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Posts Tagged ‘T Miller’

Iraq convoy was sent out despite threat

Posted by defensebaseactcomp on October 9, 2012

Unarmored trucks carrying needed supplies were ambushed, leaving six drivers dead. Records illuminate the fateful decision.

“Can anyone explain to me why we put civilians in the middle of known ambush sites?”

“Maybe we should put body bags on the packing list for our drivers.”

T Christian Miller The LA Times  September 3, 2007

Senior managers for defense contractor KBR overruled calls to halt supply operations in Iraq in the spring of 2004, ordering unarmored trucks into an active combat zone where six civilian drivers died in an ambush, according to newly available documents.

Company e-mails and other internal communications reveal that before KBR dispatched the convoy, a chorus of security advisors predicted an increase in roadside bombings and attacks on Iraq’s highways. They recommended suspension of convoys.

“[I] think we will get people injured or killed tomorrow,” warned KBR regional security chief George Seagle, citing “tons of intel.” But in an e-mail sent a day before the convoy was dispatched, he also acknowledged: “Big politics and contract issues involved.”

KBR was under intense pressure from the military to deliver on its multibillion-dollar contract to transport food, fuel and other vital supplies to U.S. soldiers. At Baghdad’s airport, a shortage of jet fuel threatened to ground some units.

After consulting with military commanders, KBR’s top managers decided to keep the convoys rolling. “If the [Army] pushes, then we push, too,” wrote an aide to Craig Peterson, KBR’s top official in Iraq.

The decision prompted a raging internal debate that is detailed in private KBR documents, some under court seal, that were reviewed by The Times.

One KBR management official threatened to resign when superiors ordered truckers to continue driving. “I cannot consciously sit back and allow unarmed civilians to get picked apart,” wrote Keith Richard, chief of the trucking operation.

Six American truck drivers and two U.S. soldiers were killed when the convoy rumbled into a five-mile gauntlet of weapons fire on April 9, 2004, making an emergency delivery of jet fuel to the airport. One soldier and a seventh trucker remain missing.

Recriminations began the same day.

“Can anyone explain to me why we put civilians in the middle of known ambush sites?” demanded one security advisor in an e-mail. “Maybe we should put body bags on the packing list for our drivers.”

Please read the entire story here

Posted in Civilian Contractors, Contractor Casualties and Missing, Contractors Kidnapped, Defense Base Act, Defense Base Act Insurance, Department of Defense, Exclusive Remedy, Follow the Money, Injured Contractors, Iraq, KBR, Misjudgements, Political Watch, T Christian Miller | Tagged: , , , , , , , , , , , , , | Leave a Comment »

ProPublica Honored With Two George Polk Awards

Posted by defensebaseactcomp on February 22, 2011

by Minhee Cho at ProPublica

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

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

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

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

Congratulations to all of the winners Please see the original here

Posted in PTSD and TBI, T Christian Miller | Tagged: , , , , , | Leave a Comment »

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

Posted by defensebaseactcomp on January 24, 2011

By T Christian Miller  ProPublica and Daniel Zwerdling NPR

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Posted in Afghanistan, Civilian Contractors, Contractor Casualties and Missing, Delay, Deny, Injured Contractors, Iraq, PTSD and TBI, T Christian Miller, Veterans Affairs | Tagged: , , , , , , , | 2 Comments »

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

Posted by defensebaseactcomp on December 20, 2010

By T Christian Miller Propublica and Daniel Zwedling NPR

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Brain Campaign

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

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

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

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

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

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

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

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

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

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

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

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

Everyone Agrees

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Contract

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

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

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

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

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

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

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

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

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

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

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

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

Tricare Criticized

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More Studies, More Waiting

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Struggling for Care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Posted in Civilian Contractors, Contractor Casualties and Missing, Injured Contractors, PTSD and TBI, T Christian Miller | Tagged: , , , , | Leave a Comment »

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

Posted by defensebaseactcomp on September 23, 2010

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Posted in Afghanistan, Civilian Contractors, Contractor Casualties and Missing, Department of Labor, Injured Contractors, Iraq, T Christian Miller | Tagged: , , , , , , | 3 Comments »

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

Posted by defensebaseactcomp on September 9, 2010

by T Christian Miller ProPublica and Dan Zwerdling NPR

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

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

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

The Army twice denied a Purple Heart for Sgt. Nathan Scheller, though the aftereffects from two roadside explosions in Iraq have left him with lasting cognitive problems, according to the Army’s own records.

Please see the entire presentation here

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High Profile Suicide in Iraq: Deeply Disturbed by Abuses Carried Out by American Contractors in Iraq

Posted by defensebaseactcomp on June 28, 2010

Greg Mitchell at Huffington Post

The scourge of suicides among American troops and reservists (which I’ve covered since 2003) remains a serious and seriously under-reported problem. One of the most high-profile cases involves a much-admired Army colonel and ethicist named Ted Westhusing — who, in his 2005 suicide note, pointed a finger at rising U.S. general named David Petraeus.

Westhusing’s widow, asked by a friend what killed this West Point scholar, had replied simply: “Iraq.”

Before putting a bullet through his head, Westhusing had been deeply disturbed by abuses carried out by American contractors in Iraq, including allegations that they had witnessed or even participated in the murder of Iraqis. His suicide note included claims that his two commanders tolerated a mission based on “corruption, human rights abuses and liars. I am sullied — no more. I didn’t volunteer to support corrupt, money grubbing contractors, nor work for commanders only interested in themselves.” One of those commanders: the future leader of American forces in Iraq, and then Afghanistan, Gen. David Petraeus.

Westhusing, 44, had been found dead in a trailer at a military base near the Baghdad airport in June 2005, a single gunshot wound to the head. At the time, he was the highest-ranking officer to die in Iraq. The Army concluded that he committed suicide with his service pistol and found his charges against the commanders unfounded. Petraeus would later attend Westhusing’s memorial service back in the U.S.

Ted Westhusing was an unusual case: “one of the Army’s leading scholars of military ethics, a full professor at West Point who volunteered to serve in Iraq to be able to better teach his students. He had a doctorate in philosophy; his dissertation was an extended meditation on the meaning of honor,” as Christian Miller explained in a major Los Angeles Times piece.

Please read the full article here

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

Posted by defensebaseactcomp on June 25, 2010

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

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

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

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

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

Posted in Contractor Casualties and Missing, PTSD and TBI, T Christian Miller | Tagged: , , , , , , , , , , , | 5 Comments »

Pentagon Puts Its Spin on Brain Injuries

Posted by defensebaseactcomp on June 9, 2010

After Our Investigation, Pentagon Puts Its Spin on Brain Injuries

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

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

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

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

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

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

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

Posted in ACE, AIG and CNA, Civilian Contractors, Contractor Casualties and Missing, PTSD and TBI, T Christian Miller | Tagged: , , , , , , | 8 Comments »

Brain Injuries Remain Undiagnosed in Thousands of Soldiers

Posted by defensebaseactcomp on June 8, 2010

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

The NPR and ProPublica investigation, however, indicates that the military waited for soldiers to seek medical attention, rather than actively seeking to evaluate those in blasts.  If you were treated in Military Medical as a Civilian Contractor you were not screened for TBI.   AIG and CNA are denying screening based on a “lack of medical evidence” that you need screening.

The military medical system is failing to diagnose brain injuries in tens of thousands of soldiers who served in Iraq and Afghanistan, and many of them receive little or no treatment for lingering health problems, despite years of promises, an investigation by ProPublica and NPR has found.

WASHINGTON, D.C.–The military medical system is failing to diagnose brain injuries in troops who served in Iraq and Afghanistan, many of whom receive little or no treatment for lingering health problems, an investigation by ProPublica and NPR has found.

So-called mild traumatic brain injury has been called one of the wars’ signature wounds. Shock waves from roadside bombs can ripple through soldiers’ brains, causing damage that sometimes leaves no visible scars but may cause lasting mental and physical harm.

Officially, military figures say about 115,000 troops have suffered mild traumatic brain injuries since the wars began. But top Army officials acknowledged in interviews that those statistics likely understate the true toll. Tens of thousands of troops with such wounds have gone uncounted, according to unpublished military research obtained by ProPublica and NPR.  Read the whole story at Propublica

Posted in ACE, AIG and CNA, Civilian Contractors, Contractor Casualties and Missing, Department of Labor, PTSD and TBI, T Christian Miller | Tagged: , , , , , , , , | 2 Comments »

Overseas Press Club Awards for international journalism

Posted by defensebaseactcomp on April 22, 2010

ProPublica, with reporters T. Christian Miller, Doug Smith and Pratap Chatterjee, won the award for Web coverage of international affairs forDisposable Army: Civilian Contractors in Iraq and Afghanistan.

The Overseas Press Club Awards were founded in 1940 to recognize excellence in foreign coverage in the categories of print, broadcast and photography. Read more at the Washington Examiner:

Posted in Interviews with Injured War Zone Contractors, T Christian Miller | Tagged: , , , , , , , , | Leave a Comment »

Contractor Deaths Accelerating in Afghanistan as They Outnumber Soldiers

Posted by defensebaseactcomp on April 14, 2010

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

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

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

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

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

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

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

Staff researcher Lisa Schwartz contributed to this report. Original here

Posted in Contractor Casualties and Missing, Department of Labor, T Christian Miller | Tagged: , , , , , , , | 1 Comment »

Miller Uncovers the ‘Hidden War’

Posted by defensebaseactcomp on April 13, 2010

By Gretchen Parker on April 13, 2010 8:10 AM

USC NEWS University of Southern California

For his work uncovering the “the hidden war” – the casualties and neglect of injured contractors in Iraq and Afghanistan – journalist T. Christian Miller of ProPublica was honored April 9 with the 2010 Selden Ring Award for Investigative Reporting.

The $35,000 annual award, which has been presented for the past 21 years by USC Annenberg School for Communication & Journalism, honors outstanding work in investigative journalism that made an impact. This year’s award was the first to go to a journalist at a non-traditional news organization.

“It’s a particular pleasure for me to give this award to T., because it represents the kind of collaboration I am confident will be an increasingly important part of the future of journalism,” said Geneva Overholser, director of the School of Journalism, as she presented the award to Miller at a luncheon ceremony.

Miller began reporting on the plight of war contractors when he worked for the Los Angeles Times. He continued his work when he moved to ProPublica, a New York-based nonprofit news organization that focuses on investigative stories that serve a public interest. The agency partners with newspapers, network news and online outfits to get the stories published and aired.

Besides the Times, which collaborated with Miller on his stories, ABCNews.com, The Washington Post, Salon.com and TheDailyBeast.com also ran pieces of the series.

Over three years, Miller untangled the bureaucracies of the Department of Defense and the Department of Labor to uncover for the first time how many contractors have died in the wars in Iraq and Afghanistan – 1,757, as of April 9. Another 37,000 have been injured.

“No one tracks these people. There is no accountability for them,” he said of the contractor ranks, which he said have become a “disposable army.”

Beyond the casualties, Miller revealed that contractors were not receiving even minimal benefits owed to them when they are injured in war zones. He also found that many of those suffering are working-class Americans who saw the contract work as a way to dig themselves out of debt and take care of their families.

Thousands of them are from Third World countries hired to do the work of cleaning toilets and mopping floors for the American military.
“What the U.S. has done is hire some of the poorest people in the world to do the dirtiest jobs in the most dangerous countries in the world. These are the people who are being killed,” Miller said.

Because of Miller’s work, congressional hearings were held and legislation is being prepared that will hold the Department of Defense more accountable for its hired workers. And the Labor Department also is taking action to step up penalties against errant insurers.

News gathered by collaborative partnerships is becoming increasingly common as news organizations struggle to make the most of resources. But Miller pointed out that these partnerships have the potential to carry more influence than one high-profile outfit pursuing a story.

“The benefit is that you can’t dismiss this as one crazy reporter at one crazy newspaper who is waging a crusade,” he said. “It’s a reverberation effect of many media and many voices participating in many different directions. And it’s increasingly difficult to ignore that story.”

Winning the Selden Ring Award has helped shine even more light on the issue, Miller said.

“The day after I won the award, I sent e-mails to all the congressional committees involved in this topic and said, ‘This has become a Selden Ring Award winner,’ ” Miller said. “They all wrote back. It’s a way to put it on their radar screens. They know it’s been recognized. They know we’re going to continue to cover it, and it’s not going to go away.

“That kind of dogged investigative journalism is the exact type that the award was created to recognize.”

And although the award also has brought more attention to non-traditional and nonprofit news organizations, Miller cautioned against looking to ProPublica to save the investigative journalism that is seeping out of established newsrooms.

“I hope it raises the profile of collaborative media, but I don’t think nonprofit journalism is ever going to replace for-profit journalism. It gives a boost to what is out there,” he said. “I really hope a message out of this is that there’s no reason not to work with nonprofits. So let’s go down this path and try to double the firepower we used to have by bringing in an outside partner.”

Miller was congratulated at the awards luncheon by legendary investigative reporter Seymour Hersh, who related the stories behind how he broke the My Lai Massacre and its cover-up during the Vietnam War.
He encouraged the audience, which included young reporters from an Investigative Reporters and Editors workshop, to pursue investigative journalism.

“It’s truly a great way to spend time, and I urge all you young people to keep at it,” he said.

The award luncheon also featured a tribute by past award winners to Douglas Ring, benefactor of the prize. Ring died in November 2009.

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ProPublica Wins Pullitzer Prize

Posted by defensebaseactcomp on April 12, 2010

ProPublica reporter Sheri Fink has been honored with a Pulitzer Prize for investigative reporting for an article published last August in the New York Times Magazine. In addition, reporting by Charles Ornstein and Tracy Weber of ProPublica on lax oversight of nursing in California, published in the Los Angeles Times, was a finalist for the Pulitzer Prize for Public Service, the Pulitzer’s highest honor.

Sheri Fink’s shocking 13,000-word chronicle, “The Deadly Choices at Memorial,” revealed how some New Orleans doctors – in the gathering chaos as Katrina’s flood waters rose, generators failed, and their hospital was cut off from the world – decided to give lethal injections to patients whom they feared could not be evacuated.

Sheri’s work is a powerful example of what ProPublica was founded to do: shine light on possible abuses of power or failures to uphold the public interest, so that the public can learn from and remedy them. In this case, her reporting provides crucial information for those charged with designing guidelines for coping with medical disasters. The key questions are who should be saved first and who should decide.

This prestigious award caps a series of honors voted for ProPublica’s work in 2009, its first year of operation with a complete staff.  They include a George Polk Award, the Selden Ring Award for investigative reporting, and two Investigative Reporters and Editors awards for subjects as diverse as environmental risks from natural gas drilling, denial of government-mandated insurance benefits for dead or wounded employees of military contractors abroad, and police shootings in New Orleans.

The honors are gratifying, and we deeply appreciate them, but they are not a goal in themselves. We view them as a sign that our nonprofit, non-partisan model – publishing both on our own Web site and in partnership with major print, video, audio and online news organizations – can make a meaningful contribution to the information needs of the American people in an era of explosive change in newspapers and other media.

Paul Steiger

President & Editor-in-Chief
ProPublica

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Video of Journalists’ Death Answer Some Questions, but Raise Others

Posted by defensebaseactcomp on April 7, 2010

by Marian Wang, ProPublica   T Christian Miller contributed to this story

April 7: This post has been corrected.

On Monday, WikiLeaks made a big splash when it released a still-classified military video [1] from 2007 that shows a U.S. helicopter gunship shooting down a group of men in a suburb of Baghdad.

Reactions to the video range [2] widely: Some believe it betrays a possible war crime; others find it completely justifiable. Interestingly enough, many commentators fail to mention that, in recent weeks, the military itself has made some serious admissions about shooting civilians.

During a videoconference to answer soldiers’ questions in March, military officials said that U.S and allied forces had killed 30 Afghans and wounded 80 others during shooting incidents at Afghan checkpoints and during convoy runs, the New York Times reported in a little noticed story [3]. Gen. Stanley McChrystal said that military inquiries into the incidents revealed that none of civilians had turned out to be threats.

“We have shot an amazing number of people, but to my knowledge, none has ever proven to be a threat,” McChrystal said during the videoconference, the Times reported.

Earlier this week the U.S. military did an about-face and admitted that American forces killed three Afghan women [4] during a nighttime raid in February. The military had previously denied involvement in their deaths.

Same Video, Different Interpretations

The aerial footage of the attack begins with several men walking down a street in Baghdad. The audio of transmissions between the helicopter pilots and gunners indicate that they believe some of the men in the group are armed, but it’s unclear from the video whether they are. The military personnel request permission to engage, and it is granted. They fire on the men, most of whom are struck down immediately. One in the group is wounded and proceeds to slowly crawl away. An unmarked rescue van pulls up, and two men get out of the vehicle to help the wounded man and transport him elsewhere, but the personnel in the helicopter request permission to shoot the van, and when it is granted, they fire on it. Later, ground reconnaissance reveals that two Iraqi children are in the van and are wounded. Both the man who had been crawling and another man who was killed in the first round of fire were later identified as journalists working for Reuters [5].

Please Read the Story in it’s entirety here

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