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Archive for October, 2010

BRB Overturn’s X Files Case ALJ Paul C Johnson and Dr John Dorland Griffith

Posted by defensebaseactcomp on October 27, 2010

“Rather, the administrative law judge was to assess the weight to be accorded to the medical evidence of record, without substituting his judgment for that of the physicians”

Congratulations to Claimants Attorney
Ralph R. Lorberbaum
Zipperer, Lorberbaum & Beauvais
Savannah, Georgia
on a job well done.

 

TW v SEI

BRB Decision 09-0573

The Benefit Review Board has overturned the ALJ’s denial of benefits in a noteworthy decision that mirrored many of the arguments made in an earlier analysis on the DBA X-files. The decision also reflects a deeper understanding of war-related trauma absent in the Board’s earlier decisions. Better late than never, although this is of little consolation to those who had to pave the way.


1. In this regard, it is undisputed that all of the physicians of record diagnosed claimant with some sort of psychological disorder. Specifically, Drs. van Holla, Reppuhn, Oram and Marshall all diagnosed claimant with PTSD. In addition, Drs. Marshall, Oram, and Reppuhn diagnosed claimant with depression. These are clinical, Axis I, disorders that may respond to medication.

Dr. Griffith, employer’s expert, diagnosed claimant with “personality disorder, not otherwise stated,” which is an Axis II disorder, and malingering. Thus, while Dr. Griffith sctated claimant does not have PTSD or depression, his diagnosis of a personality disorder may support a finding that claimant established a harm for purposes of Section 20(a), 33 U.S.C. §920(a). See generally Wheatley v. Adler, 407 F.2d 307, 313 (D.C. Cir. 1968) (en banc) (a harm occurs when “something unexpectedly goes wrong within the human frame”).

[Goes without saying that Dr Griffith also "diagnosed" TW with malingering (Ed)]

2. The Board’s decision in S.K. [Kamal] v. ITT Industries, Inc., 43 BRBS 78 (2009), is instructive in this regard. In Kamal, the employer contended that, as no doctor had diagnosed the claimant with PTSD or other psychological condition in a manner consistent with the criteria set forth in the DSM-IV, the claimant did not suffer a psychological harm sufficient to invoke the Section 20(a) presumption. The Board rejected the employer’s contention, stating first that the Act does not require use of the DSM-IV in assessing whether a claimant has suffered a psychological harm. Id. at 79-80.

Rather, the administrative law judge was to assess the weight to be accorded to the medical evidence of record, without substituting his judgment for that of the physicians.

Special Thanks to X Files crew at American Contractors in Iraq and Afghanistan

 

See also Dr John Dorland Griffith Exposed

Posted in AIG and CNA, Civilian Contractors, Contractor Casualties and Missing, Defense Base Act Law and Procedure, Defense Medical Examinations, Department of Labor, Misjudgements, OALJ, PTSD and TBI, Racketeering | Tagged: , , , , , , , , , , , , | 8 Comments »

OT: ProPublica Furious Growth and Cost Cuts Led To BP Accidents Past and Present

Posted by defensebaseactcomp on October 26, 2010

This is OT but there are so many similarities regarding Cover Ups and Safety and Compensation issues here not too mention that ProPublica deserves another nod

A ProPublica and PBS FRONTLINE investigation. “The Spill [1],” a PBS FRONTLINE documentary drawn from this reporting, airs tonight. Check local listings. [2]

Jeanne Pascal turned on her TV April 21 to see a towering spindle of black smoke slithering into the sky from an oil platform on the oceanic expanse of the Gulf of Mexico. For hours she sat, transfixed on an overstuffed couch in her Seattle home, her feelings shifting from shock to anger.

Pascal, a career Environmental Protection Agency attorney only seven weeks into her retirement, knew as much as anyone in the federal government about BP, the company that owned the well. She understood in an instant what it would take others months to grasp: In BP’s 15-year quest to compete with the world’s biggest oil companies, its managers had become deaf to risk and systematically gambled with safety at hundreds of facilities and with thousands of employees’ lives.

“God, they just don’t learn,” she remembers thinking.

Just weeks before the explosion, President Obama had announced a historic expansion of deep-water drilling in the Gulf, where BP held the majority of the drilling leases. The administration considered the environmental record of drilling companies in the Gulf to be excellent. It didn’t ask questions about BP, and it didn’t consider that the company’s long record of safety violations and environmental accidents might be important, according to Carol Browner, the White House environmental adviser.

They could have asked Jeanne Pascal.  Please read the entire story at ProPublica

Posted in Cancer, Civilian Contractors, Department of Labor, Follow the Money, Toxic Exposures | Tagged: , , , , | Leave a Comment »

Overseas Contractor Count For Third Quarter 2010

Posted by defensebaseactcomp on October 24, 2010

From Danger Zone Jobs

In 3rd quarter FY 2010, USCENTCOM reported approximately 224,433 contractor personnel working for the DoD in the USCENTCOM AOR. There was a decrease in contractors AOR wide of ~10% this quarter (from 250K to 224K), with significant decreases in Iraq and a steady state in Afghanistan.

A breakdown of those personnel is provided here. This update reports DoD contractor personnel numbers in theater. It covers DoD contractor personnel deployed in Iraq, Afghanistan, and the U.S. Central Command (USCENTCOM) area of responsibility (AOR).

 

 

IRAQ SUMMARY

The main categories of contracts in Iraq and the percentages of contractors working on them are displayed below:

Base Support 49,256 (61.8%)
Security 11,413 (14.3%)
Translator / Interpreter 5,165 (6.4%)
Logistics / Maintenance 488 (.6%)
Construction 1,336 (1.7%)
Transportation 1,782 (2%)
Communication Support 603 (.7%)
Training 574 (.7%)
Other 9,004 (11.3%)
Total 79,621

OIF Contractor Posture Highlights:

  • There was a ~17% decrease (from 95K to 79K) in contractors in Iraq compared to the 2nd quarter FY 2010 census due to ongoing efforts to reduce the contractor footprint in Iraq.
  • USF-I remains on track to reduce the contractor footprint to 50K-75K by Sep 30, 2010.
  • The military to contractor ratio in Iraq is 1 to 1.14
  • We expect a steeper decrease in the number of overall contractors as FOBs close and military footprint is reduced throughout FY 11
  • DoD and DoS are planning for post-2011 contract support

 

AFGHANISTAN SUMMARY

The main categories of contracts in Afghanistan are similar to those shown in the Iraq summary. We are working to present a similar detailed breakout for Afghanistan. We are currently capturing data by contracting activity as follows:

Joint Contracting Command- Afghanistan 19,181 (18%)
LOGCAP 27,491 (25.5%)
U.S. Army Corps of Engineers 26,191 (24.5%)
DLA 6,791 (6%)
INSCOM 5,371 (5%)
Other* 22,454 (21%)
Total 107,479

*Includes Army Materiel Command, Air Force External and Systems Support contracts, Special Operations Command.

OEF Contractor Posture Highlights:

  • The total number of contractor personnel in Afghanistan has remained constant in the first three quarters of fiscal year 2010.
  • The military to contractor ratio in Afghanistan is 1 to 1.07.
  • The number of local nationals employed on DoD contracts in Afghanistan is 68% of the overall contractor mix, just below the commander’s goal of 70%; CENTCOM is analyzing methods to enhance LN percentage to support COIN goals.

General Data on DoD Private Security Contractor Personnel in Iraq and Afghanistan

USCENTCOM reports, as of 3rd quarter FY 2010, the following distribution of private security contractors in Iraq and Afghanistan:

Posted in Afghanistan, Civilian Contractors, Iraq | Tagged: , , , , , | Leave a Comment »

Senator Byron Dorgan Says DOD Response Still Falls Short on Sodium Dichromate Exposure

Posted by defensebaseactcomp on October 22, 2010

DORGAN: DOD IG REPORT CONFIRMS PENTAGON DROPPED THE BALL ON CHEMICAL EXPOSURE OF U.S. TROOPS IN IRAQ   See the video here

Read the IG Report here

FOR IMMEDIATE RELEASE                                                                                            FOR MORE INFORMATION:

Friday                                                                                                                                      CONTACT: Barry E. Piatt

October 22, 2010                                                                                                                PHONE:   202-224-0577

(WASHINGTON, D.C.) — U.S. Senator Byron Dorgan (D-ND) said Friday a preliminary report of an investigation by the Department of Defense Inspector General confirms that the Pentagon dropped the ball in responding to the exposure of hundreds of U.S. troops to a deadly chemical in Iraq. Those failures left some exposed soldiers unaware that they had been exposed to the deadly chemical and without follow up health monitoring and treatment. Monitoring tests performed on other soldiers who were informed of their exposure were so inadequate that the agency that performed them now admits they have a “low level of confidence” in those tests.

A second and more detailed Inspector General’s report, originally scheduled to be released this month, has now been moved back to the end of the year, a development Dorgan said he finds “disappointing.”

The Senate Armed Services Committee and Dorgan requested IG investigations after he chaired hearings by the Senate Democratic Policy Committee (DPC), in June 2008 and August 2009. The hearings revealed that troops from Indiana, Oregon, South Carolina, and West Virginia were exposed to sodium dichromate, a known and highly potent carcinogen at the Qarmat Ali water treatment facility in Iraq. The DPC hearings revealed multiple failures by the contractor, KBR, and the Army’s failure to adequately monitor, test, and notify soldiers who may have been exposed of the health risks they may now face.

The IG is releasing two reports on its investigation, The first report was released in September. The second, expected to be a more detailed response to specific DPC concerns, was originally slated for release by late October. But the Department of Defense Inspector General now states a draft of that report won’t be available until the end of the year.

The first report provides no indication — seven years after the exposure – that the Army ever notified seven soldiers from the Army’s Third Infantry Division who secured the Qarmat Ali facility during hostilities that they had been exposed. It also confirms that the Army’s assessment of the health risks associated with exposure to sodium dichromate for soldiers at Qarmat Ali are not very reliable. In fact, the organization that performed these assessments, the U.S. Army Center for Health Promotion and Preventative Medicine (CHPPM), now says it has a “low level of confidence” in its test results for the overwhelming majority of those exposed.

Equally troubling, Dorgan said, is the report’s finding that the Department of Defense is refusing to provide information to Congress about the incident, because of a lawsuit to which it is not a party.

“I am very concerned about the findings we now have, and I am disappointed in the delayed release of Part II of this report. The IG’s investigation and its findings are very important to the lives of U.S. soldiers and workers who were at the site. Details and definitive findings will help us ensure accountability for this exposure and flawed follow up, but even more importantly, they will help ensure that all exposed soldiers receive appropriate notice and medical attention,” Dorgan said.

Posted in Cancer, Contractor Casualties and Missing, Iraq, Toxic Exposures | Tagged: , , , , , , | Leave a Comment »

Officer Failed to Warn CIA Before Khost Bombing that Killed Civilian Contractors

Posted by defensebaseactcomp on October 20, 2010

Officer Failed to Warn CIA Before Attack

Dane Clark Paresi, Jeremy Wise, Harold Brown Jr., Scott Michael Roberson

by Mark Mazzetti New York Times

WASHINGTON — Three weeks before a Jordanian double agent set off a bomb at a remote Central Intelligence Agency base in eastern Afghanistan last December, a C.I.A. officer in Jordan received warnings that the man might be working for Al Qaeda, according to an investigation into the deadly attack.

But the C.I.A. officer did not tell his bosses of suspicions — brought to the Americans by a Jordanian intelligence officer — that the man might be planning to lure Americans into a trap, according to the recently completed investigation by the agency. Later that month the Qaeda operative, a Jordanian doctor, detonated a suicide vest as he stood among a group of C.I.A. officers at the base.

The internal investigation documents a litany of breakdowns leading to the Dec. 30 attack at the Khost base that killed seven C.I.A. employees, the deadliest day for the spy agency since the 1983 bombing of the American Embassy in Beirut. Besides the failure to pass on warnings about the bomber, Humam Khalil Abu-Mulal al-Balawi, the C.I.A. investigation chronicled major security lapses at the base in Afghanistan, a lack of war zone experience among the agency’s personnel at the base, insufficient vetting of the alleged defector and a murky chain of command with different branches of the intelligence agency competing for control over the operation.

Some of these failures mirror other lapses that have bedeviled the sprawling intelligence and antiterrorism community in the past several years, despite numerous efforts at reform.

The report found that the breakdowns were partly the result of C.I.A. officers’ wanting to believe they had finally come across the thing that had eluded them for years: a golden source who could lead them to the terror network’s second highest figure, Ayman al-Zawahri.

As it turned out, the bomber who was spirited onto a base pretending to be a Qaeda operative willing to cooperate with the Americans was actually a double agent who detonated a suicide vest as he stood among a group of C.I.A. officers. “The mission itself may have clouded some of the judgments made here,” said the C.I.A. director, Leon E. Panetta, who provided details of the investigation to reporters on Tuesday.  Read more here

Posted in Afghanistan, Blackwater, CIA, Contractor Casualties and Missing, State Department | Tagged: , , , , | 1 Comment »

Dollars for Docs- What Drug Companies are Paying Your Doctor

Posted by defensebaseactcomp on October 19, 2010

Docs on Pharma Payroll Have Blemished Records, Limited Credentials

Hundreds of doctors paid by pharmaceutical companies to promote their drugs have been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists, ProPublica has found. We compiled data from seven companies, covering $257.8 million in payouts since 2009 for speaking, consulting and other duties.

The Ohio medical board concluded [1] that pain physician William D. Leak had performed “unnecessary” nerve tests on 20 patients and subjected some to “an excessive number of invasive procedures,” including injections of agents that destroy nerve tissue.

Yet the finding, posted on the board’s public website, didn’t prevent Eli Lilly and Co. from using him as a promotional speaker and adviser. The company has paid him $85,450 since 2009.

In 2001, the U.S. Food and Drug Administration ordered [2] Pennsylvania doctor James I. McMillen to stop “false or misleading” promotions of the painkiller Celebrex, saying he minimized risks and touted it for unapproved uses.

Still, three other leading drug makers paid the rheumatologist $224,163 over 18 months to deliver talks to other physicians about their drugs.

And in Georgia, a state appeals court in 2004 upheld [3] a hospital’s decision to kick Dr. Donald Ray Taylor off its staff. The anesthesiologist had admitted giving young female patients rectal and vaginal exams without documenting why. He’d also been accused of exposing women’s breasts during medical procedures. When confronted by a hospital official, Taylor said, “Maybe I am a pervert, I honestly don’t know,” according to the appellate court ruling.

Last year, Taylor was Cephalon’s third-highest-paid speaker out of more than 900. He received $142,050 in 2009 and another $52,400 through June.

Leak, McMillen and Taylor are part of the pharmaceutical industry’s white-coat sales force, doctors paid to promote brand-name drugs to their peers — and if they’re convincing enough, get more physicians to prescribe them.

Drug companies say they hire the most-respected doctors in their fields for the critical task of teaching about the benefits and risks of their drugs.

But an investigation by ProPublica uncovered hundreds of doctors on company payrolls who had been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists.

This story is the first of several planned by ProPublica examining the high-stakes pursuit of the nation’s physicians and their prescription pads. The implications are great for patients, who in the past have been exposed to such heavily marketed drugs as the painkiller Bextra and the diabetes drug Avandia — billion-dollar blockbusters until dangerous side effects emerged.

“Without question the public should care,” said Dr. Joseph Ross, an assistant professor of medicine at Yale School of Medicine who has written about the industry’s influence on physicians. “You would never want your kid learning from a bad teacher. Why would you want your doctor learning from a bad doctor, someone who hasn’t displayed good judgment in the past?”

To vet the industry’s handpicked speakers, ProPublica created a comprehensive database [4] that represents the most accessible accounting yet of payments to doctors. Compiled from disclosures by seven companies, the database covers $257.8 million in payouts since 2009 for speaking, consulting and other duties. In addition to Lilly and Cephalon, the companies include AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer.

Although these companies have posted payments on their websites — some as a result of legal settlements — they make it difficult to spot trends or even learn who has earned the most. ProPublica combined the data and identified the highest-paid doctors, then checked their credentials and disciplinary records.

That is something not all companies do.

A review of physician licensing records in the 15 most-populous states and three others found sanctions against more than 250 speakers, including some of the highest paid. Their misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients. Some of the doctors had even lost their licenses.

More than 40 have received FDA warnings for research misconduct, lost hospital privileges or been convicted of crimes. And at least 20 more have had two or more malpractice judgments or settlements. This accounting is by no means complete; many state regulators don’t post these actions on their web sites.

In interviews and written statements, five of the seven companies acknowledged that they don’t routinely check state board websites for discipline against doctors. Instead, they rely on self-reporting and checks of federal databases. Only Johnson & Johnson and Cephalon said they review the state sites.

ProPublica found 88 Lilly speakers who have been sanctioned and four more who had received FDA warnings. Reporters asked Lilly about several of those, including Leak and McMillen. A spokesman said the company was unaware of the cases and is now investigating them.

“They are representatives of the company,” said Dr. Jack Harris, vice president of Lilly’s U.S. medical division. “It would be very concerning that one of our speakers was someone who had these other things going on.”

Leak, the pain doctor, and his attorney did not respond to multiple messages. The Ohio medical board voted to revoke Leak’s license in 2008. It remains active as he appeals in court, arguing that the evidence against him was old, the witnesses unreliable and the sentence too harsh.

In an interview, McMillen denied nearly all of the allegations in the FDA letter and blamed his troubles on a rival firm whose drug he had criticized in his presentations.

“I’m more cautious now than I ever was,” said McMillen, who said he also does research. “That’s why I think a lot of the companies use me. I’m not taking any risks.”

Taylor said that the allegations against him were “old news” from the 1990s and that regulators had not sanctioned him. “It had nothing to do with my skills as a physician,” said Taylor, noting that he speaks every other week around the country and sometimes abroad. “Even my biggest detractors in that situation lauded my skills as a physician. That’s what’s most important.”

Disclosures are just the start

Payments to doctors for promotional work are not illegal and can be beneficial. Strong relationships between pharmaceutical companies and physicians are critical to developing new and better treatments.

There is much debate, however, about whether paying doctors to market drugs can inappropriately influence what they prescribe. Studies have shown that even small gifts and payments affect physician attitudes. Such issues have become flashpoints in recent years both in courtrooms and in Congress.

All told, 384 of the approximately 17,700 individuals in ProPublica’s database earned more than $100,000 for their promotional and consulting work on behalf of one or more of the seven companies in 2009 and 2010. Nearly all were physicians, but a handful of pharmacists, nurse practitioners and dietitians also made the list. Forty-three physicians made more than $200,000 — including two who topped $300,000.

Physicians also received money from some of the 70-plus drug companies that have not disclosed their payments. Some of those interviewed could not recall all the companies that paid them, and certainly not how much they made. By 2013, the health care reform law requires [5] all drug companies to report this information to the federal government, which will post it on the Web.

The busiest — and best compensated — doctors gave dozens of speeches a year, according to the data and interviews. The work can mean a significant salary boost — enough for the kids’ college tuition, a nicer home, a better vacation.

Among the top-paid speakers, some had impressive resumes, clearly demonstrating their expertise as researchers or specialists. But others did not –contrary to the standards the companies say they follow.

Forty five who earned in excess of $100,000 did not have board certification in any specialty, suggesting they had not completed advanced training and passed a comprehensive exam. Some of those doctors and others also lacked published research, academic appointments or leadership roles in professional societies.

Experts say the fact that some companies are disclosing their payments is merely a start. The disclosures do not fully explain what the doctors do for the money — and what the companies get in return.

In a raft of federal whistleblower lawsuits [6], former employees and the government contend that the firms have used fees as rewards for high-prescribing physicians. The companies have each paid hundreds of millions or more to settle the suits.

The disclosures also leave unanswered what impact these payments have on patients or the health care system as a whole. Are dinner talks prompting doctors to prescribe risky drugs when there are safer alternatives? Or are effective generics overlooked in favor of pricey brand-name drugs?

“The pressure is enormous. The investment in these drugs is massive,” said Dr. David A. Kessler, who formerly served as both FDA commissioner and dean of the University of California, San Francisco School of Medicine. “Are any of us surprised they’re trying to maximize their markets in almost any way they can?”

From drug reps to doc reps

For years, drug companies bombarded doctors with pens, rulers, sticky notes, even stuffed animals emblazoned with the names of the latest remedies for acid reflux, hypertension or erectile dysfunction. They wooed physicians with fancy dinners, resort vacations and personalized stethoscopes.

Concerns that this pharma-funded bounty amounted to bribery led the industry to ban most gifts voluntarily [7]. Some hospitals and physicians also banned the gift-givers: the legions of drug sales reps who once freely roamed their halls.

So the industry has relied more heavily on the people trusted most by doctors — their peers. Today, tens of thousands of U.S. physicians are paid to spread the word about pharma’s favored pills and to advise the companies about research and marketing.

Recruited and trained by the drug companies, the physicians — accompanied by drug reps — give talks to doctors over small dinners, lecture during hospital teaching sessions and chat over the Internet. They typically must adhere to company slides and talking points.

These presentations fill an educational gap, especially for geographically isolated primary care doctors charged with treating everything from lung conditions to migraines. For these doctors, poring over a stack of journal articles on the latest treatments may be unrealistic. A pharma-sponsored dinner may be their only exposure to new drugs that are safer and more effective.

Oklahoma pulmonologist James Seebass, for example, earned $218,800 from Glaxo in 2009 and 2010 for lecturing about respiratory diseases “in the boonies,” he said. On a recent trip, he said, he drove to “a little bar 40 miles from Odessa,” Texas, where physicians and nurse practitioners had come 50 to 60 miles to hear him.

Seebass, the former chair of internal medicine at Oklahoma State University College of Osteopathic Medicine, said such talks are “a calling,” and he is booking them for 2011.

The fees paid to speakers are fair compensation for their time away from their practices, and for travel and preparation as well as lecturing, the companies say.

Dr. Samuel Dagogo-Jack has a resume that would burnish any company’s sales force: He is chief of the division of endocrinology, diabetes and metabolism at the University of Tennessee Health Science Center. Dagogo-Jack conducts research funded by the National Institutes of Health, has edited medical journals and continues to see patients.

While most people are going home to dinner with their families, he said, he is leaving to hop on a plane to bring news of fresh diabetes treatments to non-specialist physicians “in the trenches” who see the vast majority of cases.

Since 2009, Dagogo-Jack has been paid at least $257,000 by Glaxo, Lilly and Merck.

“If you actually prorate that by the hours put in, it is barely more than minimum wage,” he said. (A person earning the federal minimum wage of $7.25 would have to work 24 hours a day, seven days a week for more than four years to earn Dagogo-Jack’s fees.)

For the pharmaceutical companies, one effective speaker may not only teach dozens of physicians how to better recognize a condition, but sell them on a drug to treat it. The success of one drug can mean hundreds of millions in profits, or more. Last year, prescription drugs sales in the United States topped $300 billion, according to IMS Health, a healthcare information and consulting company.

Glaxo’s drug to treat enlarged prostates, Avodart — locked in a battle with a more popular competitor — is the topic of more lectures than any of the firm’s other drugs, a company spokeswoman said. Glaxo’s promotional push has helped quadruple Avodart’s revenue to $559 million in five years and double its market share, according to IMS.

Favored speakers like St. Louis pain doctor Anthony Guarino earn $1,500 to $2,000 for a local dinner talk to a group of physicians.

Guarino, who made $243,457 from Cephalon, Lilly and Johnson & Johnson since 2009, considers himself a valued communicator. A big part of his job, he said, is educating the generalists, family practitioners and internists about diseases like fibromyalgia, which causes chronic, widespread pain — and to let them know that Lilly has a drug to treat it.

“Somebody like myself may be able to give a better understanding of how to recognize it,” Guarino said. Then, he offers them a solution: “And by the way, there is a product that has an on-label indication for treating it.’’

Guarino said he is worth the fees pharma pays him on top of his salary as director of a pain clinic affiliated with Washington University. Guarino likened his standing in the pharma industry to that of St. Louis Cardinals first baseman Albert Pujols, named baseball player of the decade last year by Sports Illustrated. Both earn what the market will bear, he said: “I know I get paid really well.”

Is anyone checking out there?

Simple searches of government websites turned up disciplinary actions against many pharma speakers in ProPublica’s database.

The Medical Board of California filed a public accusation against psychiatrist Karin Hastik in 2008 and placed her [8] on five years’ probation in May for gross negligence in her care of a patient. A monitor must observe her practice.

Kentucky’s medical board placed Dr. Van Breeding on probation [9] from 2005 to 2008. In a stipulation filed with the board, Breeding admits unethical and unprofessional conduct. Reviewing 23 patient records, a consultant found Breeding often that gave addictive pain killers without clear justification. He also voluntarily relinquished his Florida license.

New York’s medical board put Dr. Tulio Ortega on two years’ probation [10] in 2008 after he pleaded no contest to falsifying records to show he had treated four patients when he had not. Louisiana’s medical board, acting on the New York discipline, also put him on probation [11] this year.

Yet during 2009 and 2010, Hastik made $168,658 from Lilly, Glaxo and AstraZeneca. Ortega was paid $110,928 from Lilly and AstraZeneca. Breeding took in $37,497 from four of the firms. Hastik declined to comment, and Breeding and Ortega did not respond to messages.

Their disciplinary records raise questions about the companies’ vigilance.

“Did they not do background checks on these people? Why did they pick them?” said Lisa Bero, a pharmacy professor at University of California, San Francisco who has extensively studied conflicts of interest in medicine and research.

Disciplinary actions, Bero said, reflect on a physician’s credibility and willingness to cross ethical boundaries.

“If they did things in their background that are questionable, what about the information they’re giving me now?” she said.

ProPublica found sanctions ranging from relatively minor misdeeds such as failing to complete medical education courses to the negligent treatment of multiple patients. Some happened long ago; some are ongoing. The sanctioned doctors were paid anywhere from $100 to more than $140,000.

Several doctors were disciplined for misconduct involving drugs made by the companies that paid them to speak. In 2009, Michigan regulators accused one rheumatologist of forging a colleague’s name to get prescriptions for Viagra and Cialis. Last year, the doctor was paid $17,721 as a speaker for Pfizer, Viagra’s maker.

A California doctor who was paid $950 this year to speak for AstraZeneca was placed on five years’ probation by regulators in 2009 after having a breakdown, threatening suicide and spending time in a psychiatric hospital after police used a Taser on him. He said he’d been self-treating with samples of AstraZeneca’s anti-psychotic drug Seroquel, medical board records show.

Other paid speakers had been disciplined by their employers or warned by the federal government. At least 15 doctors lost staff privileges at various hospitals, including one New Jersey doctor who had been suspended twice for patient care lapses and inappropriate behavior. Other doctors received FDA warning letters for research misconduct such as failing to get informed consent from patients.

Pharma companies say they rely primarily on a federal database listing those whose behavior in some way disqualifies them from participating in Medicare. This database, however, is notoriously incomplete.

The industry’s primary trade group says its voluntary code of conduct is silent about what, if any, behavior should disqualify physician speakers.

“We look at it from the affirmative — things that would qualify physicians,” said Diane Bieri, general counsel and executive vice president of the Pharmaceutical Research and Manufacturers of America.

Some physicians with disciplinary records say their past misdeeds do not reflect on their ability to educate their peers.

Family medicine physician Jeffrey Unger was put on probation [12] by California’s medical board in 1999 after he misdiagnosed a woman’s breast cancer for 2½ years. She received treatment too late to save her life. In 2000, the Nevada medical board revoked Unger’s license for not disclosing California’s action.

As a result, Unger said, he decided to slow down and start listening to his patients. Since then, he said, he has written more than 130 peer-reviewed articles and book chapters on diabetes, mental illness and pain management.

“I think I’ve more than accomplished what I’ve needed to make this all right,” he said. During 2009 and the first quarter of 2010, Lilly paid Unger $87,830. He said he also is a paid speaker for Novo Nordisk and Roche, two companies that have not disclosed payments.

The drug firms, Unger said, “apparently looked beyond the record.”

Companies make their own experts

Last summer, as drug giant Glaxo battled efforts to yank its blockbuster diabetes drug Avandia from the market, Nashville cardiologist Hal Roseman worked the front lines.

At an FDA hearing, he borrowed David Letterman’s shtick [13] to deliver a “Top Five” list of reasons to keep the drug on the market despite evidence it caused heart problems. He faced off [14] against a renowned Yale cardiologist and Avandia critic on the PBS NewsHour, arguing that the drug’s risks had been overblown.

“I still feel very convinced in the drug,” Roseman said with relaxed confidence. The FDA severely restricted access to the drug last month citing its risks.

Roseman is not a researcher with published peer-reviewed studies to his name. Nor is he on the staff of a top academic medical center or in a leadership role among his colleagues.

Roseman’s public profile comes from his work as one of Glaxo’s highest-paid speakers. In 2009 and 2010, he earned $223,250 from the firm — in addition to payouts from other companies.

Pharma companies often say their physician salesmen are chosen for their expertise. Glaxo, for example, said it selects “highly qualified experts in their field, well-respected by their peers and, in the case of speakers, good presenters.”

ProPublica found that some top speakers are experts mainly because the companies have deemed them such. Several acknowledge that they are regularly called upon because they are willing to speak when, where and how the companies need them to.

“It’s sort of like American Idol,” said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York City.

“Nobody will have necessarily heard of you before — but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think, ‘This guy is important.’ It creates an opinion leader who wasn’t necessarily an expert before.”

To check the qualifications of top-paid doctors, reporters searched for medical research, academic appointments and professional society involvement. They also interviewed national leaders in the physicians’ specialties.

In numerous cases, little information turned up.

Las Vegas endocrinologist Firhaad Ismail, for example, is the top earner in the database, making $303,558, yet only his schooling and mostly 20-year-old research articles could be found. An online brochure [15] for a presentation he gave earlier this month listed him as chief of endocrinology at a local hospital, but an official there said he hasn’t held that title since 2008.

And several leading pain experts said they’d never heard of Santa Monica pain doctor Gerald Sacks, who was paid $249,822 since 2009.

Neither physician returned multiple calls and letters.

A recently unsealed whistleblower lawsuit against Novartis [16], the nation’s sixth-largest drug maker by sales, alleges that many speakers were chosen “on their prescription potential rather than their true credentials.”

Speakers were used and paid as long as they kept their prescription levels up, even though “several speakers had difficulty with English,” according to the amended complaint filed this year in federal court in Philadelphia.

Some physicians were paid for speaking to one another, the lawsuit alleged. Several family practice doctors in Peoria, Ill., “had two programs every week at the same restaurant with the same group of physicians as the audience attendees.”

In September, Novartis agreed to pay [17] the government $422.5 million to resolve civil and criminal allegations in this case and others. The company has said it fixed its practices and now complies with government rules.

Roseman, who has been a pharma speaker for about a decade, acknowledged that his expertise comes by way of the training provided by the companies that pay him. But he says that makes him the best prepared to speak about their products, which he prescribes for his own patients. Asked about Roseman’s credentials, a Glaxo spokeswoman said he is an “appropriate” speaker.

Getting paid to speak “doesn’t mean that your views have necessarily been tainted,” he said.

Plus pharma needs talent, Roseman said. Top-tier universities such as Harvard [18] have begun banning their staffs from accepting pharma money for speaking, he said. “It irritates me that the debate over bias comes down to a litmus test of money,” Roseman said. “The amount of knowledge that I have is in some regards to be valued.”

Please see the original story at ProPublica

See also DME Doctors at American Contractors in Iraq and Afghanistan

Posted in Defense Medical Examinations, Department of Labor, Follow the Money | Tagged: , , , , , , , | Leave a Comment »

AIG’s Fab Four Defense Medical Examination Doctors Take Another Hit

Posted by defensebaseactcomp on October 18, 2010

Not long before Dr. John Dorland Griffith was exposed

Dr Bryan Drazner was Suspended from the easy money  Designated Doctor List in Texas, only not for long enough

Update:  It was for long enough

Official Order of the State of Texas Workers Compensation

Drazner, Bryan Scott M.D. Dallas, TX Lic #J0945

On August 26, 2005, the Board and Dr Drazner entered into an Agreed Order requiring Dr Drazner to complete at least 50 hours of Continuing Medical Education in the areas of medical records, risk management, ethics and physician patient confidentiality and accessing an administrative penalty of $3,000.  The action was based on allegations that Dr Drazner breached patient physician confidentiality by dictating a note for the medical record of a patient while on an airplane flight, which was overheard by another passenger.

Drazner:  Insufficient Report


You can see Dr Bryan Drazner listed at the DBA X Files at American Contractors

He also had a Sanction Against him in Illinois

Refusal to Renew License


Also see Doctors Who Work for Insurance Companies

TEXAS DEPARTMENT OF INSURANCE

Drazner, Bryan M.D. of Dallas
Order Number: DWC10-0034
Date of Order: 5/10/2010
Order Final In: May
Action Taken: Fined $15,000; Suspended from Designated Doctor List for six months
Violation: Failed to timely file DWC Form-69 with insurance carrier (72 instances); Failed to provide documentation proving filing of DWC Form-69 (40 instances); Failed to timely file letter of clarification

Posted in AIG and CNA, Civilian Contractors, Defense Base Act Law and Procedure, Defense Medical Examinations, Delay, Deny, Department of Labor, Dropping the DBA Ball | Tagged: , , , , , , | 1 Comment »

Insurgents kill eight security guards

Posted by defensebaseactcomp on October 18, 2010

Will update as information becomes available

KABUL, Afghanistan, Oct. 18 (UPI) – Eight guards working for a private security company were killed in a clash with insurgents in Afghanistan, officials said. Three other guards were wounded.

The fighting occurred Sunday in southern Afghanistan’s Helmand province, CNN reported Monday.

The unnamed company provides security for a private firm working on the Kandahar-Heart Highway, said Daud Ahmadi, a spokesman for Helmand’s governor.

Afghan President Hamid Karzai’s administration has called for the dissolution of virtually all private security firms operating in the country. He said exceptions are firms protecting embassies and foreign diplomats, the report said.

Karzai said security companies not protecting embassies and diplomats “are a strong threat for the national security and the national sovereignty of the country.”

He ordered that 52 private security firms operating in Afghanistan be phased out by the end of 2010.

The U.S. State Department said if the plan is implemented it will leave critical aid personnel unprotected and unable to do their work.  Original story here

Posted in Afghanistan, Civilian Contractors, Contractor Casualties and Missing | Tagged: , , , | Leave a Comment »

Military using potentially harmful methods of burning trash

Posted by defensebaseactcomp on October 15, 2010

Washington (CNN) -- Military bases in Iraq and Afghanistan continue to use waste methods that expose troops to potentially toxic emissions without fully understanding the effects, according to a new government audit obtained by CNN.

Between September 2009 and October 2010, investigators from the Government Accountability Office visited four bases in Iraq and reviewed planning documents on waste disposal for bases in Afghanistan. None of the Iraq bases visited were in compliance with military regulations. All four burned plastic — which generates harmful emissions — despite regulations against doing so.

The emissions have been the source of controversy as troops have complained about a host of problems, from cancerous tumors to respiratory issues, blaming exposure to burn pits. Military officials have denied any consequential effects on most troops.

The military, the report concluded, has been slow in using alternatives and has not considered the long-term costs of dealing with subsequent health issues.

The report is expected to be released later Friday.

Posted in Afghanistan, Burn Pits, Cancer, Iraq | Tagged: , , , | Leave a Comment »

Defense Base Act DoL OALJ Case Look Up

Posted by defensebaseactcomp on October 13, 2010

The Department of Labor OALJ claim look up is a valuable resource for researching Defense Base Act Claims status and outcomes at the ALJ level.

For DBA Claims enter LDA in the drop down under Option 2

http://www.oalj.dol.gov/

Posted in ACE, AIG and CNA, Civilian Contractors, Defense Base Act Law and Procedure, Department of Labor, OALJ | Tagged: , , , , | Leave a Comment »

Linda Norgrove: aid worker ‘killed by friendly fire’

Posted by defensebaseactcomp on October 11, 2010

Linda Norgrove, the British aid worker, may have been killed by a grenade thrown by US troops trying to rescue her from Taliban kidnappers in Afghanistan.

It had initially been reported that Miss Norgrove died after her rebel captors detonated a suicide vest as American troops closed in on them.

The victim’s parents have demanded a full explanation for the events surrounding her capture and failed rescue, amid claims that her release could have been negotiated.

John and Lorna Norgrove are “devastated” by their daughter’s death and were joined at the weekend by their other daughter Sofie at their remote home on the Isle of Lewis.

Speaking at a press conference at 10 Downing Street, Mr Cameron said it was not yet certain that Miss Norgrove’s death was caused by allied forces.

US commander General David Petraeus informed Downing Street this morning that a review of the rescue operation had uncovered new information suggesting that a grenade detonated by taskforce members may have been to blame.

Mr Cameron informed Miss Norgrove’s family of the “deeply distressing development” before making his announcement at a scheduled press conference which was delayed by almost an hour.

He said the decision to mount a rescue operation was made by Foreign Secretary William Hague “after careful consideration” and had his full support as Prime Minister.

Ms Norgrove’s life was in “grave danger” from the moment she was seized, and there were fears that she might be passed up the terrorist chain and put at greater peril if she was not rescued.

“I am clear that the best chance of saving Linda’s life was to go ahead, recognising that any operation was fraught with risk for all those involved and success was by no means guaranteed,” said Mr Cameron.

“None of us can understand just how painful this must be for Linda’s family,” he said.

“Also it is deeply regrettable, particularly for them, that the information published on Saturday is highly likely to have been incorrect.

“The statements were made in good faith and on the basis of the information that we received.

“I want to assure Mr and Mrs Norgrove that I will do everything I possibly can to establish the full facts and give them certainty about how their daughter died.”

Mr Cameron said General Petraeus had treated the hostage “as if she was a US citizen” and that “he and the US forces did everything in their power to bring Linda home safely”.

“The US forces placed their own lives in danger. General Petraeus has told me they are deeply dismayed at the outcome. I want to thank them for their courage,” he said.  Read the entire story here

Posted in Afghanistan, Civilian Contractors, Contractor Casualties and Missing, State Department | Tagged: , , , , | Leave a Comment »

Stranded DBA Claimants

Posted by defensebaseactcomp on October 8, 2010

Due to the suspension of a DBA Attorney by the OALJ’s office some claimants have been receiving notices from their assigned ALJ’s that they must retain another attorney or represent themselves at their hearing.

If you retained this attorney it is he who should have notified you of his suspension.  The ALJ’s are only able to notify the claimants they had been assigned.

Here we have ALJ Romero, true to form, treating the client as if she is somehow at fault for this and sends her a notice on the 17th of August requiring a response by September 1st.  Looks like she did not make the cut.  If anyone knows this claimant please let her know the status of her claim.

Other claimants have received these notices with barely concealed contempt inferred in the wordage.

IN THE MATTER OF
JULIE PERKINS
Claimant
v.
SERVICE EMPLOYEES INTERNATIONAL, INC.
Employer
and
INSURANCE COMPANY OF THE STATE
OF PENNSYLVANIA
c/o Chartis Property Casualty
ORDER REMANDING CASE
On August 17, 2010, an Order issued to Claimant advising that Attorney Dennis Nalick had been suspended from appearing in a representative capacity before this office until such time as his suspension from practicing law in the State of Illinois is lifted and he is re-admitted to practice.
Claimant was ordered to notify the undersigned whether she wishes to proceed to hearing with alternate counsel or without representation. In the event Claimant did not notify the undersigned by September 1, 2010, she was informed that her claim would be remanded to the District Director for further
appropriate handling. Claimant has not responded to the Order.
- 2 -
IT IS HEREBY ORDERED that this case be remanded to the
District Director for further handling.
ORDERED this 20th day of September, 2010, at Covington,
Louisiana.
A
LEE J. ROMERO, JR.
Administrative Law Judge

Posted in Defense Base Act Law and Procedure, Department of Labor, Dropping the DBA Ball | Tagged: , , , , , | 11 Comments »

Mike Behr, Civilian Contractor, dies in Iraq

Posted by defensebaseactcomp on October 7, 2010

Lewiston Man dies in Iraq

LEWISTON — A 49-year-old Lewiston man has died of an apparent heart attack while working for a civilian contractor in Iraq.

Michael Behr was on his way home for a visit when someone on a bus discovered him, said his mother, Florence.

Behr had been working as a private contractor in a metal fabrication facility. He was employed by KBR, a former subsidiary of Halliburton.

Florence Behr said two men from KBR told her about her son’s death on Monday.

He died sometime over the weekend, she said.

“It’s being treated as a military, non-combatant death,” Florence Behr said.

His body will be shipped home sometime in the next few days and will undergo an autopsy to determine how he died.

Until that’s done, funeral arrangements and services will wait, she said.

Behr, a longtime biker, had spent four years in the U.S. Air Force as a young man, but he had moved around a lot.

“He was a good guy,” his mother said. “He was into the biker life.”

He was recently working in Oregon before he moved back to Lewiston last year with his wife, Cindy Morneau-Behr.

He was treated for high blood pressure and passed a physical before leaving for Iraq in November, his mother said.

“He was supposed to be on medication,” Florence Behr said. He was a constant smoker and heart troubles run in the family.

“He said he was better, but he was probably telling me what I wanted to hear,” she said

Posted in Civilian Contractors, Contractor Casualties and Missing, Iraq, KBR | Tagged: , , , , | 2 Comments »

Are UK companies on American contracts violating UK law and hiding behind the DBA exclusive remedy?

Posted by defensebaseactcomp on October 6, 2010

Posted by our Brit Guy

Thanks to a landmark ruling in the House of Lords.  A ruling as far back as August 2006

The decision means that a traveler claiming against a party insured outside of England and Wales is entitled to UK levels of damages – among the highest in the world – even if the law in the country concerned limits the scope of compensation.

Whilst the article relates to holiday makers several UK law firms are now studying the ruling to see if it can be applied to injured contractors.
This is a complicated area of law below a brief but by no means a full quote of the law but an area which gives a basic idea.

Whilst the article relates to holiday makers several UK law firms are now studying the ruling to see if it can be applied to injured contractors.
This is a complicated area of law below a brief but by no means a full quote of the law but an area which gives a basic idea.

The contract of employment is an important document as are the facts as to who has day to day control over a worker’s activities whilst he is working abroad. Many duties of an employer to their worker are not delegable to a third party (such as s foreign company where the worker is sent to do his job) even though the employer may deny responsibility for health and safety. For many practical and financial reasons it is often very important that a worker can show that there is a UK based Defendant to a accident claim even though the injury occurred whilst working abroad.

So UK companies relying on the exclusive remedy of the DBA may in fact be liable under the laws of England and Wales for any shortfall in payments. Indeed foreign contractors can have benefits commutated to halve of future installments.

Also they may be liable for the shortfall as of the maximum amount being paid to limit the insurers liability.

Whilst we have to wait for the legal profesionals to work through this it has the possibility to expose several UK companies to huge loses because of the DBA policy.


If it is found that the law applies to injured contractors then the question to be asked is why are we insured under an inadequate policy which does not apply in the UK but cost the US taxpayer millions ????

Posted in Afghanistan, Civilian Contractors, Contractor Casualties and Missing, Defense Base Act Law and Procedure, Department of Labor, Exclusive Remedy, Injured Contractors, Iraq, Political Watch | Tagged: , , , , , , | 1 Comment »

Employee accuses KBR co-worker of assault

Posted by defensebaseactcomp on October 6, 2010

HOUSTON (KTRK) A third Texas woman — the second from our area — has filed suit against Houston-based KBR over a sexual assault while she worked as a contractor in Iraq.

The latest lawsuit claims KBR failed to prevent a sexual assault by former KBR Employee David Charles Breda. The woman claims Breda sexually assaulted her and threatened her not to tell anyone about the attack. Breda was later convicted of sexual assault. KBR denied some allegations in the lawsuit and told us, “The safety and security of all employees remains KBR’s top priority. KBR maintains strong and effective sexual harassment and assault prevention and reporting programs to protect its employees.”

Posted in Civilian Contractors, Iraq, KBR | Tagged: , , , | Leave a Comment »

 
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