FINANCIAL HARDSHIPS IN MATERNITY CASES AT POSTS WHERE INADEQUATE MEDICAL FACILITIES EXIST

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP79-00639A000100040025-2
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 12
• Document Creation Date: December 9, 2016
• Document Release Date: January 5, 2001
• Sequence Number: 25
• Publication Date: February 4, 1959
• Content Type: MEMO

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MEMORANDUM FOR: Deputy Director (Support)
SUBJECT: Financial Hardships in Maternity Cases at Posts
Where Inadequate Medical Facilities Exist
REFERENCES: (a) Memorandum for Deputy Director (Support)
from Chief, Medical Staff, subject: Medical
Separation Allowance, dated 18 December 1958
(b) Memorandum for Deputy Director (Support)
from Chief, NEA, Subject: Financial Assistance
for Medical Cases in Emergency Areas (with
attachments), dated 15 December 1958
(c) Memorandum to Director of Central
Intelligence from Chief, FE, Subject: Medical
Separation Allowance, dated 16 December 1958
(d) Memorandum for Chief, Medical Staff
from Deputy Chief, Medical Staff, Subject:
Stations and Bases Having Inadequate Medical
Facilities, dated 26 January 1959
OGC HAS
REVIEWED.
1. This memorandum contains recommendations submitted for DDS
approval. Such recommendations are contained in paragraph 10.
2. References (a), (b), and (c) recite certain financial hardships
encountered by Agency employees in areas of the world where inadequate
medical facilities exist, thereby requiring patients to travel from the
employee's area of assignment to another area where suitable hospital
facilities exist. Various solutions to alleviate these hardships were
also presented in these references. Reference (d) indicates the sta-
tions and bases concerned.
3. These financial hardships arise, as a rule, only in maternity cases
since our overseas hospitalization and medical travel programs provide sub-
stantial coverage for conditions, other than maternity, which require hos-
pitalization. Maternity cases, however, including both hospitalization and
travel expenses, are specifically excluded from our overseas programs.
This memorandum, therefore, is concerned with those financial hardships
experienced by employees at posts where adequate facilities for maternity
cases do not exist.
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4. The types of expenses which are identified in references as
warranting Agency consideration for reimbursement include the following:
a. Travel expenses of the patient and an attendant, where
medically required, from the post to the evacuation city and return
travel to the post;
b. Living expenses in the evacuation city while the patient is
awaiting admission to the hospital;
c. Expenses for care of minor dependents remaining at the post;
d. Hospital and Doctor expenses;
e. The patient's living expenses in the evacuation city after
discharge from the hospital during a period of recuperation.
f. Possible second trip from the post to evacuation city for
attendant to accompany the patient back to the post.
5. It is our opinion that serious consideration should not and per-
haps legally, cannot be given to any proposal for reimbursement of the
full range of expenses listed above. We feel very strongly that considera-
tion should only be given to the possibility of reimbursement of such
expenses as:
a. Are clearly and unseasonably beyond the normal range of
personal expense encountered in maternity cases under average con-
ditions in the U.S. or abroad;
b. Are not specifically prohibited or denied other government
employees by statute or established interpretation thereof;
c. Are excessive to those intended to be provided for in Govern-
ment overseas allowances and salary differentials.
6. Using these criteria we find that transportation expenses to a
point where adequate medical facilities for maternity cases are available
appear to qualify in principle for reimbursement. However, it is our
positive understanding that it was the intent of Congress to exclude such
travel from the Government dependents medical benefits program. It ap-
pears to us, however, that a perfectly acceptable remedy is already at
hand. It is our understanding that a, Rest and Recreation travel program
has been authorized by CIA for hardship posts and we believe that any
post lacking medical facilities adequate for childbirth should qualify
as a hardship post. The normal date for child delivery can be anticipated
many months in advance. Accordingly, it is pointed out that any employee
can conserve his authorized R&R travel, if he so desires, to protect him-
self against the heavy expenses of maternity travel.
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7. The proposal that the Agency finance the cost of two round trips
to the evacuation city in order that the employee may escort his wife and
child back to the post does not appear to arrant consideration. Travel
will be performed by air and the provision of an escort for the return
trip of the mother and child does not appear medically necessary. The
expense is clearly avoidable but if the employee chooses to accompany his
wife and child on the return trip the cost should rest with him.
8. A second category of expenses also appears to qualify for reim-
bursement. These are the patient's living expenses in the evacuation city
prior to entrance and after discharge from the hospital. The period of
separation will probably range from six weeks to three months. Airline
rules normally preclude travel within several weeks of anticipated delivery
and return travel should not be medically attempted until the mother and
child are clearly in condition to do so. Our proposed solution, the3efore,
to the additional living expenses the employee will incur by reason of
maintaining his family at two separate points is to authorize a separation
allowance. The payment of a separation allowance under conditions of
maternity separation necessitated by the la k adequate medical facilities
at the post of duty appears to be i with the statutory concept
that separation is warranted at posts which are "notably unhealthful." In
this case we will merely be extending the general concept of "notably un-
healthful" conditions to a specific factual condition, i.e., childbirth at
a post lacking adequate medical care is distinctly unhealthful, indeed
dangerous, to the individual.
9. With respect to the other expenses for which consideration is
requested, we recommend that no relief be granted. The Agency offers an
adequate insurance plan with respect to hospitalization and medical ex-
penses. Possible additional expenses for the care of other minor depend-
ents remaining at the post during the extended absence of the mother are
too problematical and personal to the individual to warrant official con-
sideration. This position is particularly valid in recognition of the
post differential payable to employees stationed at hardship posts.
10. The following recommendations are made:
a. That the Chief, Medical Staff maintain a current list of
STATIONS throughout the world where adequate Government or indigenous
facilities for child delivery do not exist;
b. That an R&R program be authorized for each such post (if
such has not already been done) and that employees anticipating
family increases be cautioned and authorized to combine the maternity
evacuation with their R&R travel;
c. That the standard separation allowance be granted from the
time of the employee's departure from the evacuation city until the
patient's departure from the evacuation city, excluding the period
of her hospital confinement;
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d. That the Agency not concur the expenses for care of minor
dependent children remaining at the post;
e. That the Agency not concur the expenses of the employee's
second trip to the evacuation city.
/s/ Gordon M. Stewart
Gordon M. Stewart
Director of Personnel
*Pending the pursuit and obtainment of legislative authorities.
Signed
John R. Tietjen, M. D/ 19 MAR 1959
* Chief, Medical Staff Date
s d Richard M. Bissell Jr. 25 MAR 1959
Deputy Director Plans Date
s/ Lawrence R. Houston
* General Counsel
See General Counsel memorandum dtd 6 July 59
6 Jul 59
The recommendations contained in paragraph 10 are approved
Signed
L. K. White
Deputy Director
(Support)
9 Jul 1959
Distribution: 0 & 1 - D/Pers. w Tabs A,B,C&D
3 - DD/S w Tabs A,B,C&D
1 - C/MS it of It a rrnn
1 - 00C if It n If nil"
1 - CCD/JDD/P 11 11 ""to
1 - DD/P w Tabs of to 11"n
l - Comptroller w Tabs A,B,C&D
/ 1 - BSA-DD/S to It It n trntt
1 - C/Fe if n " nnntttt
1 - C/N EA to It it It to "it
- Stayback
0P/DC/Pers,jyr (4 Feb 59)
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 PMM
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 RAL FOR t
s V. n
/sU Pte'.?
Asal.sta":ce to.z
i n sr+ eenc . Areas
'sr Aza h three of this
?dat : o t: r approval o &t -crr 1 bu ee
I to s t > i ary .i rsss inc ,zr
ma1rta1n.1rx .ep r'=da ?ts at a site
DI
i . t" 4 s c:X.".at . i such tad : lit es
post of asei An nt,
p areav j
where I t
rw1 to the. areas without aeei t ;
tlemi. BU IC a E these p; *b1 41 has
y of the wife of asz assIg:e. Curre- 11 0 tl ,
voivx p? eenane y at ;ss4iip .sts,
A t# rn case recently re*ented 'Ce as been, forwarded to 25X1A9a
Opetto3;s D1.vteior-, M tca1. Staff T, for f rt ar
.invests ,atioa = . 1*146 CIA ze .1 cal program c 3 %Jua'.ted b Oti s
of Persoi? el has been mast helpful in * number of cave
, ` g x A e r estrt t' ve 4 ` tee be ". eft lr
employee Its se t o s e' t W th a#" Unreasonable t h e e. al
3 1igat .on In instances where :Ctenslve , ou ratl
away f mm the post are u re 3 for the employee asnr.i/o?
v r e3,.te. we feel a C"ase 1 .. point is wXcellstatl =J iu
with that of (Att . h : '
an (0 ),
ment of a ztt itnar y t; is of medical a nses, covey
it is cow rzd+ that consideration be f - ven
Vi the light of UUA ivi,:sions e.i m
operations and in anticipation of t' tune z is
NIsloP's eft',
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pre
h
not
and the
hospitaliz
to
month Rio
Div sion plak s eerlt
partial relief for sit
4. The fo ih to presented 88 ? aar s te?- sty
1.n; the aoral.s of our career for?ess in acceptt"V-
F is to certain hardship posts, wi thf n A ar
est adoption of a. licy covering childbirth camas at
foreign posts. It i s o n nd that co si.derst on 'r,.2
m the opt;o=' of the } resent lle3' of the f rs
S si nt wherein it certain unusual cases the ~i M.ir:t
is tended mp ete hospital tiar, coved! e.
5. An early reply V th' a proposal Will be
ATTACFTAMS : A, B, & C
Distribution:
0 & 1 - Addressee w/attachments
1 - SSA/DDS w/o attachments
I - OPS filed w/o/ attachments
I - D/Pers w/o/attachments
1
1 NEA,/Pers
1-CNEA
0 e*s post athile exi 1oyee escorts wl-fe
by MMA person-91 ass,
se ?_ s should I
sistemce for bcth the t'? e
11-g With ie -xt the i t
end round trip by m attendan t
d .:hi ld back to the
ink cam for ,: k. c 0pande "t$ that t
_e t
knation; (e) cost or quarter's ' Pat.
le xva ti.% entranee to hospital. i s
n tl tt uet use oIane so': o. ? ate e
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NEA/SS; JGF: dac ;?,,??"-'~"~~
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ICflTC1958
"l"~C'mt DIRECTOR OF CENTRAL, INTELLJORNCE
SUPZ T.- Medical Separation lowa co-
1. ROBL 4-
8taff as and ter i ndents at
h ale sdsr -t r fa iti s available to tbom at MMM(IO 25X1A6a
`Whn secegrEsary, V. 3 Gme at ftu"ls a324/or V. S. GOT*
edtakal siatl rites at
25X1A6a alaep a to depart from evacuate their to aia
sd. ti =adie" facilities ems. a ro lt, the** emplaa s *ad/ or
tlasir d. d nts mar expenses witka the city to Bch they are
and/or 4"
for saacb i creas 't living
baw i ce, ?.d i En'g te* C tax legislat
Ag*wy rsgalattsas.
25X1A6a
25X1A6a
f ea rienced and ca
ties witbla
aggra
a a mom prows=. This pr iaeaa Is
k at at aa-ritlr to gm* r .r burgs cad for ,fore
costs to a foreign city after evacuaa-tf fry; _
et raa sons.
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'heat, din to for lack of adze wadies to *a, It Staff
ee a /sr Its depends*) is ordered by a s iet U. S.
t r am cia l and/or U. S. Government medical w4barity to
depart travel to a city where sock ftelUtioa
el llt, the empl e s er b dependent(*) ab uld be r ?=burse~d l
his increased living is from the time of arri at such city until
he is admitted to ism medical lkc#lity for treatment &" meter dis-
=Usal from such tasty until the time he departs same to
of a a edicsl separat,
is) at the per them
sad/or his depeu4# rlt(s) Is evacu-tc
t city to the time be esters the
for treatacant and from the time be is dismissed lrosr
y evens be departo city to w Wk be has been
Wit. t+e The enpe aloe .
Fril that he departed the city to which + t ted via tb* first
be listed with" der to We baealtb.
a be tr tpvrtati t after rece of l mice that trav *1 could
Chief. Paler me" l
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pp :CIA-RDP79-00639A0001000 A
July 39
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