Storm Brewing over Departure of US Military's Medical School President

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Medical students at the Uniformed Services University perform drills.
Medical students at the Uniformed Services University of the Health Sciences perform field exercise drills during Operation Gunpowder held on Naval Support Activity Bethesda March 21-24, 2016. (Seaman Matthew Hobson/Naval Support Activity Bethesda)

A growing chorus of supporters of the U.S. military's medical school are questioning the decision not to renew the current president's contract and raising concerns over the interim replacement -- a man they say has been entrenched in a Pentagon effort to close the institution.

Uniformed Services University of the Health Sciences President Richard Thomas announced last week that he planned to step down from his position July 19.

In a letter to school faculty and staff dated July 14, Thomas said he wanted to remain at his job but he had "not yet learned from Secretary [Lloyd] Austin as to his decision to renew my contract," slated to end July 25.

Thomas said he needed to ensure a "smooth transition" to safeguard the school's re-accreditation process and facilitate the handoff, and he named the school's senior vice president, Dr. William Roberts, as interim president.

But shortly after Thomas sent his announcement to members of the USU faculty, Acting Assistant Secretary of Defense for Health Affairs Dr. Terry Adirim named Deputy Assistant Secretary of Defense for Health Readiness Dr. David Smith as interim president, adding that Smith will lead the search for a new president.

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"[Smith] is a humble servant leader and a hero of military medicine," Adirim said in an undated memo obtained by Military.com.

The choice of Smith has generated concern over the future of the university, since he has spent much of his career, first in the Navy and then as a Defense Department civilian, researching small hospitals and analyzing how to scale back the size of military medicine.

Smith was instrumental in the restructuring of military clinics and hospitals to focus on providing care for service members while directing more civilian beneficiaries to Tricare.

"We have generally found that through our contracts that our care often is cheaper in the network," he said during a roundtable discussion in February 2020 on planned changes to downsize or close nearly 50 military facilities.

His work played an integral role, according to DoD officials familiar with his office, in the Pentagon's Cost Assessment and Program Evaluation of the institution, which recommended in 2019 that the medical school be shuttered.

"He's been actively involved in all the 'cut and runs' at the university," a senior university official who requested anonymity because of worry about retaliation told Military.com.

A Defense Department spokesman did not immediately respond to a request for comment from Smith about the leadership transition and his plans for the school.

"There's an agenda to this," said Thomasine Ilyas Alvarez, president of the nonprofit Friends of USU Inc. and wife of retired Navy Cmdr. Everett Alvarez, a former Vietnam prisoner of war, of the effort to oust Thomas, "and it is the beginning of the closure of the university."

In a statement to Military.com on Monday, Pentagon spokesman John Kirby said there were no plans to renew Thomas' five-year contract.

"The Department has decided not to renew Dr. Thomas's contract," Kirby wrote in an email. "We thank him for his work and service to our country and the Department. We are now working to ensure a successful transition of the Uniformed Services University to the interim leadership as a search committee for the next president will be formed and announced in short order."

The rift between Thomas -- a retired Army two-star general who once served as deputy director of the Defense Health Agency -- and the Defense Department began under the Trump administration, when Thomas moved to stave off proposals to cut the school's budget or close it.

In February 2019, Thomas spoke out against a proposal by the DoD to cut roughly 17,000 medical billets, which he said would affect the services' medical care and negatively impact the university, which provides a pipeline of medical personnel to the military health system.

In fall 2019, when the DoD's Cost Assessment and Program Evaluation, office recommended significant cuts to school programs amounting to a 30% reduction to university operations and a 34% reduction in research, Thomas penned a letter saying the office was using flawed data to make its recommendations and said the outcome would result in the university's closure.

Then-Defense Secretary Mark Esper rejected the proposal to close the school, but he supported reductions as part of a $2.2 billion effort to cut the military health system budget, to include eliminating all research dollars for combat casualty care and reductions to infectious disease research and public health.

After Esper was fired in the waning days of the Trump administration, DoD officials stepped up pressure to oust Thomas, citing what they said was his mishandling of disciplinary actions against a subordinate, former Dean of Medicine Dr. Arthur Kellerman, who disclosed the personal information of an adjunct faculty member found to have plagiarized several research papers and who was subsequently fired before Thomas was named president of the school.

The story about the faculty member, Dr. Eric Noji, and Kellerman's involvement in trying to have him dismissed from several medical organizations, was made public in 2018 by The New York Times.

Then-Assistant Secretary of Defense for Health Affairs Thomas McCaffery signed a proposal to remove Thomas on Dec. 17. Thomas was given the chance to defend himself on Jan. 11, but that meeting was postponed until February, after Maryland Sens. Ben Cardin and Chris Van Hollen wrote then-Acting Defense Secretary Christopher Miller asking him to review the case.

"His removal at this particular time appears to be retribution for his advocacy on behalf of military medicine," the senators wrote.

The senators have continued their efforts to try to keep Thomas on the Pentagon payroll. On July 8, they, along with Maryland Rep. David Trone, also a Democrat, wrote Austin urging him to reconsider Thomas' contract.

"We recognize that throughout his service as USU's President Dr. Thomas made tough decisions," they wrote. "He has been a strong advocate within the Pentagon for USU, DoD biomedical research, and the entire MHS. That advocacy did not endear him to those who sought debilitating funding cuts to USU, DoD's core capabilities in biomedical research, Walter Reed, and the Murtha Cancer Center in the previous administration."

Eleven general officers also have taken up Thomas' case.

In a letter to Chairman of the Joint Chiefs Gen. Mark Milley on June 25, retired military leaders, including former Army Chief of Staff Gen. Carl Vuono and five former vice chiefs, joined Dr. Jonathan Woodson, assistant secretary of defense for health affairs in the Obama administration, urging him to notify Austin of Thomas' pending departure.

"Last December, the Board of Regents unanimously and enthusiastically endorsed Thomas's reappointment," they wrote. "Since then, this action has languished in the offices of the acting assistant secretary for health affairs and has not been forwarded to the secretary for his decision," they wrote. 

"We respectfully urge you to discuss this matter with Secretary Austin so that he is accorded the opportunity to decide personally on the reappointment of Dr. Thomas and the future of the University," the letter continued.

USU was established in 1972 to address a nationwide physician shortage that has since grown dire and disproportionately affects the U.S. military, which offers bonuses and incentives to doctors but whose pay falls short of what can be made in the private sector.

Among the reasons it is often targeted for cuts is the size of its budget and cost per student. According to the Institute of Defense Analyses, the school has a higher accession cost than civilian schools: It takes about $1 million to train, house and feed a military physician at USUHS versus $400,000 for a medical school scholarship. 

The leadership crisis at the university comes at a time when the 50-year-old school lacks an executive board and prepares for re-accreditation -- a complex process that involves certifying it to ensure that it meets certain educational and administrative standards.

The Board of Regents that so wholeheartedly supported Thomas' contract renewal was dissolved as part of Austin's overall effort to review 42 Pentagon advisory panels. Shortly after taking office, Austin announced a stand-down of all boards while the Pentagon conducted a "zero-based review" to ensure that advisory panels supported the work of the department and the national defense strategy.

In addition, Austin's decision effectively removed all the last-minute appointments by the Trump administration of allies to powerful panels such as the Defense Business Board, Defense Policy Board and the U.S. Air Force Academy's Board of Visitors.

In the process, agreements with all volunteer board members, including the university's regents, were terminated.

Alvarez said that having a board of directors is an accreditation issue and the school could be placed on probation or otherwise dinged for lacking such a panel.

Likewise, accreditation panels don't care to see any controversies or disruptions that appear to be "political manipulation," she added.

"The process by which they're doing this is not good and may affect the accreditation, and that could have an effect on the school's recruiting," she said.

Alvarez and others who spoke on background to Military.com also expressed concern that Adirim, who is acting in the capacity of assistant secretary and has not been nominated or confirmed to the permanent job, lacks the authority to name an interim president -- a privilege that, by law, can be done only by the defense secretary.

Thomas declined to comment on the record on the controversy but said he would gladly welcome the opportunity to keep his job.

"I didn't resign. I'm not resigning. My term is expiring," he said when reached by phone.

-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.

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