Monday, June 30, 2014

Stepping Into The Fire: Veteran Advocates & Pols Sound Off On Obama's Choice To Lead Scandal-Plagued VA

Robert McDonald is Obama's pick to run VA
Unnamed White House officials have told USA Today and other news organizations that President Obama will nominate former Procter & Gamble executive Robert McDonald today as the next secretary of the embattled Department of Veterans Affairs (VA). If approved by the Senate, and that seems likely, McDonald would replace Eric Shinseki, the retired four-star general who resigned a month ago amid a firestorm of controversy over shocking reports that veterans died waiting to be seen by a doctor, and that management at VA hospitals and clinics falsified veteran wait times, according to multiple whistleblowers inside VA.

The expected announcement later today comes just three days after Rob Nabors, a White House staffer assigned to address VA's problems, issued a review to the president concluding that the agency has “a corrosive culture” that has affected care for veterans. 

“The problems inherent within an agency with an extensive field structure are exacerbated by poor management and communication structures, distrust between some VA employees and management, a history of retaliation toward employees raising issues, and a lack of accountability across all grade levels,” the report said.

Corruption and unethical behavior are reportedly rampant among VA's mid-level management. As for the hundreds of thousands of workers at VA who are dedicated to helping veterans every day, morale is said to be at an all-time low.

Is McDonald the right man to clean up this mess? A 61-year-old West Point graduate and Army captain, McDonald reportedly worked his way from entry-level employee to CEO at Procter & Gamble over the course of three decades. He's a surprise pick, but some observers believe his combined military leadership/corporate management background make him uniquely qualified to lead the agency. 

Phillip Carter of the Center for a New American Security told the Washington Post that Obama's choice of McDonald "suggests a real focus on customer satisfaction, as opposed to what you might get from a retired general or medical leader. It is probably a wise choice given the concerns right now of veterans.”

A White House statement not surprisingly described McDonald as the "perfect person to lead the Department of Veterans Affairs during this important time." 

But some veteran advocates are skeptical.

"I have a great deal of respect for McDonalds’ accomplishments over the years, but I don’t believe he understands the internal problems of VA," said Thomas Bandzul, legislative counsel for Veterans and Military Families for Progress and past associate counsel for Veterans for Common Sense. "And by the time he does appreciate the complexities and comes up with a strategy, the next president will already be elected."

Bandzul said he can’t see the relevance of McDonald's West Point degree, "or how an O-3 from the Army will have much of an impact when he’s replacing a war General and combat soldier. VA needs a person who isn’t afraid to swing an ax to chop out the deadwood while understanding where and what to plant as replacements for the forest. I don’t think this is the guy to do that."

Rick Weidman, director of policy & government affairs at Vietnam Veterans of America (VVA), said that while McDonald's work outside the government will hopefully mean he takes a "fresh look" at the problems within VA, "The management structure at VA has been so bad for so long, and there is so much back-scratching, he will have to create a new management group at the hospital level and replace the directors and assistant directors. He must bring in people who are dedicated to helping veterans, as opposed to people who just want a job for which they get bonuses. I believe almost all of them ought to go."

Steve House, an Army veteran who was exposed to toxic chemicals while stationed in South Korea after the Vietnam War, spent a decade trying to get his disability claim approved at VA. He said that as a West Point graduate, McDonald is more likely to "roll over and go along with anything the Department of Defense says."

However, House said, if McDonald "steps into the VA management cow pie and runs it like a lean, profitable corporation and starts swinging the axe - beginning at the top - and gets rid of the overpaid, lazy VA management personnel, and puts all of the attention and money back into the system, and brings in more doctors, nurses and technicians, he could make it work."

Anthony Hardie, a Gulf War veteran and board member of Veterans for Common Sense, said, "I think the last thing VA needs is another General or symbolic war hero. What VA needs is a complete Operation Cleansweep. I hope with Bob McDonald's experience catering to stakeholders rather than employees that he will be able to clean house at VA and completely shift its focus. VA needs to be a service-oriented organization that goes above veterans' expectations to serve and help and heal them, rather than continuing to work against so many of the veterans it is supposed to be serving in VA's benefits, healthcare, and research silos."

To retain credibility, Hardie added, "one of the first goals he must achieve is to utterly destroy VA's current culture of delays, denial, and retribution against those who speak up and out." 
One respected veterans' advocate, who asked for anonymity, was in no mood to be diplomatic about the president's pick. 

"Another West Point grad? No VA experience," the advocate said. "Has he used VA medical care? Filed a disability claim? Bought a house using VA? Bought life insurance? Will he clean house? Change VA's slow culture? Work with Congress on full funding? Be transparent? Start Gulf War research for treatments? End the claim appeal disaster: 280,000 appeals waiting 5-10 years? Fire VA's Undersecretary for Benefits Allison Hickey and all her staff? Put veterans first?"

McDonald Supported Mitt Romney

Meanwhile, McDonald represents a rare case in which Obama has reached across the aisle for help. McDonald has supported numerous Republican politicians. Roll Call  reports that he gave $15,000 to the Mitt Romney campaign committees in 2012, and Politico reports that less than a year ago, McDonald made a contribution of $1,000 to House Speaker John Boehner (R-Ohio), who incidentally gave rare support to Obama for choosing McDonald, who is an Ohio native.

“Bob McDonald is a good man, a veteran, and a strong leader with decades of experience in the private sector," Boehner said in a statement. "With those traits, he’s the kind of person who is capable of implementing the kind of dramatic systemic change that is badly needed and long overdue at the VA. But the next VA secretary can only succeed in implementing that type of change if his boss, the president, first commits to doing whatever it takes to give our veterans the world class health care system they deserve by articulating a vision for sweeping reform.”

Rep. Jeff Miller (R-FL), chair of the House Veterans Affairs Committee, has been decrying VA corruption for several years and made it clear that McDonald must do more than previous VA leaders, or things at the agency will not change.

“If confirmed by the Senate, Robert McDonald will inherit a Department of Veterans Affairs under a specter of corruption that may very well surpass anything in the history of American government," Miller said in a statement. He added that McDonald will need to "root out the culture of dishonesty and fraud that has taken hold within the department and is contributing to all of its most pressing challenges. Quite simply, those who created the VA scandal will need to be purged from the system."

But personnel changes at the agency won’t be enough, according to Miller, who said the new VA leader will need to focus on "solving problems instead of downplaying or hiding them, holding employees accountable for mismanagement and negligence that harms veterans, and understanding that taxpayer funded organizations such as VA have a responsibility to provide information to Congress and the public rather than stonewalling them.” 

Paul Rieckhoff, CEO and founder of Iraq and Afghanistan Veterans of America (IAVA), said in a statement that McDonald is "not a name that was on anyone's radar over the last few weeks. His branding background may prove helpful, because there are few organizations in America with a worse reputation with its customers than the VA right now. He's been away from the military for quite a while, and will have to move quickly to show he is committed to and understands the post-9/11 generation of veterans. We look forward to hearing from him soon and working together to support our vets."

Rieckhoff added that as VA secretary, McDonald will need to do a better job reaching out to veterans service organizations (VSO) and other veteran advocates to better connect with the post-9/11 generation of veterans.

"In addition to reforming the VA healthcare system, combating veteran suicide and improving access to mental health care are major priorities for our community," Rieckhoff said. "As the new VA chief, McDonald has the ability to revitalize a broken system and alter the status quo, however without a contemporary background in our community, he will need to reach to VSOs and other leading advocates for vets. The White House did not reach out to VSOs during their search process and we hope they will now."

Robert Rosebrock, a veterans advocate and director of the Old Veterans Guard in Los Angeles, said the president should have chosen someone with hospital experience. 

"Going from a retired four-star general of the Army to a retired corporate executive of Proctor & Gamble indicates the president is rolling the dice again with another has-been of unrelated talent to run the VA," Rosebrock said. "The president should have nominated a currently employed and successful executive at a major hospital like the Mayo Clinic."

Sandy Cook, a retired Army officer and founder of Veterans United for Truth, said that while news reports emphasize "how good McDonald is with leaders, that does not mean he is going to be good with the bureaucratic drones in the VA. It certainly doesn’t mean that he will be good at the bottom of the pile where the veterans live. Generals have proven that they can’t run it. Bureaucrats don’t respond to orders. I am afraid that McDonald will prove that businessmen can’t run it either. Bureaucrats don’t respond to management, they just outlive it."

Cook said he has "little hope that anything great is going to happen soon. They’ll come up with new metrics, and fire a couple of people, and then will tell us, once again' that everything is going swimmingly, and spend most of their time patting each other on the back. McDonald will take credit, Obama will take credit, and Congressmen everywhere will take credit."

But Senate Veterans Affairs Committee Chairman Bernie Sanders (I-Vt) is taking a wait-and-see approach to McDonald.

"The VA needs significantly improved transparency and accountability and it needs an increased number of doctors, nurses and other medical staff so that all eligible veterans get high-quality health care in a timely manner," Sanders said in a statement. "I look forward to meeting with Mr. McDonald next week in order to ascertain his views on these important issues.”

Friday, June 27, 2014

San Diego Chargers 2014 Preview: The NFL's Stealth Bomber Flying Under The Radar

Charger OLB Dwight Freeney is healthy again - 
San Diego is known for its defense contractors such as Northrop Grumman, builders of the legendary aircraft known as the Stealth Bomber, which is designed to penetrate dense defenses and fly undetected. San Diego is also known for its San Diego Chargers, which is similarly designed to penetrate dense defenses and fly undetected. 

Despite a new coach and general manager, a rejuvenated Pro Bowl quarterback, consecutively stellar drafts, shrewd free-agent and in-house signings, an improbable late run last season and a 27-10 playoff road win in January against the Cincinnati Bengals, who hadn't lost at home all season, the Chargers are the Stealth Bomber of the NFL: They're a potentially lethal machine that is flying way under the national media's radar. 

The league's know-it-all pundits aren't saying much about or expecting much from this group. In Sporting News' splashy 228-page season preview, for example, the Chargers aren't even mentioned until page 24, where they're preposterously picked as the 23rd best team in league. Really, Sporting News? If their editors did send a reporter to the Chargers' facility this off-season, that correspondent must have spent more time enjoying his employer's expense account at one or more of the Gaslamp District's finest restaurants than studying the Chargers' workouts or meetings.

If NFL beat writers paid closer attention they'd discover what the Charger faithful already know: this team is ready to fly. If a few key players like outside linebackers Dwight Freeney (above) and Melvin Ingram can stay healthy, the Chargers will contend for the AFC Championship, which was in sight last year before a close but disappointing playoff road loss to the Denver Broncos, a team San Diego dominated in Denver earlier in the season with an impressive ball control offense.

There's every reason to believe the Chargers will be better this season than last, despite a tougher schedule. The virtually unstoppable offense returns all 11 starters and now boasts another veteran running back in Donald Brown. The offense will also benefit from the courageous return of wideout Malcolm Floyd, who nearly broke his neck last year. 

QB Philip Rivers loves beating the Chiefs at Arrowhead -
Even more importantly, the holes in San Diego's defense appear to have been filled (more on that in a minute). That few football sages outside San Diego recognize this is probably just the way general manager Tom Telesco and head coach Mike McCoy want it. Telesco, 40, who last year replaced the pompous A.J. Smith, and McCoy, 41, who last year replaced the hapless Norv Turner, are quietly but steadfastly making this team a contender again.

In other words, let the haters hate and the doubters doubt. Meanwhile, Telesco, who spent 15 years with the Indianapolis Colts in various positions including vice president of football operations, is a smooth and tireless operator who has resided over two superb drafts. Among others, Telesco last year picked Cal wide receiver Keenan Allen, a burgeoning superstar who Sporting News named its NFL Rookie of the Year in 2013. And this year Telesco selected TCU cornerback Jason Verrett, who has the tools to become a difference-making defensive back, which is what San Diego needs.

Telesco is also responsible for such smart free-agent acquisitions as cornerback Brandon Flowers and linebacker Freeney, and for the important re-signings of such key Charger starters as linebacker Donald Butler and offensive guard Chad Rinehart.

Meanwhile, McCoy deploys an effective coaching style that stresses discipline, toughness and accountability but also embraces a family-like environment. The only knock on the stoic first-time head coach is his sometimes dismissive posture with the media. But if he keeps winning, I can live with that. I expect McCoy to have a long and very successful NFL head coaching career. If he could just loosen up and lighten up a bit with reporters, it wouldn't hurt.

Pro Bowl Quarterback Ready for Deeper Playoff Run

The Chargers already had an elite quarterback in Philip Rivers, who as I predicted returned to the Pro Bowl for the fifth time last season after suffering behind arguably the worst offensive line in football for two prior seasons. Last year, that 'O' line was rebuilt, Rivers was given more responsibility, and more short and medium-range passes were plugged into the offensive scheme. The result was a thing of beauty.

Chargers face Bengals in road playoff win in January -
Despite losing Danario Alexander and Floyd, the team's two starting wide receivers, to injuries last season, Rivers shined. Proving his clueless doubters wrong, Rivers led the league in completion percentage, threw for 4,479 yards and 32 touchdowns, and tied a career high with a 105.5 passer rating. As I wrote last December, he easily could have been named the league's Most Valuable Player over Manning. His overall numbers were bested only by Manning's gaudy stats, but Rivers had less to work with.

With a record of 5-7 at one point and seemingly out of the playoff race, Rivers and his team caught fire, winning five in a row. They probably would have beaten the Denver Broncos in the playoffs if they had only a slightly better secondary. Despite playing in that game without workhorse running back Ryan Mathews, who had his best season overall but injured his ankle, Rivers and wide receiver Allen found their rhythm in the second half. The Bolts scored 17 points in the fourth quarter and Bronco fans feared the worst.

San Diego's defense forced two turnovers and held Denver to fewer than than 30 points for the third time last season. But ultimately it came down to a third-and-17 from Denver's 20-yard line with 3:06 left. As ESPN correctly reported, a "miscommunication in coverage" by Charger defensive backs allowed Manning to connect with tight end Julius Thomas on a 21-yard pass. And that was pretty much it.

Final score: Denver 24, San Diego 17.

Confidence Building at Charger Headquarters

Despite that bitterly disappointing loss, Charger players and coaches gained a ton of confidence last season. After the Denver game Charger defensive lineman Corey Liuget, who played all of last season with a torn labrum but is healthy now, told ESPN maturely, “We just have to learn from it. And next year, when we come into this type of environment, we know what we have to do.”

Added cornerback Shareece Wright, “We have high expectations now. We expect a lot from this team, and each player. We're looking forward."

Looking forward, indeed. There's an infectious optimism now at Chargers HQ, and it's not just because of the playoff win. It's also because the team addressed each of its alleged deficiencies. And because they are a much healthier bunch now. Anyone who watched the Chargers last year knows they were just a couple players and a little bit of confidence short of being a championship contender. 

Former Chiefs DB Brandon Flowers is now a Charger -
San Diego's weakest links were the secondary and the pass rush, which of course work in tandem. Bolt defenders gave up the fourth-most passing yards in the NFL last season, and had just 11 pics, which was the fifth-fewest in the league. But the 2014 secondary should be the team's most improved. 

Wright improved his game demonstrably in the last half of the season, and San Diego drafted the speedy and athletic Verrett in the first round. He could be a starter as soon as late September, although Wright will challenge him. It'll be one of the more interesting battles at training camp, which begins July 24.

An Enormous Free Agent Signing This Week

But the biggest news of the Chargers' entire off-season came this week, when the Bolts signed former Kansas City Chiefs' cornerback Flowers to a one-year contract filled with incentives. This is a huge get that should give San Diego what it needs to catch Denver in the AFC West.

Flowers, who's only 28, made the Pro Bowl last season, but the truth is he struggled in the Chiefs' new press-man scheme. However, there's no question he is a talented DB with huge upside and a lot left in the tank. He fits Charger defensive coordinator's scheme much better, and he's charismatic and a little cocky, with a bit of a chip on his shoulder. These are are all things San Diego's ill-defined defensive unit desperately needs. 

The fact that Flowers agreed to a one-year deal is a statement that he knows he has to prove he is worthy of a new long-term contract. Whether he's a slot corner or an outside cover guy, I think Flowers will be all over the field this year. He has the ability and the desire. He'll be a game-changer. 

Pass Rush Will Be Much Improved

As for the Chargers' pass rush, it wasn't pretty last season. In past years SD's outside pass rushers often gave the team an edge over Peyton Manning dating back to when he was with the Colts. But
San Diego tied for 23rd in the league in sacks last season with 35, and had just 10 sacks on third down, which was second worst in the NFL. 

Freeney, for whom the Bolts paid big bucks for a two-year deal, looked good for the first three games, but his season ended in the fourth game when he tore his quad tendon. Freeney is healthy now and itching to show that his career is not done. Charger fans are obviously hoping that Freeney, a class act who is very well liked off the field, lasts more than four games this season.

Freeney is bookended by two other quality outside linebackers who've battled injuries but are good to go: former Baltimore Raven Jarret Johnson, who missed five games for the Chargers last season because of hand and hamstring injuries, and Ingram, who was stalled 16 months ago by a torn anterior cruciate ligament (ACL). He played the last four games last season and is expected to be 100 percent when the Bolts play their first game at Arizona on Monday Night Football, Sept. 8.

The Chargers also drafted an athletic outside linebacker in second-rounder Jerry Attaochu from Georgia Tech, who ate quarterbacks for lunch in college. He'll likely get a fair amount of playing time this season, as well, to keep Freeney, Johnson and Ingram fresh. If the three experienced pass rushers can stay off the disabled list, and rookie Attaochu and the several other linebacker options the Bolts enjoy play as well as expected, this unit will be the team's biggest surprise to those who aren't paying attention.

Is the Charger Defense Catching Up to the Offense?

Overall, San Diego's much-improved D is working to catch up to an offense that is one of the league's best. If the offensive line plays as it did last year, and it should, the Charger offense will be scary good. One of the few football writers who's been writing about this is ESPN's Eric Williams, who recently noted that in off-season workouts, Rivers picked up right where he left off last season. 

"Few balls hit the ground during two-minute drills, as Ladarius Green, Keenan Allen, Malcolm Floyd, Vincent Brown and Eddie Royal made catches all over the field," Williams wrote. "Add to that a diverse group of running backs in Ryan Mathews, Danny Woodhead and Donald Brown in playing behind an experienced offensive line, and the Chargers should have one of the best offenses in the NFL for a second straight season."

Well put, Eric. Despite that astute observation, though, the Chargers aren't getting much love. They aren't mentioned much in discussions of post-season possibilities, let alone potential Super Bowl contenders. Sporting News doesn't even think the Bolts will make the playoffs. But they will. 

If just a few things go right, this team will not only make the playoffs, they'll shock the football world and be the AFC's representative in Super Bowl XLIX in Arizona next February, perhaps against the San Francisco 49ers in a rematch of Super Bowl XXIX in 1995. By then, maybe the Chargers will even show up on the media's radar. Meantime, keep your eyes open for the 2014 San Diego Chargers, pro football's Stealth Bomber.

Tuesday, June 24, 2014

EXCLUSIVE: Drug Sales Top $1 Trillion, Groundbreaking New Cancer Treatments, and Other Bold Predictions for Pharma's Future

What are the most popular prescription drugs in the United States? What will be the five most popular cancer drugs in five years? Which drug companies made the most money last year and which ones will make the most money in the future? A comprehensive evaluation of the national and worldwide markets for prescription drugs apparently has these answers, and more. 

Released on Tuesday, the “World Preview 2014, Outlook to 2020” report is based on market intelligence and consensus forecasts from the gurus at EvaluatePharma, a life science and healthcare firm boasting more than 85 staff analysts. Based on EvaluatePharma’s coverage of "the world’s leading 4,800" drug companies -- are there really that many!? -- the report highlights trends in prescription drug sales and breaks it down by individual therapy as well as region. 

Judging from the predictions, life is evidently good in the pharma and biotech sectors. "This much improved growth outlook comes as welcome news after two years of actual sales stagnation," Paul Hills, report author and Evaluate's head of operations, said in a statement today.
In addition to the generally bullish outlook for pharma and biotechnology, the report offers up some eye-opening predictions, which you can read here. The biggest attention-grabber for me is the projection that for first time in pharma's history, worldwide prescription drug sales will exceed one trillion dollars by 2020. 

It's always a bit chilling to read how much money really changes hands in the pharmaceutical world, and a bit off-putting to witness the accompanying giddiness by industry insiders. Sometimes, I do think they forget why this industry exists.

Don't get me wrong. I'm a capitalist and I support pharma and biotech efforts to make a profit. I'm alive because of a remarkable cancer drug (which tragically no longer exists). But a trillion dollars? Really? That feels like a benchmark the industry should not be touting too boisterously, unless they can accompany that with stats on how many lives they've saved or improved.

How will this trillion dollars translate into greater health for the citizens of the world? Indeed, will it? Is anyone doing a study on that?

But back to the report, which notes that 2013 was the best year ever for new drug approvals, with nine of the top ten forecast to reach "blockbuster status (more than $1 billion sales in the US) five-years post launch." That has to be considered good news for patients. Simple math: more products on the market = more options for patients  and potentially more people being treated.

An entire new generation of drugs are in fact coming to the market, most notably in the cancer sector, and that is also good news for me and my many fellow cancer patients and survivors. But the report only cites some of the cancer drugs currently in development. 

In its report, EvaluatePharma predicts the top five cancer treatments (in terms of sales) worldwide in 2020. I'm not in total agreement with their picks. Lots of variables here. There are so many cancer drugs in clinical trials right now. If only some of them are approved expeditiously by the FDA, marketed smartly by the drug companies, and embraced by oncologists, this can and will tip these predictions. 

For example, new-generation cancer drugs such as Gilead's idelalisib and Pharmacyclinics' ibrutinib, both of which are so-called "inhibitor" treatments showing remarkable promise for patients with lymphoma and other cancers, will certainly change the treatment landscape in the next five years and beyond.

Anyway, here's EvaluatePharma's Top Five cancer drugs for 2020:

1) Avastin - Roche's recombinant humanized monoclonal antibody treats a specific type of brain tumor, and certain types of cancers of the colon, kidney, and lung.

2) Nivolumab - Bristol Myers Squibb's humanized monoclonal antibody treats multiple cancers including renal cell carcinoma, lung cancer and melanoma.

3) Revlimid - Celgene's myeloma drug is now approved for mantle cell lymphoma and is being looked at for non-Hodgkin's and Hodgkin's lymphoma, chronic lymphocytic leukemia, and solid tumor cancers.

4) Rituxan - Roche and Genentech's blockbuster non-Hodgkin's lymphoma drug also treats arthritis.

5) Xtandi - Astellas Pharma's androgen receptor inhibitor  treats prostate cancer.

We'll see how it all shakes out in five years. Overall, the report concludes, the oncology market is expected to expand "by an average 11% per year between 2013 and 2020 and will account for $153.4 billion of global pharmaceutical sales." 

That's all great news for the pharmaceutical industry. But the bottom line for cancer patients, of course, is that all of this will hopefully mean more and better treatment options and a longer and better life. I'm optimistic, but keeping my eyes open wide. 

Tuesday, June 10, 2014

EXCLUSIVE: VA Hospitals Make Hispanic Veterans Wait Longer For Treatment, Says Former VA Doctor

Dr. Steven Coughlin
Dr. Steven Coughlin, the former Department of Veterans Affairs epidemiologist who in 2013 blew the whistle on VA's Office of Public Health for what he described as serious ethical problems with the agency's Gulf War research and more, today accused the department's hospitals of discriminating against Hispanic veterans.

In an email to The Reno Dispatch, Coughlin said that in his review of VA's access audit of medical facilities nationwide conducted May 12, 2014 through June 3, 2014, he discovered that VA healthcare facilities located in cities with sizable Hispanic populations are less likely to have scheduled patient visits within 30 days.

Veterans seeking care at a VA healthcare facility in a city with an Hispanic population of more than 25 percent "are over twice as likely to experience delays in receiving a doctor or clinic appointment," Coughlin told The Reno Dispatch today in an email.

"This violates American concepts of fairness and equality and compounds the injustice of what is clearly already an unacceptable situation," Coughlin wrote. "There may also be ramifications for the possible US Justice Department investigation of VA officials as this can be viewed as a civil rights issue. Thank you for covering this story. What academics normally do is write an article or letter to the editor and submit it to a journal and the publication appears in print in several months to a year or longer. This seems like something that needs to be addressed now."

In a letter sent today to Rep. Jeff Miller (R-FL), who chairs the House Veterans Affairs Committee, and Rep. Mike Coffman (R-CO), Coughlin wrote, "The apparent association with Hispanic ethnicity compounds the injustice of what is clearly already an unjust situation: Veterans experiencing lengthy delays in receiving VA healthcare services, or being placed on secret patient waiting lists. Hispanic patients may be less likely to receive timely referral for healthcare services because of a lack of culturally competent healthcare, because of bias, or because of institutional barriers to their receiving timely, quality healthcare services."

Coughlin, now a director at the Research Center on Health Disparities, Equity, and the Exposome at the University of Tennessee College of Medicine, said VA healthcare facilities located in cities with an Hispanic population of more than 25 percent, according to US Census data, include:

Providence, RI; Bronx, NY; Wilmington, DE; Durham, NC; Miami, FL; San Juan, PR; Orlando, FL; Chicago, IL; Houston, TX; Dallas, TX; San Antonio, TX; Texas Valley Coastal Bend Health Care System (HCS) (Harlington, TX); New Mexico HCS (Albuquerque, NM); Amarillo, TX; Big Spring, TX; Phoenix, AZ; Southern Arizona HCS (Tucson, AZ); El Paso, TX; Denver, CO; Fresno, CA; Las Vegas, NV; Long Beach, CA; San Diego, CA; and Greater Los Angeles HCS (Los Angeles, CA).

Coughlin noted in his letter to members of Congress that in the post-9/11 era, a higher percentage of Hispanics and African-Americans have served in the military as compared to their percentages in the general US population. 

"Minorities are more likely to enlist," he wrote. "Phoenix (which is 40.8% Hispanic according to the 2010 US Census) was ground zero in the scandal involving bogus patient waiting lists and deaths among Veterans seeking care who were placed on those waiting lists. I have not seen anything in VA statements or media reports suggesting that VA healthcare facilities in cities with sizable minority populations are more likely to have long waiting lists or, worse yet, to have had bogus/secret lists, but there have been media reports about problems at VA facilities in New Mexico, Texas, California, Florida, and, of course, Arizona."

Coughlin, who resigned from VA in 2012, told reporters and members of Congress last year that VA withheld research that showed a link between nerve gas and Gulf War Illness and failed to offer care to veterans who identified themselves as suicidal. Several of his charges were substantiated by the department earlier this year.

The VA could not be reached for comment this afternoon.

Friday, June 6, 2014

BREAKING NEWS: At Least Two Veterans at Phoenix VA Did Die Because of Delayed Care

VA Acting Secretary Sloan Gibson  -
While the Department of Veterans' Affairs Inspector General (IG) continues to look into unethical practices at the Phoenix VA, the preliminarily conclusion reached by the IG is that while 1,700 veterans were kept on unofficial wait lists, there is no evidence so far that delays in care led to fatalities.

In a news conference on Friday at Phoenix
VA, the agency's Acting Secretary, Sloan Gibson, said that at least 18 Arizona veterans died while waiting for initial appointments with a doctor. But he added that it is unclear whether any of the deaths was because of a delay in care.

However, The Reno Dispatch has learned that at least two veterans did die because of delayed care at Phoenix VA, according to two wrongful death lawsuits filed against the government that have both been settled for hundreds of thousands of dollars.

Phoenix VA
The court complaint for one of these lawsuits states that Leonard Kitzinger, a Navy veteran in his early 60s, died of a heart attack last November after seeking treatment for chest pain from the Phoenix VA, where he was told he had to wait nearly two months for a basic diagnostic test. He died while waiting for that test, said the complaint.

Kitzinger's widow, Grace Kitzinger, filed the lawsuit in July 2013. Last month, just days after the story of the Phoenix VA's "secret list" of veteran patients was reported by CNN, Treasury Department records show that the government issued a payment of $800,000, according to
a report in the National Law Journal.

The detailed complaint alleges there was negligence by Phoenix VA doctors. In its response to the complaint, the U.S. Attorney in Arizona said Kitzinger's injuries, damages and losses "were not proximately caused by the negligence of any employee of the United States." 

A spokesman for the U.S. Attorney in Phoenix had no further comment.

Brewster Rawls, an attorney at Rawls McNelis & Mitchell who represented Kitzinger's widow in the lawsuit, told The Reno Dispatch that neither he nor Kitzinger would be commenting on the settlement because of the widow's wish for privacy. But an attorney who regularly represents veterans in lawsuits against VA and is familiar with this case said the amount of the settlement means the government did not want to take it to a trial.

"The response from the government is standard boilerplate language," said the attorney, who asked not to be named. "They will always deny any liability and admit no negligence. But there's no way they would ever pay that kind of money if they didn't think they would lose in a trial. They might pay $10,000 or $25,000, but not $800,000, not that kind of money, unless you think you're gonna lose."

While Leonard Kitzinger's attorneys have no evidence that Kitzinger was on the Phoenix VA's notorious secret waiting list, they do assert in the complaint that Kitzinger died because of a delay in care at Phoenix VA. 

According to VA, more than 100,000 veterans were victims of manufactured waiting lists for medical appointments, And treatment delays have already led to deaths at VA hospitals nationwide. 

As USA Today reported last month, 23 veterans died as a result of delays in endoscopy screenings for potential gastrointestinal cancer at VA hospitals in Columbia, S.C.,  Hampton, Va.; Augusta, Ga.; Charleston, S.C.; Miami; West Palm Beach, Fla.; Huntington, W.Va.; Cleveland; Prescott, Ariz.; Tucson; Grand Junction, Colo.; and Iowa City, Iowa.

The Phoenix complaint states that when doctors did an EKG on Kitzinger on November 18, 2011, the result was "severely abnormal," but doctors sent Kitzinger home without any anti-ischemic medications and without a referral to a cardiologists for further follow-up.

The consult request form indicated that Kitzinger would be scheduled for the next available stress test, according to the complaint. However, the complaint said, the appointment was scheduled for January 4, 2012, almost seven weeks later.

Three days later, on Nov. 21, Kitzinger had a heart attack while at work, the complaint said, and four days later Kitzinger's wife made the difficult decision to terminate life-support for her husband. He died seven minutes later.

The complaint said Kitzinger's primary care doctor and the Phoenix VA "deviated from appropriate standards of medical care."

Meanwhile, t
he National Law Journal also reported that in December 2012, the government agreed to pay $600,000 to the wife of a veteran at Phoenix VA who died of liver cancer.

In October 2009, veteran Alphonso Coronado was diagnosed with liver cancer, and he died nine months later, according to the Journal, which noted that the complaint in that case cited actions that “resulted in significant delay in Alphonse Coronado’s care and treatment and more likely than not resulted in his death and/or the loss of a chance at an improved result."

Wednesday, June 4, 2014

EXCLUSIVE: White House Honoree Slams VA, Says Administration's Investigation Barely Scratches the Surface

U.S. troops during Gulf War -
On Wednesday, Sloan Gibson, the acting secretary of Veterans Affairs, announced he will visit the embattled Phoenix VA to discuss immediate actions taken as a result of recommendations outlined in the recent interim Inspector General (IG) report. But Jim Binns, a veterans advocate who was honored by the Obama administration for his service to veterans, said the administration's investigation of the manipulation of wait times may be successful, but an investigation of any other alleged wrongdoing at VA is unlikely to be effective until bigger changes are made at the top management levels of the agency.

In a scathing letter sent on Tuesday to Gibson, White House Deputy Chief of Staff Rob Nabors, who was handpicked by the president to oversee the government's VA investigation, and other officials, Binns said the investigation cannot be entrusted to VA staff or even the IG.

"The Chief of Staff, the Acting Undersecretary for Health, and the Undersecretary for Benefits are themselves directly implicated," wrote Binns, who chairs the Research Advisory Committee on Gulf War Veterans’ Illnesses, which Congress established in 1998 to advise VA on research to improve Gulf War veterans' health. "Like the Gulf War battlefield," he wrote, "VA is a toxic environment."

Binns, who is also an executive, attorney, former Department of Defense policy official and Vietnam veteran, was awarded the Bronze Star for meritorious service. He urged the administration to "look much higher and much deeper than hospital administrators scamming wait times with tragic results."

Jim Binns  -
Binns, who in 2011 was recognized by the Obama administration as a "Champion of Change," said in the letter that for the past two years, VA staff has been engaged in a "backdoor campaign to rig scientific studies and reports in order to revive the discredited 1990’s fiction that nothing special happened" to Gulf War veterans. 

Binns described other VA misdeeds such as slanting research studies, failing to publish critical research results, disseminating false information to the medical community, manipulating even reports of the Institute of Medicine, and failing to conduct Gulf War studies as ordered by Congress.

While multiple reports by his committee and the Institute of Medicine have "conclusively established" that Gulf War Illness is real and not a psychiatric condition, Binns wrote, the 250,000 veterans suffering from this illness "still have no effective treatments. But instead of seeking treatments, VA is quietly trying to revive the stress theory by fabricating science."

Binns told The Reno Dispatch on Wednesday evening that the wait list problems "may get addressed because they have been thoroughly publicized," but added that any acting secretary or secretary "who comes in from the outside and has to rely on the existing career staff has virtually no hope of becoming aware of, let alone solving, the systemic issues" at the agency. 

As CNN and many other news organizations reported last week, IG found in its interim report that at least 1,700 veterans waiting for their first appointment to see a doctor were never even placed on a wait list. A Phoenix resident, Binns has been closely following the developments there. 

"As inexcusable as the revelations here have been, what VA has been doing to Gulf War veterans for twenty years is far worse," he said. "Instead of middle managers lying to senior officials to get bonuses and cover up that veterans aren't getting care, you have senior officials and middle managers lying to Congress, to veterans, and to the medical community, to purposely deny veterans access to care."  

Binns said he was inspired to write the letter by the example of Dr. Sam Foote, the recently retired VA doctor who was the first whistleblower to reveal what was going on in Phoenix.

"It took a long time before the people who could change things finally paid attention to what he was saying," Binns said. "Our committee has been reporting on VA's abuse of Gulf War veterans for a long time, but now there is hope the right people will finally focus on how VA - our government - has been deliberately shafting a quarter of a million men and women who fought for this country." 

Anthony Hardie, a Gulf War veteran and board member of Veterans for Common Sense (VCS) who's testified numerous times before Congress on Gulf War issues, told The Reno Dispatch, "VCS hopes Chairman Binns' letter will help bring new attention to fix yet another area where VA is badly broken: VA's utter failure of veterans of the 1991 Gulf War. For the more then one-third of Gulf War veterans suffering from Gulf War Illness, VA has no effective treatments, no implementation of a plan to develop solutions, no confidence in VA's ability to find treatments, and VA denial of Gulf War veterans' disability claims at an overwhelming rate."

Meanwhile, Binns said that while he has heard back from several House and Senate offices, including those that received copies of the letter, "I have not heard anything from the White House or VA."

Tuesday, June 3, 2014

ELECTION SPECIAL: Lots of Rich Californians Want Your Vote Today

California Gubernatorial candidate Neel Kashkari and his ax
It's election day in eight states, but as usual my eyes are on California, my home state, where the Top-Two primary system gets another tryout. Top Two, which was passed four years ago, allows California voters to ignore political labels, cross party lines and pick whichever candidate they like most. Gee, what a concept.

But perhaps the most interesting thing about today's otherwise garden-variety non-presidential election, whose turnout is expected to be historically low, is that a whole bunch of really rich folks on the ballot are desperately trying to buy their way in. New data released by MapLight, a nonprofit, nonpartisan research organization that addresses money's influence on politics, reveals that 16 candidates on California's ballot have contributed more than $100,000 to their own campaigns. 

Doesn't do much to dispel the notion that Californians are narcissists, does it?

Of these 16 moneyed candidates - 11 Republicans, 5 Democrats - their contributions make up, on average, just over 50 percent of the overall amount raised by their campaigns, according to MapLight numbers, which are based on summaries submitted by candidate committees in Form 460 reports as of May 14.

Republican Neel Kashkari, pictured above wielding his trusty ax, is the biggest of the big spenders. Kashkari - yes, that's appropriately his real name - whose TV ads have been airing non-stop in recent days, contributed $1 million to support his not-so-Quixotic bid to unseat Gov. Jerry Brown and sit in Sacramento's comfiest chair. And he just gave himself another $1 million, post Maplight's analysis, according to the Sacramento Bee.  

It appears to be paying off for Kashkari, a former Goldman Sachs executive and Bush Administration official who looks like a cross between Howie Mandel and Dr. Evil from the Austin Powers movies. He's taken a slim five-percent lead (18 percent to 13 percent) over Tea Party rival and former border vigilante Tim Donnelly in the most recent poll commissioned by the Los Angeles Times and the USC Dornsife school. He trailed Donnelly just a few weeks ago. 

If that poll result holds up today, Kashkari, who says that if elected he will invite more oil companies to drill here, would go into a runoff with Brown, who polled at 50 percent. Now that would make for some lively debates.

Running a distant second in the "I like me" stakes is California Democrat Derek Cressman, who in his pursuit of the Secretary of State gig has spent $353,900 of his own money, according to MapLight. Meanwhile, Assembly candidates Jay Obernolte and Karina Onofre's personal contributions both embarrassingly make up approximately 95 percent of the total amounts taken in by their campaigns, according to MapLight.

But easily the most recognizable big-spending candidate in this primary is Sandra Fluke, the attorney and activist who was unfairly and harshly criticized by many on the right for testifying in favor of requiring employers to cover birth control in their health insurance plans. Rush Limbaugh rudely called her a "slut."

Fluke is among a crowded field of candidates in California's 26th Senate district, which encompasses the Los Angeles area. We'll find out today if her 15 minutes of fame combined with $100,000 from her own deep pockets - who knew? - will lead to success at the polls or prove that she really is a fluke. 

By the way, one of Fluke's opponents in the race, Amy Howorth, also spent more than $100,000 on her own campaign. But as far as I can tell, no one's called her any names.

Monday, June 2, 2014

Generous $25 Million Gift to Salk Institute is Boon For Cancer Research

Philanthropist Conrad T. Prebys  -  SDSU Newscenter
Conrad T. Prebys is at it again. The profoundly generous philanthropist, who over the years has supported countless San Diego organizations, has written a check to the Salk Institute for Biological Studies for $25 million to help find cures for a wide range of diseases. The gift, the single largest ever made to the Salk Institute's endowment, will help researchers at the renowned research facility in La Jolla discover new therapies for cancer and much more.

It will also allow Salk scientists, who are already doing groundbreaking cancer research, to take advantage of new technologies and scientific approaches that are rewriting the rules of biomedical research. And the funds will enable Salk, which of course was founded in 1960 by legendary polio vaccine pioneer Jonas Salk, to recruit more top scientists worldwide.

"The scientists at Salk are diving deep into understanding how our bodies operate at the molecular level and what happens when we get sick," Prebys said in a statement. "It is vital work that must be done before we can really conquer disease. We need this foundational science to lay the underpinnings for new therapies and cures. I'm honored to play a role in supporting this important research."

This level of generosity isn't new to Prebys, who just a few months ago gave $20 million to San Diego State University, my alma mater, to create several endowed scholarships that support at least 150 students annually. In recognition of his gift, the largest one ever made to SDSU, the university’s new student union has appropriately been named the Conrad Prebys Aztec Student Union. 

The SDSU communications office wrote back in February that thanks to Prebys, "SDSU will offer additional scholarships to student veterans and to students in bio-medical research, the creative and performing arts, the Guardian Scholars program, entrepreneurship, leadership and the SDSU Honors program."

Prebys' positive impact on the San Diego community is virtually impossible to measure. He's also supported such San Diego-area organizations as the San Diego Zoo, Boys and Girls Club, Old Globe Theater, La Jolla Music Society, Scripps Mercy Hospital, Scripps Prebys Cardiovascular Center, and Sanford/Burnham Medical Research Institute. 

In honor of Prebys' dedication to Salk, the institute's auditorium, which regularly hosts talks by acclaimed scientists from around the world, will be named the Conrad T. Prebys Auditorium.

Prebys, a native of South Bend, Ind, was raised in a blue-collar neighborhood and encouraged by an inspirational teacher. The first of five brothers to graduate from college, he went on to found Progress Construction Company, a developer of real estate enterprises in California and Texas.

When he was a child, Prebys' brother contracted polio and the family witnessed the power of scientific research to cure disease when Salk developed the first polio vaccine.

Prebys previously gave $2 million to Salk to establish the Conrad T. Prebys Endowed Chair in Vision Research for Tom Albright, one of the Institute's neuroscientists.

"Mr. Prebys is renowned for his remarkable generosity and his vision in boosting San Diego by supporting its pillar institutions," said Salk President Dr. William Brody. "His gift to Salk's unrestricted endowment provides the financial flexibility for Salk to adapt and thrive as technology, science and human needs evolve, leaving a lasting legacy."