Overseas Civilian Contractors

News and issues relating to Civilian Contractors working Overseas

Gov’t Watchdog Criticizes Pentagon Center for PTSD, Brain Injuries

By T Christian Miller and Joaquin Sapien at ProPublica  July 11, 2011

If you want more explanation about the military’s troubles in treating troops with traumatic brain injuries and post-traumatic stress, read no further than two recent but largely unnoticed reports from the Government Accountability Office.

It turns out the Pentagon’s solution to the problems is an organization plagued by weak leadership, uncertain priorities and a money trail so tangled that even the GAO’s investigators couldn’t sort it out. The GAO findings on the Pentagon’s Defense Centers of Excellence (DCOE) echo our own series [1] on the military’s difficulty in handling the so-called invisible wounds of war.

“We have an organization that exists, but we have considerable concern about what it is that it’s actually accomplishing,” said Denise Fantone, a GAO director who supervised research on one of the reports. She added: “I can’t say with any certainty that I know what DCOE does, and I think that’s a concern.”

First, some background. After the 2007 scandal over poor care delivered to soldiers at the Walter Reed Army Medical Center, Congress ordered the Pentagon to do a better job treating soldiers suffering from post-traumatic stress disorder and traumatic brain injury. The Pentagon’s answer was to create DCOE [2]. The new organization was supposed to be a clearinghouse to foster cutting-edge research in treatments.

DCOE was rushed into existence in late 2007. Since then, it has churned through three leaders, including one let go after alleged sexual harassment of subordinates [3]. It takes more than five months to hire each employee because of the federal government’s glacial process. As a result, private contractors make up much of the center’s staff.

“DCOE’s development has been challenged by a mission that lacks clarity and by time-consuming hiring processes,” according to the first report in the GAO series [4], focusing on “management weakness” at DCOE.

Just as concerning, the GAO says that it can’t quite figure out how much money DCOE has received or where it has all gone. DCOE has never submitted a budget document that fully conformed to typical federal standards, according to a GAO report released last month [5]. In one year, the center simply turned in a spreadsheet without detailed explanations.

Please read the entire article at ProPublica

July 11, 2011 Posted by | Department of Defense, Pentagon, Post Traumatic Stress Disorder, Traumatic Brain Injury | , , , , , , , | Leave a comment

U.S. Stays Mum as Iraqi Security Forces Kill, Detain and Abuse Protesters

ProPublica Blog March 1, 2011

As the Mideast protests and government crackdowns continue, one country to watch closely is Iraq, with whom the U.S. has a long-term partnership [1] and where clashes between protesters and government forces recently turned violent. Even as Iraqi security forces detained and abused hundreds of intellectuals and journalists [2], the U.S. government—in keeping with a pattern of silence on Iraq’s abuses—has withheld criticism of its strategic ally. (Salon noticed this too [3].)

Asked generally about the violence against Iraqi demonstrators [4] on Friday, White House Press Secretary Jay Carney said only “the approach we’ve taken with regard to Iraq is the same that we’ve taken with regard to the region,” which he said was to call on governments to respond to the protests peacefully. Neither the White House [5] nor the State Department seem to have mentioned the matter since. Yesterday’s State Department briefing discussed Libya, Egypt, Iran, Oman, Saudi Arabia, South Korea, China, Pakistan, Argentina, South Africa and Haiti—Iraq was never discussed [6].  Please read the entire post here

March 1, 2011 Posted by | Iraq, Safety and Security Issues, State Department | , , , | Leave a comment

ProPublica Honored With Two George Polk Awards

by Minhee Cho at ProPublica

ProPublica is pleased to announce that it has won two George Polk Awards this year, in collaboration with our partners NPR and Frontline, for the series “Brain Wars” and “Law & Disorder.”

A collaborative project by ProPublica’s T. Christian Miller and NPR’s Daniel Zwerdling and Susanne Reber, Brain Wars ” found that the U.S. military was failing to diagnose and treat traumatic brain injuries suffered by soldiers. It has been selected for the George Polk Award for Radio Reporting.

ProPublica’s A.C. Thompson along with our partners Raney Aronson and Tom Jennings at Frontline and Laura Maggi and Brendan McCarthy at The Times-Picayune won the George Polk Award for Television Reporting for “Law & Disorder,” which took an in-depth look at the controversial and often brutal actions taken by the New Orleans Police Department in the aftermath of Hurricane Katrina.

The George Polk Awards are conferred every year to honor special achievement in journalism, particularly investigative and enterprise reporting. ProPublica’s Abrahm Lustgarten [3] was among the winners last year for his reporting on the dangers of drilling for natural gas [4].

Congratulations to all of the winners [5].  Please see the original here

February 22, 2011 Posted by | Department of Defense, Journalists, Traumatic Brain Injury | , , , , | Leave a comment

Female Foreign Correspondents’ Code of Silence, Finally Broken

This piece was co-published in the New York Times as Why we need Woman in War Zones

By Kim Barker at ProPublica

Thousands of men blocked the road, surrounding the S.U.V. of the chief justice of Pakistan, a national hero for standing up to military rule. As a correspondent for The Chicago Tribune, I knew I couldn’t just watch from behind a car window. I had to get out there.

So, wearing a black headscarf and a loose, long-sleeved red tunic over jeans, I waded through the crowd and started taking notes: on the men throwing rose petals, on the men shouting that they would die for the chief justice, on the men sacrificing a goat.

And then, almost predictably, someone grabbed my buttocks. I spun around and shouted, but then it happened again, and again, until finally I caught one offender’s hand and punched him in the face. The men kept grabbing. I kept punching. At a certain point — maybe because I was creating a scene — I was invited into the chief justice’s vehicle.

At the time, in June 2007, I saw this as just one of the realities of covering the news in Pakistan. I didn’t complain to my bosses. To do so would only make me seem weak. Instead, I made a joke out of it and turned the experience into a positive one: See, being a woman helped me gain access to the chief justice.

And really, I was lucky. A few gropes, a misplaced hand, an unwanted advance — those are easily dismissed. I knew other female correspondents who weren’t so lucky, those who were molested in their hotel rooms, or partly stripped by mobs. But I can’t ever remember sitting down with my female peers and talking about what had happened, except to make dark jokes, because such stories would make us seem different from the male correspondents, more vulnerable. I would never tell my bosses for fear that they might keep me at home the next time something major happened.

I was hardly alone in keeping quiet. The Committee to Protect Journalists may be able to say that 44 journalists from around the world [2] were killed last year because of their work, but the group doesn’t keep data [3] on sexual assault and rape. Most journalists just don’t report it.

The CBS correspondent Lara Logan has broken that code of silence. She has covered some of the most dangerous stories in the world, and done a lot of brave things in her career. But her decision to go public earlier this week with her attack by a mob in Tahrir Square in Cairo was by far the bravest. Hospitalized for days, she is still recuperating from the attack, described by CBS as a brutal and sustained sexual assault and beating.

Several commentators have suggested [4] that Ms. Logan was somehow at fault: because she’s pretty; because she decided to go into the crowd; because she’s a war junkie. This wasn’t her fault. It was the mob’s fault. This attack also had nothing to do with Islam. Sexual violence has always been a tool of war. Female reporters sometimes are just convenient.

In the coming weeks, I fear that the conclusions drawn from Ms. Logan’s experience will be less reactionary but somehow darker, that there will be suggestions that female correspondents should not be sent into dangerous situations. It’s possible that bosses will make unconscious decisions to send men instead, just in case. Sure, men can be victims, too — on Wednesday a mob beat up a male ABC reporter in Bahrain [5], and a few male journalists have told of being sodomized by captors — but the publicity around Ms. Logan’s attack could make editors think, “Why take the risk?” That would be the wrong lesson. Women can cover the fighting just as well as men, depending on their courage.

More important, they also do a pretty good job of covering what it’s like to live in a war, not just die in one. Without female correspondents in war zones, the experiences of women there may be only a rumor.

Look at the articles about women who set themselves on fire in Afghanistan to protest their arranged marriages, or about girls being maimed by fundamentalists, about child marriage in India, about rape in Congo and Haiti. Female journalists often tell those stories in the most compelling ways, because abused women are sometimes more comfortable talking to them. And those stories are at least as important as accounts of battles.

There is an added benefit. Ms. Logan is a minor celebrity, one of the highest-profile women to acknowledge being sexually assaulted. Although she has reported from the front lines, the lesson she is now giving young women is probably her most profound: It’s not your fault. And there’s no shame in telling it like it is.

Please see the original at ProPublica

February 19, 2011 Posted by | Afghanistan, Africa, Iraq, Journalists, Pakistan, Rape, Safety and Security Issues, Sexual Assault | , , , , , , | 1 Comment

Congress to Investigate Pentagon Decision to Deny Coverage for Brain Injured Troops

By T Christian Miller ProPublica and Daniel Zwerdling at NPR

WASHINGTON, D.C.–A key congressional oversight committee announced [1] today that it was opening an investigation into the basis of a decision by the Pentagon’s health plan to deny a type of medical treatment to troops with brain injuries.

Sen. Claire McCaskill, D-Mo., the chairman of the subcommittee on contracting oversight, said she wanted to examine a contract issued by Tricare, an insurance-style program used by soldiers and many veterans, to a private company to study cognitive rehabilitation therapy for traumatic brain injury. Such injuries are considered among the signature wounds of the wars in Afghanistan and Iraq.

The study, by Pennsylvania-based ECRI Institute, found insufficient or weak evidence to support the therapy. Often lengthy and expensive, cognitive rehabilitation programs are designed to rewire soldiers’ brains to conduct basic life tasks, such as reading books, remembering information and following instructions. ECRI’s findings ran counter to several other studies, including ones sponsored by the Pentagon and the National Institutes of Health, which concluded that cognitive rehabilitation was beneficial.

In a letter to Defense Secretary Robert Gates, McCaskill cited an investigation [2] by ProPublica and NPR in December, which found that top scientific experts had questioned the Tricare-funded study in confidential reviews, calling it “deeply flawed” and “unacceptable.”

“If true, these reports raise significant questions regarding the Department’s award and management of the contract with ECRI Institute, and may have profound implications for hundreds of thousands of injured service members and their families,” McCaskill wrote. “We owe it to our brave service members to find the truth.”

The ProPublica and NPR investigation also found that senior Pentagon officials have worried about the high price of the care, which can cost more than $50,000 per patient. Some studies estimate that as many as 400,000 troops have suffered traumatic brain injuries in the war zones, though only a small percentage of them would need a full-scale program of cognitive rehabilitation therapy.

McCaskill joins a growing chorus demanding that Tricare reconsider its decision to deny coverage for cognitive rehabilitation. In recent weeks, the American Legion, the nation’s largest veterans’ organization, called [3] on Tricare to provide treatment. Sen. Bob Casey, D-Penn., chairman of the Senate Foreign Relations subcommittee with oversight of the Middle East, sent a letter [4] to Gates asking for an explanation of Tricare’s stance.

McCaskill was also one of the senators who signed a letter [5] in 2008 asking Gates to direct Tricare to begin providing cognitive rehabilitation to troops. This November, the Pentagon sent a response [6] to Congress informing them of the Tricare study’s findings. George Peach Taylor Jr., then-acting assistant secretary of defense for health affairs, said the Pentagon would continue to study the treatment, with another report expected later this year.

In strongly worded response [7] on Jan. 19, McCaskill said that the senators who signed the original letter believed that enough evidence existed on the treatment’s benefits to justify covering the cost for brain-damaged soldiers.

She asked for Gates to provide her committee with a series of documents on the contract and critical scientific reviews by Feb. 18.

“While we agreed that further research on cognitive rehabilitation therapy was appropriate, we also called on the Defense Department to err on the side of providing this proven treatment to service members,” McCaskill wrote.

ProPublica and NPR have filed a similar request under the Freedom of Information Act, but Tricare has denied access to the documents, giving contradictory explanations [8] for why. ProPublica and NPR have appealed.

Tricare officials have said their decision to deny cognitive rehabilitation is based on regulations requiring scientific proof of the efficacy and quality of treatment. They have said that the study by ECRI highlighted a lack of rigorous evidence proving the therapy’s benefits.

Tricare officials also noted that the agency does cover some types of treatment considered part of cognitive rehabilitative therapy. For instance, Tricare will pay for speech and occupational therapy, which plays a role in cognitive rehabilitation. Tricare officials deny that cost played any role in their decision. In a statement [9], Tricare said the care of troops was their “utmost” concern.

Tricare did not immediately return requests for comment on McCaskill’s investigation.

ECRI defended its study. The non-profit institute, which has carried out numerous health reviews for Tricare, other agencies and hospital and medical groups, said they applied standard protocols in reviewing scientific literature about the efficacy of cognitive rehabilitation therapy. ECRI provided a document explaining its review here [10].

“The issue of how well cognitive rehabilitation therapy works for traumatic brain injury is important,” said Jeffrey C. Lerner, the president and CEO of ECRI Institute. “ECRI Institute is fully committed to providing information to the U.S. Senate on our report and methodology.”

January 24, 2011 Posted by | Afghanistan, Civilian Contractors, Contractor Casualties, Department of Defense, Follow the Money, Iraq, Pentagon, Traumatic Brain Injury, Veterans | , , , , , , , , | Leave a comment

The Future of Private Forces

By ISN (International Relations and Security Network)

Despite a tarnished image, the private military security industry is thriving – and is likely to continue to do so for some time to come. In fact, these private companies continue to expand their reach beyond security and military matters into nearly every facet of government service.

A recent report from ProPublica, based on analysis of US Department of Labor statistics, showed that “more private contractors than soldiers were killed in Iraq and Afghanistan in recent months,” making 2010 the “first time in history that corporate casualties have outweighed military losses on America’s battlefields.”

The swelling numbers of contractor deaths could only result from the greatest foreign policy experiment in privatization in US history. These numbers call for a closer look at the changing role of private force and its impact on the industry.

Damage control

For years the private military and security industry has dealt with a troubled, tarnished image resulting from several high-profile abuses perpetrated in Iraq and Afghanistan over the last decade. As Blackwater quickly became the most recognized and controversial name in the industry, it long ago set out to rebrand its image, changing its name to Xe Services. More recently the entire industry appears to have felt the need for a new marketing strategy. For example, the industry’s trade union and lobbying group, the International Peace Operations Association (IPOA), changed its name to the International Stability Operations Association (ISOA).

Further, 60 private security companies – Blackwater included – signed a global Code of Conduct (COC) in Geneva last November, pledging to “curb their use of force, vet and train personnel, and report any breaches [of contract].” But even this prompted the criticism that the COC was merely symbolic, arriving nine years too late. For others, however: better late than never.

Please read the entire article here

January 12, 2011 Posted by | Afghanistan, Blackwater, Civilian Contractors, Contractor Casualties, Private Military Contractors, Private Security Contractor | , , , , , , , | 1 Comment

Pentagon Health Plan Won’t Cover Brain-Damage Therapy for Troops

Brain Wars How the Military Is Failing Its Wounded

by T Christian Miller at ProPublica and Daniel Zwedling at NPR

Versions of this story were co-published with NPR [1] and Stars and Stripes [2]. For more coverage, listen to NPR’s All Things Considered [3] starting today at 4 p.m.

Sarah Wade, 36, and her husband, Ted Wade, 33, are seen in front of the Capitol building in Washington, D.C., on Dec. 18, 2010. Ted suffered a traumatic brain injury, along with multiple other injuries, while riding in a Humvee in Iraq in 2004. Although Ted gets health insurance through the Defense Department, Sarah says "it doesn't cover what it needs to" and that he needs "more options, and less bureaucracy." The Wades live in Chapel Hill, N.C., but regularly travel to Washington for medical appointments and meetings. (Coburn Dukehart/NPR)

During the past few decades, scientists have become increasingly persuaded that people who suffer brain injuries benefit from what is called cognitive rehabilitation therapy — a lengthy, painstaking process in which patients relearn basic life tasks such as counting, cooking or remembering directions to get home

Many neurologists, several major insurance companies and even some medical facilities run by the Pentagon agree that the therapy can help people whose functioning has been diminished by blows to the head.

But despite pressure from Congress and the recommendations of military and civilian experts, the Pentagon’s health plan for troops and many veterans refuses to cover the treatment — a decision that could affect the tens of thousands of service members who have suffered brain damage while fighting in Iraq and Afghanistan.

Tricare, an insurance-style program covering nearly 4 million active-duty military and retirees, says the scientific evidence does not justify providing comprehensive cognitive rehabilitation. Tricare officials say an assessment of the available research [4] that they commissioned last year shows that the therapy is not well proven.

But an investigation by NPR and ProPublica found that internal and external reviewers of the Tricare-funded assessment criticized it as fundamentally misguided. Confidential documents obtained by NPR and ProPublica show that reviewers called the Tricare study “deeply flawed,” “unacceptable” and “dismaying.” One top scientist called the assessment a “misuse” of science designed to deny treatment for service members.

Tricare’s stance is also at odds with some medical groups, years of research and even other branches of the Pentagon. Last year, a panel of 50 civilian and military brain specialists convened by the Pentagon unanimously concluded that cognitive therapy was an effective treatment that would help many brain-damaged troops. More than a decade ago, a similar panel convened by the National Institutes of Health reached a similar consensus. Several peer-reviewed studies in the past few years have also endorsed cognitive therapy as a treatment for brain injury.

Tricare officials said their decisions are based on regulations requiring scientific proof of the efficacy and quality of treatment. But our investigation found that Tricare officials have worried in private meetings about the high cost of cognitive rehabilitation, which can cost $15,000 to $50,000 per soldier.

With so many troops and veterans suffering long-term symptoms from head injuries, treatment costs could quickly soar into the hundreds of millions, or even billions of dollars — a crippling burden to the military’s already overtaxed medical system.

The battle over science and money has made it difficult for wounded troops to get a treatment recommended by many doctors for one of the wars’ signature injuries, according to the NPR and ProPublica investigation. The six-month investigation was based on scores of interviews with military and civilian doctors and researchers, troops and their families, visits to treatment centers across the country, confidential scientific reviews and documents obtained under the Freedom of Information Act.

“I’m horrified,” said James Malec, research director at the Rehabilitation Hospital of Indiana and one of the reviewers of the Tricare study. “I think it’s appalling that we’re not knocking ourselves out to do the very best” for troops and veterans.

Defense Secretary Robert Gates, who has complained over the past year about the growing cost of the Pentagon’s health care budget, declined a request for an interview. George Peach Taylor, the newly appointed acting assistant secretary of defense for health affairs, the top ranking Pentagon health official, also declined repeated interview requests. Tricare officials defended the agency’s decision not to cover cognitive rehabilitative therapy and said it was not linked to budget concerns.

Capt. Robert DeMartino, a U.S. Public Health Service official who directs Tricare’s behavioral health department, said Tricare is mandated to ensure the quality, consistency and safety of medical care delivered to service members.

He said those standards can be difficult to meet with cognitive rehabilitation. Therapists design highly individualized treatment plans, often relying on a variety of different techniques. The holistic approach and lack of standardization makes it hard to measure the effects of the therapy, he added.

DeMartino noted that the agency covers some types of treatment considered part of cognitive rehabilitative therapy. For instance, Tricare will pay for speech and occupational therapy, which can play a role in cognitive rehabilitation.

DeMartino said cost played no role in the agency’s decision, calling such a suggestion “completely wrong.” He defended the agency’s studies of cognitive rehabilitation, calling them objective scientific reviews designed to ensure troops and retirees receive the best treatment possible.

Cognitive rehabilitation therapy “is a new field for us,” DeMartino said. “We don’t know what it is. That’s really an important thing. You don’t want to send people out when you don’t know what treatment they’re going to get and what the services are going to be.”

Officials at the Pentagon are themselves divided on the value of the treatment. A handful of military and veteran facilities provide cognitive rehabilitation therapy, though most do not have the capacity or offer programs of limited scope.

Tricare was designed to fill in such gaps in the military health system by allowing troops and veterans access to civilian medical providers. But since Tricare has a policy against covering cognitive rehabilitation, service members and retirees who seek treatment at one of the nation’s hundred of civilian rehabilitation centers could have their claims denied, or only partly paid.

The contradictory policies have resulted in unequal care. Some troops and their families have relied upon high level contacts or fought lengthy bureaucratic battles to gain access to civilian cognitive rehabilitation programs which provide up to 30 hours of therapy a week. Soldiers without strong advocates have been turned away from such programs, or never sought care, due to Tricare’s policy of refusing to cover cognitive rehabilitation therapy.

As a result, many soldiers, Marines and sailors with brain injuries wind up in understaffed and underfunded military programs providing only a few hours of therapy a week focused on restoring cognitive deficits.

Sarah Wade’s husband, Ted, was a sergeant with the 82nd Airborne Division when a roadside bomb tore through his Humvee in February 2004. The blast severed his right arm above the elbow, shattered his body and left him with severe brain damage.

After the military medically retired her husband later that year, Wade struggled to find appropriate care for him. The closest VA hospital set up to handle such complex injuries was in Richmond, Va., a 320-mile drive from their home in North Carolina.

Tricare, however, would not pay for cognitive rehabilitation at a nearby civilian program. Wade, who once worked as an intern on Capitol Hill, turned herself into a one-woman lobbyist on her husband’s behalf. She called her representatives and met with senior VA and DOD officials. She testified before Congress [5], met President George W. Bush and Gates, and was recently invited to the White House by President Barack Obama for a bill signing ceremony [6].

Wade managed to set up a special contract between the VA and a local rehabilitation doctor to help her husband. But now she wants to move back to Washington, D.C., to be closer to family.

She must begin her fight all over again — more phone calls to Tricare, more visits to government offices, more battles to get Ted Wade the care he needs.

“We go to Capitol Hill like some people go to the grocery store,” Wade joked one afternoon during a recent visit to Washington. “If we can’t figure it out, then probably nobody can.”

Brain Campaign

The campaign to persuade Tricare to cover cognitive rehabilitation therapy began in earnest after the scandal at Walter Reed Army Medical Center in Washington in 2007. News reports [7] featured brain-damaged soldiers living in squalid conditions and receiving substandard care.

The Brain Injury Association of America, a grassroots advocacy group for head trauma victims, started lobbying Congress and the Defense Department to order Tricare to cover rehabilitation for service members.

The campaign was a natural extension of the association’s mission. Each year, more than 1.4 million American civilians suffer brain injuries in car accidents, strokes and other medical emergencies. They and their families often have to battle private insurance companies for cognitive rehabilitation.

The insurance industry is divided: Five of 12 major carriers will pay for cognitive rehabilitation therapy for head trauma, according to Tricare’s study. Aetna, United Healthcare and Humana cite national evidence-based studies and industry-recognized clinical recommendations that point to the therapy’s benefits.

The federal Centers for Medicare and Medicaid Services does not have a single national policy on cognitive rehabilitation. Instead, it leaves decisions to local contractors, often insurance carriers who process claims for the agency. The contractors are able to provide the therapy case by case, so long as they determine the treatment is “reasonable and necessary,” a Medicare spokesman said.

“The totality of the evidence appears to support the value of cognitive rehabilitation for people with traumatic brain injury in improving their function,” said Robert McDonough, the head of clinical policy at Aetna. “We feel on balance the evidence leads us to conclude that cognitive rehabilitation is effective.”

Carriers and doctors providing the service can point to a long list of medical associations and scientific studies backing the effectiveness of cognitive therapy: The National Institutes of Health; the National Academy of Neuropsychology and the British Society of Rehabilitation Medicine, among others, have weighed in supporting the treatment.

Armed with such evidence, brain injury association lobbyists did not have much trouble finding support in Congress. By 2008, more than 70 House [8] and Senate members [9] had signed letters to Gates asking him to support funding for cognitive rehabilitation therapy. Then-Sen. Obama led a group of 10 senators urging Tricare to pay for therapy.

They noted that the Pentagon and the VA have improved their efforts to treat brain injury, including increases in the number of doctors and therapists available at facilities.

But the military needed to do more, they said. They wrote that Tricare should cover cognitive rehabilitation so all troops “can benefit from the best brain injury care this country has to offer.”

“Given the prevalence of TBI among returning service personnel, it is difficult to comprehend why the military’s managed healthcare plan does not cover the very therapies that give our soldiers the best opportunities to recover and live full and productive lives,” the letter said [10].

A response letter [11] from the Pentagon told the representatives that Tricare officials had not been convinced by available evidence. “The rigor of the research … has not yet met the required standard,” wrote Gordon England, then the deputy defense secretary.

Everyone Agrees

On an unusually hot spring day in April 2009, 50 of America’s leading brain specialists gathered for two days in a sterile hotel ballroom in suburban Washington, D.C.

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, the Pentagon’s lead program for the treatment of brain injury, convened the conference to help settle the debate about cognitive rehabilitation therapy.

The participants were top researchers and doctors from the military and civilian world: neurologists, neuropsychologists, psychiatrists, therapists, family doctors and rehabilitation experts.

After two days of discussion, the group hammered out a consensus report [12], representing the combined wisdom of the field. Their unanimous conclusion: Cognitive therapy improved the thinking skills and quality of life for people suffering from severe and moderate head injuries. Troops with lingering problems from a mild traumatic brain injury, or concussion, also could benefit from the therapy, the experts said.

The consensus was not binding. But those in attendance believed that their opinion — based on the decades of combined clinical experience and academic study present in the room — would lead to troops’ receiving better treatment.

“When you get the right people in the right room at the right time, you’d expect it would influence the decision makers,” said Maria Mouratidis, chairwoman of psychology and sociology at the College of Notre Dame in Baltimore and a conference participant.

Shortly after the conference ended, however, a handful of top officials from the military’s medical system met to discuss the findings at Tricare’s headquarters, an anonymous sprawl of office buildings in Falls Church, Va., known as Skyline 5.

One person familiar with the discussion, who did not want to be identified for fear of reprisal, said money was part of the debate.

Official Pentagon figures show that 188,000 service members have suffered brain injuries since 2000. Of those, 44,000 suffered moderate or severe head injuries. Another 144,000 had mild traumatic brain injuries. However, previous ProPublica and NPR reports [13] showed that number likely understates the true toll by tens of thousands of troops. Some estimates put the number of brain injuries at 400,000 service members.

Mild traumatic brain injuries are the most common head trauma in Iraq and Afghanistan. Commonly caused by blast waves from roadside bombs, such injuries are defined as a blow to the head resulting in an alteration or loss of consciousness of less than 30 minutes. Studies suggest that while most troops with concussions heal quickly, some 5 percent to 15 percent go on to suffer lasting difficulties in memory, concentration and multitasking.

For the military’s health system, the costs of treating brain damaged soldiers with cognitive rehabilitative therapy added up quickly. If tens of thousands of service members and veterans were authorized to receive such treatment, the bill might be in the billions, using high-end estimates for the cost of treatment from the Brain Injury Association [14].

The costs could swell the Pentagon’s annual $50 billion health budget — at a time when Gates has said the military is being “eaten alive” by skyrocketing medical bills.

Tricare “is basically an insurance company. They’ll take no action to provide more service,” said the person familiar with the conversation, who would only discuss it in general terms. “If they do it, it’s an enormous cost.”

At the meeting following the consensus conference, the person said, Tricare staked out its own position: “They had already decided not to do it,” the person said.

NPR and ProPublica contacted two others who attended the meeting. Jack Smith, Tricare’s acting chief medical officer, said through a spokesman that he could not recall the meeting, but “can’t say for sure there wasn’t one.” Rear Adm. David J. Smith, the joint staff surgeon, declined comment through a spokesman.

The Contract

Soon after the meeting, Tricare sprang into action. In May 2009, records show, it issued a $21,000 contract to the ECRI Institute, a respected nonprofit research center best known for evaluating the safety of medical devices.

The contract called for ECRI to review the available scientific literature to weigh the evidence for whether cognitive rehabilitation therapy helped improve patients with traumatic brain injuries.

Tricare routinely hires contractors to carry out assessments to help determine which medical treatments to fund. But in selecting ECRI, Tricare had a pretty good idea of the response it would receive. ECRI had conducted a similar review for Tricare in 2007 [15] that cast doubts on the evidence supporting cognitive rehabilitation therapy.

To carry out the new review, ECRI followed its standard protocol. It chose to include only randomized, controlled studies. Such studies randomly divide patients into groups that receive different treatments in order to compare their effects.

ECRI gave more credence to blind studies, meaning that patients did not know whether they were receiving genuine therapy or a placebo — a fake treatment. Blinding reduces bias and is considered one of the most rigorous standards that can be used in scientific testing.

ECRI also excluded studies deemed irrelevant; those studies with fewer than 10 patients; and studies where 15 percent or more of the patients were injured from a nontraumatic blow, such as stroke.

The criteria resulted in the elimination of much of the published scientific literature on cognitive rehabilitative therapy. Before applying the protocol, ECRI identified 318 articles as potential sources of information about cognitive rehabilitative therapy. The firm’s final report examined 18.

Based on this limited pool, ECRI graded the evidence for the benefits of cognitive therapy as being “inconclusive” or offering only “low” or “moderate” support of improvement in patients’ cognitive functions.

The final report [4], delivered to Tricare in October 2009, noted some areas of benefit. For instance, “tentative” evidence showed cognitive therapy significantly improved quality of life for brain-damaged patients.

ECRI’s review wasn’t limited only to science. The review noted one study that found that comprehensive cognitive rehabilitative therapy could cost as much as $51,480 per patient. By contrast, sending patients home from the hospital to get a weekly phone call from a therapist amounted to only $504 per patient.

Overall, the report concluded, the evidence for most benefits from cognitive rehabilitation therapy remained inconclusive, especially when compared to cheaper programs.

“The evidence is insufficient to determine if comprehensive, holistic (cognitive rehabilitation therapy) is more effective than less intensive care” in helping patients, the 2009 report concluded [16].

Tricare Criticized

By the summer 2009, ECRI researchers had finished a draft of the study. ECRI, later joined by Tricare, asked outside scientific experts to review it.

The reviews, according to interviews and copies obtained by NPR and ProPublica, were uniformly critical.

(NPR and ProPublica obtained a copy of the ECRI reports through the Freedom of Information Act [17]. However, Tricare denied access to reviews of the reports. ProPublica and NPR have appealed the request, but obtained copies of the reports and information on the reports from sources.)

The reviewers acknowledged that more research was needed on cognitive rehabilitation therapy. However, they noted that the Tricare report ran counter to several other so-called meta-analyses, which combine multiple, individual scientific studies to achieve greater statistical reliability.

For instance, a 2005 article in the Archives of Physical Medicine and Rehabilitation, a peer-reviewed journal that is one of the mostly widely respected in the field, examined 258 studies. It concluded that “substantial evidence” supported cognitive rehabilitation. The review included 46 randomized control studies — more than double the number in the Tricare study.

Reviewer Keith Cicerone [18], a leading civilian researcher who runs the JFK Johnson Rehabilitation Institute’s Center for Head Injuries in New Jersey, disputed Tricare’s contention that the treatment was new and untested.

“We have a significant body of evidence describing cognitive rehabilitation and showing what works in cognitive rehabilitation,” Cicerone said. “The idea that cognitive rehabilitation is new and untested is simply not true. It’s got a better evidence base than most things that we do in rehabilitation.”

Asked to explain in plain terms, Cicerone grew animated: “The arguments that are being made against” cognitive rehabilitation “in terms of the level of research that has been conducted are hooey,” he said. “It is baloney.”

The outside experts also attacked Tricare and ECRI for relying upon a methodology that ruled out important research. ECRI’s protocols, they acknowledged, are well-suited for drug studies, where it is easy to prevent patients from knowing which pill they are receiving.

But ECRI’s protocols do a poor job in assessing rehabilitation therapy where patients and doctors constantly interact in face-to-face treatment sessions. Other well-accepted methodologies, they said, have been designed to examine the benefits of therapeutic interventions.

They also questioned the reasons for excluding studies with a small number of patients, or with differing causes for brain injury, since a stroke can produce the same types of symptoms as a blow to the head.

Malec, the research director at the Rehabilitation Hospital of Indiana, said Tricare’s study sounded like it came from a private insurance company seeking to cut costs. His review [19] said that Tricare’s study “fails to represent the evidence relevant to evaluating the effectiveness of cognitive rehabilitation after traumatic brain injury.”

In an interview, he said Tricare’s demand for conclusive evidence was understandable, but ill-advised. While research continues, existing evidence indicates that the therapy helps, with no studies showing that it harms troops.

“They missed the forest for the trees. They missed the big picture,” he said.

Some of the researchers accused Tricare of using ECRI’s strict assessment protocols as a cover to justify denying troops’ coverage.

Wayne Gordon, director of rehabilitation psychology and neuropsychology services at Mt. Sinai School of Medicine in New York, called the review “dismaying” and “unacceptable.” He compared it to tobacco companies that dismissed studies that showed a link between smoking and cancer.

“The ECRI Institute seems to be stating that, while sufficient evidence exists for there to be consensus among diverse groups that cognitive rehabilitation is a useful service, this evidence is ‘not good enough’ for Tricare,” wrote Gordon, who declined to explain his comments further in an interview. He wrote that the ECRI study was “designed to reach a negative conclusion.”

ECRI also asked two additional researchers to examine the report, John Corrigan, director of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation in Columbus, and John Whyte, the director of Moss Rehabilitation Research Institute in Pennsylvania, both leading researchers in the field.

Both men declined to comment, citing their contractual obligations with ECRI, and Tricare declined to release their reviews. People familiar with their contents said Corrigan and Whyte closely mirrored the views of their fellow critics. They recommended that ECRI use a different method to judge studies of cognitive therapy, but the institute refused.

ECRI “said thank you very much, but we’re not changing anything,” said one person familiar with the review process.

More Studies, More Waiting

In an interview, ECRI Institute officials defended their firm’s methodology. The system is designed to provide a rigorous review free from researchers’ bias, they said.

Karen Schoelles, ECRI’s medical director for the health technology assessment group, acknowledged that some of the institute’s criteria — such as accepting only studies with 10 or more patients — were “arbitrary.” But she said they were widely accepted in the assessment industry.

She also noted that Tricare officials were aware of the criteria and made no attempt to change or adjust them. Tricare used ECRI Institute for almost 10 years to carry out health reviews, though the agency recently terminated the contract and selected a new firm to carry out assessments.

Cognitive rehabilitation “may be on to something,” Schoelles said. “But it needs more research.”

Schoelles acknowledged that ECRI’s own reviewers had criticized the report. ECRI offered to provide copies of the reviews, but later said that Tricare ordered them not to release them.

Stacey Uhl, the lead researcher on the review, said the criticism did not change her view that randomized controlled trials were the best way to assess the quality of evidence.

She noted the review found evidence that cognitive therapy did help in some way and said she would not rule out seeking such care for a loved one.

“I as a parent would want my child to receive all available therapies,” she said.

DeMartino, the Tricare official who commissioned the report, acknowledged the outside reviewers had “very, very strong opinions” that were “of concern.”

He said Tricare was conducting a review to determine whether ECRI’s techniques were best suited to measure cognitive therapy’s benefits. He denied submitting cognitive therapy to overly-strict review standards.

“You get what you ask for,” DeMartino said. “They tell us what they’re going to give us, and it’s our job to sort of say, ‘Okay, we understand that within the limitations of their methodology, this is the information that we get.'”

He added: “The better the information you have, the better that you can move forward and do the best thing.” The Tricare reports, coupled with high cost projections, ended the legislative push to get cognitive rehabilitation for service members and veterans.

Last year, Congress ordered the Pentagon to conduct further studies to review the effectiveness of the therapy, but those studies have not yet begun and results are not expected for several years.

Tricare said it would conduct regular reviews to monitor developments in the field. DeMartino first said Tricare would carry out a new review beginning in September. A spokesman later clarified that the National Academy of Sciences Institutes of Medicine would perform the review. It is scheduled to be completed by the end of 2011.

Susan Connors, president of the brain injury association, said she was stunned by the need for legislation at all. As the Pentagon conducts yet more studies, thousands of troops and veterans may be going without the best known treatment available. Thousands more would have to rely on military hospitals or veterans clinics far from their homes, or with substandard programs. The Tricare refusal shut down access to the hundreds of civilian rehabilitation clinics nationwide.

“I’m very disappointed by the resistance,” she said. “The military should want to do this.”

Struggling for Care

Tricare’s stance has not made it impossible to get cognitive rehabilitative. But it has discouraged civilian clinics from treating soldiers.

In interviews, several clinic owners and medical directors described their frustrations.

On some occasions, they were paid after developing relationships with individual Tricare claims processors or case managers, only to have the arrangements fall apart if the person left.

“We have tried to get Tricare and just beat our head against the wall,” said Brent Masel, the president of the Transitional Learning Center in Galveston, Texas. “It took forever to get paid. It was always a fight.”

Mark Ashley, the president of the Centre for Neuro Skills, a chain of rehabilitation clinics, said Tricare and other insurance providers were unwilling to pay because those with brain injuries can often perform basic functions that let them get through their daily lives.

They are “able to walk around, able to maneuver, but can’t function cognitively in a manner that’s safe, appropriate or competent,” said Ashley, a past president of the brain injury association. “We can fix much of that, but it takes an exhaustive amount of time and effort. That’s where the payers are out of touch.”

One of the nation’s top brain injury centers set up a charity program to help cover gaps left by Tricare. Susan Johnson, who runs Project Share at the Shepherd Center in Atlanta, said Tricare pays only about 40 cents of each dollar of care provided for the type of comprehensive program that the clinic has found successful. The rest comes from Bernie Marcus, a billionaire philanthropist, and income from inpatient services.

“These guys go and they put their lives on the line and we put them in this situation that’s difficult for some and less difficult for others to get care,” Johnson said. “I find it frustrating.”

Other clinic owners said they were able to game the system by providing cognitive therapy, but billing for other Tricare-covered services — putting them at risk of being accused of false billing.

One clinic manager acknowledged being “creative” when submitting bills to Tricare. He said that he submitted bills to Tricare for occupational therapy when the treatment focused more on improving memory.

“They won’t pay for this, but they will pay for that,” said the manager, who did not want to be identified for fear of damaging his ability to receive payments. “You just have to figure out how to work the system.”

Soldiers and families agreed that Tricare’s stance has made getting care a battle.

Sarah Wade said she patched together adequate care for Ted, arranging for him to go to a VA hospital for some services and to travel to Walter Reed Army Medical Hospital for others.

Tricare would have paid for some things, such as a physical therapist to help him learn to walk again. But she has had no luck trying to persuade Tricare to pay to treat his brain injury.

In frustration, Wade personally visited a high-ranking official at the Veterans Affairs Department. He, in turn, ordered a VA hospital to fund a special contract with a local civilian rehabilitation doctor near the Wades’ North Carolina home.

“Yes, we have been able to get [cognitive rehabilitation] paid for, but it’s been with a lot fighting, red tape, and bureaucracy,” Sarah Wade said. “It’s his greatest injury and the one that impacts his life the most, that impacts his ability to be a human.” She added, “It shouldn’t be this hard.”

The Wades credit the rehabilitation that Ted has received with markedly improving his cognitive problems. After his 2004 injury, Ted spent months regaining consciousness. Doctors were unsure about his mental state, not certain he would ever talk or even think rationally.

Today, Ted speaks in slow, sure sentences, even cracking jokes. He can make decisions — choices that seem simple enough to someone with normal cognitive skills, but which often stymie those with brain injury.

He knows, for example, to buy cherry tomatoes at the store rather than big tomatoes, which are hard for him to chop and slice with only one arm. He can read through a menu, and pick food that’s nutritious. He can wash and fold his own laundry.

One recent day after dining at a Mexican restaurant in Washington, Ted smiled when Sarah reminded him that he was once unable to figure out whether he liked hot sauce on his tacos.

“It’s been a long, slow process,” he said.

Inform our investigations: Do you have information or expertise relevant to this story? Help us and journalists around the country by sharing your stories and experiences [20].

December 20, 2010 Posted by | Civilian Contractors, Contractor Casualties, Department of Defense, Pentagon, Private Military Contractors, Private Security Contractor, Traumatic Brain Injury | , , , , , , | Leave a comment

Contractor Deaths Exceed Military in Iraq and Afghanistan

This Year, Contractor Deaths Exceed Military Ones in Iraq and Afghanistan

by T Christian Miller ProPublica Disposable Army

More private contractors than soldiers were killed in Iraq and Afghanistan in recent months, the first time in history that corporate casualties have outweighed military losses on America’s battlefields.

More than 250 civilians working under U.S. contracts died in the war zones between January and June 2010, according to a ProPublica analysis of the most recent data available from the U.S. Department of Labor, which tracks contractor deaths. In the same period, 235 soldiers died, according to Pentagon figures.

This milestone in the privatization of modern U.S. warfare reflects both the drawdown in military forces in Iraq and the central role of contractors in providing logistics support to local armies and police forces, contracting and military experts said.

Steven Schooner, a professor of government contracting at George Washington University Law School, said that the contractor deaths show how the risks of war have increasingly been absorbed by the private sector. Private contractors in Iraq and Afghanistan provide fuel, food and protective services to U.S. outposts — jobs once performed by soldiers.

“It’s extremely likely that a generation ago, each one of these contractors deaths would have been a military death,” Schooner said. “As troop deaths have fallen, contractor deaths have risen. It’s not a pretty picture.”

Schooner, who conducted a recent study of contractor fatalities published in Contractor Services [1] (PDF), an industry newsletter, said contractors now make up more than 25 percent of total deaths in Iraq and Afghanistan — a proportion that has grown steadily throughout the conflicts. Official figures show that 5,531 troops and 2,008 civilian contract workers have died in Iraq and Afghanistan between the beginning of hostilities in 2001 and June 2010.

Many working under U.S. contracts are local civilians, often working as translators for troops, or are hired from third world countries to do basic labor, such as cleaning kitchens and toilets.

Previous ProPublica stories [2] have noted that companies employing such workers often fail to report their deaths and injuries to the Labor Department, as required by law. Government figures likely understate the total number civilian contractor deaths.

The rising fatalities have received little public attention, concealing the full human cost of the war, Schooner said. When President Obama spoke of troop deaths in Afghanistan earlier this month, he made no mention of fatalities among the private workforce that feeds and fuels U.S. forces.

“I’m not accusing either the Bush or the Obama administration of intentionally deceiving the public,” Schooner said. “But when a president applauds a reduction in military deaths but fails to acknowledge the contractor personnel now dying in their place, someone isn’t telling the whole story.”

The wars in Iraq and Afghanistan are the most privatized in American military history. Today, there are 150,000 troops in Afghanistan and Iraq. As of March 2010, there were more than 200,000 private contractors, though that number is believed to have declined with the drawdown of U.S. forces.

Defense Secretary Robert Gates announced [3] a plan last month to sharply reduce the number of contractors, saying the Pentagon has become overly dependent on private workers to carry out jobs once done by soldiers.

A recent Congressional Research Service report [4] (PDF) found that the heavy use of contractors had exposed troops to supply shortfalls, wasted taxpayer money, and stirred anger among locals. In several high-profile incidents, heavily armed private security contractors have killed unarmed Iraqi and Afghan civilians.

“Some analysts believe that poor contract management has also played a role in abuses and crimes committed by certain contractors against local nationals, which may have undermined U.S. counterinsurgency efforts in Iraq and Afghanistan,” the report found.

Marcie Hascall Clark, an advocate for contract workers, said that contractor deaths and injuries reflected contractors’ importance in fighting the wars.

Labor Department figures [5] show that more than 44,000 contractors have reported injuries since 2001, compared to about 40,000 U.S. troops. The figures are not entirely comparable, since contractor injuries include minor workplace injuries.

“I don’t think most contractors expect to be treated as nobly as our soldiers, but they don’t expect to be forgotten, either,” said Hascall Clark, who runs a group called American Contractors in Iraq and Afghanistan [6]. “I think there should definitely be some recognition of what they do.”

September 23, 2010 Posted by | Afghanistan, Civilian Contractors, Contractor Corruption, Defense Base Act, Iraq | , , , , , | Leave a comment

Soldiers With Brain Trauma Denied Purple Hearts, Adding Insult to Injury

By T Christian Miller ProPublica and Daniel Zwerdling NPR

The U.S. Army honors soldiers wounded or killed in combat with the Purple Heart, a powerful symbol designed to recognize their sacrifice and service.

Yet Army commanders have routinely denied Purple Hearts to soldiers who have sustained concussions in Iraq, despite regulations that make such wounds eligible for the medal, an investigation by NPR and ProPublica has found.

Soldiers have had to battle for months and sometimes years to prove that these wounds [1], also called mild traumatic brain injuries, merit the honor, our reporting showed. Commanders turned down some soldiers despite well-documented blast wounds that wrenched their minds, altered their lives and wracked their families.

Please see the entire presentation here

September 9, 2010 Posted by | Afghanistan, Iraq, Pentagon, Post Traumatic Stress Disorder, Traumatic Brain Injury | , , , , , , , , | Leave a comment

A Reading List to Put the WikiLeaks ‘War Logs’ in Context

by Nicholas Kusnetz and Karen Weise ProPublica,

This morning, The New York Times [1], England’s The Guardian [2] and Germany’s Der Spiegel [3] published reports on what’s been termed the “War Logs”—nearly 92,000 documents about the war in Afghanistan made public by WikiLeaks. To put the leaked documents in context, we pulled together some of the best, past reporting on the main themes in the reports.

Pakistan’s influence on Afghanistan

The documents suggest [4] that Pakistan’s intelligence service has been aiding the Taliban and the Afghan insurgency. (See some of the documents here [5].) At the heart of this debate is the question Dexter Filkins posed in his Pulitzer-Prize winning coverage [6] in late 2007: “Whose side is Pakistan really on?”

Much of the reporting on this issue centers on the border between Pakistan and Afghanistan, where Taliban warlords and Al Qaeda have a strong base. A “Frontline” documentary [7] from 2006 looked at those groups’ presence in the Waziristan region, and how the Taliban there received assistance from the Pakistan intelligence service. Later, The New York Times’ David Rohde detailed the inner workings of the Taliban in the region in his account [8] of his kidnapping in 2009, when he was taken over the border from Afghanistan to Pakistan. Further south in Pakistan, the Taliban has grown in Quetta, where, as Carlotta Gall wrote [9] in 2007, there were signs that “Pakistani authorities are encouraging the insurgents, if not sponsoring them.”

For more analysis, in a 2008 Q&A with Harpers, the Pakistani journalist Ahmed Rashid explained [10] that the roots of Pakistan’s covert support for the Taliban solidified when the U.S. focused on hunting down Al Qaeda after Sept. 11, leaving the Taliban free to develop in Pakistan. Now, the New Yorker’s Steve Coll says [11] Pakistan’s military believes that Islamic militias could be “useful proxies to ward off a perceived existential threat from India.”

One particular member of Pakistan’s intelligence agency frequently appeared in the WikiLeaks documents. According to the documents, the agency’s former director, Hamid Gul, has strong connections with the Taliban and has been supporting the Afghan insurgency. The Washington Post’s Candace Rondeaux profiled [12] Gul last year, when he was implicated in the bombings in Mumbai.

Civilian casualties

From the beginning of the war, press reports have drawn attention to civilian deaths resulting from U.S. and NATO strikes in Afghanistan. One Washington Post report from October 2001 noted growing concern [13] among Afghans over errant airstrikes, saying locals were beginning to view Americans as just another in the long line of invaders that had come through the country.

Just months later, The New York Times reported [14] that American attacks had already killed hundreds, if not thousands, of Afghan civilians. The story line was much the same in 2007, when the Times reported that civilian deaths [15] were causing divisions within NATO and undermining support for the Afghan government. The reports range far and wide, but below is a sampling of some of the most devastating attacks in recent years.

  • In April 2007, Marines opened fire on unarmed civilians and killed 10 people, wounding more than 30 others. The Washington Post reported it was “one of the largest [16]” civilian death tolls since the war had begun.
  • In August 2008, the Post noted that increased reliance on airstrikes had led to more civilian deaths, including one attack that killed [17] at least 90 innocent Afghans.
  • In an incident highlighted in the Times’ coverage of the WikiLeaks documents, NATO bombs targeted a couple of hijacked fuel tankers and killed more than 100 people in Kunduz Province last September. At the time, The Washington Post reported [18] that at least a dozen of the victims were civilians. The leaked documents show [19] the military concluded the strike had killed 56 people, none of them insurgents.
  • Today, the Times reported that a NATO strike in Helmand Province killed 52 people [20], according to Afghan officials. American military officials did not deny the report, but said it was premature to reach any conclusions.

Secret commandos

The Times reports that the leaked documents also include details on secret commando raids, citing notable successes but also increased civilian casualties from the operations. In February of last year, the paper detailed just such a raid [21], in which bearded American and Afghan forces kicked open the door to one man’s house. The story recounts how Syed Mohammed was taken from his home by the commandos and interrogated for several hours before being released:

“When he returned home, Mr. Mohammed said, he went next door to his son’s house, only to find that most of his family had been killed: the son, Nurallah, and his pregnant wife and two of his sons, Abdul Basit, age 1, and Mohammed, 2. Only Mr. Mohammed’s 4-year-old grandson, Zarqawi, survived.”

A month later, the Times was reporting that the military had temporarily halted [22] such raids after media coverage and a U.N. report that singled out the secret missions for contributing to a rising civilian death toll.

Unmanned drones

The Times says the documents show that drone aircraft have not been as “impressive” as they are typically portrayed. “Some crash or collide, forcing American troops to undertake risky retrieval missions before the Taliban can claim the drone’s weaponry,” the Times writes. The documents mention one situation [23] of a drone that went “rogue” and eventually had to be shot down by a fighter jet before it crossed out of Afghan territory.

The drones have become an increasingly popular tool for the military. Because they’re operated off-site, in theory they reduce casualties for U.S. troops. NPR [24] and “60 Minutes [25]” each went inside the Nevada headquarters of the Army’s drone operations, where pilots use remote controls to fly and monitor the drones. They use satellites and a camera mounted inside to be the eyes of the drone, which NPR said was like “seeing the world through a soda straw.”

The drones are gaining popularity not only with the Army, but with the CIA as well. The New Yorker’s Jane Mayer looked at the how the CIA’s increased dependence on drones [26] represent “a radically new and geographically unbounded use of state-sanctioned lethal force.”  Please see the original at ProPublica

July 26, 2010 Posted by | Afghanistan, Pakistan | , , , , , | Leave a comment

Leader of Military’s Program to Treat Brain Injuries Steps Down Abruptly

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR

WASHINGTON, D.C.–The leader of the Pentagon’s premiere program for treatment and research into brain injury and post traumatic stress disorders has unexpectedly stepped down from her post, according to senior medical and congressional officials.

Brig. Gen. Loree Sutton told staff members at the Defense Centers of Excellence [1], or DCOE, on Monday that she was giving up her position as director. Sutton, who launched the center in November 2007, had been expected to retire next year, officials with knowledge of the situation said. The center has not publicly announced her leaving.

Sutton’s departure follows criticism in Congress [3] over the performace of the center and in recent reports [4] by NPR and ProPublica that the military is failing to diagnose and treat soldiers suffering from so-called mild traumatic brain injuries, also called concussions.

It comes just as the Pentagon prepares to open a new, multimillion-dollar showcase treatment facility outside Washington, D.C., for troops with brain injuries [5] and post traumatic stress disorder, often referred to as the signature wounds of the wars in Iraq and Afghanistan.

Late Wednesday, in a sign of disarray within the program, Sutton cancelled a scheduled appearance at the opening of the National Intrepid Center of Excellence [6], a gleaming new facility of waving glass and futuristic virtual reality treatment rooms in Bethesda.  Read the Entire Story here

June 25, 2010 Posted by | Pentagon, Post Traumatic Stress Disorder, Traumatic Brain Injury | , , , , , , , , | Leave a comment

Pentagon Puts It’s Spin on Brain Injuries

After Our Investigation, Pentagon Puts Its Spin on Brain Injuries

by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR

ProPublica and NPR reported today that the military is failing to diagnose soldiers who suffered brain injuries in Iraq and Afghanistan. It didn’t take long to get a response. Soon after learning that the stories were about to air, the Pentagon’s public affairs machine began circulating talking points on traumatic brain injuries—just in case senior medical commanders weren’t up to speed on what the military’s been doing for troops with one of the wars’ signature wounds.

The talking points, which we obtained and were sent to top Army officials, don’t directly address the findings of our investigation [1]. We found that the military’s system has repeatedly overlooked soldiers with so-called mild traumatic brain injuries. These blast injuries, which some doctors call concussions, leave no visible scars but can cause lasting physical and mental harm in some cases. The Pentagon’s official figures [2] say about 115,000 soldiers have suffered a mild traumatic brain injury since the wars began. But we found that military doctors and screening tools routinely miss soldiers who have suffered mild traumatic brain injuries on the battlefield. Experts we interviewed and documents we obtained said the military’s count may understate the true toll by tens of thousands of soldiers.

The talking points are upbeat. One says that the Department of Defense has the “world’s best TBI medical care for our service members [3].” Leading neuropsychologists and rehabilitation therapists have told us that’s not true, however. They say the military doesn’t always provide the kind of intensive cognitive rehabilitation therapy most experts recommend. The talking points also stressed that one military screen, called the ANAM [4], for Automated Neuropsychological Assessment Metrics, will be “utilized when soldiers come home [5] to help measure the effects of any identified mild brain trauma that may have gone unnoticed or untreated.”

But when we talked to the man who ran that program, he told us the ANAM was rarely used that way. Lt. Col. Mike Russell, the Army’s senior neuropsychologist, said that more than 580,000 ANAM tests have been administered to soldiers before they deploy to the battlefield. But doctors have only used them about 1,500 times to diagnose soldiers after they’ve suffered a blow to the head.

The talking points tick off a number of initiatives the military has undertaken to better diagnose and treat the soldiers. But as we note in our stories, the problem is not the lack of initiatives, it’s that nine years into the war, nobody at the Pentagon knows how big the problem is, nor how best to treat it. You can find the complete talking points memos [6] and PowerPoint [7] here.

Phone calls to the medical command’s spokeswoman were not immediately returned.

June 9, 2010 Posted by | Civilian Contractors, Defense Base Act, Traumatic Brain Injury | , , , , | Leave a comment

State Beats Pentagon, Unfortunately

David Isenberg at Huff Post

Recently I wrote about the contract for training the Afghan National Police. Actually I wrote about a Newsweek/Pro Publica article on the subject. This contract was held DynCorp which naturally enough, given some of the allegations in the article, took exception with what I wrote.

I don’t know what the truth is. T. Christian Miller from Pro Publica who worked on the article has an outstanding record on reporting on this issue. But DynCorp said it had records proving it did everything required under the contract. Hopefully, the truth of the matter will come out in the near future.

But since DynCorp subsequently brought up the issue of its record, albeit limited to Afghanistan, I think it fair to look back further. So let’s step into Mr. Peabody’s time machine and look at its performance doing similar training in Iraq.

We don’t have to travel very far in time; only to February 24, when the House Foreign Affairs Subcommittee on International Organizations, Human Rights, and Oversight, chaired by Rep. Russ Carnahan (D-MO) held a hearing, “Hard Lessons Learned in Iraq and Benchmarks for Future Reconstruction Efforts.” The witness was Stuart W. Bowen, Jr., Special Inspector General for Iraq Reconstruction (SIGIR). Before you read the below excerpt. bear in mind that it says as much about the U.S. government as it does about DynCorp.

REP. CARNAHAN: Thank you. Now I want to move on to talk about the issue of the police training. When I traveled to Iraq back in early 2005, I had a tour of a police training facility, and there was much fanfare about — this was one of the highest priorities for success in the country, and substantial funding had been provided to it, and there were glowing numbers about how quickly they were going to get the numbers of police trained up to where they needed to be. And, you know, even today, as you mentioned, General McChrystal saying, you know, that’s one of the number one priorities, is to get our police trained. You know, between 2005 and now we haven’t seen anywhere near the progress that we need to have seen. And I guess with the planned withdrawal of U.S. troops from Iraq by December 31, 2011, what challenges do you foresee — I guess my first question – what challenges in terms of the transition and responsibility from the military to state, and do you believe state will be able to successfully take over that training program in October of 2011? MR. BOWEN: First of all, great question, because I think it is the critical issue to ensure improved security in Iraq going forward. We’re going to go down to 50,000 troops in four months. And that’s going to obviously mean that the Iraqis have to shoulder the complete security burden moving forward. We have trained hundreds of thousands of police and equipped them over the last five years, and we’re doing an audit now to provide you the particulars of how the military executed the police training contract. And that’ll be out later this year.

But the transition issue I think that’s paramount is the fact that the contract and the management of the contract that we criticize in this — most recent audits, the DynCorp contract, is up for bid right now in Iraq, and no surprise. DynCorp is one of the bidders for that, and I think that it’s got — it’s a contract that has to be managed by the State Department. And the core of our criticism was the lack of in-country oversight, the failure to review invoices, the questions raised about the vulnerability to fraud and waste regarding billions of taxpayer dollars.

Those weaknesses have not been remedied yet. Now, Deputy Secretary Lew, when I met with him on this a month ago, assured me that he is going to take a personal interest and ensure that there is adequate oversight. But that promise needs to be fulfilled, and thus, here is the issue, the number one issue, ensuring contract management of this continuingly very expensive oversight package for Iraq.

REP. CARNAHAN: So to the question of this transition, how do you see that happening?

MR. BOWEN: Well, I have visited with the State Department, individual in charge of management. It’s going to be a radical reform, I think, of the approach simply because of the limited assets the State Department has vis-a-vis the Department of Defense. And so it’s going to move, as he described it, up to 30,000 feet from 5,000 feet. It’s going to be about macro improvements to ministry capacity, and it’ll be a reduction — there won’t be the individual police training execution at the level that’s going on now.

REP. CARNAHAN: And to the specific contract, you indicated we have put $2.5 billion into police training — that’s correct —

MR. BOWEN: Mm-hmm, yes, sir.

REP. CARNAHAN: — and that this is the largest single contract —

MR. BOWEN: Yes.

REP. CARNAHAN: — in all of the Iraq reconstruction?

MR. BOWEN: In State Department —

REP. CARNAHAN: In —

MR. BOWEN: — in — the State Department has ever managed.

REP. CARNAHAN: In State Department history.

MR. BOWEN: Yes.

REP. CARNAHAN: And how many U.S. government officials were overseeing this contract?

MR. BOWEN: In-country contracting Office of Representatives — three. This is the tough story here, Chairman Carnahan. We looked at this four years ago, and the problem we identified four years ago was lack of contract management raised in our first audit issued in first month of 2007. Then we got into the whole contract and found that it was inauditable, and so we issued a review in October saying the State Department asked for three to five years to get their records in order because it just — it was a mess. And then we went in in 2008 to see if there were remedial measures, and there were. Then we go in last summer and find the same problem, three people in-country overseeing a contact that has — that is spending hundreds of millions of taxpayer dollars. And more disturbing — the lack of clarity about who was supposed to do what. The in-country contracting Office of Representatives — my auditors interviewed said well, invoice accountability is being done back in Washington. We went back to Washington, asked them. They said it’s being done in Iraq. Huge vulnerability.

REP. CARNAHAN: And with regard to the contractor, DynCorp, describe how that contract was initially awarded.

MR. BOWEN: It was an existing contract that was held by the State Department that was used
— I don’t have the specific facts of the bidding process, but it was in existence in 2004 and used to apply to this program in — at the level of $2.5 billion. And again, as I said, it was DOD money that went into it. So I think DOD was looking for a vehicle that it could use to spend this money, and it did so, and I think there are some questions about that process. But it certainly shows how bifurcated or disjointed both the source of the money, the contract management of the money, and then the execution of the contract, all different places. It shows, I think, just the lack of clarity in stabilization reconstruction contracting.

REP. CARNAHAN: And in your reviews, to what extent can you account for how that money has been spent?

MR. BOWEN: As I said, we’re looking at the execution of it now. My auditors in Iraq are
today reviewing that matter, and the outcomes, which are an important question for you, we
will answer later this year.

REP. CARNAHAN: And you expect that report out when?

MR. BOWEN: By July. No later than July.

REP. CARNAHAN: I’m going to yield to Judge Poe.

REP. POE: Thank you, Mr. Chairman. I had just one question. Which of our government agencies, in your opinion, was the most irresponsible about money, DOD, State Department, USAID?

MR. BOWEN: I think that the State Department did not carry out its contract oversight responsibilities sufficiently enough. In this particular contract we’re discussing – is the most egregious example of that. And the disturbing point is it hasn’t remediated that weakness sufficiently today.

REP. POE: All right, thank you. Thank you, Mr. Chairman.

REP. CARNAHAN: Thank you, Judge Poe. Yeah, I think if — I don’t know anything about police training, but if I had a $2.5 billion contract, I think I could figure out a way to train police. I mean, that’s outrageous.

Think about that last question and Bowen’s answer for a moment. When the State Department is judged to be more irresponsible than the Pentagon in terms of contract oversight you know you have a huge problem on your hands.

Follow David Isenberg on Twitter: www.twitter.com/vanidan

April 27, 2010 Posted by | Civilian Contractors, Contractor Oversight, DynCorp, Pentagon, State Department | , , , , , , | Leave a comment

Senators Call for Changes to Troubled, Costly Afghan Police Training Program

by Ryan Knutson, ProPublica

State and Defense department officials took a tongue-lashing today, trying to explain to a Senate subcommittee how the government has poured $6 billion since 2002 into building an effective Afghan police force with disastrous results.

ProPublica and Newsweek examined the problems [1] with police training in Afghanistan in a story published last month. The program, managed under a contract with DynCorp International, has faced challenges on every front, from recruitment to inadequate training periods to corruption to poor officer retention.

“Everything that could go wrong here, has gone wrong,” Gordon S. Heddell, the inspector general of the Department of Defense, acknowledged to an ad hoc subcommittee [2] of the Senate Committee on Homeland Security and Governmental Affairs. Heddell’s office, along with the State Department’s Inspector General, completed a six-month audit in January of the program that found significant lapses.

Sen. Claire McCaskill, D-Mo., the subcommittee chair, and others on the panel were less interested in rehashing the program’s well-known shortcomings and more interested in hearing about solutions. “What you laid out was a problem we knew in 2001,” said Sen. Edward Kaufman, D-Del., in response to comments from Heddell. “What are the two or three things you can spend $6 billion on and not end up with essentially nothing?”

Defense and State Department officials agreed that clearer guidelines for the contractor and more oversight are needed to improve the program. Currently, the State Department has just seven contract overseers in Afghanistan, said David T. Johnson, an assistant secretary for the State Department. The agency hopes to have 22 in place by September, Johnson said.

Another key would be to make training ongoing, rather than just the six weeks that police recruits are getting now, said David S. Sedney, a deputy assistant secretary with the Defense Department. “This is not a weeks- or months-long [process] — it’s a years-long process,” he said, adding that police need to be partnered with American military and more experienced Afghan troops on whom they can model their behavior.

Even if the program makes headway, some senators questioned whether it would be sustainable without a massive ongoing commitment from U.S. taxpayers. The Afghan police and army are slated to receive $11.6 billion to fund their operations for 2011, with just over half going to the police, Sedney said. McCaskill pointed out that’s only $2 billion less than the entire country’s Gross Domestic Product.

“It’s obvious that Afghanistan is not going to be able to afford what we’re building for them,” she said. The U.S. has made a “billion-dollar commitment for years to come.”

The government is already exploring whether a change in contractors might benefit the police-training program. DynCorp’s contract has been extended for several months, but the State Department has issued a call for new bids, hoping an array of companies will step up to compete for the job, Johnson said. McCaskill was skeptical, however.

“I will be shocked — like winning the lottery — if we end up with anybody other than DynCorp,” she said.

Write to Ryan Knutson at Ryan.Knutson@propublica.org

April 15, 2010 Posted by | Civilian Contractors, Contractor Corruption, DynCorp, Wartime Contracting | , , , , , , , , , , , | Leave a comment

Contractor Deaths Accelerating in Afghanistan as They Outnumber Soldiers

by T. Christian Miller, ProPublica – April 14, 2010

A recent Congressional Research Service analysis [1] obtained by ProPublica looked at the number of civilian contractors killed in Afghanistan in recent months. It’s not pretty.

Of the 289 civilians killed since the war began more than eight years ago, 100 have died in just the last six months. That’s a reflection of both growing violence and the importance of the civilians flooding into the country along with troops in response to President Obama’s decision to boost the American presence in Afghanistan.

The latest U.S. Department of Defense numbers show there are actually more civilian contractors on the ground in Afghanistan than there are soldiers. The Pentagon reported [2] 107,292 U.S.-hired civilian workers in Afghanistan as of February 2010, when there were about 78,000 soldiers. This is apparently the first time that contractors have exceeded soldiers by such a large margin.

Using civilian contractors to haul food, prepare meals and act as bodyguards has kept the Pentagon’s official casualty figures lower than they would have been in past conflicts, where contractors were not as heavily used.

Contractor casualties are, by and large, invisible to the public, disguising the full human cost of the wars in Iraq and Afghanistan. They are not reported in totals given by the government. If they were, the death toll in Afghanistan would have surpassed 1,000 — 848 soldiers, 289 civilian contractors — from 2001 to 2009, a milestone that has gone entirely unmarked.

The number of contractor dead are released only though the Labor Department, which keeps count as part of an insurance program for contractors known as the Defense Base Act. And these numbers, agency officials have admitted and our reporting has shown, undercount fatalities. As David Isenberg [3] pointed out in the Huffington Post recently, a new database designed, in part, to track contractor deaths is still not being used to do so.

Staff researcher Lisa Schwartz contributed to this report.   Original Here

April 14, 2010 Posted by | Civilian Contractors, Contractor Casualties, Wartime Contracting | , , , , , , , , | Leave a comment