Saturday, May 19, 2012

Sing it, Barry!









In Spokane, Washington, the Lilac Festival is taking place.  As usual, the third Saturday of the month (tomorrow) will be the Festival's Armed Forces Torch Light Parade. The festival has taken place since 1938 when the chair of the Associated Garden Clubs and the Spokane Floral Association, Ethyl Goodsell, organized the first event.  This Saturday's parade will start at 7:45 p.m. by the INB Performing Arts Center and will feature "high school bands, community floats, equestrian groups and individuals, and military with groups of veterans, and active military marching."  Iraq War veteran Danielle Nienajadlo's mother will be there and Lindsay Wediman will be carrying a picture of her daughter Danielle. 
John Stucke (Spokesman-Review) reports that, after graduating high school, Danielle enlisted in the army and served 13 years.  A year after she left the military, in 2009, Danielle was battling "an aggressive form of leukemia."  Like so many others who worked in and around the burn pits (open areas where every discarded item from standard trash to human waste to medication, etc. was burned to dispose of it), Danielle saw her record good health vanish.  While stationed at Balad, she coughed up blood, suffered sores and bruises over her body, experienced severe weight loss and had headaches.  Attempts to address the situation resulted in her symptoms being dismissed and ignored: "Danielle was finally sent to Walter Reed Army Medical Center and diagnosed with acute myelogenous leukemia.  She became one among hundreds of soldiers brought home from the war to battle cancers and other diseases.  Many -- though not all -- blame the burn pits for their illnesses, and class-action litigation is pending in federal court."
In March 2010, Beth Hawkins (Mother Jones) reported on Sgt Danielle Nienajdlo's passing and observed:
The government's reluctance to acknowledge the potential hazard has frustrated veterans' advocates, who remember how long it took for the Pentagon to recognize Gulf War Syndrome in the 1990s, and to acknowledge the health problems caused by aerial spraying during the Vietnam War. "We don't want another Agent Orange," says John L. Wilson, DAV's assistant national legislative director. "Silence does not do any good."
If the pits are harming troops and Iraqis, there's no telling how many. Many cancers won't reveal themselves for a decade or more, and many respiratory symptoms tend to be misdiagnosed as asthma. Like Nienajadlo, Air Force Reserve Lt. Colonel Michelle Franco, 48, had a clean bill of health when she shipped out to Balad three years ago. The 18-foot walls surrounding her quarters kept out mortar fire, but not the smoke: "You could smell it; you could taste it." As a nurse, Franco suspected the "plume crud" was hazardous. She knew that in addition to amputated limbs from her medical facility, the base's waste included hundreds of thousands of water bottles every week -- and she knew burning plastic releases cancer-causing dioxins. After just five months at the base, Franco sustained permanent lung damage. She's lucky, she says, that she kept asking questions when harried doctors handed her an inhaler. She expects her diagnosis -- untreatable reactive airway dysfunction syndrome -- to ultimately push her into retirement.
Last Friday, Iraq War veteran Spc Dominick J. Liguori died.  Bob Kalinowski (Times-Tribune) reports he died of sarcoidosis, "Family members say Spc. Liguori developed the disease from exposure to open-air burn pits while serving in Iraq, and the ailment slowly scarred and destroyed his lungs."  Denise Hook says of her 31-year-old nephew, "They did scans of his lungs.  You could see on the scans that most of his lungs were destroyed.  You'll see a lot more in the future.  You really will."  She also states, "Since he was little, he wore camouflage for Halloween every year.  He painted his wagon camouflage.  He painted his little trucks camouflage.  He hid in the trees with camouflage.  All he ever dreamt about was being in the military.  That was his lifelong dream.  I think if God could have made him better, he would have rejoined."

While the government collectively shrugs its shoulders, Iraq War veteran Leroy Torres and his wife Rosie Torres have continued to battle on behalf of veterans exposed to burn pits -- which includes Leroy Torres -- and they have contiuned to educate the nation on the issue. The Torres have a website entitled BURNPITS 360. They are also on Facebook.  Last month, she was interviewed by Rachel Cole (KRIS -- link is text and video):

His wife, Rosie, has been battling for years with Congress to get legislation passed that will recognize a connection with toxic exposure for soldiers and their poor health conditions. "To sum it up, at 39-years-old, he's lost both his careers that he's worked very hard for because of his health. Toxic exposure is something that it slowly takes over one organ at a time." Rosie said.
According to Rosie, her husband is in stable but she says others aren't so lucky. "There's several soldiers awaiting lung transplants and others on full liters of oxygen constantly." She said.
At RT for Decision Makers in Respiratory Care, Kalie VonFeldt, MS, PA-C; Maura Robinson, BS; and Cecile Rose, MD, MPH explore these issues and they note, "Reports of increased acute respiratory illnesses in deployed troops began surfacing in 2004.3 Subsequent epidemiologic studies showed that deployers have higher rates of newly reported respiratory symptoms than nondeployers (14% versus 10%), although rates of physician-diagnosed asthma and chronic bronchitis were not increased.4 More recent studies suggest that obstructive airways diseases, including asthma and constrictive bronchiolitis, are occurring in excess in returning troops.1,5 The magnitude and spectrum of respiratory illnesses from deployment are difficult to judge. Lack of predeployment spirometry and challenges with diagnosis limit accurate estimates of disease incidence and prevalence."

Currently, US House Rep Todd Akin is proposing a burn pit registry in the House.  If US Barack Obama wants to earn veterans votes or to stop his empty grand standing and actually have an accomplishment to his name, he could throw some public support being Akin's bill.   Yesterday, Barack did sign into law legislation Akin sponsored . . . to name three US Post Offices in Missouri after 3 native sons who died serving in Iraq: Spc Peter J. Navarro, Lance Corporal Matthew P. Pathenos and Lance Cpl Drew W. Weaver.  Though an honor, it also really doesn't cost the government much more than the cost of plaque.  Maybe that's why the president could get on board with that but has provided no leadership for or advocay of a burn pit registry?
Wednesday the House Veterans Affairs Subcommittee on Health held a hearing.  Subcommittee Chair Ann Marie Buerkle noted the hearing was entitled "Optimizing Care for Veterans With Prosthetics."  The Subcommittee heard from four panels.  The first one was featured Gulf War Veteran John Register and Vietnam Veteran Jim Mayer.  Disabled American Veterans' Joy Ilem, American Orthotic & Prosthetic Association's Michael Oros, Paralyzed Veterans of America's Alethea Predeoux and Southeast Wounded Warrior Project's Jonathan Pruden made up the second panel (we covered the second panel in Wednesday's snapshot).  The third panel was the VA's Office of Inspector General's Linda Halliday accompanied by Nicholas Dahl, Kent Wrathall and Dr. John D. Daigh Jr. and Dr. Robert Yang.  The fourth panel was the VHA's Dr. Lucille Beck accompanied by Dr. Joe Webster, Dr. Joe Miller and Norbert Doyle.  Yesterday we covered some of Chair Ann Marie Buerkle's questions during the fourth panel. Today, we're going to note Ranking Member Mike Michaud questioning the same panel. 
Before we do though, we're going to note some of the remarks Iraq War veteran Jonathan Pruden made on the second panel.
Jonathan Pruden:  Under the change, only a contracting officer could procure a prosthetic item costing more than $3,000.  This policy would effect essential items including most limbs like mine and wheel chairs.  It would require the use of a system designed for bulk procurement purchases that involves manually processing over three hundred -- that's 300 -- individual steps to develop a purchase order.  This system may be great for buying cinder blocks and light bulbs but it is certainly not appropriate for providing timely and appropriate medical care.  Equally troubling, this change offers no promise of improving service to the warrior.  Instead, it would mean greater delays. The change could realize modest savings but at what cost?  A warrior needing a new leg or wheel chair should not have to wait longer than is absolutely necessary.  I know warriors who have stayed home from our events, stay home from school, from work, can't play ball with their kids or live in chronic pain while they wait for a new prosthesis.   I know first hand what it's like to not be able to put my son into the crib while I'm waiting for a new prosthetic, to live in chronic pain and to have my daughter ask my wife once again, "Why can't Daddy come and walk with us?"   With VA moving ahead on changing procurement practices, wounded warriors need this Committee's help.  A prosthetic limb is not a mass produced widget. Prosthetics are specialized, medical equipment that should be prescribed by a clinician and promptly delivered to the veteran.  We urge this Committee to direct VA to stop implementation of this change in prosthetic procurement.
That sets us up for the problem.  VA is proposing a change which will add steps to attempting to get prosthetics and which veterans groups fear (I agree with them) will lead to veterans not getting what their doctors are prescribing but instead some cheap knock-off that doesn't do what they need and that's why their doctor didn't prescribe it in the first place.   Will this fear come true?  That's a yes-or-a-no answer.  But as we saw in the hearing during the fourth panel, a lot of words flow out of the mouths of VA employees appearing before the Subcommittee but "yes" and "no" are not among them.
Ranking Member Mike Michaud:  I just want to follow up, Mr. Doyle, on your comment that you made where you mentioned that contracting officers do not change what the clinician prescribes but actually, in testimony that we heard earlier, from PVA, that is not the case -- because that is not the case. Their testimony states that contracting officers when they do receive the orders the request for the devices is modified and even denied in cases because of the cost. So that is a huge concern. There seems to be a disconnect between what you are hearing versus what the VSOs are hearing  The cost is a factor, it's not the veteran's health care. So do you want to comment on that and --
Norbert Doyle: Yes, yes, sir.  Thank you.  First of all contracting officers -- all contracting officers do have a mandate under Federal Acquistion regulations to ensure that there's a price reasonable aspect to the cost we're providing.  So I don't know if that is a concern or not.  I can't really speak to, uh, what may have happened before but I have put out to the contracting community that under 8123 that if a contract -- that if the contracting officer recieves a physicians consult for a specific product we'll do due dil -- due deligence to ensure that we pair a fair and reasonable price for that product but we're going to get that product for that individual.  So I -- So I don't know if it's a -- a concern that -- again I'll take full blame for not bringing the veterans service organizations into the loop, into this discussion, and we can fix that but I don't know if that's part of the issue there -- if that's why that concern was being raised.
Ranking Member Mike Michaud: Well its very clear from the VSOs, some of their statements, that it's not uncommon for  clinicians to prescribe something and it's being modified by contracting officers.  And primarily because of cost.  And that's a big concern that I would have.  My other question is, Mr. Oros talked about older veterans at his practice complaining that there appears to be a new administrative hurdle to prevent their continuing to receiving care at Scheck and Siress. The VA has assured veterans that they may choose their own prosthetist and yet veterans who wish to use community-based providers report wide-spread administrative hurdles and other pressures to choose in house VA care.  How would you explain the perception among the veterans and the community based providers because there seems to be a disconnect here as well as far as what you have told us versus  what's actually happening out there.
Dr. Lucille Beck:  Uhm, uhm, yes, sir.  I'll start and, uhm, uh, we do have contracts with 600 providers -- uhm, approximately 600 providers.  Uhm, we do offer choice to the -- to our veterans.  Uhm, and, uhm, when our  -- In our amputee clinic, when we initiate the process for the multi-disciplinary care that we provide, uhm, we have our physicians and our clinicians and our prosthetists there.  We also have contract -- our vendors, our contracted community partners, our contracted prosthetic vendors from the community are there as well.  The veterans do have that choice. That's part of our policy.  And, uhm, and, uhm -- We -- As we become aware of we-we will reaffirm that policy with the field based on what we have heard from our veterans today.  And, uhm, and we are improving the processes.  I think the Inspector General report pointed out that we -- There's some contract administration initiatives that we need to undertake including streamlining the way that we do our quote reviews so that they happen in a more timely fashion and, uhm, that they really clarify the prescriptive elements for fabrication of the leg and we are doing that -- or fabrication of the limb and we are doing that.  Uhm, the second thing that we are doing is, uhm, we are, uh, making sure that our contracting officers and their technical representatives who have as part of their, uh, responsibility to review those quotes and certify that they are doing that regularly and in a timely fashion, there's guidance that's being prepared even now, uhm, with, uh, to get -- to get -- to reinstruct the field and educate them on that.  And the third thing that we are doing is that we are taking a contracted -- what we call contracted template where we are developing policy and guidance that can actually go into our contracts so that it is clearly specified for the contract provider and the VA exactly what the requirements are and the timelines.  So, uhm, we've taken the report that we've had from the Inspector General about the need to improve contract adminstration and support our veterans seriously and we are making those corrections, uhm, and have been doing that over the last several months.
Ranking Member Mike Michaud:  And do you feel that with the new changes you're providing, which goes back to my original question, that the clinicians will have final say in what a veteran receives versus a contracting officer who has to look at contracts and saving costs -- which I believe that we have to do.  But the bottom line for me is to make sure that the veterans get the adequate prosthetics that they need.  And if it costs a little bit more then they should be able to get it if it fits them more appropriately.  And the concern that I have is that, yes, you have to look at cutting costs but not at the cost of providing what our veterans need and I do have a concern with contracting officers injecting, uh, more costs versus the clinician looking at the veterans' needs.  
Dr. Lucille Beck:  Uhm, yes, sir, I have a concern with that too.  I'm a clinician myself, working in another area, who provides rehab technologies to veterans.  And it is critically important that what the clinician requests and that of course is done in collaboration and in partnership with the veteran -- these are the choices and decisions about technologies that our veterans make with out clinicians.  And, uhm, we are absolutely -- Uhm, rehabiliation is not effective unless we are able to, uh, provide the-the products and services that our veterans need.  And, uhm, our role in prosthetics and in rehabilitation is to assure that any, uhm, uh-uh, that any, uh, contracts, uh -- And the way we procure items  uhm, enhances and-and, uh, not only enhances but provides high quality individualized care.  Uhm, we have done that successfully, uhm, for a long time.  And, uh, we believe that we are able to do that, uhm, as we move forward.  And as Mr. Doyle has cited, the, uhm -- We can certainly, uhm,  work within the framework of contracting requirements and the added authority that Congress gave us many years ago for 8123 is, I think, the other piece of-of sole source procurement that we can do when we need to provide and are providing highly individualized products and services.
Ranking Member Mike Michaud:  Thank you.  Thank you, Madam Chair.
The above dance was only topped by the moves Doyle proved when Chair Ann Marie Buerkle asked him more questions in the second round.  Specifically, when the Chair asked, "In the panel with Mr. Pruden -- Captain Pruden, I should say -- he talked about this new system that you're going to go to, the Electronic Contract Management System -- and talked to us about the fact that it requires 300 steps to get the request in.  Can you comment on that?"
Guess who couldn't comment?  Did you think it was Lucille?  Yeah, it was Dr. Beck.  Why was she present?  She had nothing to say, no answers to questions but after Doyle misdirected for two to three minutes every time he opened his mouth, Dr. Beck would jump in at the end to start offering slogans she must have read on hand outs in the VA's waiting room. 
She couldn't comment.  But Norbert Doyle did want to comment on the Electronic Contract Management System.  He began insisting that it "new" and that he knows the process is "labroious" and has many steps but 300?  "That's a new one on me." 
How many steps is he familiar with?
He never said.
What sounded like a highly frustrated Chair Ann Marie Buerkle replied that they weren't talking about "lightbulbs," they were talking about something "intimate," something that "becomes a part of the veteran's body."  And if she was frustrated then (she sounded it -- many of us observing the hearing had frustrated looks on our faces as well during the fourth panel's testimony), she most likely only grew more frustrated by the flat affect with which the VA witnesses greeted her comments.
Meanwhile if you're think Iraq falling off the US media radar means it's safe and rainbows flow from Nouri al-Maliki's armpits and carmel and butterscotch out of his ass, think again.  The White House issued the following today:
The White House
Office of the Press Secretary
For Immediate Release
May 18, 2012

Message -- Continuation of the National Emergency with Respect to the Stabilization of Iraq

Section 202(d) of the National Emergencies Act (50 U.S.C. 1622(d)) provides for the automatic termination of a national emergency unless, within 90 days prior to the anniversary date of its declaration, the President publishes in the Federal Register and transmits to the Congress a notice stating that the emergency is to continue in effect beyond the anniversary date. In accordance with this provision, I have sent the enclosed notice to the Federal Register for publication continuing the national emergency with respect to the stabilization of Iraq. This notice states that the national emergency with respect to the stabilization of Iraq declared in Executive Order 13303 of May 22, 2003, as modified in scope and relied upon for additional steps taken in Executive Order 13315 of August 28, 2003, Executive Order 13350 of July 29, 2004, Executive Order 13364 of November 29, 2004, and Executive Order 13438 of July 17, 2007, is to continue in effect beyond May 22, 2012.
Obstacles to the orderly reconstruction of Iraq, the restoration and maintenance of peace and security in the country, and the development of political, administrative, and economic institutions in Iraq continue to pose an unusual and extraordinary threat to the national security and foreign policy of the United States. Accordingly, I have determined that it is necessary to continue the national emergency with respect to this threat and maintain in force the measures taken to deal with that national emergency.
Recognizing positive developments in Iraq, my Administration will continue to evaluate Iraq's progress in resolving outstanding debts and claims arising from actions of the previous regime, so that I may determine whether to further continue the prohibitions contained in Executive Order 13303 of May 22, 2003, as amended by Executive Order 13364 of November 29, 2004, on any attachment, judgment, decree, lien, execution, garnishment, or other judicial process with respect to the Development Fund for Iraq, the accounts, assets, and property held by the Central Bank of Iraq, and Iraqi petroleum-related products, which are in addition to the sovereign immunity accorded Iraq under otherwise applicable law.

Recommended: "Iraq snapshot"

Friday, May 18, 2012

Which country is he president of?










Yesterday, the House Veterans Affairs Subcommittee on Health held a hearing. 
WASHINGTON, D.C. -- Today, the Subcommittee on Health held a hearing to examine VA's current capabilities to provide state-of-the-art care to veterans with amputations. The Committee heard testimony concerning VA's proposal to change procurement processes for prostheses, potentially hindering a veteran's ability to acquire the latest prosthetic and corresponding care and support.
"VA has been struggling to keep pace with the rising demands of younger and more active veterans with amputations," stated Rep. Ann Marie Buerkle, Chairwoman of the Subcommittee on Health. "VA must continue to provide multi-disciplinary care to maintain long-term and life-time quality of life. Placing prosthesis procurement into the hands of contracting officers is alarming. VA needs to match the determination and spirit demonstrated by our wounded warriors and recommit themselves to becoming a leader once again in prosthetic care."

Currently, VA provides care to approximately 42,000 veterans with limb loss. As of August of 2011, 1,506 servicemembers had experienced amputations on active duty from Operations Enduring and Iraqi Freedom. An additional 2,248 veterans underwent major amputations at VA in 2011. VA prosthetic costs have more than doubled in the past five years, yet, VA's care has fallen behind that of the Department of Defense (DoD).
"Prosthetics are a truly individualized extension of one person's body and mobility, not your typical bulk supply purchase," stated Jim Mayer, a Vietnam veteran, double amputee, and wounded warrior advocate and mentor. "When today's warriors are referred to VA and seek the newer, cutting-edge, technologically superior prosthetics they have been accustomed to [through DoD], will VA be able to meet that demand? DoD centers of excellence provide state-of-the-art and often newly evaluative prosthetics that have allowed warriors to thrive, not just in walking, but also run competitively, compete in the Paralympics, rock climb, play myriad sports and other endeavors."
"Prosthetic technology and VA have come a long way from the Civil War era. Following World War II, veterans dissatisfied with the quality of VA prosthetics stormed the Capitol in protest. Congress responded by providing VA with increased flexibility for prosthetic options and federally funded research and development," said Buerkle. "As a result, VA has been a leader in helping veterans with amputations regain mobility and achieve maximum independence. This is why I am troubled by VA's proposed changes in procurement policies and procedures which shifts the emphasis from the doctors to contracting officers."
So what kind of change is being discussed?
Jonathan Pruden:  Under the change, only a contracting officer could procure a prosthetic item costing more than $3,000.  This policy would effect essential items including most limbs like mine and wheel chairs.  It would require the use of a system designed for bulk procurement purchases that involves manually processing over three hundred -- that's 300 -- individual steps to develop a purchase order.  This system may be great for buying cinder blocks and light bulbs but it is certainly not appropriate for providing timely and appropriate medical care.  Equally troubling, this change offers no promise of improving service to the warrior.  Instead, it would mean greater delays. The change could realize modest savings but at what cost?  A warrior needing a new leg or wheel chair should not have to wait longer than is absolutely necessary.  I know warriors who have stayed home from our events, stay home from school, from work, can't play ball with their kids or live in chronic pain while they wait for a new prosthesis.   I know first hand what it's like to not be able to put my son into the crib while I'm waiting for a new prosthetic, to live in chronic pain and to have my daughter ask my wife once again, "Why can't Daddy come and walk with us?"   With VA moving ahead on changing procurement practices, wounded warriors need this Committee's help.  A prosthetic limb is not a mass produced widget. Prosthetics are specialized, medical equipment that should be prescribed by a clinician and promptly delivered to the veteran.  We urge this Committee to direct VA to stop implementation of this change in prosthetic procurement.
At the start of yesterday's hearing, Subcommittee Chair Ann Marie Buerkle noted the hearing was entitled "Optimizing Care for Veterans With Prosthetics."  The Subcommittee heard from four panels.  The first one was featured Gulf War Veteran John Register and Vietnam Veteran Jim Mayer.  Disabled American Veterans' Joy Ilem, American Orthotic & Prosthetic Association's Michael Oros, Paralyzed Veterans of America's Alethea Predeoux and Southeast Wounded Warrior Project's Jonathan Pruden made up the second panel (we covered the second panel in yesterday's hearing).  The third panel was the VA's Office of Inspector General's Linda Halliday accompanied by Nicholas Dahl, Kent Wrathall and Dr. John D. Daigh Jr. and Dr. Robert Yang.  The fourth panel was the VHA's Dr. Lucille Beck accompanied by Dr. Joe Webster, Dr. Joe Miller and Norbert Doyle. 
We're going to stay on the issue of the proposed change.  And we're going to go to the fourth panel. The VA is just eating up time in the excerpt below.  They have no idea what they're saying -- I don't think Dr. Beck even knows what "impetus" means judging by her answer -- and you would think, "At last they're done" but then they'd launch back in.  I really think that Congress needs to address the issue of witnesses whose words wander all over but never arrive anywhere.  Yes, some people speak that way.  But with government employees, it always seem to be an  attempt to run out the clock.
Chair Ann Marie Buerkle:  I have a lot of questions.  A lot of it is based on what we heard from the three previous panels -- especially the veterans and the veterans service organizations.  I think they provide for us a reliable source of information and they identify needs for us.  My first question is: What was the impetus behind the change?  You heard the concern from the previous panels.  What was the impetus behind the change in the procurement policy?  And did you consult with the veterans service organizations and/or veterans?  Who did you talk to to make this change?
Dr. Lucille Beck: The impetus for the change, uhm, is an impetus from the department to assure compliance with federal aquistion regulations.  I have with me Mr. Norbert Doyle who is VHA's chief procurement logistics officer today.  We were anticipating some of these questions.  And he's available to provide more information about  the change and what's happening.
Chair Ann Marie Buerkle: And just if you would, before you start, so does that mean heretofore the VA was not compliant?  I mean if that's the basis for your change -- that compliance is an issue -- maybe you could make that clear to us.
Norbert Doyle:  Yes, ma'am.  Thank you, Dr. Beck.  I -- Ma'am, yes, the impetus was to bring VA contraction -- to include VHA and all the other VA contracting organizations and veteran alignment with the federal aquistion regulations.  We also, uh, it's my understanding the department recognized several years ago that they were weakened in certain areas, in contract administration and the awarding of contracts and this was also to bring it inhouse to ensure proper stewardship of the government dollars. In reference to your question "did we talk to veteran service organizations?" Uh, actually last, uh -- before -- I don't believe we did before we started the process;however, last week -- And I'm happy to meet with any organization to discuss what we're doing.  I heard the complaints from the veterans service organizations that they feel out of the loop.  I met last week with Dr. Beck, with the Secretary's Advisory Committee on Prosthetics and Special Disabilities.  We spent a great deal of time with them.  And I think that group has representatives from many veterans service organizations to east -- address their concerns that they may -- that they may have.  Again, I make that offer that I would be happy to meet with any group to discuss these.
Chair Ann Marie Buerkle: Thank you.  I think it would be in the best interest as we go forward to do what's best for our veterans and to hear from the veteran service organizations and from the veterans themselves and from those who have gone through this process who understand it intimately as did the first two panelists.  That -- It would seem like very basic to meet with them and have them identify needs and concerns.  You heard Wounded Warriors say, "We're asking you, Congress, to please freeze this change." And the other point I wanted to bring up was the pilot.  You heard Paralzyed veterans, their organization asked or mentioned a pilot.  Have you done a pilot?  If so, what were the findings?  Is that the justification for this change?
Norbert Doyle: Yes, ma'am, I actually have a number of issues to address along these lines.  First, uh, to put it in context -- and, granted, we're talking about the more expensive items that we're talking about today -- the transfer of authority from prosthetics to contracting only impacts those procurements above $3,000 which is the mandated federal aquistion -- or federal, uh, micropurchase threshold. So only 3% of orders that we estimate fall in that realm.  So 97% of prosthetic orders will stay with prosthetics.  Uh, as I said we-we are doing this to bring us more in line with federal acquistion regulations and also to address many of the issues that the IG has mentioned although those were identified, I think, previously.  Now I want to assure everybody that if a clinician  specifies a specific product for a veteran, contracting will get that product for that individual. I-I do not, as a-a-a chief -- as a chief contracting person in-in the Veterans Health Administration I do not want my contracting officers making a decision as to what goes in a veterans body or gets appended to it.  That is clearly a clinician decision. And how we, uh, going to get that, uh, product the clinician specifies for the veteran and we're going to do it under the auspices of the federal aquisition regulations.  We're going to cite the authorities of 8123 which one individual mentioned that, the broad latitude given by Congress to the veteran -- to the Veterans Administration.  We're going to do that by properly preparing justifications for approvals for sole source citing in paragraph 4 the authorities granted under 8123.  There are seven exceptions in part six of the FAR [Federal Acquistion Regulation] to full and open competition.  Exception 5 is the one that  as authorized by statute and that's the one that we will -- we will use.  We have gone through great pains to ensure success in this transfer.  And a little bit of history, even starting last summer when we started this process under the direction of the department, Dr. Beck's and my folks, uh, we formed a team.  And that team included field personnel -- both prosthetics and contracting which we thought was critical.  They developed a plan on the transfer.  It was a very detailed plan.  The plan, actually, as we got into it, got more detailed as we identified other issues.  We then worked with our union partners to make sure that they did not have issues and we could proceed successfully.  There were pilots as part of the plan which is probably the best part other than bringing field people into the planning process, the pilot was a great aspect.  We did pilot in three VISNs -- in VISN 6, 11 and 20 -- and that's the Virginia, North Carolina area, the Michigan area and the Pacific northwest.  We piloted beginning in January for about 60 days.  Those pilots concluded in March.  We did learn from those pilots and we're implementing changes to ensure that care is not impacted.  Some of the things that we learned is that our staffing models are incorrect in the number of procurements that we could do in a day.  In the contracting office, we are hiring.  We have received approval to hire additional people to ensure we can keep up.  We are streamlining the process by, I mentioned, justification approvals, by templating that process so it becomes more fill-in-the-blank with the clinicians prescription.  Those are the type process.  We're slowly now implementing in the rest of the Veterans Health Administration.  I think four more VISNs are starting that process now and the rest of the VISNs will be coming on in June and July.  The goal is to have all of this done by the end of July. There is a contingency plan that we have discussed.  Uh, we still have the legacy procurement system if something does not go right or something unexpected happens that we can fall back on.  But we don't expect-expect that to happen.
Dr. Lucille Beck:  I would like to add that this has been -- has been a very strong collaboration and partnership prosthetic and sensory aid services very concerned that we can continue to provide the services to the veterans that, uhm, they deserve and that we have always been able to do and so our prosthetics organization at our local medical centers and at the VISN level remain the eyes and ears so all orders still come through prosthetics.  Prosthetics is managing them and we're working with contracting officers to achieve the, uh, placement of the order in, uh, uhm, uh, as it's required to be, uh, meeting all of our acquisition requirements and, uhm, we-we are as Mr., uh, Doyle has said, very aware of the ability to use 8123 and have spent a significant amount of time developing justifications and approvals that allow us to use that and really reflect the needs of our -- the individualized rehab needs of our veterans.  We're very much aware that we customize these products and services, that they are selected based on an individual, uhm, veterans needs and that has been our goal as we have managed this transition.  We're coming into a critical time as we move the transition forward and extend it to other VISNs.  And, uhm, we, uh, have very, uh-uh-uh, very well developed and exact procedures in place to monitor this as we go.  And we are prepared,  I think, Mr. Doyle and I, as a team, to -- and our offices as teams to uhm, uh review this very carefully and make recommendations on the way forward based on how this process affects veterans.
Norbert Doyle:  And, uh, I'm sorry, ma'am
Chair Ann Marie Buerkle: Go ahead, Mr. Doyle.
Norbert Doyle:  I add that when I met with the Advisory Committee on Prosthetics and Special Disability uh, uh, last week, they had many of these same concerns.  I think after spending a degree of time with them, uh, they at least understood what we were doing. They're still very interested in ensuring that we do achieve success but I'll let Dr. Beck comment. I don't think we left there with a burning issue -- at least, I did not -- that we needed to address. Also as-as-as a veteran myself who made several trips to Iraq and Afghanistan both in a military and civilian capacity, you know, I am very sympathetic to the needs of the veterans population.  And I will do no -- I can assure you I will do nothing that hurts the veterans because, you know, there but for the grace of God go I actually and that's the way I look at it.
Chair Ann Marie Buerkle: Thank you.  My time is way run over. However, if my colleagues will indulge me, I just have a couple of quick follow up questions and then I'll allow you to have as much time as you need.  My first concern is that you said that with the procurements it just only pertains to those over 3,000 and you said only 3% of the orders are over 3,000.  How many requests do you have?
Norbert Doyle: Uh, that is still not an insignificant number. Uh, based on our planning estimate, our planning figures for Fiscal Year '10 in which we planned the transfer over it was, uh, 3% of the orders equals roughly 90,000 orders.
Chair Ann Marie Buerkle:  So I would suggest that because we're talking about 1500 warriors with amputations that proably are in need of prosthetics that that is probably going to be a small percentage of what you are doing; however, all of those are going to exceed that $3000 threshold.  We heard earlier about a $12,000 limb.  And if it's $25,000 that doesn't matter because the veterans need prosthetics and need state of the art prosthetics.  So that concerns me, that piece right there. But the other thing that concerns me, you mentioned you talked with your union partners.  It would seem to me more appropriate to talk to your veteran partners and to the veterans who have gone through this and be more concerned with their thoughts about this being a program that works versus talking to the union partners. And, lastly, the pilot information, the results of those pilots?  If I could respectfully request that you provide us with -- I think you said that you did three: 6, 11 and 20 VISNs. If you could provide us with the findings for those pilot programs, I would greatly appreciate it.
Tomorrow's snapshot will include US House Rep Mike Michaud's questions.  Right now, whether you're pro-union or not (I am pro-union), the VA really doesn't get it or thought everyone would overlook that.  They failed -- failed -- to speak to veterans about this change but spoke to unions?  That just doesn't look or sound right.  You're talking about, as Chair Buerkle noted at the very end of the hearing, something more than isn't a sock or a pair of pants.  Why would you leave veterans out of this discussion?  It makes no sense at all.
The pilot program that Doyle babbled on about?  That pilot program was a failure.  By his own description, it was a failure.  You can't fine tune 'we're overwhelmed.'  When that's the case, you need another pilot program to see if your adjustments worked.
There are so many problems with what was said.  And while you could pan for bits of gold with Doyle, someone needed to tell Dr. Beck that she had nothing worth saying and she really wasted everyone's time.  I do get that there's a temptation to think, "I have to speak!  The other person's gone on forever! So let me rattle something off!"  Like many temptations, that one can be resisted.  And, in fact, it should be.
From the House Veterans Affairs Committee to the Senate where Senator Patty Murray is the Committee Chair.  Her office notes:
Thursday, May 17, 2012
CONTACT: Murray 202-224-2834
                 Burr 202-228-1616
VETERANS: Murray, Burr Introduce Bill to Ensure Dignified Burials
Comes after veteran's remains were discovered to have been buried in cardboard box

(Washington, D.C.) – Today, U.S. Senator Patty Murray (D-WA), Chairman of the Senate Committee on Veterans' Affairs, and U.S. Senator Richard Burr (R-NC), Ranking Member, introduced legislation to help ensure every veteran receives a dignified burial. The Dignified Burial of Veterans Act of 2012 would authorize the U.S. Department of Veterans Affairs (VA) to furnish a casket or urn to a deceased veteran when VA is unable to identify the veteran's next-of-kin and determines that sufficient resources are not otherwise available to furnish a casket or urn for burial in a national cemetery. This bill would further require that VA report back to Congress on the industry standard for urns and caskets and whether burials at VA's national cemeteries are meeting that standard. Under current law, VA is not authorized to purchase a casket or urn for veterans who do not have a next-of-kin to provide one, or the resources to be buried in an appropriate manner.
Chairman Murray and Ranking Member Burr, joined by U.S. Senators Bill Nelson (D-FL) and Marco Rubio (R-FL), introduced this legislation after a veteran, with no known next-of-kin, was buried in a cardboard container at a VA National Cemetery in Florida. The exposed remains were discovered during a raise and realign project at the cemetery. The veteran's remains were later placed in a bag and reburied with what was left of the cardboard box.
"When America's heroes make a commitment to serve their country, we make a promise to care for them," said Chairman Murray. "That includes helping to provide them with a burial honoring their service. I was deeply disturbed when I heard this news. There is no reason why the remains of a veteran should ever be treated with this lack of dignity. I am pleased we are taking the appropriate steps to right this indescribable wrong."
"Those who have served our country in uniform deserve our honor, appreciation, and respect, and that responsibility does not end when they pass away," said Senator Burr. "My heart goes out to those affected by the problems at the Florida National Cemetery in Bushnell. We must ensure that the remains of veterans and servicemembers are treated with dignity and respect and that the families of those who have passed away have no doubts as to the quality of the final resting place of their loved ones."
"All veterans deserve a dignified final resting place," said Senator Nelson. "A cardboard box certainly isn't one. That's why we've got to make sure this doesn't happen again."
"Those who serve our nation in uniform deserve our respect and support, from the moment they commit to serve through their deaths and even beyond as we honor their legacies," said Senator Rubio. "Providing dignified burials for veterans is a solemn pledge we must uphold. Cases like this are outrageous and need to be corrected so that no deceased veteran is ever dishonored in this way again."
Meghan Roh
Deputy Press Secretary | Social Media Director
Office of U.S. Senator Patty Murray

Recommended: "Iraq snapshot"
"Moqtada waits on an answer"
"Cougar Town "Square One""
"5 men, 1 woman"
"revenge: lydia is not to be trusted"
"The offense rests"
"Barack is Gay For Play"
"I'm done with Information Clearing House"
"Barack, Kucinich and Nikita"
"The sad downward spiral?"

Thursday, May 17, 2012

The sad downward spiral?





"Our nation's commitment to restoring the capabilities of disabled veterans struggling with devasting combat wounds resulting in the loss of limb began with the Civil War," declared US House Rep Ann Marie Buerkle this morning shortly after she brought the House Veterans Affairs Subcommittee on Health to order.  "Restoring these veterans to wholeness was a core impetus behind the creation of the Department of Veteran Affairs and then, now, it continues to play a vital role in the Department's mission."
Buerkle is the Chair of the Subcommittee and this morning's hearing was entitled "Optimizing Care for Veterans With Prosthetics."  Chair Burerkle also noted, "Following WWII, 1945, veterans disatisfied with the quality of VA prosthetic care stormed the Capitol in protest. "  How is the care today?  To answer that question, the Subcommittee heard from four panels.  Gulf War Veteran John Register and Vietnam Veteran Jim Mayer.  Disabled American Veterans' Joy Ilem, American Orthotic & Prosthetic Association's Michael Oros, Paralyzed Veterans of America's Alethea Predeoux and Southeast Wounded Warrior Project's Jonathan Pruden.  The third panel was the VA's Office of Inspector General's Linda Halliday accompanied by Nicholas Dahl, Kent Wrathall and Dr. John D. Daigh Jr. and Dr. Robert Yang.  The fourth panel was the VHA's Dr. Lucille Beck accompanied by Dr. Joe Webster, Dr. Joe Miller and Norbert Doyle.  Some of the issues were outlined in the Ranking Member's opening remarks.
Ranking Member Mike Michaud: I've said it on this Committee before, but what seems to be the case, there is little accountability in management and, once again, procurement procedures and policies were not in place or not followed in managing nearly $2 billion worth of prosthetics and sensor aids.  The VA, in the last year's budget submission, claims $355 million in savings in the Fiscal Year 2012 and 2013 due to aquistions improvements.  But if the VA can't follow its own policies and procedures, how much faith can we have in the claim of acquisition savings?  I hope the VA can help us understand today what accountability we should expect and to make certain that the VA does not continue to overpay for prosthetics in the future, that taxpayers and veterans receive the best value for their devices, and for management to ensure that the prosthetics and sensor aids services is fully meeting veterans needs. Finally, it has come to my attention that VA has proposed changes in the procurement of prosthetics and that there is a high degree of concern among some of our witnesses today as to the effectiveness of these changes. I look forward to hearing from the VA on these changes as well.
A proposed change that's bothering some veterans?  What proposal is Ranking Member Michaud speaking of?  On the second panel, Jonathan Pruden explained the proposal (and here we're using his opening written remarks which differ some what from what he delivered):
Under current practice, VA physicians and prosthetists are able to see a veteran, make a determination regarding the most appropriate type of prosthetic equipment for a veteran, and relay that information to a Prosthetics Service purchasing officer to complete a purchase-order to obtain the needed item.   Those purchasing officers exclusively handle prosthetics' purchases, and are specialists in ordering medical equipment specified by health care providers.  A major change that the Veterans Health Administration intends to institute on July 30th, would require that any prosthetic item whose cost exceeds $3000 -- to include such essential items as limbs, wheelchairs and limb-repair components – must be procured by a contracting officer.  This is not simply a matter of substituting a generalist for a specialist.  Under the proposed change, these contracting officers would use a labor-intensive system (the Electronic Contract Management System (eCMS)) designed to achieve cost savings.  That system, designed for high-dollar bulk-procurement purchases that benefit from using the Government's purchasing power, requires over 300 individual steps to manually process a purchasing order.  While well-suited for buying widgets, the system was neither designed for nor well-suited to procuring highly specific, individualized medical equipment. Ill-suited to prosthetics, this new process would also require increased coordination between clinicians and off-site contracting officers who would be responsible for purchasing everything from light bulbs to now highly specific prosthetic legs.
This is not a small change.  Moreover, it not only increases the margin for error but also the potential for prolonged, delaying "back-and-forth," with the likelihood of clinicians having to justify why a more expensive wheelchair is clinically necessary when a seemingly-similar less- costly model exists.  We see no prospect that this planned change in prosthetics procurement holds any promise for improving service to the warrior.  Instead, it almost certainly threatens greater delay in VA's ability to provide severely wounded warriors needed prosthetic devices.
This would be "the wrong path" Iraq War veteran Jonathan Pruden stated.  He was injured in a July 1, 2003 Baghdad bombing resulting in multiple surgeries including the amputation of his right leg.  This next excerpt is from his oral testimony.
Jonathan Pruden:  Under the change, only a contracting officer could procure a prosthetic item costing more than $3,000.  This policy would effect essential items including most limbs like mine and wheel chairs.  It would require the use of a system designed for bulk procurement purchases that involves manually processing over three hundred -- that's 300 -- individual steps to develop a purchase order.  This system may be great for buying cinder blocks and light bulbs but it is certainly not appropriate for providing timely and appropriate medical care.  Equally troubling, this change offers no promise of improving service to the warrior.  Instead, it would mean greater delays. The change could realize modest savings but at what cost?  A warrior needing a new leg or wheel chair should not have to wait longer than is absolutely necessary.  I know warriors who have stayed home from our events, stay home from school, from work, can't play ball with their kids or live in chronic pain while they wait for a new prosthesis.   I know first hand what it's like to not be able to put my son into the crib while I'm waiting for a new prosthetic, to live in chronic pain and to have my daughter ask my wife once again, "Why can't Daddy come and walk with us?"   With VA moving ahead on changing procurement practices, wounded warriors need this Committee's help.  A prosthetic limb is not a mass produced widget. Prosthetics are specialized, medical equipment that should be prescribed by a clinician and promptly delivered to the veteran.  We urge this Committee to direct VA to stop implementation of this change in prosthetic procurement.
We'll note this exchange from the second panel.
Chair Ann Marie Buerkle: Mr. Pruden, in you testimony, you talked about how VA prosthetic research has lagged in recent years.  Now Mr. Oros talked about outcomes but I think you're talking more generally in terms of the research.  What impact -- and I shouldn't speak for you.  I should let you say what research you were referring to.  And then, if you could, after you tell us that piece, what impact has that had on veterans and the service that they need?
Jonathan Pruden:  VA has-has stepped up in a number of capacties in the past few years.  But, as Mr. Mayer pointed out earlier, DoD has taken the lead on the development of the DEKA Arm [a project DoD and the VA work on together] and all of these advanced techonology things.  In years past, VA has been -- One of its key roles and one of the reasons it exists is to provide specialized medical equipment for our combat wounded, for our veterans.  And VA really needs to have the capacity and the focus on research for durable medical equipment when DoD and Global War on Terror Dollars go away.  And this also ties into the discusssions about the centers of excellence at Walter Reed, Brooke Army Medical Center and so forth.  When these dollars go away, those DoD facilities will certainly scale back their capacity both for rehabilitation and for research.  And what we're calling for is for VA through the amputee system of care and enhancements and research to be prepared to meet the needs as DoD scales back.
Chair Ann Marie Buerkle: Thank you.  Miss Predeoux, I'm extremely concerned with regards to your comments about the filing system being outdated and the backlog that it creates.  Could you comment on that for us?
Alethea Predeoux:  Yes, in my written statement with the filing system, it refers to medical records in one VA medical center.  And if, for instance, one veteran was to relocate -- For example, our director of benefits relocated to this area from San Diego and it took quite a bit of time for the medical records to be delivered from San Diego to DC simply because there's not one central system in which all the medical centers are able to locate and actually view  the medical records of a veteran.  And as the panel before us testified, it's not just a wait time, it's a matter of being able to be comfortable and actually to be mobil.
Noting that Wounded Warrior was favoring a freeze on VA's proposed change, Ranking Member Michaud asked Oros, "Do you think we should ask the VA to freeze the reorganization? Bringing everthing in house?"   Oros responded, "Absolutely. Absolutely." US House Rep Gus Bilirakis wanted to know about the real life effects if VA went through with their change in procurement?
Jonathan Pruden:  Under the current system, there are safeguards in place to ensure that VA is being fiscally responsible. And it can take a month, two months.  Some of this is predicated on the clinical needs of the patient and the availablility of the product in their area  which is appropriate.  Our real concern is that -- is that with the new system, it would be supposition but it may take months and months longer to get purchase orders for needed equipment. And the veterans should not have to wait and the clinician's hands should not be tied.  If they feel that a device is appropriate and going to provide the best care for a warrior, they should be able to prescribe that device.  I have had the opportunity to speak with over a dozen VA clinicians and prosthetists who are currently serving in several former chiefs of prosthetics.  And every single one of them said that they share our concerns about the ability to remain timely and potential delays in veterans receiving needed prosthetic devices under this new system.  Dr. Bechel and she'll say that, 'One of the things that we're going to consider is if a device is generally available and interchangeable.  Then it will fall under the federal acquisition regulations.'  Who is determining what is generally available and interchangeable? It's going to be somebody in acquisitions , not a physician, not a clinician who has the patient's best interest at heart.  And that -- that's our real concern.
That's one of the main points from the hearing.  Time permitting, we may cover some other issues or go deeper into this one in another snapshot.
From the House to the Senate, Senator Patty Murray is the Chair of the Senate Veterans Affairs Committee and the Committee issued the following today:
Wednesday, May 16, 2012
Contact: Murray Press Office
(202) 224-2834
Senator Murray's Statement on Sweeping Army-Wide Review of Behavioral Health Evaluations and Diagnoses
Investigations Will Review Mental Health Diagnoses Since 2001
(Washington, D.C.) -- Today, U.S. Senator Patty Murray, Chairman of the Senate Veterans Affairs Committee, released the following statement after the Army announced that they will begin a comprehensive, Army-wide review of soldier behavioral health diagnoses and evaluations since 2001.  This major announcement comes after Senator Murray spurred an investigation into inconsistencies in diagnoses at Joint Base Lewis-McChord in her home state of Washington.  The Army has since returned PTSD diagnoses to over 100 servicemembers that sought treatment there.  Murray has repeatedly pushed Army leadership to investigate whether problems similar to those at Madigan were being seen at Army bases across the country.
For more information on the Army's announcement visit:
"The Army clearly realizes they have a nationwide, systematic problem on their hands. I credit them with taking action, but it will be essential that this vast and truly historic review is done the right way.  That means continued engagement from Army leadership at the highest levels, prompt attention to the problems of servicemembers identified during the review, and not only the identification of problems but quick action to implement and enforce solutions.
"This comprehensive review is born out of a review I helped initiate in my home state that has already returned PTSD diagnoses to over 100 servicemembers since the beginning of this year.  That review has been successful because the Army identified and reached out to affected servicemembers and veterans, conducted reevaluations using the appropriate tools and best practices, and was made a priority by top military leaders.  This nationwide review must be given the same attention from leadership in order to succeed.
"But the bottom line is that the Army needs to fix the inconsistencies we have seen in diagnosing the invisible wounds of war.  Out of this review, the Army needs to provide a uniform mental health policy so that service members are given the care they need.
"This is an issue that affects every aspect of the lives of those returning from Iraq and Afghanistan. Without proper mental health treatment we will continue [to] see see servicemembers struggle to readust to family life, contine to self-medicate, and in far too many cases, take their own lives.
"Servicemembers, veterans, and their families should never have to wade through an unending bureaucratic process to get proper access to care. The Army has an extrordinary opportunity to go back, correct the mistakes of the past, and ensure that they are not repeated."
Matt McAlvanah
Communications Director
U.S. Senator Patty Murray
202-224-2834 - press office
202--224-0228 - direct

Wednesday, May 16, 2012

If only he were cute when he flirts








Today is a really sad day as the BBC spits on human rights and treats 'confessions' most likely stemming from torture as being real.  Americans (wrongly) built a shrine to the BBC in 2003.  And, yes, by comparison to American outlets, the BBC coverage of the lead up to the war was better.  But compared to the basic standards of journalism, the BBC didn't even cut it.  It was as much a failure as the American outlets.  (And the providing of a confidential source's name to Blair's cabinet goes far beyond any known crimes of US outlets.)  No surprise that it would again be Iraq that saw the BBC reveal its true nature.
KUNA reports, "The first session for the trial of former Vice President Tareq Al-Hashemi began here Tuesday with the charges being guiding and financing terrorist attacks."  Tareq al-Hashemi (pictured above) has been a vice president since 2006.  He is currently serving his second term.  Currently serving.  He has not been removed from office so this trial is legally not supposed to take place.  But the law's never mattered in Nouri's Iraq.  Nouri waited until the bulk of US forces had left to Iraq to suddenly declare his political rival al-Hashemi a "terrorist."  The vice president remains in Turkey.
Iraq practices forced confessions and, despite the Iraqi Constitution insisting upon innocence until proven guilty, the Baghdad court declared al-Hashemi guilty back in Februray.  Tareq al-Hashemi has repeatedly requested that the trial be moved elsewhere -- a request that should have been honored the moment the Baghdad judges declared him guilty in February at their press conference and while one judge was stating that he had been threatened by al-Hashemi! (He actually claims to have been threatened by 'supporters' of al-Hashemi -- he can't even make the claim if press for proof that it was by a bodyguard of al-Hasehmi.) Today, after being pushed back twice, the kangaroo court finally hopped into session.

Chen Zhi (Xinhua) reports that, as the trial started this morning, the court sent out spokesperson Abdul-Sattar al-Birqdar to insist, "There are many crimes that Hashimi and his bodyguards are accused of and we have confessions from them, including the assassination of six judges."  A court that's dropped even the pretense of being impartial is exactly the sort that would send out a spokesperson to declare they had confessions.
AFP had a confusing report which was confusing for many reasons including: "Three other witnesses gave testimony, accusing Hashemi of masterminding the assassinations, before reporters were led out of the room."  If reporters are led out of the courtroom while a trial is going on, hate to break it to AFP, but that's your lede, not the fifth sentence and fifth paragraph of your report.  And that's all the more true when there were calls for international observers in advance of the trial and that call does not appear to have been heeded.  Equally true, if reporters are led out of the courtroom, you explain why they were.  And if no reason given to the reporters, you include that: "Reporters were ushered out of the courtroom.  No reason was given for the removal."
AFP declares there were three witnesses who testified after "families of three victims whose deaths Hasemi is accused of orchestrating."  They tell you nothing about those three witnesses.  As noted this morning, "But I do expect to know if these people could even offer any testimony against al-Hashemi. By that I mean, victims families can testify to losses. That's all they can do unless they're eye witnesses.  Even if they are eye witnesses, they have no testimony on al-Hashemi."  This was confirmed by this afternoon by Sinan Salaheddin (AP) when Salaheddin reported of the family witnesses, "They said they did not witness the attacks, and only complained against al-Hashemi after hearing the accusations against him in Iraqi media." Salaheddin also states there was one other witness, someone who was an ex-employee of al-Hashemi's (worked in the vice president's "media office") and that reporters "were ordered to leave the court during" that testimony. Suadad al-Salhy, Ahmed Rasheed, Barry Malone and Alistair Lyon (Reuters) note two bodyguards and "five relatives of people allegedly killed by the death squads" and that the court is now adjourned until May 20th. 
BBC files a report that indicates they had no one in the courtroom and that they didn't bother to do anything other than scan the wire reports quickly and then (also quickly) dash off a 'report.'  It's very shoddy.  But let's skip their bad journalism to note their shame: "Mr Hashemi's supporters have also claimed that some of his bodyguards made allegations about death squads under torture. The Iraqi judiciary dismissed the accusations of torture." How very sad that the BBC chooses to self-embarrass and self-shame on a day when the world learns (yet again) that Nouri al-Maliki is still running secret prisons and torture chambers.  Equally true,  Human Rights Watch and Amnesty are not "supporters" of Tareq al-Hashemi.  They are human rights organizations. 
March 23rd, Human Rights Watch called for an investigation into the death of Amir Sarbut Zaidan al-Batawi, a bodyguard of al-Hashemi's who died in custody, whose family states he was tortured to death and whom photos show "a burn mark and wounds."  The Iraqi government tried to say his kidneys failed.  As though he had some pre-existing condition (which the family denies). If he did, that would still be on the Iraqi government.  If someone has a medical condition when you take them into custody, you're having custody of them means in you're responsible for their well being.  Had the alleged kidney failure resulted from natural causes, the Iraqi government would still need to explain how they failed to provide treatment for a known condition?  But most likely the kidneys were damaged in torture which isn't at all uncommon, especially in Latin America.  Especially in Latin America?  The US government taught the thugs of Iraq to behave like the death squads of El Salvador in the 80s.
The Prospect has learned that part of a secret $3 billion in new funds tucked away in the $87 billion Iraq appropriation that Congress approved in early November will go toward the creation of a paramilitary unit manned by militiamen associated with former Iraqi exile groups. Experts say it could lead to a wave of extrajudicial killings, not only of armed rebels but of nationalists, other opponents of the U.S. occupation and thousands of civilian Baaathists up to 120,000 of the estimated 2.5 million former Baath Party members in Iraq.
"They're clearly cooking up joint teams to do Phoenix-like things, like they did in Vietnam," says Vincent Cannistraro, former CIA chief of counterterrorism.  Ironically, he says, the U.S. forces in Iraq are working with key members of Saddam Hussein's now-defunct intelligence agency to set the program in motion.
[. . .]
But the bulk of the covert money will support U.S. efforts to create a lethal, and revenge-minded, Iraqi security force.  "The big money would be for standing up an Iraqi secret police to liquidate the resistance," says [John] Pike. "And it has to be politically loyal to the United States." 
In addition to Human Rights Watch, Amnesty International issued the following January 30th:
Rasha Narneer Jaafer al-Hussain and Bassima Saleem Kiryakos were arrested by security forces at their homes on 1 January.  Both women work in the media team of Iraqi Vice-President Tareq al-Hashemi, who is wanted by the Iraqi authorities on terrorism-related charges. 
Al-Hasehmi has denied the charges, saying the accusations are politically motivated. 
"The arrest of the two women appears to be part of a wider move targeting individuals connected to Tareq al-Hashemi," said Hassiba Hadj Sahraoui, Amnest International's Deputy Director for Middle East and North Africa.
"The Iraqi authorities must immediately disclose the whereabouts of Rash al-Hussain and Bassima Kiryakos.  At the very minimum they should have immediate access to their family and a lawyer.
"The circumstances of their arrest and their incommunicado detention when we know that torture is rife in Iraq can only raise the greatest fears for their safety," she said.
One of the two women working for the Iraqi Vice-President's Office who were arrested on 1 January has been released. The other woman's whereabouts are still unknown. 
Rasha Nameer Jaafer al-Hussain, who was working at the Iraqi Vice President's Office, was arrested without a warrant at her parents' house in Baghdad's al-Zayuna district on 1 January 2012. The security forces claimed they were taking her away for questioning and that she would return two hours later.  Since her arrest her family has not known her whereabouts.  However, the Iraqi media reported on 30 January that a Human Rights Parliamentary Committee had visited several of the Iraqi Vice-Preisdent's employees, including both arrested women, who claimed they had been tortured in detention.  It is believed she was arrested in connection with a warrant for the arrest of the Iraqi Vice-President Tareq al-Hashemi, who has been wanted by the authorities since December 2011.  He is accused of terrorism-related offenses, an accusation which he has publicly said is politically motivated.
But let's all make like the BBC and pretend as if torture never happens in Iraq and that the only ones claiming it does are "supporters" of Tareq al-Hashemi.

Let's stay with the topic of torture and then we'll do an Iraq fact check.  Human Rights Watch issued the following today:
(Beirut) -- Iraq's government has been carrying out mass arrests and unlawfully detaining people in the notorious Camp Honor prison facility in Baghdad's Green Zone, based on numerous interviews with victims, witnesses, family members, and government officials. The government had claimed a year ago that it had closed the prison, where Human Rights Watch had documented rampant torture.
Since October 2011 Iraqi authorities have conducted several waves of detentions, one of which arresting officers and officials termed "precautionary." Numerous witnesses told Human Rights Watch that security forces have typically surrounded neighborhoods in Baghdad and other provinces and gone door-to-door with long lists of names of people they wanted to detain. The government has held hundreds of detainees for months, refusing to disclose the number of those detained, their identities, any charges against them, and where they are being held.
"Iraqi security forces are grabbing people outside of the law, without trial or known charges, and hiding them away in incommunicado sites," said Joe Stork, deputy Middle East director at Human Rights Watch. "The Iraqi government should immediately reveal the names and locations of all detainees, promptly free those not charged with crimes, and bring those facing charges before an independent judicial authority."
The government should appoint an independent judicial commission to investigate continuing allegations of torture and other ill-treatment, disappearances, and arbitrary detention in Camp Honor and elsewhere, Human Rights Watch said.
Multiple witnesses told Human Rights Watch that some detainees arrested since December 2011 have been held in the Camp Honor prison in Baghdad's International Zone, known as the Green Zone. In March 2011 the government announced it had closed Camp Honor prison, after legislators visited the site in response to evidence Human Rights Watch provided of repeated torture at the facility.
The two most sweeping arrest dragnets occurred in October and November 2011, detaining people alleged to be Baath Party and Saddam Hussein loyalists, and in March 2012, ahead of the Arab summit in Baghdad at the end of that month.
In April two Justice Ministry officials separately told Human Rights Watch that since the roundups began in October, security forces often have not transferred prisoners into the full custody of the justice system, as required by Iraq law. Instead, the officials said, security forces have transported dozens of prisoners at a time in and out of various prison facilities, sometimes without adequate paperwork or explanation, under the authority of the military office of Prime Minister Nuri al-Maliki.
Fourteen lawyers, detainees, and government officials interviewed by Human Rights Watch said that recent detainees have been held at Camp Honor prison. Some of the officials said that detainees have also been held at two secret detention facilities, also inside Baghdad's Green Zone. These allegations are consistent with concerns raised in a confidential letter from the International Committee of the Red Cross (ICRC) obtained by Human Rights Watch in July 2011 after the letter's existence was made public by the Los Angeles Times.
Officials, lawyers, and former detainees also told Human Rights Watch that judicial investigators from the Supreme Judicial Council continue to conduct interrogations at the Camp Honor prison. Between December and May, Human Rights Watch interviewed over 35 former detainees, family members, lawyers, legislators, and Iraqi government and security officials from the Defense, Interior, and Justice Ministries. Without exception, they expressed great concern for their own safety and requested that Human Rights Watch withhold all names, dates, and places of interviews to protect their identities.
"It's a matter of grave concern that Iraqis in so many walks of life, officials included, are afraid for their own well-being and fear great harm if they discuss allegations of serious human rights abuses," Stork said.
"Precautionary" Detentions ahead of March 2012 Arab Summit
The most recent mass arrests occurred in March as the government dramatically tightened security throughout Baghdad in preparation for the Arab League summit there on March 29. Family members and witnesses told Human Rights Watch that arresting officers characterized the roundups as a "precautionary" measure to prevent terrorist attacks during the summit. Six detainees released in April told Human Rights Watch that while they were in detention, interrogators told them that they were being held to curb criminal activity during the summit and any "embarrassing" public protests.
Legislators from Prime Minister al-Maliki's State of Law party have denied in the news media that any preemptive arrests took place, claiming that all arrests were of suspected criminals and in response to judicial warrants. All detainees and witnesses interviewed, over 20 in all, said they had not been shown arrest warrants.
In Baghdad neighborhoods where multiple arrests were made, including Adhamiya, Furat, Jihad, Abu Ghraib, and Rathwaniya, residents told Human Rights Watch it appeared that a large proportion of those detained had previously spent time in prisons run by the US military, including Abu Ghraib, Camp Bucca, and Camp Cropper. Some family members and legislators concluded that people were being arrested not because of suspected current criminal activity, but simply because they had been detained before.
In May an Interior Ministry official told Human Rights Watch that "security forces, in the interest of keeping security incidents to a minimum during the summit, while the world was watching, sometimes decided it was easier to just round up people who had been imprisoned years before, regardless of what crime they may have committed." In April a Justice Ministry official told Human Rights Watch that of the hundreds arrested, "some have been released, about 100 will be officially charged within the justice system, and the rest are somewhere else. We do not know where."
During an April 9 parliament session, Hassan al-Sinead, head of the parliament's Security and Defense Committee and a member of Prime Minister al-Maliki's State of Law Party, held up what he said were official security reports of Baghdad Operation Command and said, in response to allegations of pre-emptive arrests by other legislators, that there were only 532 arrests in all of Baghdad during the month of March, and that none were pre-emptive.
Two other members of the parliamentary committee subsequently told Human Rights Watch that this figure greatly underreported arrests that month. At the April 9 session an investigative committee was formed, made up of members of the Security and Defense and Human Rights committees. Members of the investigative committee told Human Rights Watch that plans to visit detainees never happened. To date, no investigation results have been released.
"Baathist" Arrests
In October and November 2011, security forces arrested hundreds of people in Baghdad and outlying provinces, almost all during nighttime raids on residential neighborhoods. State television reported that Prime Minister al-Maliki ordered these arrests. Government statements, including by the prime minister, claimed that those arrested were Saddam Hussein loyalists plotting against the government. Family members told Human Rights Watch that security forces came to their doors with lists and read off names. Some of those listed were former Baath party members and others were not, including people who had died years ago. Three officials separately told Human Rights Watch that the total number arrested in the campaign approached 1,500.
A man whose 57-year-old father was arrested along with 11 neighbors on October 30 told Human Rights Watch in December, "A week after my father was arrested, some of the same police officers who arrested him came back and found family members to give them belongings [of neighborhood men who had been arrested], like clothes or money or IDs, but they still said they had no information about where they were being held, or what they were being charged with."
The man's son showed Human Rights Watch a document the police had given to him that listed the date his father was arrested but left blank the space reserved for the name of the detention facility.
Upon learning that some prisoners were being held in Baghdad's Rusafa prisons, run by the Justice Ministry, Human Rights Watch asked Justice Minister Hassan al-Shimmari on January 4 for access to the prisoners. The request was refused.
Though not all arrests have been on the same scale as those in October, November, and March, regular arrest campaigns have taken place, often in largely Sunni neighborhoods in Baghdad as well as in several outlying provinces, said witnesses, family members and media reports. Strict government secrecy regarding the number of arrests and exact charges makes it difficult to assess the scope.
While some prisoners were released within hours or days and say they were not mistreated, others told Human Rights Watch they were tortured, including with repeated electric shocks. Most said interrogators forced them to sign pledges not to criticize the government publicly or to sign confessions. They said interrogators threatened that unless they signed these documents they would suffer physical violence, female family members would be raped, or they would never be released. Some families told Human Rights Watch that they were told to pay thousands of dollars in bribes to secure their loved ones' release. In two cases known to Human Rights Watch, detainees were released after the families made such payments.
Camp Honor Prison
Camp Honor is a military base of more than 15 buildings within Baghdad's fortified International Zone, which Iraqis and others continue to refer to as the Green Zone. The Iraqi Army's 56th Brigade, also known as the Baghdad Brigade, which falls under direct command of the Office of the Commander in Chief of the Armed Forces, controls the Camp Honor complex and is responsible for the security of the Green Zone.
On March 29, 2011, Justice Minister al-Shimmari told Human Rights Watch that the government had closed the camp's main detention facility, Camp Honor prison (often simply referred to as "Camp Honor"). Al-Shimmari said that authorities had moved all its detainees, whom he alleged were terrorists and Islamist militants, to three other facilities under the control of his ministry.

Contrary to this assurance, Human Rights Watch has received information from government and security officials indicating that some detainees from the "Baathist" and "Summit" roundups were held in Camp Honor prison and that it is still being used at least as a temporary holding site, or as a place to extract confessions before moving detainees into the official correctional system. This use of military prisons outside the control of the Justice Ministry is consistent with known procedures at other publicly acknowledged facilities outside of the ministry's control, such as Muthanna Airport Prison and a facility in western Baghdad run by the army's Muthanna Brigade, both of which have also housed hundreds of detainees from the recent arrests, according to government officials and former detainees.
A security official from the Defense Ministry told Human Rights Watch in April that judicial investigators attached to the Supreme Judicial Council go to the Camp Honor prison on a regular basis, where they participate in investigations and interrogations, alongside military investigators from the 56th Brigade. A lawyer who works for the government but did not want his department identified corroborated this allegation in an April interview with Human Rights Watch.
Three former detainees who spoke with Human Rights Watch between December and April gave credible accounts of what they said were their interactions with judicial investigators in Camp Honor prison. These allegations are consistent with judicial procedures known to have taken place there in the past. One detainee told Human Rights Watch in April that he had been held for over a month in Camp Honor prison, from late October to early December.
In a March interview, another man told Human Rights Watch he had been detained in Baghdad in early November and taken to a prison inside the Green Zone, which guards and other detainees told him was Camp Honor prison. His description and a sketch he made of the layout of the cells and interrogation trailers were consistent with the known layout of the facility.
Another detainee said in early December that he could confirm that he was in Camp Honor prison in May 2011 by the proximity of clearly recognizable surrounding buildings. When he was taken from the main holding facility to adjacent trailers for violent interrogations on three separate occasions, he said, he was not blindfolded. "The Defense Ministry and the old Council of Ministers [Hall] are right there," he said. "I'm a former military man, and I used to work very close to there, so I knew right where I was."
In July Human Rights Watch obtained a copy of a May 22,2011 letter written by the International Committee of the Red Cross (ICRC), which said the ICRC had "collected reliable allegations" of two separate secret detention facilities attached to Camp Honor military base, plus another facility next to the headquarters of the Counter-Terrorism Service, also in the Green Zone, "that are used to this day to hold and conceal detainees when committees visit the primary prison."
In the letter, the ICRC also documented the methods of torture used inside Camp Honor prison and affiliated facilities, consistent with torture methods Human Rights Watch had previously reported.The ICRC addressed the letter to Prime Minister al-Maliki and copied Farouq al-Araji, head of al-Maliki's military office, General Mahmoud al-Khazraji, commander of the 56th Brigade, other defense officials, Justice Minister al-Shimmari, and Judge Midhat al-Mahmoud, head of the Supreme Judicial Council.
After the Los Angeles Times made public the letter's existence on July 14, the ICRC released a statement declining to confirm or deny its authenticity, as per long-standing policy to confine its communications to officials of the government concerned. In July and August, two Iraqi government officials and one former official familiar with the letter assured Human Rights Watch of the letter's legitimacy.
Two defense lawyers separately told Human Rights Watch in May 2012 that clients of theirs had been held in Camp Honor prison as recently as August 2011. Another lawyer told Human Rights Watch that while working at the Supreme Judicial Council over the past year he encountered frequent references in comments by judges and others, as well as in court paperwork, to prisoners being held in Camp Honor prison and in "two other prisons in the Green Zone also run by the 56th Brigade." Four officials from the Defense and Justice ministries, plus two former officials, also told Human Rights Watch of the existence of these secret prisons, one also part of the Camp Honor complex, unofficially called "Five Stars," and another outside the base, but still within the Green Zone.
Treatment of Detainees
Statements to Human Rights Watch by those captured in the roundups and detained in various prisons, including those run by the Justice Ministry, varied in describing the treatment they received. Some said they were not physically mistreated. Three people detained in the "Summit" dragnet told Human Rights Watch that security officers assured them that they just had to wait until the Arab Summit was over and they would be released -- that holding them "was just a precautionary measure." Others described multiple beatings and threats and some described abuse that amounts to torture.
In May, a 59-year-old man told Human Rights Watch that he was arrested in late October in a southern province of Iraq and transported with more than 60 other prisoners to a detention facility in Baghdad, which he identified but asked Human Rights Watch to keep confidential. "When I first arrived, I was blindfolded and had my hands tied behind my back, and I had to walk down a long line of men, each of whom punched me in the face and hit my head with wire cables as I passed them," he said. "After that, I was in solitary confinement for some time, and then they brought me before the judicial investigators. I couldn't believe that they beat so hard and gave me electric shocks for three continuous hours, without even asking me any questions."
He also said that during other interrogations his captors stripped him naked, hit him with wire cables, boxed his ears, poured cold water over him, and shocked him with electrodes attached to his back.
He was released in March, five months later, after his family paid over US $10,000 in bribes and an influential politician intervened on his behalf. Before leaving custody, he was forced to sign what he said was a confession, though he is not sure of its contents, as well as a pledge to never speak "against the government" and never to talk to the media about his arrest. "They told me that if I break any of these rules, they will bring in my sons and destroy them, and rape my wife," he said. "As I left, they told me, 'We will arrest you again, and make sure you're executed.'"
Family members of detainees who spoke with Human Rights Watch said they had no idea where their loved ones were being held, despite multiple inquiries to the Ministry of Human Rights and the headquarters of the security forces that arrested them. In cases in which the government disclosed where prisoners were being held, security forces hindered or completely blocked detainees' access to legal and family visits.
"On paper, a defendant can be defended by a lawyer, but in real life, it is next to impossible," said a defense lawyer who is attempting to represent two men arrested in the "Summit" sweep in March. He told Human Rights Watch that when he is actually informed of the location of a detainee and allowed in, he is kept waiting for hours, and then told to go home because it is the end of the day. "Any lawyer attempting to see his client will be subjected to threats by the security forces holding the detainees," the lawyer told Human Rights Watch. "Several times in the past few months, they said, 'So, you want to represent a Baathist and a terrorist? I wonder what is making you do this, why you are on his side.' This is clearly an attempt to intimidate attorneys from standing up for their victims."
Families who tried to hire lawyers to defend relatives arrested in the "Baathist" sweep gave strikingly similar accounts. In December, one man told Human Rights Watch that his family went to four separate criminal defense lawyers who were at first cooperative. But when they learned that his father was taken in the "Baathist" arrests, he said, "each immediately told us that they could not interfere in this case because the arrests were by order of the prime minister's office." He cited one lawyer as saying: "This case is already decided. It's a lost case, and I can't be part of it, because they were arrested by the order of the prime minister.'"
"It is amazing that all four had the same reaction and this made us lose hope," the family member said. "We did not try to get another lawyer, and have no idea where my father is."