navy career as a General Medical Officer at Camp Lejeune, North Carolina in 1971, and was promoted to flag rank while serving as Commanding Officer at the same hospital 25 years later. Throughout his Naval career, Dr. Cowan held numerous leadership positions, most notably as Deputy Executive Director of TRICARE (2000-01); Chief of Staff to the Assistant Secretary of Defense (Health Affairs) (1999-2000); and Joint Staff Surgeon (1997-99). He was a leading force for numerous initiatives to include the creation of the National Disaster Medical System (NDMS), Defense Policies for “Force Health Protection,” and development of information systems. During Operation Restore Hope in Somalia (1992-93) he served as the Task Force Surgeon. On Aug. 10, 2001, Vice Adm. Cowan became the 34th Surgeon General of the Navy and Chief, Bureau of Medicine and Surgery. He retired from the Navy in 2004 after serving 33 years. Following retirement he was the Senior Vice President for Healthcare Solutions at Oracle, Inc., (2004-05). Dr. Cowan joined Deloitte Consulting LLP in June 2009 upon their acquisition of BearingPoint’s Federal Practice.

Dr. Cowan earned his M.D. from Washington University, St. Louis, and completed residency training at the National Naval Medical Center in Bethesda. He is Board Certified in Internal Medicine, a Fellow of the American College of Physicians, and Distinguished Professor of Military Medicine at the Uniformed Services University of the Health Sciences (USUHS). He attended the National War College as a Senior Research Fellow, and is a Certified Executive of the American College of Physician Executives. In addition to multiple military awards, the American Medical Association recognized him as the Outstanding Federal Health Executive of the Year in 1999.

What is the meaning of the “new normal” as it relates to federal health?

The American health system has undergone radical changes, including the Affordable Care Act (Obamacare) and technology advances, and is now entering a new phase. Military medicine is recovering from two wars and the biggest medical system reorganization in history. Patients – especially war wounded – are finishing their initial therapy and rehabilitation, returning to life as their “new normals.”

How can families prepare for the new normal?

Doctors used to take care of a disease or injury as an entity of its own. Medical organizations operated in parallel. Increasingly, patients go through several stages of treatment, rehab, and recovery to functional status, not just as an individual patient, but as a family, and with the assistance of multiple organizations, each providing its particular expertise, such as the Military Health System (MHS), Department of Veterans Affairs (VA), the private sector, Veterans Service Organizations (VSOs) and Military Support Organizations (MSOs).

Are there particular advances that have been key to increased battlefield wound survival?

The transformation from a Cold War organization to a 21st century medical department operating under the principles of “Force Health Protection” (FHP). Essentially, FHP is designed so that all the phases of health and health care are equally important to providing a healthy and fit service-member; protecting them from hazards; safeguarding their families; providing world class medical care anywhere any time; and keeping faith with retired warriors and their families with health care for life.

You are considered the “father” of Force Health Protection and your efforts as leader of Navy medicine focused on reshaping fleet hospitals and their resources to make them flexible enough to forward deploy with today’s warfighters. Can you describe those efforts? What were the results/outcomes?

I talked about FHP above.

Post Cold War, we deployed huge five-hundred bed hospitals to combat zones. Patients were to be kept in theater until they could return to battle. The U.S. Air Force would only medevac “stable” patients. If a patient might die on the plane, they would not transport. Today, that is all flipped. We deploy medical care in small specialized mobile units and rely on rapid stabilization followed by controlled transport of “stabilized” patients. The Air Force has built sophisticated intensive care units (ICU) into their transport aircraft. The survival rate of wounded is astronomically high as a result; over ninety percent. This was unthinkable in prior conflicts.

Medevac Training

Soldiers from the 2nd Battalion, 30th Infantry Regiment “TF Wild Boars” test their triage and rapid transport skills during a mass casualty exercise at Tactical Base Gamberi on Oct. 17, 2015. (Photo by U.S. Army Maj. Asha Cooper, MAT PAO

We now involve the family from the beginning. Often, the first face a wounded service member would see as he/she arrived in Bethesda a few days later, would be a spouse or mother waiting. Just as important as the survival is that we no longer patch people up to go out on their own destined to be invalids. That’s where the healing of the family comes in. Today, many of our wounded – even amputees – return to active duty

Can you provide insight into improvements in battlefield pain management? How much has changed when it comes to providing safe and effective pain relief in “austere” combat environments since you joined the Navy in 1971?

Multiple programs have and are being developed and fielded, including acupuncture, meditation, and other holistic modalities, in an attempt to minimize the use of opiates. When it comes to direct opioid therapy (OT), treatment services to patients with chronic pain in Department of Veterans Affairs (VA) or Department of Defense (DOD) health care settings are using local policies or procedures to reduce the chances of substance abuse in special populations: polytrauma; traumatic brain injury (TBI); mild traumatic brain injury (mTBI); post traumatic stress disorder (PTSD); substance use disorder (SUD); and psychiatric health co-occurring conditions.

What else is on the horizon for the future of military medicine?
I believe MilMed is in a phase of stabilization with efforts concentrated on eliminating the low level frustrations and difficulties and inefficiencies of referral systems, care at the interface between the private sector and military treatment facilities, and eliminating petty bureaucratic obstacles which harm the patient experience in the “new normal.” Some in Congress are hell bent on the idea that TriCare is “broke” and needs radical reform. If they prevail, all bets are off.

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