Labor Dept Slow to Help Injured War Zone Contractors

T. Christian Miller of ProPublica reports that under Secretary Hilda Solis, the Labor Department has continued to be slow to act in its oversight of medical care for civilian workers injured in war zones (Read Injured Abroad, Neglected at Home: Labor Dept. Slow to Help War Zone Contractors | December 17, 2009). The report states that DOL has failed to pursue sanctions against corporations accused of ignoring federal requirements to purchase such insurance, according to a ProPublica review of court cases, federal records and interviews with worker advocates. Quick excerpts below:

The department has also taken no action in cases where insurance carriers allegedly provided false or misleading information to the federal government to terminate medical benefits for injured civilians–another potential crime under the law, known as the Defense Base Act [2].

The lack of enforcement has allowed carriers and contract companies to abuse the system by avoiding or blocking payments, forcing contractors to spend months and sometimes years battling carriers in court for benefits, claimants and their attorneys said.[…]But the ProPublica examination shows that the department has rarely deployed the tools available under the law to crack down on fraud and abuse–a record that extends back through Democratic and Republican administrations. Labor officials can recommend cases for prosecution to the Justice Department–but have only done so once in the past two decades, according to Labor officials.

They can directly levy civil penalties, but have done so sparingly. As of June, Labor officials have imposed fines in only about 50 of more than 36,000 cases processed by the two largest insurance carriers, according to an internal Congressional memo [3] obtained by ProPublica.[…]Passed in 1941, the Defense Base Act requires every company with an overseas U.S. contract to obtain health insurance for its workers. But no single U.S. agency is fully in charge of implementing the program, which has exploded since the wars in Iraq and Afghanistan. More than 1,600 civilians have died and 37,000 have reported injuries.[…]"We put our lives in danger for our military. We supply them with water, food, ammunition, housing. And yet, we’re screwed," said Philemon, an Air Force veteran. "I almost give my life for my country and I get treated like dirt? "Something’s not right with that picture," he said.

Read the whole thing here.

Post-Deployment Screenings Recommended

Image by Divine Harvester via Flickr

For Deployed Civilians to War Zones

State generally requires a medical clearance as a precondition to deployment but has no formal requirement for post-deployment screenings of civilians who deploy under its purview. Our prior work has found that documenting the medical condition of deployed civilians both before and following deployment is critical to identifying conditions that may have resulted from deployment, such as traumatic brain injury.[…]To address these matters, we recommended that [...] (5) State develop post-deployment medical screening requirements for civilians deployed under its purview. The agencies generally concurred with these recommendations, with the exception of USAID, which stated that it already had an ombudsman to assist its civilians. USAID officials, however, did not provide any documentation to support the establishment of the ombudsman position. In the absence of such documentation, we continue to believe our recommendation has merit.

Excerpt fromHUMAN CAPITAL: Improved Tracking and Additional Actions Needed to Ensure the Timely and Accurate Delivery of Compensation and Medical Benefits to Deployed Civilians GAO-09-1019T | September 16, 2009

You can't serve in Iraq if you're on MEDs?

Peter Van Buren is a Foreign Service Officer with 20 years experience under his belt. He is trying to go to Iraq and has gone public with his quest. The following piece from US Foreign Service Officer Denied Iraq Service is reprinted in full via Cryptome. No mainstream media, as far as I know, has covered Mr. Van Buren's case (more sexy to cover diplomats who refused to go):

This is my story. I am a Foreign Service officer trying to actually go to Iraq instead of trying to get out of serving there. Please feel free to contact me at work 703-875-4344 or by email. If you'd like to contact the Department of State about this matter, please call Acting Director General Teddy Taylor at 202-647-9438. I can supply emails with the quotes noted below if you'd like. Peter Van Buren

* * *

The Department still works hard to round up enough volunteers though apparently is ready to cut out willing FSOs because they are afraid they'll get depressed. No kidding.

Peter Van Buren has served with the Foreign Service for over 20 years. He received a Meritorious Honor Award for assistance to Americans following the Hanshin Earthquake in Kobe in 1995, a Superior Honor Award for assisting an American rape victim in Japan and another award for work in the Tsunami Relief efforts in Thailand. Unlike many of his colleagues, he has worked extensively with the military while overseeing evacuation planning in Japan and Korea. This experience includes multiple field exercises and drills, plus civil-military conferences in Seoul, Tokyo, Hawaii and Sydney, working closely with allies from the UK, Australia and elsewhere. He was selected to travel to Camp Lejeune in 2006 to participate as "Ambassador" in a week-long field exercise that included simulated Iraqi conditions and problems. Van Buren spent a year on the Hill and brings that understanding of Congress to Iraq.

Sounds like the kind of guy you'd want in a PRT in Iraq, right?

Van Buren wants to go, and the assignments office in the Department offered him a senior team leader job in Anbar. The problem is that Van Buren suffers from depression, treated with the drugs you see advertised on TV all the time, and the State Department Medical Office says they can't support depressed people in Iraq. Med came to the stunning conclusion in Van Buren's case that "there are strong safety and health concerns for any in Iraq at this time. In addition, living conditions are most austere." Better yet, Med first approved Van Buren for Iraq and then pulled the decision back a week later after the Medical Officer in Baghdad, there for only one week, balked.

Despite the denial, Van Buren remains committed to the job. He is appealing the decision internally at State and has even contacted Senator Webb's office seeking assistance.

"Success in Iraq remains a vital component of U.S. foreign policy in the Middle East, and the PRTs are central to President Obama's Iraq strategy. The State Department continues to need the very best to serve as PRT leaders to ensure that our effort in Iraq remains strong," said the State Department in a recent cable to the field seeking volunteers for Iraq.

Too bad Med did not get the memo.

Below is the composition of the PRTs in Iraq as of last year:

According to the GAO, the United States was leading 28 of 31 PRTs and other coalition countries were leading 3 PRTs in Iraq. As of August 2008, three types of U.S.-led PRTs were operating in Iraq: 11 PRTs at the provincial level of government; 13 ePRTs embedded with U.S. brigade combat teams and operating in local governments in Baghdad, Anbar, Babil, and Diyala provinces; and 4 Provincial Support Teams (PST), which are smaller PRTs that cannot be based in the intended province due to security concerns. PRTs and ePRTs are a joint State and DOD mission, operating under the command of both the Ambassador and the MNF-I Commanding General.

All U.S. PRTs and ePRTs in Iraq are led by the State Department and consist primarily of civilian personnel. The teams, however, rely heavily on U.S. military forces for their security, food, housing, and other support. The Office of Provincial Affairs at the U.S. embassy in Baghdad directs and supports the operations of PRTs and ePRTs, providing political and economic direction to team members. The military commander has authority over the security and movement of ePRTs; many others provide security for PRTs that are colocated with U.S. military units.

Given the drawdown of military presence in Iraq, I’m sure the PRT numbers and composition will probably change with the needs on the ground. But then again, I don't know how much of that would impact this case, since MED is the one saying "no" to this one. Will keep you posted if we learn anything more about this case.

As I understand it -- MED has agreed to "re-review" Mr. Van Buren’s case if the Department were to offer him a Baghdad PRT vice something further afield. The idea probably so MED could "monitor" him if he was in Baghdad. I wonder how much of that is CYA and how much monitoring that really means?


Considering the challenges that FSOs and their families are subjected to in missions all over the globe, the constant relocation and reinvention of self every 2-4 years, the fragmentation of one's emotional life as you leave friends and make friends anew and the missing presence of extended families and relations -- I'm surprised that not many more are suffering from depression. One other FSO is also wrestling with MED for exactly the same reason as Mr. Van Buren's.


Which begs the questions of -- 1) how often does MED really screen for depression unless it's self reported by the employees and the family members? (Presently, you can simply update your medical records when you relocate to a new place; you won't even need a physician to give you a thorough look see under the hood ...). And 2) If you suffer from depression but do not seek treatment, what's the chance of you ending up in Iraq or Afghanistan or one of the hardship posts in the FS?

Related Item:

GAO-09-86R PROVINCIAL RECONSTRUCTION TEAMS
October 1, 2008 | PDF

Join the Petition: Revised Q21 for the Foreign Service

I don't know what it is like to have post-traumatic syndrome disorder or PTSD; the closest I've been was what I'd call "moving blues" which lasted for about six months. It was dark and depressing but nothing like what Kristin Loken, a Foreign Service officer with USAID had experienced. In the January 2008 issue of the Foreign Service Journal, she writes:

"Strong emotions would come and go without any relevance to what was happening around me. I had regular nightmares about running away from uniformed men with guns trying to kill me. Sometimes I would also have what I called “daymares.” I would encounter a person at work in a meeting and see them suddenly fall victim to some horrible trauma — a car wreck, a shooting, a bomb explosion. These daymares struck quickly, then disappeared, leaving me sitting in a meeting not knowing what I had missed. As I tried to regain normal functioning, I noticed that my mouth wouldn’t work right; I couldn’t talk properly and could hardly communicate with people around me.

There was a great deal going on inside my head, but it had no relevance to what was going on in the world around me. I could answer a direct question in a few words, but then could not say anything more for long periods of time. I didn’t feel sad; I didn’t feel happy. Often I didn’t seem to feel anything at all."

It seems like every week, I get somebody online with the search phrase "PTSD and security clearance concerns." It's been months since the Secretary of Defense has successfully advocated the revision of Question 21 of the SF-86 Questionnaire for National Security Positions for DOD and I have not heard a single thing out of State. With a few remaining days left in office, I doubt if this is going to get any attention from the current occupant of the 7th Floor.


I also find it troubling that none of the webpages of Mental Health Services, Bureau of Diplomatic Security or "M" carry any information nor guidance on mental health consultations/treatment and its relevance to the employee's medical and security clearance. Please don't tell me they are on the intranet. Family members and partners do not have ready access to that thing.


In any case, I figure that with an incoming Secretary of State, this would be a good time to initiate a petition. I have considered the pros and cons of an online petition and have reservations not just with publicly posting names of petitioners, but also whether the intended recipients ever actually read online petitions. Thus, this one is going to be an old fashion, paper and snail mail petition.


Below is the text of the petition urging the revision of Question 21 of SF-86 for the Foreign Service. You can download the petition in Word file here or PDF file here. Please sign it, collect five other names/signatures from your immediate colleagues and mail it off to the Mother ship. I also urge you to pass on this petition to family members and friends of the Foreign Service for additional support.


The Senate Foreign Relations Committee is scheduled to examine the nomination of Hillary R. Clinton to be Secretary of State on Tuesday (January 13, (9:30 am, SH-216). On January 15, the SFRC will have a business meeting to consider HRC's nomination. With a simple majority needed for confirmation, I expect that she will be confirmed very shortly after the new president takes office. I would therefore suggest that petition letters be mailed off between now and February 20, 2009 to help ensure that the letters will be at her office when she assumes her duties.

~ ~ ~

Date

The Honorable Hillary R. Clinton
Secretary of State
U.S. Department of State
2201 C Street NW
Washington, DC 20520

PETITION: Revised Q21 for the Foreign Service

We, the undersigned call on the Secretary of State Hillary Clinton upon assumption into office, to reaffirm that the Department of State strongly endorses the practice of seeking professional help to address all health- related concerns whether mental or physical; to also reaffirm that the Department of State considers it a mark of strength and maturity to seek appropriate health care whenever required; and to make clear that seeking professional care for mental health issues in and itself is not a reason to revoke or deny an individual’s security clearance. This is important in the Foreign Service, whose members are exposed to traumatic events with psychological impact not only in conflict zones but also in diplomatic hardship assignments worldwide.

Nearly 60% of our Foreign Service personnel are at posts considered by the U.S.Government as "hardship" due to difficult living conditions (for example, violent crime, harsh climate, social isolation, unhealthy air, and/or terrorist threats). Of those hardship posts, half are rated at or above the 15-percent differential level which constitutes great hardship, and where family members are unable to accompany such assignments.

In April 2008, the Secretary of Defense has successfully advocated the revision of Question 21 of the SF-86 Questionnaire for National Security Positions, which asks about mental health treatment. The revised question excludes counseling related to marital, family or grief issues, unless related to violence by the applicant/employee. It also rules out counseling for adjustments from service in a military combat environment. The OSD guidance also points out that failure to seek care increases the likelihood that psychological distress could escalate to a more serious mental condition, which could preclude an individual from performing sensitive duties.

Your immediate predecessor has not released a similar affirmation to encourage the treatment of PTSD and other related mental health issues. The Concerned Foreign Service Officers has noted “the continued revocations of security clearances based on mental health treatment - a practice that the Bureau of Diplomatic Security routinely perpetuates even after DOD and OPM have agreed not to count certain types of treatment, e.g. for PTSD, against the employee.”

The organization of the 21^st century will be judged by the wholeness of its people. The first step to getting us there is to help ensure that Foreign Service officers, specialists, and family members and partners obtain the help they need without fear that such consultation/treatment jeopardizes their security clearance and employment.

Sincerely,
Employees, Family Members/Partners and Friends of the U.S.Foreign Service

Your name/signature:

Collect five more names/signatures

Name/signature 1:

Name/signature 2:

Name/signature 3:

Name/signature 4:

Name/signature 5:

References:

Office of the Secretary of Defense - Revised Q21
http://www.army.mil/docs/OSD_Guidance_on_Revised_Q21.pdf

Concerned Foreign Service Officers Warning On Mental Health Treatment
http://www.emaxhealth.com/7/11720.html

Foreign Service Journal January 2008: Focus on PTSD and the Foreign Service
http://www.afsa.org/fsj/2008.cfm

Executive Order 10450
http://www.archives.gov/federal-register/codification/executive-order/10450.html

Executive Order 12968
http://www.opm.gov/extra/investigate/eo12968.asp

~ ~ ~

Download:
Petition in Word (if you want to insert your own story)
Petition in PDF

Sorry I don't have a mail budget so the stamp is on you :-). Please mail signed petition to:

Secretary of State
U.S. Department of State
2201 C Street NW
Washington, DC 20520


Many thanks for your help!