Homeless Veterans Need Assistance

December 5, 2007 – “Support our troops.” How often have we heard this Bush administration mantra whenever Congress or the public demands Iraq funding accountability or an Iraq withdrawal timeline? Yet, once the troops become veterans, too often they are woefully neglected. In a 2006 survey, the Department of Veterans Affairs (VA) estimates that 26{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of homeless people are veterans. VA further estimates that at least 195,827 veterans are homeless in the United States, a conservative estimate, 49,724 in California, and 3,000 in San Francisco, with 1,356 of these 3,000 classified as “chronically homeless.” The VA defines “chronically homeless” as an individual with a disabling condition who has been continually homeless for a year or more or has had four or more episodes of homelessness over the past three years.

The National Alliance to End Homelessness estimates that 89,553 to 467,877 veterans were at risk of homelessness, meaning that they were below the poverty level and paying more than 50 percent of household income on rent.

Homelessness is rising among veterans because of high living costs, the lack of adequate funds, and many are struggling with the effects of Post Traumatic Stress Disorder (PTSD) and substance abuse, exacerbated by a lack of support systems.

The VA has been severely criticized for diagnosing wounded veterans with a personality disorder, instead of PTSD, thus denying them disability pay and medical benefits. In the past six years, more than 22,500 soldiers have been suspiciously dismissed with personality disorders, rather than PTSD. By doing so, the military is saving an estimated $8 billion in disability pay and an estimated $4.5 billion in medical care over their lifetimes. (These figures are from “How Specialist Town Lost His Benefits” by Joshua Kors, citing Harvard professor Linda Bilmes’ study, in The Nation (April 9, 2007)).

How many of San Francisco’s homeless veterans, discharged for personality disorders rather than PTSD, would be off the homeless roles if they had disability pay and VA medical care? While not every homeless veteran was misdiagnosed with a personality disorder rather than PTSD, it seems obvious that the VA should do more to reach its stated “goal to provide excellence in patient care, veterans’ benefits and customer satisfaction.”

Passage of the FY 2008 HUD appropriations bill would be a modest start. It includes $75 million for nearly 7,500 HUD-VA Supported Housing vouchers for homeless and disabled veterans. Unfortunately, President Bush has threatened to veto this bill because it exceeds his spending request. It is shameful that we can spend $473.4+ billion conducting the Iraq war, but not an additional $75 million for war casualties.

Ralph Stone is a Vietnam veteran living in San Francisco. Send feedback to stonere@earthlink.net.

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Wounded Warrior Bill Win on Horizon – S 1606 Makes it Through Conference Committee

Congress OKs new pay and benefits provisions

[VCS Note: VCS worked very hard on key passages of this critical legislation.  We await word on the final details of the bill and how it will be implemented when it becomes law, as expected.] 

Friday, December 7, 2007 – After months of bickering, congressional negotiators have approved a $696.3 billion defense policy bill that includes a 3.5 percent military pay raise, improvements to treatment and benefits for wounded combat veterans, and precedent-setting changes in reserve retired pay and survivor benefits.

The agreement comes in time for Congress to pass it, and President Bush to sign it, before the Dec. 31 expiration of a variety of recruiting and retention benefits, including enlistment and re-enlistment bonuses — as long as no surprises pop up when lawmakers take the required final votes on the measure.

The pay raise, the wounded warrior assistance package, the more generous reserve retirement plan and a monthly increase in survivor benefits are all examples of congressional initiatives that were opposed by the White House and Pentagon, but which lawmakers felt were needed in time of war.

Under the agreement struck Dec. 6, active and reserve members would get a 3.5 percent increase in basic pay and drill pay Jan. 1, an amount 0.5 percentage point more than the Bush administration proposed. The White House sought a 3 percent increase that would have matched average private-sector wage growth last year.

But negotiators dropped a House plan that would have provided raises in 2009 through 2012 that also would have been modestly higher than civilian wage growth, something White House and defense officials said was overly generous and would take money from other priorities.

However, lawmakers stood firm against continued administration calls to raise Tricare premiums and retail pharmacy co-pays for many beneficiaries. As they did last year, negotiators banned such increases for fiscal 2008.

A large section of the bill, the Wounded Warrior Assistance Act, is a congressional response to complaints from combat-injured troops about cumbersome policies regarding treatment of injuries, the process for determining whether they can stay in the military, the benefits they get if they separate, and the transfer of their health care from the military to the Department of Veterans Affairs.

The bill orders the creation of a Wounded Warrior Resource Center to serve as the main point of contact for troops and families for questions about health care and benefits. The bill also orders the Pentagon and VA to set common standards for disability evaluations, develop a common policy for care and management of those injured in war, and find a way to share electronic medical records — a longstanding complaint.

It also orders an expansion of the Family and Medical Leave Act to give people caring for combat-injured troops up to 26 weeks of unpaid time off, twice the amount currently allowed.

Rep. Ike Skelton, D-Mo., House Armed Services Committee chairman, said he hopes the provisions on combat-injured troops would “restore confidence in the quality of care and service received by wounded warriors and their families.”

And Rep. Bob Filner, D-Calif., the House Veterans’ Affairs Committee chairman, said Congress is not finished. He said his committee plans to do even more next year, particularly in smoothing the transition of injured troops between military and VA care facilities. A key issue is to “make sure that VA has the resources it needs to care for our returning service members and the veterans from previous conflicts,” Filner said.

Negotiators approved a Senate proposal to allow some National Guard and reserve members to draw military retired pay earlier than the current age 60, and a House-passed plan to provide $50 per month to survivors to partly make up for the offset in military survivor benefits required of those who are also eligible for VA Dependency and Indemnity Compensation. The payment would rise to $100 in 2014.

Negotiators decided that military retirees with VA disability ratings of less than 100 percent who are nevertheless considered fully disabled because they cannot work should be treated the same as other 100 percent disabled retirees when applying to concurrently receive their full military retired pay and veterans’ disability compensation.

And lawmakers ordered that people who are medically retired before completing 20 years of service also should qualify for “concurrent receipt.”

The reserve retirement plan would allow a reservist to begin drawing retired pay 90 days earlier than age 60 for every 90 days of mobilization.

Pentagon officials argue the change would encourage experienced reservists to leave service. But supporters, led by Sen. Saxby Chambliss, R-Ga., said a more generous system is only fair, considering the increased burden on Guard and reserve members since the Sept. 11 terrorist attacks.

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Senator Webb Says Bush Using ‘Fear Tactics’ For More War Funding

December 2, 2007 – Senator Jim Webb (D-VA) went on the offensive over the delay of supplemental funding for the war in Iraq, dismissing recent comments by President Bush saying delays in funding puts troops in harms way as “fear tactics.” Appearing on the program Meet The Press, Webb also suggested that the issue at the heart of the current fight over war funding is how long American troops will be deployed in Iraq.

“The problem with the administration’s approach to [war funding] is that they constantly use fear tactics,” Webb said, citing the President Bush and Congressional Republicans defeat of his amendment to give troops longer breaks between deployments. “If President Bush had said to do it they’d be saluting and doing it.”

“There’s no one in the Congress who’s going to interrupt funding that goes to the ability of the military to take care of the present responsibilities, Webb said. He said that by engaging in scare tactics, Bush and his Republican allies in Congress avoid debate over the length of the American mission in Iraq.

“The elephant in the bedroom for this entire time period is how long are we going to be in Iraq? What are we funding implicitly as well as implicitly, and we don’t get to have this debate,” Webb said, expressing concerns that President Bush wishes to establish permanent bases in Iraq using the American presence on the Korean peninsula as a model.

Later in the interview, host Tim Russert pressed Webb on his party’s plan for funding the war.

“There are some Democrats who have said they want to stop funding the war period,” Russert said.

“And I think that’s just not a winning formula,” Webb responded.

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Feeding Off the Pentagon – Winkenwerder Lands $800 Million Contract

December 4, 2007 – In April 2007, William Winkenwerder Jr. retired from his position as assistant secretary for health affairs at the Department of Defense, where he had been in charge of all military healthcare. On June 1, he went to work for a Wisconsin-based private contractor named Logistics Health Inc., which hired him to serve on its board of directors and “advise and counsel LHI on business development,” according to a company press release. It was a hire that seems to have paid quick dividends.

On June 13, 2007, the Department of Defense began accepting bids for a contract to give soldiers medical and dental exams before they head off to war. Logistics Health was among the companies bidding on the contract, which was worth hundreds of millions of dollars over four years. Before he left the DOD, in addition to running military healthcare, Winkenwerder had also been in charge of the office that wrote the contract.

On Sept. 25, Logistics Health won the contract despite bidding $800 million, meaning it was not the low bidder. At least one other company bid $100 million less.

After objections by competing companies, the contract has now been “stayed,” or put on hold, while the Government Accountability Office, the investigative arm of Congress, evaluates those complaints. At least one firm alleging unfair bidding practices has also asked congressional watchdog Rep. Henry Waxman, D-Calif., to investigate. But the contract may still be awarded to Logistics Health; the GAO will issue a decision by Jan. 14. The contract, which at one time was also going to benefit a second firm with its own revolving door to the federal government, exemplifies the culture of cronyism in privatized military healthcare. Military healthcare is a lucrative wartime bazaar for private contractors that is largely free of oversight — and of Halliburton- or Blackwater-size headlines.

You might remember William Winkenwerder from earlier this year. While still at the Pentagon and responsible for military healthcare, he expressed shock at reports in the Washington Post on neglect of outpatients at Walter Reed Army Medical Center, even though Salon had reported the same neglect two years earlier. “This news caught me — as it did many other people — completely by surprise,” he said at a Feb. 21 press conference.

On paper, the process of awarding the contract for soldiers’ medical and dental exams was handled through the U.S. Army Medical Research Acquisition Activity, a contracting shop at Fort Detrick in Frederick, Md. Winkenwerder didn’t control that office when he was at the Pentagon.

But as assistant secretary of defense for healthcare, Winkenwerder was also director of a DOD office called TRICARE Management Activity. When the government contracts out for services, the details of the services it wants from a bidder are contained in a document called the “statement of work.” In the case of the medical and dental exam contract, the “statement of work” was not written at Fort Detrick, where it belonged officially, but by Winkenwerder’s office, TRICARE Management Activity. “We are just the contracting office,” explained Christopher Sherman, a civilian official at Fort Detrick. “That contract is managed by the TRICARE Management Activity … We have them put together the statements of work and the solicitations.” Sherman said Winkenwerder’s office had been preparing the contract since late 2006.

Dina Rasor, author of “Betraying Our Troops: The Destructive Results of Privatizing War,” said it was likely that Winkenwerder’s office configured the statement of work in such a way that a contract would be awarded to a favored company over its competitors. Though she had not reviewed the statement of work in question, Rasor said manipulating these documents is a common abuse in government contracting. “They take something unique about the company and they put that in the statement of work or [add] requirements that the other companies [can’t meet],” said Rasor. “It is the kind of thing that is hard to put your finger on. These people have become very sophisticated at doing this.”

The competing companies that protested the Logistics Health deal have taken note of Winkenwerder’s role. “I think it is a conflict scenario,” said Charles Roché, chairman of United States Military Dental Service Corp. He expressed the alleged conflict of interest in a rhetorical question. “You end up being employed by the very people that you are helping put together the deal for?”

Roché and other contractors have also seized on what they say is an additional anomaly with the contract. When Logistics Health put together its bid, it partnered with other firms, including QTC Management Inc., another contractor that is the largest private provider of government-outsourced disability examination services in the country. The company has raked in hundreds of millions through contracts with the Department of Veterans Affairs. Anthony Principi, the former secretary of the VA, is chairman of the board. And President Bush recently nominated QTC Management chief operating officer James Peake to be the next VA secretary. (Peake was also the former Army surgeon general through 2004.) His confirmation hearing is slated for Dec. 5.

The details of the proposal that Logistics Health submitted to the Defense Department are not public. It is known that QTC Management was supposed to be a partner in the deal; competitors like Roché believe QTC Management was supposed to be a significant partner, since it employs more than 600 clinical associates to perform the sort of medical exams the contract would require. This fall, investors from Logistics Health and QTC Management were even in merger talks.

But on Sept. 10, just days before the contract was awarded, QTC suddenly withdrew from the Logistics bid and pulled the plug on merger talks, both for reasons unknown.

In a telephone interview, Principi, the QTC chairman, would not say why his company suddenly cut off relations with Logistics Health mere days before the $800 million contract was awarded. “It was just a business decision that was made,” Principi said. “QTC decided not to have anything to do with LHI.”

But more important, other contractors say the Defense Department was aware of the falling out. And that means that right before Logistics Health won the contract, the company lost what was probably a significant partner — a partner whose potential contribution DOD must have evaluated when considering which bidder was most qualified to get the contract.

Other contractors were flabbergasted that Logistics Health was still awarded that $800 million contract, despite QTC’s exit just days earlier. “That’s like saying I made a deal with you and this is what you are supposed to do, and I am going to sign this deal,” explained Roché. “But … the very people that were part of the deal are no longer present on your side of the desk. So how can you tell me you are able to make a deal when half of your business fell apart?”

Roché’s protest was dismissed by the GAO on technical grounds. But another company, Comprehensive Health Services, has also objected to the award of the massive contract. The GAO will decide the merits of the protest by Jan. 14.

And Roché has also appealed to Congress for help. “At the time the contract was awarded, LHI had lost its partner in the bid,” Roché recently wrote Henry Waxman, the pugnacious California Democrat who has subpoena power as chairman of the House Committee on Oversight and Government Reform. “The offering made to the government was substantively altered by the withdrawal of a key partner in the bid.”

Waxman’s staff did not return a call from Salon seeking comment. But on Nov. 8, Waxman wrote Roché saying his investigative staff would review information passed along by Roché.

In a statement to Salon, Diana Henry, the Logistics Health corporate communications manager, said, “Logistics Health Incorporated (LHI) has established a reputation as an outstanding company with a track record of superior service to its customers.” She added that the company “conducts all of its business activities in a highly ethical and professional manner.” She did not respond to questions about Winkenwerder.

In an Oct. 26 Los Angeles Times article, Winkenwerder was quoted as saying that he had nothing to do with the procurement process, had not talked to Logistics Health about working there until after he left the government in April, and had not lobbied the government for the contract after leaving the Pentagon. The Los Angeles Times article contained the first report that other companies had protested the contract, and that one losing bid from another firm was for $100 million less than the Logistics Health proposal.

Interestingly, prior to this award Logistics Health had already had a contract to perform medical and dental exams on guard and reserve soldiers, which ended in 2006. But that contract was administered through the Department of Health and Human Services, a major client that has paid the company more than $185 million since 2000, according to data available through the nonprofit group OMB Watch. Logistics Health’s president is Tommy Thompson, the former secretary of that department, who joined the company in March 2005 two months after leaving DHHS.

In September 2006, the government announced that the responsibility for the contract would be transferred from DHHS to the Department of Defense. Winkenwerder joined Logistics Health in June 2007, two months after leaving the DOD, and in September the company won the new contract from the DOD for performing medical and dental exams.

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Iraq War Veterans Try to Ease the Re-Entry for Others

December 2, 2007 – Marine Cpl. Sean Scharf still has a vivid memory of how he was greeted on his new job at a bowling alley two years ago when he had returned from his second tour of duty in Iraq . “This guy goes, ‘Oh you’re back from the war? Well, don’t flip out on me!,’ ” Scharf said, shaking his head at the memory. “What did he think I was going to do?”

Scharf’s pal from his platoon, Cpl. Sean O’Neill, had an even more typical encounter. He was at a party when it came up that he had just finished his second tour. “So, of course, someone asked me, ‘Hey man, did you kill anyone?’ ” O’Neill said, rolling his eyes with disgust. “You wouldn’t believe how many people ask that. Like, ‘So, you a killer?’ “

Vets helping vets: When I caught up with Scharf and O’Neill last month at UC-Berkeley, where O’Neill is studying political science, it had been more than two years since I’d seen them at a friend’s house in Saratoga . Scharf is now a student at San Jose City College , studying law enforcement and moonlighting as a security guard. Both have helped form the fledgling Bay Area chapter of Vets For Vets, helping veterans readjust to life at home.

Recently released statistics on the alarming number of suicides among Iraq war veterans are the most dramatic sign that Vets for Vets and groups like it are an essential part of helping soldiers with their often bewildering re-entry to civilian life.

The Associated Press published preliminary information from the Department of Veterans Affairs that 283 combat veterans who served in the war between 2001 and 2005 killed themselves after returning home. A CBS News report in November said that from 2004 to 2005, veterans ages 20 to 24 – those most likely to have served in Iraq and Afghanistan – killed themselves at twice the rate of civilians in that age group.

Scharf and O’Neill said they haven’t yet counseled anyone they thought might be suicidal, but they have talked to plenty of vets who seem to be lost at home. They said most soldiers they speak to aren’t so much stymied by the politics of the war as they are by being back in a life without the structure, comradeship and solid identity of the military.

“You know, one minute you’re this action hero, and the next, you’re at home doing some job stacking and kicking boxes around,” Scarf said. “It can be really difficult to make that change.”

Where to look: And then there are those who had a wartime experience that’s so wrenching they can’t come to terms with it and don’t know where to find help.

Mostly, Scharf and O’Neill talk to the vets at barbecues and outings they arrange, and they refer them to services ranging from places to get an affordable apartment and a job to how they can get help from the VA. They also work in connection with the San Francisco-based veterans’ advocacy group, Swords to Plowshares.

One member of Vets for Vets, Tia Christopher, has even written a manual for returning soldiers that includes a chapter for civilians on what to say and not to say to a vet.

“What they don’t want to hear is, ‘You kill anyone?’ or ‘You see any action?’ or “Are you OK mentally?’ ” Christopher told me. “Just say, ‘Welcome back.’ Or maybe, ‘How’s your transition going?’ “

O’Neill said the question he appreciated the most was, “How can I help?” That’s something that many returning vets desperately need to hear.

IF YOU’RE INTERESTED: For more information about Vets for Vets, e-mail bayareavets@gmail.com. Contact Swords to Plowshares at www.swords-to-plowshares.org or call (415) 252-4788.

Contact Sue Hutchison at shutchison@mercurynews.com

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Former Bragg General, Dr. Peake, on Track for VA Secretary

“In all fairness, Gen. Peake was really busy setting up combat hospitals in the Iraq and Afghanistan war zones,” VCS Executive Director Paul Sullivan said. “And he gets an ‘A’ for doing a fine job at that.  But when it came to the long-term outpatient health care needs and long-term benefits for soldiers leaving the military … Peake dropped the ball.”

December 6, 2007 – A retired general who once commanded the hospital at Fort Bragg spoke Wednesday before the U.S. Senate in a hearing to determine whether he should lead the federal Department of Veterans Affairs.

Retired Lt. Gen. James Peake — who served at Fort Bragg as commander of the 44th Medical Brigade and as the post’s health services director — pledged to be an advocate for injured veterans and to fight for funding for their care.

Peake, who is 63, became commander of the 44th Medical Brigade at Fort Bragg in 1992. He left in 1994 to command Madigan Army Medical Center at Fort Lewis, Wash.

Peake retired from the Army in 2004 after being lead commander in several medical posts, including four years as the U.S. Army surgeon general.

In the 2½-hour confirmation hearing, The Associated Press reported, Peake also vowed to work on making headway in fixing gaps in care and reducing delays in disability pay.

But Peake hedged on offering specific solutions, according to the AP, deferring to detailed briefings he will receive later if confirmed. He indicated that his greatest mark on the agency in the waning months of the Bush administration might be improved communications with the Defense Department.

The AP reported that most major veterans organization are not opposed to Peake’s nomination.

But at least one group has reservations.

Paul Sullivan, executive director of Veterans for Common Sense, a non-profit group that advocates for veterans’ rights, said his organization is concerned about the long-term health care veterans will receive from a VA under Peake’s direction. Sullivan said he is concerned because Peake was surgeon general of the Army when problems at Walter Reed Army Medical Center came to light.

“In all fairness, Gen. Peake was really busy setting up combat hospitals in the Iraq and Afghanistan war zones,” Sullivan said. “And he gets an ‘A’ for doing a fine job at that.

“But when it came to the long-term outpatient health care needs and long-term benefits for soldiers leaving the military … Peake dropped the ball.”

Sullivan said he expects Peake to be confirmed as VA secretary. The Associated Press reported that the full Senate is expected to confirm his nomination as early as this month.

Staff writer Laura Arenschield can be reached at arenschieldl@fayobserver.com or at 486-3572.

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New Anthrax Vaccine Doomed by Lobbying

December 2, 2007 – Shortly after the Sept. 11, 2001, terrorist attacks and the subsequent anthrax mailings, top U.S. science advisors said the country “urgently needed” a new, improved anthrax vaccine.

The existing vaccine often caused swollen arms and muscle and joint pain. Inoculation required six injections over 18 months, followed by yearly booster shots. The estimated shelf life was just three years.

The scientists’ report, issued by the Institute of Medicine, called for “an anthrax vaccine free of these drawbacks” — a vaccine that would require only two or three injections, achieve protection within 30 days, stay potent for a long time and cause fewer adverse reactions.

Yet nearly six years later, the old vaccine is still the only one available — and the government is buying it in mass quantities for the Strategic National Stockpile.

The manufacturer, Emergent BioSolutions Inc. of Rockville, Md., prevailed in a bitter struggle with a rival company that was preparing what federal health officials expected to be a superior vaccine. The episode illustrates the clout wielded by well-connected lobbyists over billions in spending for the Bush administration’s anti-terrorism program.

Emergent’s rival, VaxGen Inc. of South San Francisco, had spent four years developing a new anthrax vaccine and had won an $877.5-million federal contract to deliver enough doses for 25 million people. The contract threatened Emergent’s very existence. The old vaccine, its only moneymaker, would likely be obsolete if VaxGen succeeded.

Emergent responded by mobilizing more than 50 lobbyists, including former aides to Vice President Dick Cheney, to make the case that relying on the new vaccine was a gamble and that the nation’s safety depended on buying more of Emergent’s product.

The company and its allies in Congress ridiculed VaxGen and impugned the competence or motives of officials who supported the new vaccine. The lobbying effort damaged VaxGen’s credibility with members of Congress and the Bush administration, a Los Angeles Times investigation found.

When VaxGen encountered a stubborn scientific problem and needed more time to deliver its vaccine, the firm found scant support, even among officials who had earlier backed its efforts. The government then imposed tougher testing requirements on the struggling company.

A senior federal scientist who oversaw the project said she sought authority to allow advance payment to VaxGen to help it work through the difficulties. Top administration officials blocked her requests, she said.

Finally, a year ago, officials canceled VaxGen’s contract, all but capsizing the company.

Emergent, meanwhile, has won federal contracts worth at least $642 million for the old vaccine and is in line to win many millions more as the government expands the strategic stockpile.

Kimberly B. Root, a spokeswoman for Emergent (formerly BioPort Corp.), said the company’s lobbying ultimately served the national interest.

“Had we just thrown up our hands, what position would we be in now?” Root asked. “Where would the government be? There wouldn’t be, potentially, a vaccine in the stockpile.”

Bill Hall, a spokesman for the U.S. Department of Health and Human Services, said VaxGen’s “poor performance” sealed its fate. In canceling the contract, Hall said, officials acted “as effective custodians of government finances.”

Yet Dr. Philip K. Russell, a vaccinologist and retired Army general who was a senior biodefense official in the Bush administration, described the outcome as “a big, dramatic failure.”

“National security took a back seat to politics and the power of lawyers and lobbyists,” said Russell, who supported the decision to award VaxGen the contract.

If officials had granted the company a bit more time, Russell said, it would likely have solved its scientific problem and delivered a superior vaccine. He noted that setbacks are common in developing vaccines and said VaxGen appeared capable of overcoming this one.

“It wasn’t an insurmountable problem,” said Russell, who after leaving the government did not lobby for or advise either of the competing vaccine companies. “It was a solvable problem.”

Effort to contain threats

On the Sunday night after Sept. 11, 2001, Health and Human Services Secretary Tommy G. Thompson convened an urgent meeting of health officials and leading scientists.

“Tommy Thompson was really, really concerned that something could happen,” recalled Dr. Donald A. “D.A.” Henderson, a former World Health Organization physician who led successful efforts to eradicate smallpox. “There was intelligence information coming through and some chatter coming through, suggesting there was going to be a second event, that the second event could very likely be a biologic event.

“And anthrax and smallpox were both raised as possibilities.”

The imperative was clear: Find a way to eliminate both threats.

About 10 p.m., as they filed out of HHS headquarters, Henderson and health department lawyer Stewart Simonson acknowledged their fears.

“I told D.A., ‘We’re going to make this work.’ And he said, ‘I just hope we’re not too late,’ ” Simonson recalled. “That’s how scared we were.”

They and other federal officials later scored a victory over one of the two threats: Working closely with vaccine manufacturers, they assembled 200 million doses of smallpox vaccine.

Countering anthrax quickly proved to be more complicated.

In October 2001, six envelopes containing powdered anthrax were sent through the mail on the East Coast, killing five people and sickening about 20 others. Authorities closed contaminated buildings in Washington and Florida, and treated hundreds of congressional employees with antibiotics. No one has been charged in the attacks.

The anthrax mailings showed that the most reliable way to prevent death is with an antibiotic such as Cipro or doxycycline, administered quickly and for up to 60 days. Inhaled anthrax otherwise can kill up to 90{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of those infected. The Strategic National Stockpile now holds enough such antibiotics to treat more than 40 million people.

Dr. Anthony S. Fauci, who directs the National Institute of Allergy and Infectious Diseases and has advised President Bush and Congress on U.S. preparedness, said: “We already know that we prevented a serious problem on the Hill by essentially blanket-treating people with [Cipro]. We know that because when we went back and did surveys, we found that many people who had absolutely no symptoms were actually exposed.”

The success in limiting deaths from the 2001 mailings brought into focus the lack of expert consensus about the magnitude of the anthrax threat. Some scientists have said that terrorists could disperse anthrax over a wide area, inflicting casualties on the scale of a nuclear weapon.

Skeptics, however, note that although anthrax is relatively easy to obtain and can linger tenaciously on surfaces, it is not contagious and is difficult to deliver lethally outdoors.

Another attack, Fauci said, “would create massive panic in this country. It would create economic and other real, logistical problems. But at the end of the day, you’re not going to kill as many people as you would if you blasted off a couple of car bombs in Times Square.”

Nevertheless, fear of a panic-inducing anthrax event generated momentum for amassing millions of doses of vaccine as a backstop to the antibiotics that would be the first line of defense.

Bush underscored the threat as he rallied support for the Iraq war. In an October 2002 speech in Cincinnati, the president told a crowd that Saddam Hussein’s regime had supplies of anthrax and other biological weapons “capable of killing millions.” Such weapons could be easily deployed, Bush added: “All that might be required are a small container and one terrorist or Iraqi intelligence operative to deliver it.”

The U.S. already had a military stockpile of anthrax vaccine, filled with Emergent’s product. Now, support grew for creating a civilian cache, to allow mass inoculations immediately after an attack.

The idea was that a new vaccine — faster-working, with fewer doses and fewer side effects — would protect people who couldn’t tolerate antibiotics and would work against anthrax that withstood antibiotic treatment. A vaccine might also help protect people reentering a building that had been contaminated.

In February 2002, the Institute of Medicine released its report, calling the old vaccine “reasonably safe” but “far from optimal” and concluding: “A new vaccine, developed according to more modern principles of vaccinology, is urgently needed.”

Officials meeting privately in late 2003 — including Russell, Simonson, representatives of the vice president’s office, the Centers for Disease Control and Prevention, the Department of Homeland Security and Fauci’s staff — decided to push for the purchase of 75 million doses of a new, genetically engineered vaccine.

Dr. Kenneth W. Bernard, then a biodefense advisor to Bush, estimated that such a stockpile — providing three doses for 25 million Americans — would be enough to respond to simultaneous attacks on New York, Los Angeles and Washington.

Henderson and Russell said the requirement for 75 million doses was based as well on a desire to keep a manufacturer operating continuously, so it could quickly ramp up production in a crisis.

The problem now, both said in recent interviews, is that the nation has not gotten a newer, better vaccine.

Project BioShield contract

In July 2004, President Bush signed legislation called Project BioShield, providing $5.6 billion for “next generation” vaccines and drugs to counter threats of biological terrorism.

VaxGen had been working for two years on its anthrax vaccine, building on earlier efforts by the Army. VaxGen’s early work had impressed Fauci’s staff, which oversaw $100 million in federal research grants to the company.

Now VaxGen wanted to win the first BioShield contract. The company had been formed in 1995 by scientists from Genentech Inc., which retained an ownership stake. Lance K. Gordon, inventor of the first vaccine for infant meningitis, became VaxGen’s chief executive in 2001.

But by 2003, the company’s survival was in doubt. It had seen an experimental AIDS vaccine fail in late-stage testing. And in August 2004, the Nasdaq stock exchange delisted VaxGen for failing to file timely financial results; the company’s stock price sank 35{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d}.

VaxGen sought the BioShield contract by proposing to genetically engineer an anthrax vaccine with greater purity, more consistent potency and fewer unwanted side effects than Emergent’s old vaccine.

But inside the company’s salmon-colored walls facing San Francisco Bay, technicians were seeing disquieting data: Blood samples drawn from study patients showed that the vaccine failed to trigger enough anthrax-fighting antibodies.

VaxGen hired more vaccine experts, including a new chief scientific officer.

The complication did not deter federal health officials. On Nov. 4, 2004, HHS Secretary Thompson announced that VaxGen had been awarded the BioShield contract, worth $877.5 million. The money would start to flow when the company made its first delivery of vaccine, expected in two years.

“Acquiring a stockpile of this new anthrax vaccine is a key step toward protecting the American public against another anthrax attack,” Thompson said.

The announcement was bad news for Emergent, whose vaccine remained the only revenue generator for its BioPort subsidiary.

“We were worried about it,” recalled retired Navy Adm. William J. Crowe Jr., a former chairman of the Joint Chiefs of Staff who served on the company’s board from 1998 through late 2005. (Crowe was interviewed at a hospital in Virginia in late August, two months before his death at age 82.)

BioPort was founded in 1998 by Ibrahim El-Hibri, a Lebanese financier. Along with Fuad, his U.S.-educated son, El-Hibri formed BioPort by purchasing vaccine-making facilities of the state of Michigan for $24.75 million. The company’s only product was the anthrax vaccine, called BioThrax, which it sold chiefly to the U.S. military. In mid-2004, the company reorganized as Emergent BioSolutions.

To counter the challenge posed by VaxGen, Emergent invested where it could buy immediate impact: lobbying.

“We had 500 employees who were about to lose their jobs, and we went out and became advocates for them,” said Allen Shofe, a company vice president who managed its lobbyists.

In 2005, Emergent’s yearly spending for lobbying nearly quadrupled, to $1.41 million. Last year it reached $2.1 million, federal records show. All told, from 2004 through June 2007, the company used 52 lobbyists at a cost of $5.29 million, the records show.

During the same period, VaxGen spent $720,000 on six lobbyists.

Emergent’s lobbyists stressed a core message:

* U.S. civilians were at risk of death without an immediately expanded stockpile of anthrax vaccine;

* Emergent stood ready to supply the civilian stockpile, whereas VaxGen had yet to prove it could deliver a new product;

* Emergent might stop making the vaccine if the government chose not to buy its product for the stockpile.

The company enlisted friendly members of Congress and recruited a cadre of former government officials to press its attack. Among them was Jerome M. Hauer, a former acting assistant secretary for emergency preparedness at HHS.

Hauer had been in the thick of decisions to pursue a new anthrax vaccine. While at HHS, he told Emergent in a February 2003 letter that the department had concluded a new vaccine was “a better long-range option than investing in expanding manufacturing capacity” for BioThrax. Hauer wrote that “the scientific basis” for a genetically engineered vaccine was “very sound and will result in an improved product.”

But after leaving the Bush administration in late 2003, Hauer did an about-face, delivering Emergent as a client to his new boss, the Fleishman-Hillard public relations and lobbying firm, according to company records and people familiar with the matter.

At a December 2004 biotech-industry conference, Hauer said the government should purchase more of the old vaccine. He also took aim at Simonson, the HHS lawyer, who had succeeded him as assistant secretary. Hauer said that Simonson should be stripped of his authority for his handling of the BioShield contract.

In June 2005, Emergent placed Hauer on its board of directors. In that year and 2006, Emergent paid $360,000 to Fleishman-Hillard, records show.

In an interview, Hauer said he lobbied members of Congress and advised the company how to “educate” the administration. He said he changed his mind about Emergent’s vaccine after concluding that he had relied earlier on “biased information” from his then-colleagues at HHS.

In the spring of 2005, VaxGen became more vulnerable to its rival’s onslaught. VaxGen scientists determined that the problem with the new vaccine’s potency was not the result of a lapse in refrigeration, as they had first speculated. The difficulty lay with the vaccine’s formula. An aluminum additive, expected to increase potency, had the opposite effect.

“Our vaccine had a stability problem,” said Dr. Marc J. Gurwith, a scientific executive with VaxGen. “The problem was going to take more testing to figure out what went wrong and how to fix it.”

VaxGen needed patience and flexibility from its presumed allies in Washington. But Thompson had resigned as HHS secretary, and Emergent’s lobbying had changed the atmosphere. Officials who had backed VaxGen’s drive to deliver a better vaccine were no longer responsive.

“We had a very productive partnership with the government until we encountered a problem,” said Piers Whitehead, VaxGen’s vice president for corporate and business development. “Things deteriorated very rapidly.”

In April 2005, Dr. Noreen A. Hynes took over the HHS office that oversaw development of new drugs and vaccines under Project BioShield. Hynes, previously a bioterrorism advisor in the White House, said she was concerned about whether any small company could shoulder the costs of developing a new vaccine.

The Project BioShield law allowed advance payments of up to 10{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of the value of a contract. But when she sought permission to grant such payments, Hynes said, she was turned down.

“I was told that the administration had decided there would be none,” Hynes said in an interview. Asked who made the decision, Hynes said that she did not know but that it flowed from “the highest level.”

Hynes, an infectious-disease specialist now at Johns Hopkins University, added: “It was not surprising, frankly, that this new type of vaccine would have been delayed in development. That’s just the way vaccine development is. . . . It’s one of the reasons why you would want to have the advance-payment authority.”

VaxGen officials said they sought advance payment three times in 2005 and 2006: twice in discussions with HHS and once in writing. Hall, the health department spokesman, said any consideration of such payments “became moot” because of VaxGen’s lack of progress.

Emergent executives knew well the problems inherent in developing and manufacturing vaccines. The state facilities they acquired in Lansing, Mich., had been beset with problems. In 1999 and 2000, inspectors from the Food and Drug Administration found deficiencies in the company’s vaccine, including problems with stability, potency and purity.

The company pledged to rectify the inadequacies — and the government stuck with it as the sole supplier of anthrax vaccine to the military.

Now, as Emergent sought to neutralize the competitive threat from VaxGen, it added to its lobbying team John V. Hishta, who had deep ties to the Republican congressional leadership.

Hishta was chief of staff to Rep. Thomas M. Davis III (R-Va.) and has continued to serve him as a campaign advisor. Hishta also directed national efforts to elect Republicans to the House from 2000 through 2002.

In July 2005, he arranged for an Emergent executive to appear before the House Government Oversight and Reform Committee, which was chaired by Davis.

In his opening statement, Davis voiced “concern” that federal officials had “made insufficient efforts to stockpile existing countermeasures while new and improved ones are being developed.”

The Emergent executive, Robert G. Kramer, told the committee that health officials were undermining national security by contracting for VaxGen’s product instead of buying more of Emergent’s.

“HHS has staked the nation’s protection against the No. 1 biologic threat on an experimental product,” Kramer said.

Kramer emphasized that Emergent would reassess whether to keep making the anthrax vaccine. The company, he said, “finds itself at a critical juncture in terms of its ability and willingness to commit resources to a product that lacks a committed customer.”

Representatives of VaxGen were not invited to appear.

Asked about his role, Hishta said, “I don’t want to comment on my lobbying work.”

Davis did not respond to questions submitted through an aide.

Another key lobbyist for Emergent was Todd A. Boulanger, who had served as an aide to Republican members of Congress. Boulanger helped shape a letter by Sen. Charles E. Grassley (R-Iowa) to Thompson’s successor as HHS secretary, pressing him to explain why his department had not purchased more anthrax vaccine from Emergent.

The selection of VaxGen, Grassley wrote, was “highly suspect.” In his letter, dated Jan. 28, 2005, Grassley told the new secretary, Mike Leavitt, about “a number of troubling allegations” regarding the vaccine contract. Grassley suggested that HHS “acted prematurely” in awarding it to VaxGen. “Some have questioned the effectiveness” of VaxGen’s product, he wrote, noting that the old vaccine “has been available for use in this country for several decades.”

Nine weeks later, Grassley again wrote to Leavitt: “I remain greatly concerned that the department is not prepared to protect the American people from an anthrax attack.”

Grassley also questioned the independence of Russell, the vaccine specialist who backed awarding the BioShield contract to VaxGen. Grassley claimed the former general had been involved in developing the vaccine years earlier with the Army.

Russell, who left the health department in late 2004, said he had no financial stake in the vaccine and no role in developing it.

“How do you confront a whisper campaign?” Russell asked. “The lobbyists have to earn their pay.”

Boulanger’s role in providing material to Grassley — including language for the senator’s January 2005 letter — was described by people who said they had direct knowledge of his actions. Asked for comment, Boulanger said, “I’m not going to say anything about my private conversations with his [Grassley’s] staff.”

Emergent paid Boulanger’s firm, Cassidy & Associates, $300,000 from 2004 to 2006.

A spokeswoman for Grassley, Jill Kozeny, said the senator’s letters were “based on information from a number of sources.”

Grassley’s intervention hurt VaxGen on two fronts, company executives said:

Because of his reputation as a fiscal watchdog, his criticism sowed reticence about VaxGen within Congress and the administration. And the prospect of overcoming potent political opposition while trying to solve a tough scientific challenge weakened the resolve of VaxGen’s major investors.

Emergent, meanwhile, broadened its connections to the White House by hiring Cesar V. Conda and Ron Christie as lobbyists. Both had been policy aides to Vice President Cheney, who championed Project BioShield.

According to people familiar with the lobbyists’ conversations with lawmakers, Conda and Christie raised doubts about Simonson’s handling of the vaccine contract, just as Hauer had.

As assistant secretary for emergency preparedness, Simonson could have made the case within the Bush administration for giving VaxGen an advance on its contract. But that prospect was dimmed after the lobbyists’ attacks, said Russell.

“Simonson was neutralized,” he said.

Simonson, who left the government in mid-2006, declined to comment on Emergent’s lobbying effort.

Neither Conda nor Christie responded to messages seeking comment. Emergent paid their firm, DC Navigators, $340,000 from 2006 through June of this year.

One of Emergent’s other lobbying firms, McKenna Long & Aldrich, has taken credit for helping write the Project BioShield law. Seven members of the McKenna firm subsequently registered to lobby for Emergent.

From 2005 through June 2007, Emergent paid the firm $380,000.

Government changes rules

VaxGen’s contract called for delivery of the first 25 million doses of vaccine by November 2006.

In May of that year, government health officials extended the deadline three years.

But they also erected new hurdles: They required VaxGen to complete, at the company’s expense, new testing of the vaccine in animals, plus an additional study in humans. The original contract had allowed VaxGen to defer such studies until after the company began receiving payments.

VaxGen fought without success for better terms, notably partial payment before delivering the vaccine. It objected to the new regulatory requirements. It kept at work on the stability problem.

After reviewing VaxGen’s progress, the FDA on Nov. 2, 2006, denied approval to begin the new study in humans, citing concern about whether the vaccine was stable enough.

On Dec. 19, 2006, the health department canceled VaxGen’s contract. By this fall, VaxGen had laid off 90{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of its workforce, which peaked two years ago at 295 employees, a spokesman said. The company plans to merge with another Bay Area biotech firm.

In an October report, the Government Accountability Office said that health officials and VaxGen had been “unrealistic” in believing the company could deliver its vaccine on schedule. The GAO also said VaxGen was hindered by regulatory requirements that “were not known” to the company when the contract was awarded.

VaxGen’s Gurwith said in an interview that based on lab results, he was convinced as of July that the company had figured out how to maintain the vaccine’s stability. Chief executive James P. Panek said that if the government had stood by VaxGen, it probably would have delivered a better vaccine “well ahead” of any other manufacturer and at far lower cost.

Emergent, meanwhile, has continued to win contracts to deliver more of the old vaccine to the civilian stockpile. In a recent interview, two senior federal health officials, Gerald W. Parker and Carol D. Linden, said they remained determined to buy enough vaccine to inoculate 25 million Americans.

Henderson, the Bush administration advisor and former World Health Organization official, said he was uncertain how much of the old vaccine should be stockpiled for civilians, considering its shortcomings.

“All of us were quite persuaded that once you got the [new] vaccine, you wouldn’t be buying the old stuff,” he said.

david.willman@latimes.com

Times researchers Janet Lundblad in Los Angeles and Sunny Kaplan in Washington contributed to this report.

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Casualty of War? Yet Another Iraq War Veteran Suicide

December 2, 2007 – Livermore Falls, Maine – Tyler Curtis escaped mortars, bullets and bombs in Iraq. Yet, he failed to survive his homecoming.

On Thanksgiving morning, three months after the young veteran returned home to Livermore Falls, he took his own life. The emotional wounds of war left him unable to go on, his sister, Gretchen Errington, told mourners who filled a rural funeral home last week to say goodbye.

“He served his country and ended up paying the ultimate price,” she said.

In the months since his return, the 25-year-old got into bar fights. He talked about his desire to return to Iraq. And he talked about his grief for the families of those he may have killed.

“It’s not the fact I had to shoot people,” he told former wife Randi Sencabaugh about two weeks before his death.

“It’s the fact they had a brother or a sister,” she remembered him saying. “I can’t imagine somebody – my sibling or my parents – dying.”

Details of Curtis’ death are sketchy. Police said they received a call from a family member early on Thanksgiving with a plea to check on him. An Androscoggin County sheriff’s deputy found him a short time later.

An investigation is continuing, Capt. Ray Lafrance said Thursday. However, it is clear that it was a suicide, he said.

“He had lots of problems,” Lafrance said.

Many calling for help

Curtis was not alone among returning veterans.

The Pentagon has not released any numbers on how many veterans of the Iraq war have killed themselves since their return. Some numbers have trickled in, though.

At least 147 soldiers have committed suicide during their service in Iraq and Afghanistan since the wars began, the Associated Press reported in October.

The outlook is similarly grim for returning veterans. At least 283 combat veterans who left the military between the start of the war and the end of 2005 have taken their own lives, according to preliminary Veterans Affairs Department research obtained by the wire service.

Veterans of any war are twice as likely to commit suicide than members of the general public, according to a 2006 article in the Journal of Epidemiology and Community Health.

The new veterans are a puzzle, experts say.

Attempts to define a particularly at-risk segment of returning soldiers – young, old, male, female, married, single – have been fruitless, said Kerry Knox, a psychologist who is leading a U.S. Department of Veterans Affairs (VA) effort to end suicide.

“I think it’s such a wide range,” said Knox, who runs the VA’s Center of Excellence in Canandaigua, N.Y. “We are right at the beginning of understanding what we’re seeing.”

They’re seeing a lot. Knox’s center created a phone bank at the end of July, launching a branch of the nationwide suicide hot line. Anyone who calls the number, 1-800-273-TALK, is asked to press “1” if they are a veteran or calling on behalf of a veteran. Those calls are diverted to workers in Canandaigua.

In only four months, the New York call center received about 15,000 calls, said Janet Kemp, who runs the phone program.

Of them, about 250 have been categorized as rescues – people who were stopped from a suicide they were poised to commit. They often had already taken drugs or were armed with a gun.

In most cases, the call center managed to alert police for help. In less imminent cases, a call was made to the suicide prevention coordinator in the nearest VA hospital.

“One suicide is too many,” said Knox, who manages all of the coordinators. “We know it is preventable. It’s really a community responsibility to have that philosophy.”

Dramatic change

It’s unclear whether Curtis called for help.

“He called me the day that it happened, but I didn’t answer the phone because my daughter was crying,” said Sencabaugh, who was Curtis’ high school sweetheart. “It’s very hard. That’s difficult to me.”

Though they were divorced in October 2005, they remained friends.

“He was the type of friend who would call me in the middle of the night to talk,” she said. “I think he was unhappy with a lot of things.”

He’d changed dramatically after seeing combat.

“The look in his eyes was different to everybody,” Sencabaugh said. “He would look right through you.”

At his funeral, Curtis was remembered as a mischievous kid who had always wanted to be in the Army.

“His death seems to empty the whole future of happiness,” the Rev. Roger Chabot told the roughly 200 mourners.

Too distraught to speak, Curtis’ sister, Gretchen, made her remarks through a letter read by a friend. As they left the service, family members including his mother, Joyce L’Italian, and his father, Gary Curtis, filed past photos of Tyler from childhood to his Army service.

Later, friends talked about his energy.

His football coach at Jay High School, Mike Henry, remembered Curtis as a vibrant kid who loved competition. What he lacked in size – he was about 5 feet, 8 inches tall – he made up for in gumption, Henry said.

Henry made him a lineman.

“Because he was smaller, he had to be that much more intense,” Henry said.

Even after his first of two tours in Iraq, the intensity seemed intact, said Sencabaugh. To her, he compared combat to one of his favorite video games, “Ghost Recon.”

But when she saw him again in August, he’d grown inward and sad.

‘He was just unhappy’

In Curtis’ obituary, family members blamed “post-traumatic stress syndrome” for his death. They did not respond to phone calls seeking interviews. However, Sencabaugh said Curtis believed he suffered from the symptoms.

“He knew he had it,” she said. “I know he did.”

Part of his sadness may have come from his desire to return to his Army buddies, she said.

“He told me a thousand times he wanted to go back,” she said. “Being in the Army was the only thing Tyler ever wanted, even if he had nothing. He was happy sitting in Iraq at 9 o’clock at night when the thermometer read 150 degrees.”

He’d begun to work as a truck mechanic, but he was bored.

“He was just unhappy,” she said. “He didn’t know what he wanted to do with himself.”

In ways, he tried to reach out. About a week before his death, he applied to become a member of the local Veterans of Foreign Wars post.

But it wasn’t enough. He’d been fighting more than ever, Sencabaugh said. He was avoiding old friends, who never seemed to compare to the Army buddies.

Whether he ever reached out for the help of counselors, it was available. Army rules would have forced him to meet with a counselor before his discharge. He would have also been given information on the VA, both from the national organization and Maine.

But he never enrolled with the VA, said James Doherty, spokesman for the VA in Maine.

It would have taken a step by either Curtis or his family to get the VA involved.

“Unless we know about them and they come to us, there’s nothing we can do,” Doherty said.

For Curtis, it is too late.

Sencabaugh, 23, wiped away tears last week as she thought of Curtis’s last moments.

“He was so uncomfortable in his own skin, he needed to get out of it,” she said.

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Veteran Died After VA Center, Jail Refused Him

November 20, 2007 – IOWA CITY, Iowa (AP) A homeless Vietnam veteran whose body was found beneath an Iowa City bridge had been turned away just days before from a Veterans Affairs center and the county jail.

The nearly naked body of Sonny Iovino, 55, was found Nov. 7 under a bridge, and an autopsy showed he died of hypothermia. His body was found two days after Iovino had repeated run-ins with police.

According to University of Iowa police reports obtained by The Gazette, campus police found Iovino lying on the ground on the morning of Nov. 5. He wasn’t wearing shoes and seemed confused as he talked and dug in mulch, the reports said.

Officers got Iovino to put on shoes, then cited him for trespassing and told him to leave. Later in the morning, officers responded to another call and found Iovino wearing only pants. They persuaded him to dress and leave.

After dealing with Iovino less than two hours later, officers took him to a psychiatrist at the VA center. Iovino asked for medication but wouldn’t consent to an evaluation and was released back to police.

After a shelter declined to take him, reports show officers arrested Iovino and took him to jail, where deputies also refused to admit him because of rules regarding people with medical needs.

Officers cited Iovino for criminal trespass, then released him pending a Nov. 20 court date. He signed the charge and walked off toward the bridge where his body was later found.

Advocates for mentally ill people said it’s hard to help when people refuse treatment.

“If they don’t want to go and if they aren’t committed there’s nothing anyone can do,” said Gene Spaziani, former chairman of the National Alliance on Mental Illness of Johnson County. “They’re on their own. That’s the way it goes.”

Information from: The Gazette, http://www.gazetteonline.com/

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VA Hospital in Florida Illegally Uses Unlicensed Psychologists to Treat Veterans with PTSD

“Would Violate State Law”

Complaint targets VA psych staff: Treatment by unlicensed psychologists doesn’t affect patient care at Haley, the VA says.

December 4, 2007 – TAMPA, FLORIDA – Providing the very best mental health care to soldiers returning from combat in Iraq and Afghanistan is one of the highest priorities for the U.S. Department of Veterans Affairs.

But at the nation’s busiest VA hospital, the James A. Haley VA Medical Center in Tampa, the most-troubled and vulnerable veterans are often treated by the least-experienced psychologists, according to a complaint to the state.

How to get help: Veterans who are suicidal or have concerns about other mental health issues can call the VA at 1-800-273-TALK (8255).

About 12 of Haley’s 34 psychologists – more than a third – are unlicensed and receive little if any direct supervision, according to a complaint filed Nov. 29 with the Florida Board of Psychology.

The VA disagrees with the complaint’s figure, saying just nine are unlicensed.

The complaint, filed by Haley psychologist Brian Nussbaum, said some of these psychologists still use the title of either “psychologist” or “clinical psychologist” with patients.

If true, that would violate state law.

In an interview on Monday, Nussbaum said three of the four psychologists working in Haley’s Post Traumatic Stress Disorder Clinic are unlicensed. Nussbaum is the only licensed psychologist in the clinic.

And he said Haley’s suicide-prevention coordinator also is an unlicensed psychologist.

Nussbaum, who agreed to an interview after the St. Petersburg Times obtained a copy of his complaint, said he fears patient care is endangered by this inexperience.

Unlicensed psychologists, he said, are typically people who have recently obtained their psychology doctorate and have far less clinical experience than their licensed counterparts.

“I have nothing to gain by doing this and everything to lose,” he said. “The majority of mental health services provided to our newest generation of veterans is being provided by our least-experienced staff.”

VA officials denied that patient care is impacted and said that all unlicensed psychologists receive ample supervision and are on track to receive their licenses in the future.

Florida and federal law allows unlicensed psychologists to work as long as they receive constant supervision, the VA and state said.

Regional VA spokesman John Pickens said the VA places the highest priority on veteran mental health treatment and that unlicensed psychologists do receive constant supervision.

“I’m fearful these sorts of allegations are going to cause veterans to think that the care we provide is less than what they deserve,” said Pickens. “The VA at Tampa and nationally has done a very good job treating vets.”

Nussbaum said what is happening at Haley is not the norm. But a national VA spokesman did not return a call asking about VA hiring policy.

At the Bay Pines VA Medical Center in St. Petersburg, which also operates a PTSD clinic, none of the hospital’s 22 psychologists are unlicensed, said Pickens.

Some veteran advocates questioned the practice of relying heavily on unlicensed psychologists at a time when the numbers of veterans requiring mental health treatment is increasing.

“How would you feel going to the airport and getting on an airplane and finding out the pilot didn’t have a license?” said Michael O’Rourke, an assistant director of veteran health policy with Veterans of Foreign Wars. “Experience counts.”

To obtain a state license, the state says an applicant must complete 2,000 hours of supervised clinical work, which must include a supervisor reviewing their notes.

In addition, the state says applicants must have two hours of direct supervision each week with a licensed psychologist. At least one hour must be face-to-face, rather than over the phone.

“For many of these unlicensed psychologists, there is no face-to-face supervision,” Nussbaum’s letter said. “For others, there is sporadic supervision, clearly not meeting the required two hours per week.”

In his complaint, Nussbaum said the Haley doctor who supervises most of the unlicensed people, Arthur Rosenblatt, cannot provide adequate oversight. Rosenblatt could not be reached to comment.

“It is not possible for him to solely provide the supervision of such a large quantity of trainees in addition to his many other duties, especially since many of these staff are placed in outlying clinics 45-plus miles away (where they function independently) and rarely, if ever, see one another face-to-face,” Nussbaum’s letter said.

Complaints to the Board of Psychology, a division of the Florida Department of Health, are confidential and the department won’t comment on or confirm a pending complaint.

The state investigates such complaints and can take a range of actions, from suspending a license to levying a fine against anyone accused of misconduct.

But it was unclear Monday whether the state has jurisdiction over the VA.

Nussbaum would not speculate about why he thinks Haley has hired so many unlicensed practitioners. O’Rourke at the VFW said the VA is struggling to find qualified mental health personnel.

The VA employs 10,000 mental health professionals nationally, up 15 percent since 2003.

Nussbaum said veterans deserve care from the most-experienced professionals available.

Unlicensed psychologists “often lack the specialized skills and experience that this extremely sensitive population of veterans often requires,” Nussbaum said. “They’ve been in combat. Developing a strong, empathetic relationship with them is essential.

“That’s something not easily taught in a class,” he said. “It takes experience.”

Times staff writer William R. Levesque can be reached at (813) 226-3436 or levesque@sptimes.

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