“Military treatment facilities (MTFs) can provide life-changing treatment for victims of acts of terror.”

“I urge the Department to fully utilize this authority and ensure that victims of terror are aware of their options to receive care at MTFs.”

Text of Letter (pdf) 

Washington, D.C. - United States Senator Elizabeth Warren (D-Mass.), Chair of the Senate Armed Services (SASC) Subcommittee on Personnel, sent a letter to Assistant Secretary of Defense for Health Affairs Dr. Lester Martinez-Lopez requesting information on how the Department of Defense (DoD) is using its authority to treat civilians and veterans who are victims of acts of terror at Military Treatment Facilities (MTFs). 

Previously, veterans and civilians who had been severely wounded or injured by acts of terror could only receive treatment at MTFs if they were granted Secretarial Designee status by the Secretary of Defense, making it challenging for victims of terrorist attacks to get the support they need.

In 2016, Senator Warren introduced the Jessica Kensky and Patrick Downes Act to make it easier for victims of terrorist attacks to receive care at MTFs. This bill was incorporated into Section 717 of the FY 2017 NDAA, as amended by Section 712 of the FY 2018 NDAA. This gave the Secretary of Defense authority to waive prioritization requirements for covered beneficiaries at MTFs so that veterans and civilians who have been severely wounded or injured by acts of terror can receive treatment there. In the letter, the Senator urges the DoD to provide updates in order to assess how it is using these authorities to treat civilian victims of terror.

“MTFs can provide life changing treatment for victims of acts of terror. I am proud of the critical provision I secured in the FY 2018 NDAA that provides the Secretary of Defense with authority to allow MTFs to treat veteran and civilian victims of terrorism. I urge the Department to fully utilize this authority and ensure that victims of terror are aware of their options to receive care at MTFs,” the Senator wrote.

The bill is named after Jessica Kensky and Patrick Downes, who were severely injured in the April 2013 Boston Marathon Bombing. While the initial care they received from Boston trauma centers was instrumental to their survival and initial recoveries, Jessica and Patrick realized that to continue to progress in their recoveries, they needed the expertise available at military treatment facilities. After receiving approval from the Secretary of Defense for treatment at Walter Reed, they were able to achieve a more fulsome recovery than they would otherwise. 

MTFs have also played a critical role in assisting victims of mass shootings. For example, after the May 2022 mass shooting at Robb Elementary School in Uvalde, Texas, the Brooke Army Medical Center treated two victims – “a reminder of the extraordinary care the military health system can provide when called upon,” as noted by then-Acting Assistant Secretary of Defense for Health Affairs Seileen Mullen. The Government Accountability Office found that treating civilian emergency patients [at MTFs] “creates the opportunity for more encounters for medical personnel, including military surgeons'' and “gives MTF personnel more trauma experience.” Treating civilians also allows military medical personnel to work on more complex and diverse cases that better prepare them for battlefield injuries, supports “(i)ncreased medical readiness training through team training,” and increases in the volume of patients and complex cases “can assist MTFs in obtaining or sustaining trauma center designation.”

Senator Warren has long fought to ensure affordable and accessible healthcare for all veterans and civilians: 

• On March 7, 2023, Senator Elizabeth Warren and Representative Joaquin Castro (D-Texas) sent a letter to the Department of Defense’s Assistant Secretary for Health Affairs Dr. Lester Martinez-Lopez and Director of the Defense Health Agency Lieutenant General Telita Crosland, urging the agency to waive civilian patients’ medical debts incurred at military treatment facilities, using statutory authority established by the lawmakers’ provision in the Fiscal Year 2021 NDAA.
• In December 2022, Senator Warren and Representative Castro introduced the Financial Relief for Civilians Treated at Military Hospitals Act, legislation that would ensure that MTFs run by the DoD can continue to enhance military readiness without racking up huge bills for civilians receiving emergency medical care.
• In August 2022, Senator Warren and Rep. Castro sent a letter to Secretary of Defense Lloyd Austin raising concerns that the DoD may be misleading or misinforming civilians about debt they incur when they receive emergency medical care at military health care facilities, and calling for improved billing practices to protect patients.
• The FY 2021 NDAA included Senator Warren's provision, based on the Financial Relief for Civilians Treated at Military Hospitals Act, to give DoD the authority to waive medical debt when the civilian is unable to pay the costs of the care provided and the care enhances the knowledge, skills, and abilities of military healthcare providers.
• Senator Warren originally introduced the Financial Relief for Civilians Treated at Military Hospitals Act in June 2020.
• In January 2020, Senator Warren sent a letter to DoD and the Treasury Department requesting information about the collection of military hospital debt from low-income, civilian patients.

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