Category Archives: MED

State Department on PTSD Workers’ Comp Claims: How Well Is This Working?

– Domani Spero

 

We received a note recently from a reader who is deeply concerned about his/her State Department friend diagnosed with PTSD from an assignment in a war-torncountry. The condition is allegedly aggravated by the lack of understanding on the part of the officer’s superiors who “pressured” the employee to return to another “very stressful/high pressure work duties.”

“My friend was not shot, raped, tortured or maimed by explosive devices. No single, well-defined, event happened. That said, s/he/it now lives a life far more constrained by physiological barriers due to time spent in dangerous climes.”

That got us looking at what resources are available to State Department employees suffering from PTSD.  We found the following information on state.gov.

Employees working in high threat environments such as Afghanistan, Iraq, Pakistan, Libya and Yemen may develop symptoms of Post Traumatic Stress Disorder (PTSD) as a result of their performance of duty.

PTSD may be basis for a workers’ compensation claim under the Federal Employees’ Compensation Act (FECA). The FECA is administered by the U.S. Department of Labor, Office of Workers’ Compensation Programs (OWCP). If an OWCP claim is accepted, benefits may include payment of medical expenses and disability compensation for wage loss.

When an employee develops any mental health symptoms, including symptoms of PTSD, he/she is encouraged to make a confidential appointment with a counselor in the Office of Medical Services (MED)’s Employee Consultation Services (ECS) office. If the initial evaluation indicates symptoms suggestive of PTSD, ECS will refer the employee to MED’s Deployment Stress Management Program (DSMP) for further evaluation. A psychiatrist designated by DSMP will document the initial symptoms for the OWCP claim form (CA-2) and CA-20 (Attending Physician’s Statement). If the employee requires assistance in completing the OWCP claims package, HR’s Office of Casualty Assistance (OCA) will help the employee gather the required documentation, complete the necessary paperwork, and submit the claims package.

OWCP has advised the Department that PTSD claims will be handled expeditiously. PTSD claims from Department employees have been successfully adjudicated by OWCP in the past. The Office of Employee Relations (HR/ER) will remain the point of contact with OWCP. HR/ER will provide consultation, advice and guidance on the OWCP process and on issues regarding the employee’s use of leave (annual, sick, and use of FMLA), disability accommodation options, and benefits. HR/ER will manage the employee’s claim after OWCP receives it and continue in its liaison role with OWCP to meet the employee’s needs.

Some PTSD patients may require treatment by a specialist outside of the Department of State. For such cases, MED/DSMP may refer the employee to an outside provider. MED will cover the initial cost of treatment until OWCP accepts the claim, submitted by the employee through HR, and OWCP will reimburse MED once the claim is accepted. If OWCP does not accept the case as work-related, the employee should submit the medical bills to his/her insurance carrier to reimburse MED for the initial treatment costs. Subsequent treatment costs will be the responsibility of the employee’s health insurance provider.

Throughout this process, the Office of Casualty Assistance (OCA) will assist the employee and his/her family as they adjust to the employee’s medical condition and explore various options affecting their career with the Department. OCA’s role is to assist the employee with paperwork and coordinate with other Department offices as appropriate.

Workers’ Comp Resources: (* = Intranet Website)

DoL Workers’ Compensation Program Website
OWCP Forms: CA-2 CA-2a CA-20 (pdf)
DoL’s Publication CA-801

DoS Office of Casualty Assistance (OCA)* Tel: 202-736-4302
DoS Office of Employee Relations (HR/ER)*

Email: HRWorkersCompensation@state.gov

 

Frankly, the Office of Casualty Assistance (OCA) has not been terribly impressive. So we’d like to know how responsive is OCA at State when it comes to offering assistance to employees with PTSD who had to deal with worker’s comp?

And how well is DOL’s Workers’ Comp program working if you have PTSD?

We must add that while PTSD is typically associated with assignments to high threat environments such as Afghanistan, Iraq, Pakistan, Libya and Yemen, Foreign Service employees and family members are assigned to over 280 posts around the world.  Some of these assignment are to war-torn countries in Africa that are not priority staffing posts like AIP or are in critical crime posts such as some cities in Mexico, the DRC, and several posts in the Western Hemisphere (looking at Honduras, Guate and El Salvador). Studies show that crime events are also associated with high rates of PTSD.   The focus on PTSD and employees in high threat environments in the state.gov information above excludes a long list of critical crime posts and appears to discount, by omission, crime-related PTSD and post-traumatic experience in posts not located in Afghanistan, Iraq, Pakistan, Libya and Yemen.

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EEOC Affirms Class Action Certification For Disabled Applicants to the U.S. Foreign Service

– Domani Spero

 

In October 2010, we blogged that the Equal Employment Opportunity Commission (EEOC) has certified a class action brought on behalf of all disabled Foreign Service applicants against the U.S. State Department.  (see  EEOC certifies class action against State Dept on behalf of disabled Foreign Service applicants).

Related items:

Meyer, et al. v. Clinton (Department of State), EEOC Case No. 570-2008-00018X (September 30, 2010) (certifying class action based upon disability discrimination in State Department’s Foreign Service Officer hiring)

This past June, the EEOC affirmed the class certification for applicants to the Foreign Service denied or delayed in hiring because of their disabilities, based upon the “worldwide availability” policy.  (see Meyer v. Kerry (Dept. of State), EEOC Appeal No. 0720110007 (June 6, 2014)).

The State Department Disability Class Action now has its own website here.  Bryan Schwartz in San Francisco and Passman & Kaplan in Washington represented the class. The State Department’s Office of Legal Advisor and Office of Civil Rights represented the department.

Below is an excerpt from the class action website:

The EEOC decision found that the Class Agent in the matter, Doering Meyer, has had multiple sclerosis (MS) in remission for decades, without need for treatment, but was initially rejected outright for State Department employment anywhere in the world because the Department’s Office of Medical Services perceived that her MS might cause her problems in “a tropical environment.” This was notwithstanding a Board Certified Neurologist’s report approving her to work overseas without limitation.
[...]
The Department challenged the judge’s initial certification decision because, among other reasons, Meyer eventually received a rare “waiver” of the worldwide availability requirement, with her attorney’s assistance, and obtained a Foreign Service post. She is now a tenured Foreign Service Officer, most recently in Croatia, and being posted to Lithuania. Meyer’s attorney argued to the EEOC that she was still delayed in her career growth by the initial denial in 2006, and missed several posting opportunities over the course of an extended period, losing substantial income and seniority. The EEOC agreed with Meyer – modifying the class definition slightly to include not only those denied Foreign Service Posts, but those “whose employment was delayed pending application for and receipt of a waiver, because the State Department deemed them not ‘worldwide available’ due to their disability.”

Schwartz indicated that the case may ultimately have major implications not only for Foreign Service applicants, and not only in the State Department, but for all employees of the federal government abroad who have disabilities, records of disabilities, and perceived disabilities, and who must receive medical clearance through the Department’s Office of Medical Services. He noted that he has already filed other alleged class cases, also pending at the EEOC – one on behalf of applicants for limited term appointments (who need “post-specific” clearance, but are also denied individualized consideration), and another on behalf of employees associated with people with disabilities, who are denied the opportunity to be hired because of their family members who might need reasonable accommodations (or be perceived as disabled).

The Commission had also received an “Amicus Letter” from a consortium of more than 100 disability-related organizations urging the Commission to certify the class.

Read the full ruling at (pdf) Meyer v. Kerry (Dept. of State), EEOC Appeal No. 0720110007 from June 6, 2014 where the State Department contends that since this complaint was filed, the Office of Medical Services has changed many of its procedures in assessing “worldwide availability.”It also suggested that “many of those individuals who were found not worldwide available in 2006 maybe currently worldwide available under new definitions and procedures.”

The Commission, however, says that it “is not finding that changes made to the Medical Clearance process subsequent to the filing of the instant complaint have remedied any alleged discriminatory policy.”  

The order states (pdf): “It is the decision of the Commission to certify the class comprised of “all qualified applicants to the Foreign Service beginning on October 7, 2006, who were denied employment, or whose employment was delayed pending application for and receipt of a waiver, because the State Department deemed them not “world-wide available” due to their disability.”

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State Dept Awards $4.9 Million Contract to Phoenix Air for Air Ambulance Evacuation #Ebola

Domani Spero

 

Yahoo News reported on September 9 that “an undisclosed number of people who’ve been exposed to the Ebola virus — not just the four patients publicly identified with diagnosed cases — have been evacuated to the U.S. by an air ambulance company contracted by the State Department.”  The report identified Phoenix Air Group as the provider of the air ambulance services. The VP of the company said medical privacy laws and his company’s contract with the State Department prevented him from revealing how many exposed patients have been flown from West Africa to the U.S.  He did tell the reported that Phoenix Air has flown 10 Ebola-related missions in the past six weeks. The report also says that the State Department confirmed the four known Ebola patient transports but couldn’t provide details on any exposure evacuations to the United States.  An unnamed State Department official told Yahoo News that “every precaution is taken to move the patient safely and securely, to provide critical care en route, and to maintain strict isolation upon arrival in the United States.”(See Ebola evacuations to US greater than previously known).

Public records indicate that the State Department awarded the air ambulance contract on August 18, 2014.  The sole source contract was awarded to Phoenix Air for a period of six (6) months at an estimated cost of $4,900,000.00 under FAR 6.302-2  for “unusual and compelling urgency.” The services include among others, air ambulance evacuation, a dedicated on-call aircraft and flight crew, an aero-biological containment system, and emergency recall and mission preparedness:

This requirement is in response to Department of State’s diplomatic mission overseas to provide movement of emergency response personnel into and out of hazardous/non-permissive environments and medical evacuation of critically ill/injured patients, including those infected with unique and high contagious pathogens. This is an immediate response to the Ebola Virus Crisis.

The contract justification says that the movement of patients infected with highly contagious pathogens, as with the current Ebola Virus epidemic, requires the use of an air-transportable biocontainment unit. A unit was designed and built by the Center for Disease Control in 2006 in collaboration with the Phoenix Air Group in Cartersville, GA. The Aeromedical Biological Containment Shelter (ABCS) is the only contagious patient airborne transportation system in the world which allows attending medical personnel to enter the containment vessel in-flight to attend to the patient, thus allowing emergency medical intervention such as new IV lines, intubation, etc.

Yes, the Pentagon has a transport tube but –

“The U.S. Department of Defense has a transport “tube” which a patient is placed into, but once sealed inside the patient is isolated from medical care. It is admittedly (by the DOD) more designed for battlefield causalities than live human transport, especially over long distances. It is also only certified for DOD aircraft and not by the FAA for commercial aircraft which makes this capability not feasible in meeting the Department’s urgent need for the capability to transport contagious patients world-wide.”

Why is this a sole-sourced contract?

Below is part of the justification statement extracted from publicly available documents:

As a matter of standard business practice, Phoenix Air Group does not provide chartered transport of highly contagious patients outside of a standing government contract. As the only vendor with this unique capability, Phoenix Air Group has never offered this service on a one-off basis to private of government entities. The capability was developed on a multi-year contract with the CDC (2006-2011). When the CDC could no longer to afford to maintain the stand-by capability, the equipment was warehoused. While it is technically true that the movement of two American citizens in late July, 2014, was a private transaction, those missions were conducted after the Department requested that PAG consider a break in their standard business practice on a humanitarian basis, with the assurance that the USG would make all necessary arrangements for landing clearances, public health integration, decontamination, and provide press guidance. Simply put, the transportation of this type of patient requires too much international and inter-agency coordination, and incurs too much corporate risk, for PAG to provide the service outside the protection of a federal contract to do so.

The U.S. Department of State has always been responsible for the medical evacuation of official Americans overseas, regardless of their USG agency affiliation. Because of the unique severity and scope of the current Ebola outbreak, and the complete lack of host nation infrastructure to support victims of EVD infection, the international community is finding recruitment of professional staff very difficult without being able to articulate a sound medical evacuation plan. To that end, the Governments of Mexico, Japan, the United Kingdom, Canada, and the United Arab Emirates, as well as the World Health Organization and the United Nations, have separately approached PAG to establish exclusive contracts for this limited resource. Had the Department not moved very quickly to establish its own exclusive use contract, our negotiating position would have shifted, placing USG personnel and private citizens at significant risk.

The availability of the PAG resource is thus a foreign policy issue, placing the U.S. Department of State as the logical arbiter of international agreements to assure equitable coverage while protecting U.S. national interests. The Department is moving to establish Title 607 agreements with these and other eligible entities, allowing coordinated sharing of the resource on a cost-reimbursable basis under 22 U SC 2357 authorities.

Private American citizens responding to this crisis would lack the resources to privately contract for this service, even if it were available on the open market. By establishing the contract through the Department, additional options are provided to American Citizen Services, allowing them to structure the funding as a form of repatriation loan. This would be very difficult to do if not for a Department-level contract; by bringing the resource in-house, the money flow remains within the Department, spreading the financial risk across a much larger budgeting pool. Foreign governments are being encouraged to take similar steps with their own private citizens through high level dialogue that is only possible when the Department is in the lead on this issue.

Given recent CDC guidelines for the movement of asymptomatic contacts, an unprecedented level of control and coordination is necessary to move these individuals that, despite not being contagious or even clearly infected, are nonetheless quarantined. The USG is left with only two options in supporting a CDC scientist that has a high risk exposure to an EVD patient — use the PAG capability to fly the person back to the US for observation and optimum care should disease develop, or leave the person in place where no care is available if the disease develops. The question, then, is not how many EVD patients will be moved, but rather how many contacts and EVD patients will be moved across the entire international response population (as many as three per month). Finally, from a pragmatic stand point, given the limited options for movement of even asymptomatic contacts, it has become clear that an international response to this crisis will not proceed if a reliable mechanism for patient movement cannot be established and centrally managed.

The “special missions” G-111 aircraft, what is it?

 The ABCS was certified by the Federal Air Administration (FAA) under a Supplemental Type Certification (STC) for use in an aircraft. The STC further lists only two (2) air- craft by serial number as approved for the installation and operation of the ABCS. Both aircraft are owned and operated by Phoenix Air.

The two aircraft listed by serial number in the STC are “special missions” Gulfstream G-III jets owned and operated by Phoenix Air. There are only three “special missions” G-111 aircraft in the world and Phoenix Air owns and operates all three. These are unique aircraft converted in the Gulfstream Aerospace factory during the original manufacturing assembly line from standard “executive” aircraft to “special missions” aircraft which includes a large cargo door forward of the wing measuring 81.5” wide X 61” high thus allowing the large components of the ABCS to be installed in the aircraft and post-flight decontamination to be performed, each aircraft has a heavy duty cargo floor allowing the ABCS floor attachment system to be installed, and each aircraft is certified at the factory for passenger, cargo or air ambulance operations.

Phoenix Air holds various DOD Civil Aircraft Landing Permits (CALP’s) from all U.S DOD service branches allowing its aircraft to land at all U.S. military bases and facilities worldwide. For security reasons, all medical evacuations of patients with highly contagious pathogens must land at military airfields. Recent experience reinforces the importance of using military airfields, especially OCONUS where the host nation governments have refused to allow the aircraft access to civil airports in the Azores, but have conceded to allow the aircraft to refuel on USMIL airfields in their country.

All Phoenix Air flight and medical personnel have the Commission on Accreditation of Medical Transport Systems (CAMTS) required accreditation and CDC recommended inoculations for air ambulance missions as well as missions into disease~prone areas around the world providing DOS a unique capability that may not be available with other aviation vendors.

 

Unlike the outbreak of the highly pathogenic avian influenza (H5N1) virus and fears of a pandemic in 2007, one thing we haven’t heard this time is  “shelter-in-place.” Back then, Americans abroad were advised to identify local sources of healthcare and prepare to “shelter-in-place” if necessary. “In those areas with potentially limited water and food availability, Americans living abroad are encouraged to maintain supplies of food and water to last at least two and as long as 12 weeks.” We remember thinking then about the embassy swimming pool and wondering how long it would last if city water runs out. Or what happens if a mob comes into the compound in search of food and water.

That does not seem to be the case here. At least, this time, there will be an air ambulance equipped to evacuate  Americans back home should it come to that. Note that the  justification statement does not include details of how much of the cost will be accounted for as part of the repatriation loan program (pdf) for private Americans.

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Freaking out over the disease that’s “coming for us”? Watch this!

 

 

 

 

 

 

 

 

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U.S. Embassy Dakar Issues Security Message on Ebola Virus Disease (EVD) in Senegal

– Domani Spero

 

Today, the U.S. Embassy in Dakar issued a security message to U.S. citizens in Senegal concerning the country’s first confirmed case of Ebola Virus Disease (EVD):

On August 29, the Senegalese Minister of Health and Social Action (MOH) announced the country’s first confirmed case of EVD.  At a press conference, the MOH reported that Guinean authorities reached out to Senegalese authorities to advise them about a young Guinean student who is confirmed to have the virus.  The student is currently placed in isolation at a local hospital and is in stable condition.  At this time, there are no other confirmed cases in Senegal. The Department of State is working with the government of Senegal, the World Health Organization (WHO), and the Centers for Disease Control and Prevention (CDC) to monitor the situation.

 

On August 21, the government of Senegal has closed its borders with Guinea. It has also closed air and sea borders for aircraft and ships from Guinea, Sierra Leone, and Liberia.

The State Department has previously issued travel warnings for two countries in the region - Liberia and Sierra Leone- and warned U.S. citizens against non-essential travel to these countries. Due to the lack of available medical resources in these countries and limited availability of medical evacuation options, the U.S. Department of State ordered the departure of family members residing with Embassy staff in Monrovia and in Freetown. (see U.S. Embassy Sierra Leone Now on Ordered Departure for Family Members #Ebola and U.S. Embassy Liberia Now on Ordered Departure For Family Members, New Travel Warning Issued).

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State Dept Issues Travel Alert on Ebola-Related Screening and Travel Restrictions in West Africa

– Domani Spero

 

On August 28, the State Department issued a Travel Alert for screening and restrictions related to the Ebola outbreak in parts of West Africa:

The Department of State alerts U.S. citizens to screening procedures, travel restrictions, and reduced aviation transportation options in response to the outbreak of Ebola Virus Disease in Guinea, Liberia, Nigeria, and Sierra Leone.   This Travel Alert will expire on February 27, 2015.

Due to an outbreak of Ebola Virus Disease (EVD) in the West African nations of Liberia, Guinea, and Sierra Leone, the Centers for Disease Control and Prevention (CDC) issued  Level 3 Travel Warnings for those three countries advising against non-essential travel and provided guidance to reduce the potential for spread of EVD.  The CDC also issued a Level 2 Travel Alert for Nigeria to notify travelers of the Ebola outbreak in that country.  The Bureau of Consular Affairs’ website prominently features an Ebola Fact Sheet and links to the CDC Health Travel Warnings, Travel Alert, and general guidance about Ebola.

The World Health Organization (WHO) and CDC have also published and provided interim guidance to public health authorities, airlines, and other partners in West Africa for evaluating risk of exposure of persons coming from countries affected by EVD.  Measures can include screening, medical evaluation, movement restrictions up to 21 days, and infection control precautions.  Travelers who exhibit symptoms indicative of possible Ebola infection may be prevented from boarding and restricted from traveling for the 21-day period.  Please note neither the Department of State’s Bureau of Consular Affairs nor the U.S. Embassy have authority over quarantine issues and cannot prevent a U.S. citizen from being quarantined should local health authorities require it.  For questions about quarantine, please visit the CDC website that addresses quarantine and isolation issues.

The cost for a medical evacuation is very expensive.  We encourage U.S. citizens travelling to Ebola-affected countries to purchase travel insurance that includes medical evacuation for Ebola Virus Disease (EVD).  Policy holders should confirm the availability of medical care and evacuation services at their travel destinations prior to travel.

Some local, regional, and international air carriers have curtailed or temporarily suspended service to or from Ebola-affected countries.  U.S. citizens planning travel to or from these countries, in accordance with the CDC Health Travel Warnings and Health Travel Alert, should contact their airline to verify seat availability, confirm departure schedules, inquire about screening procedures, and be aware of other airline options.

The Department is aware that some countries have put in place procedures relating to the travel of individuals from the affected countries, including complete travel bans.  Changes to existing procedures may occur with little or no notice.  Please consult your airline or the embassy of your destination country for additional information.

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According to the WHO’s Outbreak News, the total number of probable and confirmed cases in the current outbreak of Ebola virus disease (EVD) as reported by the respective Ministries of Health of Guinea, Liberia, Nigeria, and Sierra Leone is 3069, with 1552 deaths.  The World Health Organization reports that the outbreak continues to accelerate with more than 40% of the total number of cases occurring within the past 21 days.  The overall case fatality rate is 52%.

A separate outbreak of Ebola virus disease not related to the four-country outbreak was laboratory-confirmed on  August 26 by the Democratic Republic of Congo (DRC). The DRC’s index case was a pregnant woman from a village who butchered a bush animal that had been killed and given to her by her husband. From July 28- August 18, 2014, a total of 24 suspected cases of haemorrhagic fever, including 13 deaths, have been identified in that outbreak.

As of this writing, Senegal also confirmed its first case of Ebola related to the four-country outbreak in West Africa.

 

 

 

 

 

 

 

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U.S. Embassy Sierra Leone Now on Ordered Departure for Family Members #Ebola

– Domani Spero

 

On August 14, the State Department  announced the ordered departure of family members not employed at U.S. Embassy Freetown from Sierra Leone. This follows the ordered departure of family members from U.S. Embassy Liberia on August 7. No Travel Warning has yet been issued for Sierra Leone as of this writing but we expect one coming out soon. Below is the statement of the U.S. Embassy Freetown ordered departure:

At the recommendation of the U.S. Embassy in Sierra Leone, the State Department today ordered the departure from Freetown of all eligible family members (EFMs) not employed by post. The Embassy recommended this step out of an abundance of caution, following the determination by the Department’s Medical Office that there is a lack of options for routine health care services at major medical facilities due to the Ebola outbreak.

We are reconfiguring the Embassy staff to be more responsive to the current situation. Our entire effort is currently focused on assisting U.S. citizens in the country, the Government of Sierra Leone, international health organizations, local non-governmental organizations (NGOs), and the Sierra Leonean people to deal with this unprecedented Ebola outbreak.

We remain deeply committed to supporting Sierra Leone and regional and international efforts to strengthen the capacity of the country’s health care infrastructure and system — specifically, the capacity to contain and control the transmission of the Ebola virus, and deliver health care.

According to the World Health Organization, a total of 128 new cases of Ebola virus disease (EVD) (laboratory-confirmed, probable, and suspect cases) as well as 56 deaths were reported from Guinea, Liberia, Nigeria, and Sierra Leone between August 10-11, 2014. See the disease update from the WHO:

via WHO

via WHO

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U.S. Embassy Liberia Now on Ordered Departure For Family Members, New Travel Warning Issued

– Domani Spero

 

On August 7, the State Department ordered the departure of all family members not employed at the U.S. Embassy in Monrovia, Liberia.  The new Travel Warning issued today says that the U.S. government employees in Liberia will remain on active duty at the Embassy and additional staff are being deployed to assist the Government of Liberia in addressing the Ebola Virus Disease outbreak.  This follows the departure of  the U.S. Peace Corps from Liberia on July 30 as a result of the current outbreak of Ebola Virus Disease in the region. Yesterday, the CDC also issued a Level 3 warning urging all US residents to avoid nonessential travel to Sierra Leone, Guinea, and Liberia.  

Full State Department statement below:

At the recommendation of the U.S. Embassy in Liberia, the State Department today ordered the departure from Monrovia of all eligible family members (EFMs) not employed by post in the coming days. The Embassy recommended this step out of an abundance of caution, following the determination by the Department’s Medical Office that there is a lack of options for routine health care services at major medical facilities due to the Ebola outbreak. We are reconfiguring the Embassy staff to be more responsive to the current situation. Our entire effort is currently focused on assisting U.S. citizens in the country, the Government of Liberia, international health organizations, local non-governmental organizations (NGOs), and the Liberian people to deal with this unprecedented Ebola outbreak.

We remain deeply committed to supporting Liberia and regional and international efforts to strengthen the capacity of the Liberian health care infrastructure and system – specifically, their capacity to contain and control the transmission of the Ebola virus, and deliver health care. Additional staff from various government agencies including 12 disease prevention specialists from the Centers for Disease Control and Prevention and a 13-member Disaster Assistance Response Team from USAID are deploying to Liberia to assist the Liberian Government in addressing the Ebola outbreak.

A new Travel Warning for Liberia also came out today indicating that the ordered departure of USG family members will begin tomorrow, August 8. The new warning also advised travelers that some airlines have discontinued service and flights to Liberia and that air carriers chartered by medical evacuation insurance companies may not be able to provide timely services in Liberia or the region. Excerpt below:

In May 2014, a case of Ebola Virus Disease (EVD) was confirmed in Liberia, marking the first case in a second wave of the EVD outbreak. Since then, EVD has continued to spread and intensify. The latest wave of the outbreak has overwhelmed Liberia’s health system and most health facilities lack sufficient staff or resources to address the continuing transmission of EVD.  Options for obtaining routine medical care are severely limited.  For more information concerning EVD, please visit the Centers for Disease Control and Prevention website.  Please direct inquiries regarding U.S. citizens in Liberia to EbolaEmergencyUSC@state.gov. Callers in the United States and Canada may dial the toll free number 1-888-407-4747.  Callers outside the United States and Canada may dial 1-202-501-4444.

If you arrive in Liberia and subsequently need routine or emergency medical care, you should expect limited, if any, options.  Travelers are advised that air carriers chartered by medical evacuation insurance companies may not be able to provide timely services in Liberia or the region.  Policyholders should confirm the availability of medical evacuation services prior to travel.  While commercial flights are still available from Monrovia, some airlines have discontinued service and flights may become more difficult to obtain.  If you plan to visit Liberia despite this warning, you should purchase travel insurance that includes medical evacuation, and confirm that the coverage applies to the circumstances in Liberia.

According to USAID , the deployed staff came from the Agency’s Office of U.S. Foreign Disaster Assistance (OFDA)  and will be overseeing critical areas of the response, such as planning, operations, logistics in coordination with other federal agencies, including the U.S. Departments of Defense and Health and Human Services. Members of the Centers for Disease Control and Prevention (CDC) are also on the DART to lead on public health and medical response activities.

USAID has already provided $2.1 million to the UN World Health Organization and UNICEF for the deployment of more than 30 technical experts and other Ebola response efforts.

Two days ago, USAID also announced an additional $5 million in assistance to help ramp up the international community’s Ebola response efforts. This new funding will support outreach campaigns via radio, text messages, and through local media as well as the expansion of Ebola outbreak programs the Agency is already supporting in Guinea, Sierra Leone, and Liberia. These programs help trace people who may be infected with the disease, as well as provide health clinics and households with hygiene kits, soap, bleach, gloves, masks, and other supplies to help prevent the spread of disease.

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U.S. Embassy Bolivia: A Post Far From Heaven, Read the Fine Details in the Classified OIG Annex!

– Domani Spero

 

Which regional bureau recalled one post’s top two officials prior to the arrival of the OIG inspectors?
Burn Bag, March 23, 2014

 

According to the OIG report on the US Embassy in La Paz, Bolivia released on July 17, just before the OIG inspection conducted in February and March 2014, the State Department “recalled the chargé and the political/economic section chief who served as acting DCM from August 2012 to September 2013 and took steps to mitigate some of the embassy’s leadership problems.”

How do you recall the embassy’s top two officials? Very quietly, presumably.  There were no public announcements or statements.  There have been some pretty awful embassies with leadership problems but we have seldom heard the recall of both the number #1 and #2 at the same time. So, what happened?

This OIG report has a classified annex which includes supplemental narrative and recommendations.  This is not the first time that a report has a classified annex but this is one of the few we can recall since the OIG stopped issuing the Inspector’s Evaluation Reports for senior embassy officials.  So now, all the bad stuff is just dumped in the classified annex of the report where the OIG says that “Portions of context, leadership, resource management, Equal Employment Opportunity, and quality of life in the annex should be read in conjunction with this report.” We have no access to the annex and of course, only State Department insiders who theoretically, have a “need to know” can access the classified material.

via US Embassy La Paz/FB

via US Embassy La Paz/FB

Here is what the publicly available, sanitized report on US Embassy Bolivia says on Leadership:

The former chargé interacted with senior government officials more often and more effectively than the hostile environment might have suggested. He expanded his personal engagement with the local media. He negotiated an unexpected $2.4-million reimbursement of value-added taxes. Also, he initiated development of an updated mission vision that called for expanded outreach to the Bolivian people and greater focus on cultural programs and English-language training.

Despite these and other successes, nearly all American staff members told the OIG team that they did not understand mission priorities or their part in achieving goals. The OIG team frequently heard staff tell of instructions given one day only to have the former front office forget or reverse them the next. Skepticism about public diplomacy programming one month could be replaced by front office enthusiasm for a cultural project the next. Reporting officers, already in a difficult environment for contact development and reporting, stated that the front office did little to direct reporting or provide training and mentoring. Embassy staff members told the OIG team they wanted clear and steady guidance from the front office but did not receive it.

Is that not enough to get two senior officials recalled?

On Resource Management:

Although the 2013 annual chief of mission statement of assurances identified no significant management control deficiencies, many of the vulnerabilities discussed in this report would have been apparent if embassy leadership had conducted a thorough review of management controls prior to submitting the chief of mission statement.

On Equal Employment Opportunity:

Within the past year, the EEO counselors handled more than 10 inquiries, many involving gender bias or sexual harassment.

On Quality of Life:

The Health Unit  ” handled eight medical evacuations of U.S. personnel within the past year and provides ongoing support to mission personnel for altitude-related ailments.”

 

Well, what do you think?  The report’s key judgments, are pretty well, bland; no one ran off to a new job in Tripoli or Sana’a. And man, whose fault was it that La Paz was assigned a cadre of inexperienced officers?

  • Embassy La Paz lacked the strong, consistent leadership and the sustained attention from Washington that it needed to manage a complicated bilateral relationship and had a relatively inexperienced officer cadre and a locally employed staff emerging from a reduction in force.
  • The embassy registered several impressive successes despite a drastic reduction in programs and work force in response to the Bolivian Government’s expulsion of the U.S. Agency for International Development and the Department of State’s decision to end all U.S. counternarcotics programs.
  • The embassy needs a clearly defined mission strategy.
  • The management section has a number of potential management control vulnerabilities related to record keeping and funds control. It is still coping with 2013’s major reduction in force of locally employed staff and an almost 50-percent reduction in the embassy’s services budget.

According to the OIG report, as of January 2014, the embassy had a total staff of 310, slightly more than one-third of 2008 numbers. The U.S. Embassy in La Paz has not been a typical embassy operation since 2008. In September that year, Bolivia expelled Ambassador Philip S. Goldberg (now ambassador to the Philippines). Shortly thereafter, the Drug Enforcement Administration and the Peace Corps suspended their operations in the country. In May 2013, Bolivia expelled USAID and the USG subsequently also shut down all International Narcotics and Law Enforcement (INL) programs in the country.   The OIG inspectors conclude that the US-Bolivia relationship is “unlikely to normalize soon.” Below are some additional details extracted from the publicly available report:

La Paz, A Post Far From Heaven

  • The Bureau of Western Hemisphere Affairs (WHA) paid sporadic attention to embassy operations.
  • Since 2008, WHA used a series of deputy chiefs of mission (DCM) as chargé d’affaires and after July 2012 detailed section heads (first from the political/economic section, then from public affairs, and just before the inspection from the management section) to serve as acting DCM for extended periods. The Department also decided not to assign a permanent office management specialist for the chief of mission, and the front office relied on office management specialists from other sections for months at a time. [...] The effects of these stopgap measures were threefold. First, they required officers to serve as acting DCM for extended periods without appropriate training. Second, they took seasoned leaders out of embassy sections, leaving those sections in the hands of usually capable—but inexperienced—deputies. The deputies rose to the challenge, but they did not receive adequate guidance or leadership from their former supervisors. Productivity and morale suffered.

Love Letters Written, Never Sent

  • The political/economic section staff is frustrated and discouraged, primarily because of lack of front office policy direction, as well as poor communication, organization, and training within the section. Given the deteriorating political environment and unclear policy guidance from both the front office and the Department, the section had an opportunity to devise and drive a revised policy and action agenda, but did not do so. [...] The OIG team reviewed a number of substantive and useful report drafts prepared by officers and local employees that were never sent, usually because the former section chief dismissed them without working with the drafter to improve the texts. This wasted effort caused significant staff frustration.

Tearing Your Hair, Learning on the Job

  • The public affairs section does not have enough experienced grants officers. Only one person in the section, a FAST officer, had a grants warrant as of February 2014. From June through August 2013, in the absence of any public affairs section grants officer, two political/economic FAST officers signed about 100 public diplomacy grants, about which they knew little.

Not Leading By Example – Managing From Desk Via Email

  • The consular section is a small operation, processing fewer than 20,000 nonimmigrant visas, approximately 800 immigrant visas, and about 1,600 passport applications in 2013. The section chief manages from her desk and via email. This remote management style is not appropriate for the size of the operation and has a negative impact on section morale and operations.
  • The consular section chief only adjudicates high-profile or referral visa cases. Recent guidance in 13 STATE 153746 reminded consular managers that they are expected to do some interviewing themselves. The section chief’s lack of hands-on participation contributes to longer hours that the more junior employees have to spend interviewing, and remoteness from actual processing undermines her credibility as an expert. It also reduces the opportunities for management to train new personnel and to identify potential interview technique and workflow efficiencies.
  • Neither the former chargé d’affaires nor the former acting DCM reviewed the 65 cases that the consular chief handled in the past year. Failure to review the required 10 percent of visa approvals and 20 percent of refusals, per 9 FAM 41.113 PN 17 and 9 FAM 41.121 N2.3-7, leads to lack of consistency in visa issuance and refusal. Adjudication reviews are also a vital management control to prevent malfeasance.

FSN Evaluations and Health Plans

  • The human resources office memo also listed 11 locally employed staff whose performance evaluations were between 21 and 242 days late. Locally employed staff members cannot qualify for in-grade salary increases if their performance reviews are not current.
  • Although the embassy participates in the local social security retirement plan, it does not participate in the local social security health program. Instead, the embassy provides a private health plan for locally employed staff. When locally employed staff members retire, most of the social security health plans are unwilling to accept them because they have not been longstanding contributors. The retirees are left with diminished health insurance coverage for their retirement years.

Allowances Paid on Outdated Info

  • The Department of State Standardized Regulation 072.12 requires that the hardship differential report, consumables allowance report, and cost-of-living survey be submitted every 2 years. All these reports are late. The embassy is paying allowances based on outdated information.

Power Outages with No Fully Functional UPS. For 3 Years!

  • The embassy’s centralized uninterruptible power system is in disrepair and has not been fully functional for the past 3 years. As a result, the chancery building experiences frequent power outages caused by the instability of the local power infrastructure. The power outages have caused permanent damage to the server room and disrupted the network infrastructure.

 

Just before the inspection, the WHA bureau and the Bureau of Human Resources apparently agreed that, because a permanent ambassador is not likely in the foreseeable future, the Department would assign a permanent chargé d’affaires and a permanent DCM in La Paz. It only took them about five years to make up their minds.

Peter Brennan was appointed chargé d’affaires of the U.S. Embassy in La Paz in June 2014. Prior to his appointment in Bolivia, he was Minister-Counselor for Communications and Public Affairs at the U.S. Embassy in Islamabad, Pakistan.  It does not look like post now has a permanent DCM as Public Affairs Officer, Aruna Amirthanayagam, who was acting chargé is now Acting DCM.

The inspection took place in Washington, DC, between January 6 and February 4, 2014, and in La Paz, Bolivia, between March 5 and 20, 2014. Ambassador Gene Christy (team leader), Thomas Allsbury, Laurent Charbonnet, Eric Chavera, Leo Hession, Tracey Keiter, Keith Powell, Ashea Riley, Richard Sypher, Alexandra Vega, Roman Zawada, and Barbara Zigli conducted the inspection.

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Related item:

-07/31/14   Inspection of Embassy La Paz, Bolivia (ISP-I-14-16A)  [595 Kb]  Posted on July 17, 2014

 

 

 

 

 

 

 

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Burn Bag: One RMO/P’s ‘just need a man’ prescription

Via Burn Bag:

“When I finally saw the Regional Medical Officer/Psychiatrist (RMO/P) for help, I was told I just needed a man to make me happy.”

Via reactiongifs

Via reactiongifs

 

 

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