Health Law Judge Advocate Discusses Changing Practice Area

The Military Health System (MHS) is in the midst of an historical, timely, and necessary healthcare transformation to improve patient care for its 9.6 million beneficiaries, which includes active and Reserve service members, veterans, and their families.
 
“The MHS transformation has provided Navy Medicine an unmatched opportunity to refocus on our true mission – the reason why we have uniformed medical personnel – which is achieving maximum future life-saving capabilities and survivability along the continuum of care,” said Rear Adm. Bruce L. Gillingham, Navy surgeon general, in a statement to the House Appropriations Committee Subcommittee on Defense on March 5, 2020.
 
Since then, the Navy’s Bureau of Medicine and Surgery (BUMED) – the headquarters for Navy Medicine, which manages personnel at Military Treatment Facilities (MTFs), and at medical research, medical training, and support commands – has been at the forefront of this historic change.
                                                                                                      
Deputy staff judge advocate Lt. Conrad W. Cascadden – a JAG community member currently assigned to BUMED – recently participated in a question-and-answer session to discuss his background and share his perspectives on practicing health law during the MHS transformation.
 
Cascadden attended Boston College, where he earned a Bachelor of Arts in Political Science.  In 2008, he earned his Juris Doctor from Franklin Pierce Law Center (now University of New Hampshire Franklin Pierce School of Law).  After law school, he worked as associate counsel at Shaheen & Gordon, P.A.'s Concord, New Hampshire office specializing in complex corporate litigation in both state and federal courts.  In October 2014, he commissioned through the Navy JAG community’s Direct Appointment Program.
 
From July 2017 through September 2020, he was a victims’ legal counsel at Naval Station Norfolk, Va.  From November 2014 through July 2017, he was a first-tour judge advocate at Region Legal Service Office Mid-Atlantic Detachment Groton and Defense Service Office North, before joining the BUMED legal team.
 
Question:  How many judge advocates – and other members of the JAG community – currently work in this legal practice area? Is it growing and/or expanding its reach?
 
Cascadden:  Currently, there are 12 judge advocates working in the Navy Medicine Enterprise.  This number is set to shrink in the near term with budgetary cuts to nine.
 
Q:  Can you describe the work you do each day? How is your work at BUMED different from a judge advocate’s work at a MTF?
 
C:  BUMED is an echelon 2 command located outside of Washington D.C. proper, but inside the beltway.  It is fast-paced and medically focused.  It is best described like working for the CEO of a medical hospital system that spans the world.  In the office, I am one of two uniformed attorneys and five general counsel.  Unlike a normal staff judge advocate job, this job never slows down.
 
Q:  How was your daily work impacted by COVID-19 during the past year-and-a-half?
C:  Early on, we were shifted to an almost exclusive telework schedule.  As BUMED played a critical part in the response to the pandemic, front office staff were brought back to the office earlier and reduced the amount of telework.  Many questions are still COVID-related.
 
Q:  What do you want JAG community members to know about this practice area, which they may not already know?
 
C:  Having worked in private practice before, this position has the rhythm and pace of private practice, minus the billable hours.
 
Q:  What do you find most rewarding about this tour?
 
C:  Working in this position has been most similar to when I worked at a law firm before I joined the Navy JAG Corps.  The fast pace, the high level of expectation on your work product, the variety of topics on which I work are all challenging on a daily basis.  Also, working closely with the medical community is a role that’s distinct from serving the line community. 
 
Q:  Can you explain the MHS transformation, and the shift in authority to the Defense Health Agency (DHA)? How long has this been underway, and when will it be complete?
 
C:  This is best described as a merger and acquisition except on the governmental scale.  The shift has been underway for years.  There are many difficulties in merging such large organizations and many things to learn from being in the trenches and being responsible for merging unique Navy Medicine processes into the combined DHA system.
 
Q:  How will that transformation impact your work? How will it affect patients, health practitioners, and the wider Navy?
 
C:  It should not affect my work too much.  There are large transitions on the delivery of healthcare to patients.  The level of care will remain the same; however, depending on the status of the patient (retired/dependent/active/Reserve), the transition will affect where care may be delivered and the process is ever evolving, so stay tuned.