THE SUPPORT SERVICES HISTORICAL SERIES OVERVIEW OF THE OFFICE OF MEDICAL SERVICES

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP90-00708R000400120001-2
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 103
• Document Creation Date: December 19, 2016
• Document Release Date: November 7, 2006
• Sequence Number: 1
• Publication Date: February 1, 1973
• Content Type: REPORT

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Secret
The Support Services
Historical Series
OVERVIEW OF THE OFFICE OF MEDICAL SERVICES
1947-1972
Secret
OMS-6
February 1973
Copy 2 of 4
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WARNING
This document contains information affecting the national
defense of the United States, within the meaning of Title
18, sections 793 and 794, of the US Code, as amended.
Its transmission or revelation of its contents to or re-
ceipt by an unauthorized person is prohibited by law.
Exempt from general
declassification schedule of E.O. 11652
exemption category 5B(1), (2), (3), (4)
classified by signer
declassified only on approval of
the Director of Central Intelligence
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THE SUPPORT SERVICES HISTORICAL SERIES
OVERVIEW OF THE OFFICE OF MEDICAL SERVICES
1947-1972
by
February 1973
Nohn R. Tie den, .
e or of Medical Services
HISTORICAL STAFF
CENTRAL INTELLIGENCE AGENCY
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Foreword
The purpose of this volume of the history of
the Office of Medical Services is to provide an
overview of the activities of the office from 1947
to 1972. This is one of six volumes devoted to the
Agency's medical programs; the other five describe
the specific programs of the Field Support Staff,
the Operations Division, the Psychiatric Staff, the
Clinical Division, and the Psychological Services
This volume was written by
who has been with the office since 1952 and is now
(September 1972) Executive Officer.
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Contents
Page
I.
Inheritance, 1945-47 ........................
A.
B.
OSS Forebears ...........................
The Garage ..............................
II. Getting Things Started, 1947-50 .............
A.
The Founding Fathers ....................
7
B.
Military to Civilian ....................
7
C.
Early Overseas Interests ...............?
8
D.
Move to a Larger Facility ...............
9
E.
The First Doctor Hired ..................
11
III.
The Korean War, 1950-53 .....................
A.
The Great Expansion .....................
13
B.
Recruitment .............................
14
C.
Training ................. ..............
~
19
D.
Management....
Organizational Growth and
22
IV.
The Cold War, 1953-60 .......................
A.
Medical Support to the Outer Bastions...
34
B.
Maturation ..............................
36
1. Professional Programs ...............
37
2. Overseas Programs ...................
40
3. Other Signs of Maturation...........
43
C.
Career Personnel ........................
44
D.
Career Development ......................
47
V.
Three Active Years, 1960-62..
A.
The Cuban Operation.. ...... .. .......
50
B.
Changes in Command and Organization.....
51
C.
Operational Support.. ....................
53
D.
Field Support ...........................
56
E.
Liaison .................................
57
F.
Movement and Expansion ..................
58
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Page
VI. The Sixties, 1962-70 ...................... 61
A. Organization and Management ........... 61
1. Organizational and Building
Changes .......................... 61
2. Personnel Changes ................. 65
3. Programs and Procedures ........... 67
4. The Inspector General's Survey.... 70
B. New Programs .......................... 71
1. Clinical .......................... 71
2. Management Assistance ............. 75
3. Operational Support ............... 78
4. The Drug Abuse Program ............ 81
C. Expanding Medical Support ............. 82
D. Field Support ......................... 85
E. Casualties ............................ 87
V1.I. Conclusion and Projection ................. 89
A. Conclusion ............................ 89
B. Projection ............................ 91
Photographs
Figure 1. The Garage -- the original home of
the Agency Medical unit ............. 3
Figure 2. Modern equipment in present Office
of Medical Services laboratory...... 3
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Appendixes
Pace
A.
Chronology of Key Office of Medical
Services Personnel
94
B.
Budget and Staff Employee Authorizations
98
C.
Agency Medical Personnel Who Have
Received Honor, Merit, or Service Awards
99
D.
Agency Medical Personnel Who Have Died or
Been Wounded in Service
100
E.
Office of Medical Services Organizational
Chart, September 1972
101
F.
Source References
102
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OVERVIEW OF THE OFFICE. OF MEDICAL SERVICES
I. Inheritance, 1945-47
A. OSS Forebears
The Office of Medical Services of the Central
Intelligence Agency may be unique in the Western
World and perhaps in the entire world. It is not,
however, unprecedented. There was a Medical Serv-
ices Office in the Office of Strategic Services
(OSS) at the time of its discontinuance in October
1945, and thereafter the medical office was attached
to the Strategic Services Unit (SSU) of the War
Department and then to the Central Intelligence
Group (CIG) when it was established by President
Truman in January 1946.
A history of the OSS Medical Services Office 1/*
describes its evolution -- in response to exigencies
* For serially numbered source references, see
Appendix F.
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rather than planning -- over a two-year period, from
1942 to 1944. In May 1942 the author of the history,
I I
Medical Corps at the time, was assigned to one of the
OSS outlying detachments in the Washington area.
Undoubtedly because OSS Headquarters on E Street had
no other available medical resources,
upon with increasing frequency for assistance. In
March 1943 this tendency resulted in his assignment
as "Chief Surgeon" to the headquarters Services Branch,
, for
the purpose of operating a Headquarters Dispensary.
This dispensary amounted to two small rooms on the
second floor of th
25X1 Building. *
was to be responsible for sick
call, examinations for civilians going overseas, and
administration of an OSS medical service. By now
promoted to Major, he was given two Army enlisted
men to assist in the dispensary. This dispensary
* See Figure 1, p.3
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a Captain in the Army
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was what the CIA medical service inherited.
The account of the evolution of the OSS med-
ical service mentioned developments that were later
to be remarkably similar to those in the evolution
of the CIA medical service -- its emergence as a
separate office not under administrative services
or the personnel office, the tendency for operating
branches to plan or act without appropriate medical
coordination, the need for secure handling of covert
civilians who are ill or injured, and the efforts
toward accommodation between a medical service and
a psychological assessment service that were organ-
izationally separate.
B. The Garage
When the OSS medical service phased through the
Strategic Services Unit to the Central Intelligence
Group, personnel changed, of course, but in 1946
they remained essentially military. In November of
that year, First Lieutenant John R. Tietjen, MC,
reported for duty as a staff medical officer after
completion of a military training course at Brooke
Army Medical Center at Fort Sam Houston, Texas. Thus
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the physician who was to head the CIA medical ser-
vice for a quarter of a century, and whose personal
career is almost synonymous with the growth and
development of that service, came on stage.
Chief Surgeon of the Medical Office, which was part
of the CIG Personnel Division. He, Dr. Tietjen,
some 13 Army enlisted technicians, and three civilian
nurses staffed the Medical Office. Tietjen directed
the activities of the dispensary, which -- although
still over the Garage -- had expanded to take over
the entire second floor, a total now of six rooms.
There were also two health rooms in other buildings.
In 1947 the CIG medical program involved entrance-
on-duty and overseas physical examinations -- 2,600
of both types in that year -- immunizations, sick
call in which there were some 11,800 out-patient
visits, and a growing interest in medical intelli-
gence, particularly epidemiology.2/
Following the activation of the Central Intelli-
gence Agency in September 1947, plans were acceler-
ated for the conversion of the Medical Office to
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civilian staffing. The original intent was to use
US Public Health Service (USPHS) medical officers
for this. This was a time, however, when the num-
ber of physicians available to the USPHS, as with
the military services, was decreasing, and USPHS
medical officers were not available to the new CIA.
In January 1948, Tietjen, still a military offi-
cer but by then a Captain, succeeded
of the Medical Office. In May of the following year,
when he was separated from the Army, Dr. Tietjen
continued in this position as a civilian. He was
then in the position he was to hold without inter-
ruption for almost a quarter of a century.
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II. Getting Things Started, 1947-50
A. The Founding Fathers
In the late 1940's the Medical Division, as it
was then called, was part of the Personnel Office it was not to attain independent status until 1950 and was made up of some dozen employees, two of whom
were medical officers. Two of the employees who were
present at the creation remain with the OMS to this
day (1972) -- Dr. Tietjen himself and
1 -1
who was then a staff nurse and is now the
E. Military to Civilian
The Medical Division was a small and not un-
conventional Government medical unit in an era --
between World War II and the Korean War that was to
come -- that seems quiet and uneventful in retro-
spect. This is not to say that there were no chal-
lenging problems in connection with the establishment
and development of a new civilian medical unit. Much
effort went into the development of standards for
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selection, which were based essentially on those of
the Civil Service Commission, and for overseas
assignment. The Division was also concerned with
the opening of Agency health rooms -- by then there
were 12 of these, the compilation and specification
of immunization requirements, and the initiation of
an acceptable and confidential system for the main-
tenance of medical records. Not the least of the
accomplishments of this period was, of course, that
by early 1948 the medical component had become a
truly civilian one.3/
C. Early Overseas Interests
Involvement with planning for overseas medical
support began in 1948 with the
was detailed to the Agency
Operations (OSO). It was also in 1948 tha
for a special assignment in the Far East. Pending
the negotiations for this assignment,
and the Office of Special
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]served
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in the Medical Division for more than a year.* He
was of great assistance in developing and presenting
some of the initial courses in first aid and in the
design of the early medical kits for Agency use.**
D. Move to a Larger Facility
By the spring of 1948 the medical unit had out-
grown the Garage, and the nursing element moved to
the first floor of the west wing of Central Building.
In late 1948 the rest of the medical unit -- office,
pharmacy, X-ray, laboratory, and examination elements
-- followed. The CIA Medical Office was then in the
building where it was to remain until the move into
the Langley Headquarters in 1962.
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With the passage of the Central Intelligence
Agency Act in June 1949, CIA medicine received its
first statutory authority for its overseas activities.
This was to provide the necessary foundation for the
later development of the overseas medical program.
Headquarters medical service had been, and still is,
provided essentially under the authority of Public
Law 658 of 1946 and subsequent amendments and ex-
ecutive orders.*
The year 1949 was also a milestone for another
reason. In October the Personnel Director approved
the request of the Chief of the Medical Division for
the establishment of a medical consultant service.A/
This action was a major advance in developing the
* PL 79-658 authorized Federal departments and
agencies to establish employee health service pro-
grams limited to emergency treatment of on-the-job
illnesses and dental conditions, pre-employment and
other physical examinations, and preventive medical
programs. The law required that employees be referred
to private physicians and dentists for all other-
than-emergency treatment. Public Law 110 of 1949,
the so-called Central Intelligence Act, contained
authorization for Agency medical services not
authorized by PL 658. For a discussion of the
authorizations in PL 110, see HS Project No. 5.037,
The CIA Clinical Medicine Program, 1947 - 1965, S.
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professional potential of the CIA medical element.
One of the first medical consultants was Dr
the services of many of the consultants who followed.*
It was also in 1949 that formal coordination
between the CIA medical unit and the US Public
Health Service and the Bureau of Employees' Compen-
sation was established.
who was of great assistance in securing
E. The First Doctor Hired
doctor hired by CIA as such. In March 1950 he left
private practice in Washington, D. C. to become the
second civilian medical officer in the Agency.
I I
Army Air Corps in World War II was to stand him in
both just out of residency training, ear ier in 1949
became the first "When-Actually-Employed" (WAE)
Examiners for the Medical Division. In this capacity,
working on a scheduled basis in the division, they
were in effect part-time employees. WAE medical
officers are still an important part of OMS
professional capabilities.
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experience as a flight surgeon with the
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good stead, as he was given responsibility for the
Medical Division's liaison with the Office of Policy
Coordination (OPC). In June 1950, on the eve of
the Korean War, this liaison relationship developed
appointment as Medical Representative
on OPC, Staff II, for the purpose of establishing
operational medical support. This was added to his
primary assignment as Deputy to Dr. Tietjen. It
was also in June 1950 that the Medical Division
became the Medical Staff, reporting directly to the
CIA Executive.
During 1950 medical support planning for the
accelerated. In January 1951 this resulted
in the assignment of
was the first medical technician assigned
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III. The Korean War, 1950-53
A. The Great Expansion
Within a month of the invasion of South Korea
by the Communists (25 June 1950) requests for
operational support from the elements of OPC were
pouring in to the harried OPC Medical Representative,
These requests were generally for medi-
cal assistance in planning and executing paramilitary
activities in the Far East. This in turn involved
specifics such as medical kits, aid stations and
even hospitals, medical personnel requirements,
medical training, and medical aspects of other
Agency activities in support of the US efforts as
part of the United Nations mission.5/ The demands
were such that in August 1950 it was necessary to
establish a new and separate division in the Medical
Staff to handle them. In addition to his other
duties,
headed this Special Support Division,
as it was called.6/ The pace of Agency activities
increased suddenly and appreciably in other parts
of the world as well as in the Far East. Somewhat
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similar requests -- but of less magnitude -- were
coming in, for example, from Europe and the Middle
East. These involved kits, other medical supplies,
and in some instances medical training.7/ The small
Medical Staff was to be sorely tried during the next
two years. It rose to the occasion, however, and
responded in a manner that in retrospect gives pride
to those who were involved.
The major urgent problem areas that confronted
the Chief of the Medical Staff in 1950 were:
Personnel -- the procurement of medical officers
and medical technicians required for suddenly
expanded activities and new Agency activities.
Training -- the training and orientation of
these individuals and the provision of elementary
medical training for certain Agency lay personnel.
Management -- the development of an enlarged
Agency medical organization and the management
of it.
B. Recruitment
In mid-1950 there were not enough physicians for
the civilian economy of the US, and the US Armed
Forces entered the Korean War woefully short of med-
ical officers. The crisis was so acute that Congress,
in response to the urgent recommendation of the
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President, did an unprecedented thing: in September
1950 it passed a law drafting for two years of mili-
tary service one special class of citizen -- physic-
ians./ This unheard-of step was the only way the
Armed Forces could fill thousands of vacancies for
medical officers in the expanding military establish-
ment. This was the situation that confronted the
Chief of the Medical Staff when his job was to hire
physicians for the Agency. The Agency's solution
to this problem was to solicit the assistance of
the Department of Defense. With the approval of
Anna Rosenberg, the Assistant Secretary of Defense
for Manpower -- the first, and thus far, the only
woman to hold such a position, an arrangement was
made whereby physicians who had been commissioned
and were about to be ordered to active military
duty would be interviewed by a CIA recruiter. If
they were interested and acceptable to the Agency,
their active-duty orders would be revoked. After
CIA clearance they would enter on duty as full-time
contract medical officers for two years. Upon com-
pletion of this service, and upon certification by
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CIA, the physicians' military files in The Pentagon
would be annotated to indicate that they had served
for two years as civilian medical officers for CIA
and should not be ordered to active duty by the
military.*
This was the way CIA provided itself with medi-
cal officers during the great expansion of the Korean
War. A consultant physician was employed for this
of Washington,
D. C., who was later to become famous as the orig-
spent
* This was the arrangement that came to be known
unofficially as the "equivalent service" agreement.
The military files of a score of physicians who
served with CIA from 1951 to 1953 were accordingly
documented. In the latter year it was discontinued
when a complication developed. The agreement was
with DOD and not with the Selective Service System.
It was adequate for any physician who had at any
previous time been inducted into military service
by Selective Service -- even as a medical student.
It was not, so it was learned, adequate for any
physician who had never been inducted. The latter
was subject to induction in the General Draft as
well as the Doctors' Draft; it was a "double
jeopardy" case, and civilian service with CIA did
not satisfy the obligation to the Selective Service.
Only actual military service would satisfy that.
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25X1
much time traveling to various parts of the country
to interview prospective physicians, and his effec-
tiveness in this effort was largely responsible for
the success of this recruitment effort.*
Staff recruiters from the office of Personnel
made similar trips to recruit the medical technicians
needed for the Agency expansion. There was no civil-
ian shortage in this type of personnel; indeed the
military veterans from World War II provided a
ready source for such recruitment, and many fine
former military medics were recruited. Many of these
remain with the Agency to this day (1972) -- they
have had distinguished careers and have risen to
positions of considerable responsibility.
who is now with the
Agency's Office of Research and Development, was one
of the first physicians recruited in this effort.
He came aboard in January 1951 and was assigned to
I I
* is not related to the author of this
his ry.
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in March of that year.
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who now holds a senior administrative position in
the Office of Medical Services (OMS), was one of
the first medical technicians recruited in the great
expansion. He entered on duty in January and in May
1951 became the first medical technician assigned to
In all, some
technicians were recruited for Agency employment in
the accelerated recruitment efforts of 1950-52.
Some of these were assigned to the Headquarters
Medical Staff, which was expanding as described be-
low. Most of them, however, were assigned to the
newly created medical positions overseas. Early
overseas assignees in this group were the following,
assigned in 1951:
Medical officers
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Medical Technicians
C. Training
The Korean War led to a tremendous acceleration
of all Agency training activities. One of the pri-
mary purposes of the first foreign temporary-duty
(TDY) trip by an Agency medical officer -- in August
1950 -- was to survey the site one for a
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For new medical officers the presumption was
made -- with the justification that they were just
out of internship or residency training -- that no
professional training by the Agency Medical Staff
was required. They required orientation in Agency
management and administration, and perhaps in cer-
tain technical procedures; but after these were
taken care of they were ready for their Agency
assignments.
Not so with the new medical technicians. Many
of these men had been out of the medical field since
their World War II military service and required
refresher training in laboratory, X-ray, and clinical
procedures. In September 1951, to provide this type
of training, the Medical Staff established its own
temporary structure on Independence Avenue. Medical
officers served as instructors and gave technicians
a highly concentrated but comprehensive review prior
to field assignment. A major thrust of this training
was medical support for the paramilitary operations
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being projected by OPC. An interesting and
important subsidiary effort of this school was the
preparation of medical manuals for the use of medi-
cal and lay personnel in field assignments.
As the Agency Office of Training developed new
courses in response to OPC requirements, there were
demands on the Medical Staff for speakers and
demonstrators to present the medical sections of
the courses -- first aid, personal health maintenance,
and field sanitation. There were also increasing
requirements for briefings and tutorials for individ-
ual non-medical employees being assigned to the
field, as the Agency deployed additional personnel
throughout the world -- some to posts devoid of any
provisions for US-type medical care.10/
Medical technician personnel were also selected
as cadres for new Agency training installations in
By February 1951 training demands on the Medical
Staff required the establishment of a separate
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Program Coordination Division, as described below,
to coordinate medical training and related activities.ll
D. Organizational Growth and Management
The Technical Services Division (TSD) was a
recognized organizational entity within the CIA
medical element from as far back as 1946. This was
essentially the clinical, laboratory, pharmacy, and
X-ray activity. Dr. Tietjen himself operated this
activity, with the assistance of part-time consultants
proliferating demands from OPC required more of his
time than did his duties as DC/MS. In March 1951
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made the second overseas medical survey, this
time to Europe. In August and September 1951 he
made another but more extensive survey of Agency
installations in the Far East. It was also in the
summer of 1951 that a clearer definition of the
organizational relationship of OPC to the parent CIA
resulted, incidentally, in more formal des-
ignation as Medical Advisor to OPC, attached to the
Office of the Chief of the Administrative and Logis-
tical Staff of OPC.12/
It was becoming increasingly clear that the
growing demands from OPC elements for medical sup-
port could not be satisfied by any traditional med-
ical advisory relationship. The demands now involved
large quantities of medical supplies and equipment
as well as medical personnel. In January 1952, the
Chief of the Medical Staff (C/MS) formally recommended
to the Deputy Director for Administration (DDA) that
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One other significant development in field
support in 1952 might be recorded. This was the
approval that the Chief of the Medical Staff obtained
in April of that year for a privileged means of
communication between medical officers in the field
and in headquarters. This was the RYBAT MEDICAL
communication system whereby cables and dispatches
concerning the medical diagnosis and treatment of
individuals would be seen only by the medical officers
concerned.* This was an important advance in the
proper handling of privileged personal information.
Approval for this arrangement did not come easily;
certain operational individuals resisted long and
tenaciously what they considered to be a concession
to medicine. The Chief of the Medical Staff was
* It was understood, of course, that the medical
officer would inform the Chief of Station of any
command or administrative implications of such
cables and dispatches.
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able, however, with the assistance of the DDA, to
convince the appropriate senior officials of the
Clandestine Services of the wisdom of the arrange-
ment.14/ The RYBAT MEDICAL system remains in effect
to this day and has clearly justified itself on
many occasions in providing an effective means for
the exchange of clinical information between Agency
medical officers.
Throughout 1950 and well into 1951 the Special
Support Division itself handled all matters pertain-
ing to OPC medical support, including the recruit-
ment and training of new medical
the merger of OPC and the Office
(OSO) in early 1952 demands
more.
personnel.
of Special operations
increased even
Even before this merger the need for a
support structure in the Medical Staff had
pressing, and in February 1951 the Program
tion Division (PCD) had been established.
larger
become
Coordina-
In March
25X1 195 was appointed the first
chief of PCD; and his staff consisted of four medi-
cal officers, one non-physician training officer,
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and secretarial personnel. Major missions of the
division were training and research, and, as part of
the training mission, a school for medical technicians
was established in September 1951. In addition to
this type of training and training in first aid and
field sanitation for lay employees, the division
also provided special training in medical aspects
of survival for staff and agent personnel being pre-
pared for special assignments.*
Much of the division's research was done in
response to requests from overseas medical officers.
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I In 1952, PCD research efforts were greatly
facilitated by the establishment of a medical library
as a division of the Agency library but in the PCD/
MS area. A librarian was also provided. These were
the resources that permitted the Medical Staff to
produce the medical manuals for use in the field.
In August 1951, to relieve the existing divisions
of personnel administration, finance, and medical
supply chores, the Administrative Services Division
(ASD) was established, with
as its chief. The change-over of responsibilities
was gradual; it was not until 1953, for example,
that ASD assumed total Medical Staff responsibility
for the recruitment and administration of medical
personnel for field assignment and for the adminis-
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tration of the field medical supply system.* Up to
that time the Special Support Division under
had directed those activities as part of
its general responsibility for the field medical
program.
Since 1946 the Chief of the Medical Staff had
become increasingly convinced of the need for a
psychiatric service as the increasing complexity
of Agency operations surfaced problems of mental
illness. The major expansion during the Korean
War made the need even more acute. Dr. Tietjen's
conviction was shared by the DDA and by the DCI
* It was as part of this planned development of
the Administrative Services Division that two
administrative officers joined the CIA Medical
Staff upon separation from military service as
Army Medical Service Corps Officers. These were
who joined in December 1952
as Chiet. cm i rative Services Division, and
who joined in March 1953 as
Chief o the upp y Branch of that division.
f
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Psychiatric Division was established.
himself.*
In July 1952, as a result of this concern, the
who had served the Medical Staff as its
psychiatric consultant since 1951, was the moving
force behind the plan to establish a psychiatric
unit.** It was he who, at the request of Tietjen,
had studied the need for a psychiatric input to
the Agency's medical selection techniques; the
report of his lengthy investigation was submitted
in February 1952.16/ It was also who
recruited the first Agency psychiatrist,
who, at the
request of the Agency, was detailed and entered on
* One more item might be added to the legendary
accounts concerning General Walter B. Smith. By way
of lending his endorsement to the establishment of
an Agency psychiatric selection program, Smith in-
formed the Chief of the Medical Staff that he wanted
a program that would "keep the fuzzy-heads out."
25X1 ** is still an OMS consultant. In 1969
25X1 the DCI recognized long and distinguished
service to CIA by a congratulatory letter, which was
an unprecedented gesture for medical consultant
service.
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duty in July 1952.
The psychiatric program was planned for develop-
ment in phases, and the plan provided for the use
of psychiatry in Agency selection activities, clini-
cal psychiatry under certain stipulations, consul-
tation, education, research, and advisory assistance
to operating officials.
A second staff psychiatrist and a clinical
psychologist were added to the division in 1953.
Growth steadily increased with the expansion of
division requirements. By 1956 there were six
psychiatrists and two clinical psychologists on
full-time duty in the division. The division's
staff of consulting psychiatrists and psychologists
had also been greatly expanded.
Initial successes of the Psychiatric Division
outside of the Medical Staff were with the Office
of Security for professional assistance in selection
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Thus by 1952 the Medical Staff consisted of
staff employees. One other management
milestone of this period should also be recorded.
By mid-1952 there was in being within the staff a
"Personnel Policy Board" for the consideration of
personnel matters involving its own medical personnel.
Made up of the Chief and other senior officials of
the Medical Staff, it was clearly a forerunner of
* The then-DDI, Robert Amory, had mentioned to the
Chief of the Medical Staff that he "hoped that the
Intelligence Directorate would not be overlooked in
the Agency's psychiatric program." This triggered
discussion with the DDI in which it was agreed that
three experimental groups, each led by a professional
psychiatrist, would be established for the purpose
of identifying and understanding some of the behavior-
al influences of importance in the DDI area. Although
the groups met for more than a year, after reviewing
the effort the Chief of the Medical Staff decided
that he did not have sufficient substance for a
report to the DDI on the matter of "DDI dynamics."
Two follow-on groups continued until 1960-61, but
the effort was eventually discontinued.
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the Medical Career Board that was to be established
with the formation of Agency career services in
1953.
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IV. The Cold War 1953-60
A. Medical Support to the Outer Bastions
The new year of 1953 brought a new national
administration with a new foreign policy. This
came to be closely identified with the new Secretary
of State, whose brother became the new Director of
Central Intelligence in February 1953. Henceforth,
"massive retaliation" and "containment" were to be
key policies that were greatly to affect the Agency's
course. Containment involved the development of
bastions in far-flung areas, and the Agency was
called on for support. Medical support was in turn
requested from the Agency Medical Office -- which
it again came to be called in early 1953.
In early
1954, NSC 5412 formalized the Agency's role in many
of these new efforts and charted its course for the
next several years.
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The direction and support of the new medical
field installations required frequent overseas TDY
trips by senior Medical Office officials. Starting
with the initial circumnavigation by the Chief of
the Medical Office in February 1953, there was to be
an average of one overseas trip every six months.
In addition to Dr. Tietjen, the Deputy Chief and
the division chiefs made such survey trips. These
trips had the beneficial effect of keeping field
medical personnel in touch with the headquarters
Medical Office developments and of enabling head-
quarters to respond more knowledgably to emergent
field problems.
In January 1956, Tietjen was asked to designate
of the Medical Office, was so designated, and the
office was thus brought into the U-2 project.18/
Medical responsibilities for the project were assumed
jointly by the Medical Office and the Air Force, with
a specified division of functions. The Medical Office
became responsible for the emotional and personality
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evaluations of pilot candidates and for the con-
tinuing care of Agency personnel assigned to the
project.
B. Maturation
As with most of the Agency, the Medical Office
was started and directed by young men. These men,
cast into positions of senior responsibility with-
out the years of training and experience that pre-
pare senior officials in most other organizations,
undoubtedly experienced problems -- some self-
generated, perhaps -- that older hands would have
avoided. Yet this very youth and inexperience made
for a certain elan and aggressiveness that were
appropriate for the new and unprecedented tasks they
faced.
During the 1950's, the Medical Office weekly
staff meetings -- "Medical Office Advisory Staff
Meetings," as they were called -- were lively affairs
with a noticeable lack of unanimity. There was also
no small amount of divisional rivalry. This was
most evident in the Psychiatric Division; and other
divisions, perhaps understandably, tended to resist
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what they considered the higher priorities accorded
the activities of the Psychiatric Division.
If the early 1950's was a period of accelerated
growth for the Medical Office, the mid and late
1950's was a period of maturation -- a time for
catching up and refining some of the hastily
developed procedures and approaches adopted at the
time of the Korean War expansion. Some of the areas
in which this maturation was evident in the 1950's
follow:
1. Professional Programs. The psychiatric
program did unquestionably receive special attention
and encouragement. It was born on the first day of
FY 1953, and its growth and development were con-
spicuous for the remainder of the decade.l9/ This
growth was both in quantity and quality. By 1957,
for example, of the six staff psychiatrists in the
Psychiatric Division, five were board-certified in
this specialty. Efforts were also made to extend
the psychiatric attitude to other office officials.
Both the Chief and the Deputy Chief of the Medical
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Staff,* for example, made visits to the Mecca of
psychiatry -- the Menninger Clinic in Topeka -- as
part of this effort to expand the psychiatric aware-
ness of staff officials. June 1954 was a milestone
for the Psychiatric Division; approval was granted
by the DDA for the division's use of the Personal
Index, the individual test battery that was to pro-
vide the basis for the volume screening necessary
* The medical office was redesignated the Medical
Staff on 11 March 1955.
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Poliomyelitis was a major Agency clinical prob-
lem before the advent of the Salk vaccine in the
mid-1950's. This crippling disease was a hazard for
agencies engaged in overseas activities, and the
Agency was not untouched. Competition for the
limited amount of vaccine that became available in
1955 was intense throughout the US. The Agency was
successful in obtaining quantities for its overseas
assignees and their dependents, and by the end of
that year inoculations were routine for these groups.
A major health threat to Agency overseas activities
was thus removed almost at one stroke, thanks to
this great advance of modern medicine.
In 1954 the Medical Office's Zone of Interior
(ZI) Consultant Program was established. This pro-
vided contractual agreements between the Agency and
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purpose of these regional medical conferences was
to reduce the "psychological distance" between
headquarters and field medical personnel. Head-
quarters representatives returned with more insight
into field problems, and field personnel were left
with a better understanding of the "whys" behind
some of the headquarters decisions. The result of
this improved understanding was presumably a more
efficient field medical program.
The desirability of providing medical evaluations
for dependents prior to overseas movement with Agency
employees had been recognized and discussed for many
years,* and in 1958 with the assistance of the DDS
and the DDP, the Medical Staff's proposed program for
such evaluations was approved; and the additional
resources required -- personnel, funds, and space --
were forthcoming.22/ The program was initiated on
10 April 1958, and it developed on a phased basis,
examinations for returning dependents being added in
* Inoculations for these dependents had always
been provided.
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1960.
3. Other Signs of Maturation. Much of 1954
and 1955 was taken up with planning the medical
space requirements for the new Headquarters Building.
Even after these were submitted in final form, there
were space changes and improvements to be considered
for the existing Medical Office facilities, which
were spread out in
IFor example, in 1956 the Medical
Staff Registrar's Office, which had been established
in 1954 as the central repository for the storage of
medical clinical records and for the handling of
medical administrative matters, installed an ingenious
"dumb waiter" to transmit medical charts from the
chart room on the second floor to the Registrar's
office itself on the first floor of
It was also a significant improvement when the filing
of charts in this same chart room was converted from
the cumbersome four-drawer cabinets to an open-shelf
system in 1958.
It was also during the 1950's that the staff of
the office began to derive whatever satisfaction
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comes from having other Government agencies seek
advice -- the National Security Agency, which was
just then starting its medical program, was especially
interested in the experiences of the Agency Medical
Staff. The 1950's will also be remembered for the
several surveys of and inquiries into Agency
activities by Presidential groups. In 1955 it was
the Hoover Commission, and in 1957 it was the Killian
Committee -- General Cassidy of the latter met with
each division and staff chief of the Medical Staff in
the course of the survey.
In 1955 the Medical Office underwent its first
full-scale routine survey by the Inspector General.
C. Career Personnel
The procurement of medical officers in the early
1950's was based largely on the Agency's "equivalent
service" agreement with the Department of Defense
whereby the physician, as a military reserve officer,
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could satisfy his two years of obligatory military
service under the Doctors Draft Law by serving as a
civilian medical officer in CIA.* This arrangement
was necessary because of the scarcity of physicians,
many of whom were in the military services. Such
medical officers were obviously not careerists with
the Agency. When this arrangement was discontinued
in 1953, there were but five career medical officers
with the Agency. As the non-careerist medical officers
left the Agency after their typical two years of
service, it became necessary to resort to active-
duty military and Public Health Service (PHS) officers
to replace them. At the Agency's request these
officers would be assigned to the Agency and would
serve -- not in uniform -- in any assignment, head-
quarters or field, as determined by the Chief of the
Medical Office. These officers served with great
distinction; some of them served in senior positions,
and a few of them made lasting contributions to the
Agency medical program. They, too, however, were
* See p.15, above.
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not careerists and were not the appropriate types
on which to build a career medical program. This
was clearly enunciated in the program announced by
the Chief of the Medical Office in September 1954,
which called for the intensification of efforts to
recruit civilian and potential career medical offi-
cers rather than to rely on the military and PHS.
One of the first medical officers to be recruit-
a physician who had enjoyed a distinguished
career as a wartime military medical officer and
who was then engaged in industrial medicine. Dr.
II
entered on duty in June 1955 as Chief of the
Program Coordination Division. He enjoyed another
distinguished career as an Agency medical officer,
making a unique contribution to the intelligence
The citation for this award
made a unique and lasting contribution in
placing the skills and insights of professional
became Deputy Director of Medical Services
in 1969 and retired in 1971 with the Distinguished
Intelligence Medal.
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medicine at the disposal of the Agenc . In
founding what is in effect a separate
he has provided
unparalleled precedent for his successors of the
manner in which great specialized competence and
dedication may be devoted to the service of the
Nation.24/
The goal of an all-civilian corps of medical
officers with career potential was attained by the
end of the decade. This was achieved despite the
continuing disadvantage of a GS salary schedule that
had not yet become even reasonably competitive with
salaries in industrial and private medicine.
D. Career Development
Beginning in 1954 there were expanded efforts
toward establishing a staff of career medical offi-
cers, and of course there were many discussions
about how this might be best achieved. The con-
sensus of these considerations was recorded in a
paper written by the Chief of the Medical Office in
January 1955, "Policies Relating to Employment and
Career With the Medical Office." This paper set the
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pattern for the ensuing years.*
The paper recognized the desirability of con-
tinuing professional development and recommended,
among other things, Agency-sponsored extended pro-
fessional training for career medical officers.
Approval of the DDA would be necessary in each case.
under this program. In 1955, following completion of
his overseas tour as Senior Far East Medical Repre-
sentative, he entered one-year residency training
in internal medicine in Chicago. Nine career medi-
cal officers have had this type of extended Agency-
sponsored training, and there is clear evidence that
the program has been a wise investment for insuring
the Agency's continuing medical professional com-
petence.**
* The paper was issued -- after approval by the DDA --
as MO Regulation 7-55, 30 December 1954, Policies
Relating to Employment and Career with the Medical
Office.
** Seven of these nine medical officers have remained
with the Agency.
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I as also the first medical officer
to participate in another expansion of career
development for Agency medical officers. On com-
pletion of his residency training in 1956, he was
assigned to the office of Scientific Intelligence of
the Intelligence Directorate. This, the result of an
agreement between the Director of Scientific Intelli-
gence and the Chief of the Medical Staff, opened a
continuing rotational assignment opportunity for
Agency medical officers.
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V. Three Active Years, 1960-62
A. The Cuban Operation
On 17 March 1960 President Eisenhower directed
CIA to undertake the military training of Cuban
nationals striving to establish a democratic govern-
ment in Castro-dominated Cuba. From that date
through the actual military operation of April 1961,
and well into the phasing-down of 1963,
* In thanking the DDS for support of the project,
25X9 the DDP indicated that Support Directorate
personnel were active in the project.25/
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During the three-year period from the beginning
of 1960 through 1962 there were a number of other
developments that warrant recording.
B. Changes in Command and Organization
During this period there were many changes in
senior personnel of the Agency. The Chief of the
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Medical Staff, for example, was called upon to
brief the new DCI-designate, John A. McCone, in
October 1961 and the new DDCI, Lieutenant General
Marshall S. Carter, in April 1962 on activities of
the Medical Staff. There were also significant
Agency organizational changes such as the creation
of the position of Executive Director in April 1962
-- during the previous month Dr. Tietjen had appeared
before the Agency Reorganization Committee, which was
chaired by Lyman Kirkpatrick, who became the Executive
Director. Within the Medical Staff there was also
a major realignment of responsibilities. In December
1961 the Chief of the Medical Staff announced that
the Chief of the Operations Division was relieved of
responsibility for communications, overseas support,
25X1 liaison, ands uin order
that he might concentrate on operational activities.
The Deputy Chief of the Medical Staff assumed direct
responsibility for the first three of these functions,
and the Support Division took over
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C. Operational Support
As part of the new Medical Staff emphasis on
operational support,
completed Agency-sponsored residency training in
psychiatry in 1961, was assigned in January 1962
directly to the Office of the Deputy Director for
Plans to provide continuing professional advice in
operational and personnel activities of the Clandes-
tine Services.
Other developments in expanded operational sup-
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D. Field Support
As previously noted, in the late 1950's key
personnel of the Medical Staff did considerable
traveling in support of overseas operations. The
Chief of the Medical Staff, as personal physician,
had previously accompanied the DDCI and his party
on overseas TDY's -- including an extensive round-
the-world trip in November-December 1959. In
January 1961 the Chief of the Medical Staff accom-
panied the DDS on a Far East Survey, and returned
to the area again in October of that year to rep-
resent headquarters at the Annual Far East Medical
Conference. In October 1961 the Chief of the Support
Division made the initial survey of medical support
for paramilitary activities in Southeast Asia, an
effort that was to expand greatly later in the
decade. This survey recommended the expanded and
continuing use of medical supplies in Agency opera-
tions in Vietnam. It also recommended the assignment
of an Agency medical service officer to Saigon to
coordinate the provision of these supplies and to
coordinate an expanded medical training program for
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indigenous medical personnel.27/
E. Liaison
The liaison activities during this period were
also extensive. In early 1961 there was a series of
meetings with the newly appointed Medical Director
of the Department of State. In 1962, planning for
the release of the Cuban liberation fighters captured
at the Bay of Pigs required frequent liaison with the
US Public Health Service and with the Surgeon Gen-
erals of the military services.
1 -1
Agency medical supply personnel later actually
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worked in the Department of Justice to coordinate
the collection of the medical supplies used as ran-
som for these liberation fighters.* Also in 1962,
at the request of the Federal Aviation Agency, the
Psychiatric Staff provided psychiatric screening
for candidates for the FAA "goon squads" in one of
the initial national efforts to counteract airplane
hijackings.28/
F. Movement and Expansion
On 29 and 30 March 1962 the Medical Staff moved
to the new Headquarters Building, its third and by
far its finest home. In October of that year came
the Cuban missile crisis, and the Medical Staff,
with the rest of the Agency and the Government,
assumed a tense DEFCON 3 position; medical personnel
remained on alert for days while emergency plans and
medical support procedures were readied and refined.
* The story of these negotiations is given in detail
in the Office of Security history Overseas Securit
Support, OS-7, April 1972, pp. 359-379, by 25X1
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A last, but by no means least, important develop-
ment in this period was the transfer on 14 November
1962 of the Assessment and Evaluation (A&E) Staff
from the Office of Training to the Medical Staff.
I I
and the appropriate portion of the OTR budget thus
became part of the Medical Staff and the Medical
Career Service. This was a decision reached by the
DDS and senior management after months of study; it
was based on the conclusion that a professional activ-
ity such as A&E psychological services would be more
appropriately located as part of a larger professional
component like the Medical Staff. Thus, through this
transfer, two Agency elements -- the Assessment and
Evaluation Staff and the Psychiatric Staff -- which
on more than one occasion had engaged in jurisdictional
dispute -- were now part of the same operating staff.
Any future disputes would be "family fights."*
Of more importance in the longer range interest
* Subsequent differences would reflect the normal
professional differences of presentation expected
of psychology and psychiatry.
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of A&E, however, was the decision to keep its staff
intact -- in effect, its own sub-career service --
and transfer it to the Medical Staff with its basic
program unchanged. With its professional and organ-
izational integrity assured, in the next decade the
A&E Staff, as a part of the Medical Staff, was to
have an impressive broadening of its charter; "assess-
ment and evaluation" would no longer adequately des-
cribe the range of its varied services, and A&E
became the Psychological Services Staff.
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VI. The Sixties, 1962-70
25X1 I
A. Organization and Management
1. Organizational and Building Changes. Even
before the new Headquarters Building was occupied
the Agency knew that the building was not big enough.
Some units would never move in; and some units, after
moving in, would -- in the never-ending ways of
bureaucracy -- move out. Thus in November 1963
the Assessment and Evaluation Staff of the Medical
Staff moved to the
Two months later they wer
joined by a newly established Medical Staff unit,
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Staff remained at until August 1971
when it moved to the adjacent
Building -- again another new building. The Depend-
ent Medical Facility, however, remained a
only until December 1966 when it was moved to
thel janother new structure,
in preparation for its subsequent integration with
the Selection Processing Center in 1967. In October
of 1967 all initial physical examinations -- pre-
employment and entrance on duty -- were moved from
the Headquarters Medical Facility to
as part of the general plan for making that area the
"gateway" for all Agency personnel processing. In
December 1968, after lengthy negotiation to obtain
the appropriate personnel and funds, this medical
activity was formally established as the Selection
Processing Division of the Office of Medical Services
-- the Medical Staff had been formally redesignated
the Office of Medical Services in October 1964,
with Dr. Tietjen assuming the title of Director of
Medical Services.
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In 1964 there were three other internal organ-
izational developments in the office of Medical
Services in addition to its change of name. For
the first time there was a full-time Executive Offi-
cer, OMS; the Medical Career Board was reorganized
into its present configuration of a Board with three
subsidiary panels representing physicians, psychol-
ogists, and medical administrative/technician per-
sonnel; and the first of the OMS consultant panels
was established. This was the Psychiatric Consult-
ant Panel, which assembled for the first time in
March 1965. The purpose of the panel was to review
the Agency's psychiatric program on a continuing
basis to assure that it remained professionally
current in its field. In 1966 an analogous Psy-
chological Consultant Panel was established to
assure the professional currency of the Agency
psychological services effort. The third panel,
the Clinical Consultant Panel, had its initial
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meeting in February 1970.*
In April 1965, with the expert advice of a
consultant interior decorator the Agency had re-
tained, the grey face that came with the new OMS
quarters in 1962 was lifted. The OMS facility be-
came a multi-colored suite with varying red, yellow,
and orange doors and other appointments, redecorated
in the same manner as the rest of the Headquarters
Building.
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A noteworthy personnel development of the decade
was the fact that three senior medical officers who
resigned during the period to enter private or in-
dustrial medicine chose, after only a matter of
months, to return to the Agency as careerists. Each
reported that private practice, despite the greater
remuneration, did not provide certain satisfactions
that work in the Agency did.
3. Programs and Procedures. At a DDS staff
meeting in January 1966 a representative of the Office
of Planning, Programming, and Budgeting told about the
new requirement -- the "Combined Program Call" by
which the Agency would thereafter conduct its planning
and budgeting. There had been some previous long-
range planning; in 1965, at the direction of the DCI,
each operating official had submitted a 5-10-15 year plan.*
This had been accomplished on a task-force basis, but
* OMS long-range plan featured the following:
1966-70: Conservation of manpower, Management assist-
ance, operational support, and Improved field support.
1971-75: Automation. 1976-80: Medical program of
the Intelligence Community.
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now it was to be an annual requirement.
The first OMS plan under this new procedure was
submitted in March 1966 to cover the FY 1968-72
period.29,/ This plan projected ten goals for the
period:
a. Field Support Program -- augmentation
b. Selection Processing Center -- estab-
lishment
c. Improved Diagnostic Procedures
d. Annual and Executive Examination Pro-
gram -- expansion
e. Professional Development -- establishment
of professional consultant panels
f. Automation of Medical Records
g. Counseling Service -- expansion
h. Special Studies Program -- management,
personality, operational
i. Direct Operational Support -- expansion
j. Behavioral Aspects of Human Resources --
assistance to management through a multi-discipline
approach to human resources.
Most of these goals continue to be relevant to this
day (1972).
In 1965 the OMS Clinical Review Board (CRB) first
met. Its purpose was to conduct a total OMS review
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of certain medical evaluations before OMS disposition
to insure that all aspects of a case -- clinical,
psychiatric, and administrative -- had been con-
sidered. The CRB was an immediate success and re-
mains active to the present.
Also in 1965 the first Board of Medical Examiners
(BME) under the new CIA Retirement and Disability
System convened. The BME continues to be effective
to this day. The value of another kind of board
convened for a special purpose is illustrated by the
special OMS board that met in September 1965 to re-
view the case of a chief of station
Through careful gathering
o a-a, inc it to the hospital by an
Agency medical officer, the board established that
the facilities and standards at the hospital were
sufficiently below those found in US hospitals that
the case appropriately should fall within the pur-
view of the Employees' Compensation Act. As the
result of the work of the OMS board and the resulting
Agency recommendation to the Bureau of Employees'
Compensation, the monthly compensation to the COS's
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widow was increased 88 percent over what it would
have been without the board's findings.
4. The Inspector General's Survey. In Septem-
ber 1967 the D/MS met with the Inspector General
and the IG team that was to conduct the routine per-
iodic IG survey of the OMS; the last one had been
conducted in 1955. The team completed its survey
in June 1968. Its report of the survey was summar-
ized as follows:
The Director of Medical Services has
developed one of the finest civilian medical
programs in the Federal Government. It is
a high-quality program, designed to be re-
sponsive to the specialized needs of the
Agency. It has made a very impressive con-
tribution to the morale and spirit of the
organization.*30/
Although not connected with the IG survey, there
was conducted in February 1968 what amounted to a
professional audit of the OMS. John McCone, the
former DCI, had written to Richard Helms, then the
* Among the several specific recommendations of
the IG survey report was one that the title of the
Assessment and Evaluation Staff be changed to the
more appropriate Psychological Services Staff. Thus
in July 1969, A&E became PSS.
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DCI, recommending that a
ed by the Agency for any occasional medical require-
ment the Agency might have. The Director of Medical
Services was consulted and, on the basis of his con-
outstanding reputation as an
internist, the Executive Director-Comptroller request-
to conduct a survey of the OMS clinical
activity. This he did in January and February 1968.
In a verbal report to the Executive Director-Comp-
troller he gave his unqualified endorsement to the
OMS program.*31/
B. New Programs
1. Clinical. In 1963 the Chief of the Clinical
25X1 Division,
at the time, presented
a major plan for a bioelectronics program in the
Agency.32/ This involved primarily the introduction
of advanced electronic procedures in the diagnostic
25X1 * I Iwas retained as a consultant until
1969 when he retired.
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activities of the Clinical Division.* It also pro-
posed the extension of these procedures to the Of-
fice of Security in a joint effort involving the
polygraph and the recording of certain physiological
data. The Office of Communications was to have a
major support role, and officials of the Research
Directorate, such as Dr. Albert D. Wheelon, were
consulted. The plan was presented to the DCI in a
formal briefing, but approval was not forthcoming --
undoubtedly because of the size of the funds proposed.
Seven additional staff members and $204,968 were
requested for the first year; a total of $1,677,413
and ten staff employees were requested for the pro-
posed four-year duration of the project.
The idea did not die, however. In 1967 a new
Chief of the Clinical Division, 25X1
* For example, laboratory procedures would be auto-
mated by the introduction of an automatic analyzer
that would provide several standard test procedures
on several blood specimens at a time -- procedures
that were being done by technicians on a case-by-
case basis; electrocardiograms would be more sophis-
ticated; and certain additional tests such as pulmon-
ary capacity tests would be introduced.
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I approached the matter in a more modest
fashion by first visiting the George Washington
University Medical Center, where certain innovations
were being made in the use of computerized electro-
cardiography. From this evolved a continuing low-
keyed Clinical Division effort of an applied research
nature, using existing resources. In 1970, upon his
return from two years of Agency-sponsored residency
training,
was appointed to the new pos-
ition of OMS Medical Systems Development Officer,
with the responsibility for developing such programs.
The Multiphasic Screening, Periodic Health Evaluation,
and Information Processing System Program (MPS/PHE/IPS)
proposed for FY 1973 in the OMS Program Submission of
March 1971 was, in a sense, the sequel to these various
earlier efforts. This program is described further
in Section VII below.
The MPS/PHE/IPS program is, however, only a means
to an end -- the "Conservation of Agency Manpower."
This latter concept was initially proposed by Dr.
Tietjen at an OMS staff meeting in June 1965. He
pointed out that since its beginning the Agency had,
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for good reasons, given primary attention to the
selection of personnel; perhaps the time had come
to give more attention to the health of personnel
already on duty. Dr. Tietjen followed this up in
August 1965 with a paper, "Medical Views on Planning
and Human Resources." This think-piece written for
Agency senior management called for no specific action
but did signal a major change in emphasis in the
Agency medical program, one that prevails to this day.
This change in direction of effort was facilitated
by the coincidental issuance in June 1965 of a Bureau
of the Budget directive that expanded the scope of
health service programs for Federal Employees.33/
Although the directive made no great change in the
existing Agency health service program, it did give
official sanction for the provision of certain serv-
ices that were already being provided.*
* Even as this history was being completed (October
1972) announcement was made 110 Aug 72) of 25X1
OMS' Health Education Program, an e first in a
series of quarterly Medical Newsletters in support
of that program was issued (September 1972).
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2. Management Assistance. In the early 1960"s
the specter of alcoholism loomed as an element in
the evaluation of several Agency officials who were
nearing retirement. Although its incidence in the
Agency was small, in 1965 the Director of Medical
Services established an OMS Committee on Alcoholism.
The purpose of the committee, made up of the chiefs
of the professional OMS divisions, was to study the
problem and submit recommendations for action. The
committee met periodically through 1969. Some re-
sults of its study and recommendations were:
a. In March 1967 the Chief of the Psychiatric
Staff and the Chief of the Psychological Services
Staff presented to the Operations Familiarization
Course the first formal lectures on Alcoholism.
b. In May 1968 Dr. Tietjen and other OMS
officials made a similar but expanded presenta-
tion to senior officials of the offices of Per-
sonnel, Security, and Training.
c. In 1968 the Director of Medical Services
proposed an Alcoholism Program for the Agency
as suggested for all Federal agencies by the
Chairman of the Civil Service Commission.
Agency management chose, however, to defer such
a program. In 1972, in the wake of the enact-
ment of Public Law 91-616 requiring a program
in each agency, such a program has been in-
augurated by the Agency and a DCI statement
of Agency policy on problem drinking has been
issued, essentially as drafted by the OMS in
1968.
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The present wide spectrum of new forms of manage-
ment assistance being provided by the Psychological
Services Staff had its origin in a paper on "feedback"
to management that OMS submitted to the DCI's ad hoc
Planning Group in September 1965. The basic problem
was the provision to management of data about the
attitudes, personal satisfactions and dissatisfactions,
and aspirations of personnel -- data that management
was not getting in a systematic way. Such information
would, of course, enable management to improve organ-
izational effectiveness. The first major study of
the feed-back problem itself was a 1966 PSS survey of
the attitudes of career trainees.34/ In 1970 the
Inspector General requested the help of PSS in re-
sponding to a Government-wide inquiry concerning
youth in the Federal Government. The resulting PSS
survey of Agency professionals was presented by PSS
psychologists in a formal briefing of the DDCI. The
chief of PSS now (1972) chairs a DDS group that has
proposed a similar survey of all Agency human re-
sources.
In 1968 PSS assistance in counseling employees
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preparing for retirement was requested by the office
of Personnel. For this and other counseling activit-
ies a Counseling Center was established in PSS. Ex-
pansion of this kind of service by PSS and other OMS
elements resulted in the formal establishment in 1969
of an OMS Consultative Services Program.35/ Under
this program an employee -- and his supervisor if he
wishes -- may get professional counseling on a job-
related problem. The employee may also get consulta-
tive help on a personal or family problem of health
or adjustment. Emphasis is placed on ease and prompt-
ness in getting an appointment -- without the proce-
dural machinery of formal request.
In 1966 the OMS Support Division devised a means
for providing the Clandestine Services with periodic
indications of the medical assignability of its
personnel. This procedure, which makes use of code
letters to indicate the readiness of an employee and
his dependents for overseas assignment, was extended
in 1967 to cover Office of Communications personnel.
Finally, in the area of new concepts in manage-
ment assistance, in 1969 OMS completed arrangements
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for a "Medical Assistance Group" of experienced medi-
cal technicians and medical service officers who
would be prepared on a 24-hour basis to provide on-
the-spot para-medical assistance to Agency components
in the Washington area, particularly to the Office of
Security Emergency Force.
3. Operational Support. In a 1964 survey of
the Clandestine Services the Inspector General rec-
ommended that OMS conduct a research project on
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It was one of the specific recommendations of
the IG's 1967-68 survey of the OMS that special
efforts be made to apprise the Clandestine Services
of OMS support capabilities. Accordingly, starting
in late 1968 with the Foreign Intelligence (FI) Staff,
a series of such briefings was conducted by an OMS
briefing team. According to the OMS personnel in-
volved -- members of the Psychiatric Staff, the
Psychological Services Staff, and the Operations
Division -- many Clandestine Services personnel who
attended the briefings were apparently unaware of
the scope of available medical support. The OMS
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officers felt that the briefings resulted in closer
working relationships with DDP operational officers.
4. The Drug Abuse Program. The most recent
program of note is that designed by the Operations
Division to assist Agency personnel and their de-
pendents to understand and avoid the misuse of drugs.
The drug problem has never been a serious one among
Agency employees; the program was initiated largely
as a preventive measure. It emanated from OMS dis-
cussions in 1970 with the Office of Security; Office
of Personnel and Office of Training officials later
joined these discussions. The program features an
elaborate exhibit, which has been displayed at the
Headquarters Building and at other Agency installa-
tions, and lectures by OMS professional personnel.
In June 1972 the exhibit was displayed at the Annual
Convention of the American Medical Association in
San Francisco. This was a departure from traditional
low-profile practices in Agency medical affairs and
required the sanction of the DCI. To the great de-
light of the OMS, and the DCI as well, the Agency's
exhibit was awarded first prize in its class of
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exhibits. This was the Billings Gold Medal for
teaching exhibits.
C. Expanding Medical Support
An especially interesting feature of OMS history
in the 1960's was the significant increase in the
frequency of requests to OMS from other agencies
for advice or assistance. Examples of some of
these requests, by agency and general type of
assistance requested, are:
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was to reflect this wider spectrum of services that
its name was changed in 1969. It was particularly
gratifying to the OMS that this wider recognition,
more frequent use, and generally enhanced profession-
al reputation of the PSS should follow its incorpor-
ation into the OMS.
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VII. Conclusion and Projection
A. Conclusion
The Agency medical program is now a quarter of
a century old. It has served the Agency through two
wars, six DCI's, numerous contingencies, and count-
less personal health crises of employees who have
grown old and worn in service and a few others --
very few, in fact -- who have worn out before their
time. Each one of the thousands of people who worked
in the Agency during this period passed through the
OMS at some time in his career. It has been an
impressive cavalcade, a rich and rewarding but humb-
ling experience.
What can be said in a summary way about the pro-
gram? Perhaps the Inspector General said it best in
the summary statement of his 1968 report of survey
already quoted.*
As much as any program in the Agency's experience,
the medical program has been the work of one man.
* p.70, above.
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John Tietjen has been the only D/MS. He conceived
the program, nurtured it through its long years of
growth, and brought it to its present maturation.
For most of this long journey there was no chart,
no guidebook, no SOP; most of the things that had
to be done in running a new medical program in a
new intelligence service were being done for the
first time. The book was being written.
The problems over this quarter of a century were
many and varied. Not the least of these was the
great and almost constant turnover of professional
personnel -- a problem not uncommon to an organization-
al medical program in Government or industry. Another
problem of great moment was, and is, that of ensuring
the confidentiality of personal medical information
-- always a problem for an organizational medical
service in its dual role as guardian of the health of
employees and advisor to management. Although the
Agency medical program has been remarkably free of
allegations of invasion of privacy, the danger has
always been present. The success of the OMS Con-
sultative Services Program since its inauguration
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in 1.969 would seem to indicate that an effective
balance has been achieved in the competing demands
of the guardian-adviser role. In an era of great
sensitivity to threat of invasion of privacy, how-
ever, maintenance of the confidentiality of personal
medical data -- particularly in an intelligence or-
ganization -- must be a matter for continuing vigi-
lance. But if the problems have been great, the
rewards have also been great. Not the least of these
has been the abiding satisfaction and sense of ful-
fillment in serving the people of the Agency.
B. Projection
If what is past is prologue, the OMS is hearten-
ed. But what is past is also gone, and the accom-
plishments of yesterday are of limited value in
solving the problems of today. The hallmark of
modern medicine and psychology is change, accelerat-
ing change. It must be the major goal of OMS to
assure that the advances in medicine and psychology
are integrated into the Agency medical program.
Two major areas of application will receive partic-
ular attention in the immediate future: multi-
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I Special
Assistant
S-E-C-R-E-T
Appendix E
OFFICE OF MEDICAL SERVICES ORGANIZATIONAL CHART
Director September 1972
of
Medical Services
Assistant Director for
Clinical Activities
Psychiatric
Staff
Clinical
Divis ion
Selection
Processing
Division
Field
Support
Staff
Operations
Division
Psychological
Services
Staff
Support
Division
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Ap~nendix F
SOURCE R-7ERENCES
1. Memo for Director, /OS J History Project from Colonel
25X1 MC, Chief Surgeon, Medical Serv-
ices uttice, sun: istory of Medical Services up to
1 September 1944, 2 Aug 55, U. (CIA/HS archives)
2. Draft, Annual History of Medical Staff Activities,
circa 1952, S. (OMS files)
3. Ibid.
4. Recollection of John R. Tietjen, M.D.
5. HS/HC-69, Medical Office, 1950-1953, draft, Aug 55,
S.
6. Ibid.
7. Ibid.
8. PL 81-779, 9 Sep 50.
9. HS/HC-69 (5, above).
10. Ibid.
1.1. Ibid.
12. Ibid.
14. Recollection of John R. Tietjen, M.D.
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16. Recollection of John R.. Tietjen, M.D.
17. Memo for AD/SO from Chief, FDZ, sub: Suggested
Procedure for Handling of Staff Personnel Requiring
Psychiatric Attention Overseas, 5 Jul 51, S. (OMS
files)
18. Minutes of MS Advisory Staff Meeting, 3 Jan 56, S.
(OMS files)
19. HS/HC-69 (5, above).
20. Memo for DDA from Chief, MS, sub: Summary of
Activities for Week of 21-25 June, 28 Jun 54, S.
(OMS files)
10 Mar 58, S.
23. Report of IG Survey of Medical Staff, Apr 55, S.
24. Recommendation for Honor or Merit Award, sub:
14 Apr 71, S. (Official
25. Memo for the Record by AD/MS, sub: OMS Staff Meeting
19 April 1961, 19 Apr 61, S. (OMS files)
26. SS Historical Series No. OMS- 3. medical Su ort for
the 1961 Cuban Operation by Jul 25X1
69, S.
28. Letter for Chief, MS/CIA from Civil Air Surgeon, FAA,
5 Jan 62, OUO. (OMS/PS files)
29. Memo for Director, PPI3 from Director, MS, sub:
Combined Program Call, 9 iviar 66, S. (OMS files)
30. Report of IG Survey of the Office of Medical Services,
Jul 68, S.
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Bureau of the Budget Circular No. A-72, sub: Federal
Employees Occupational Health Services Programs, 18
Jun 65, U.
34. Staff Study, OMS/PSS, sub: Attitudes of Career Train-
ees Before and After Orientation Course, 8 Apr 66, S.
(OMS files)
25X1 35. CIAI sub: OMS Consultative Services, 2 Jul
69, s.
36. Memo for D/MS from ADDP, sub: Medical Super- 25X1
visor Plan, 1 Jun 66, S. (OMS files)
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