State Dept’s Bureau of Neglected Disease – Dengue+Encephalitis, What Help Is There?

— By Domani Spero

She joined the Foreign Service over 20 years ago.  Among her overseas postings were New Delhi, Damascus, Alexandria, Northern Iraq, and Beirut.  In 2009, she opened the new Consulate’s PD shop in Hyderabad.  In 2010, she contracted dengue fever. And encephalitis. She was medevaced to Singapore and spent 10 days at a hospital there.  That was not her only hospital confinement.

In the November 2013 issue of Foreign Service Journal, FSO Juliet Wurr writes:

“Over the next year, first in Hyderabad and then in Washington, D.C., I discovered and then struggled to cope with the repercussions of my illness. My doctor concluded that my now-unreliable memory, constant drowsiness and cognitive impairment were all the result of my encephalitis. I knew that my Foreign Service career had come to an end.”

The CDS describes Dengue (pronounced den’ gee) as a disease caused by any one of four closely related dengue viruses (DENV 1, DENV 2, DENV 3, or DENV 4). The viruses are transmitted to humans by the bite of an infected mosquito. The CDS says that with more than one-third of the world’s population living in areas at risk for transmission, dengue infection is a leading cause of illness and death in the tropics and subtropics. There are reportedly as many as 100 million people infected yearly.   In September this year, the NYT reported about India’s dengue problem.  In October, the Raw Story called it New Delhi’s “mysterious dengue fever epidemic.

Click on image to see an interactive Dengue map of the word.

Click on image to see an interactive Dengue map of the word.

Dengue is an endemic illness in India, the second-most populous country in the world.  Anecdotal reports suggest that the U.S. Embassy in Delhi has about half a dozen dengue cases among mission members this year alone. We’ve requested information on current mission-wide dengue cases and medevaced cases but have not heard anything back.

A separate report in the Indian Critical Care Medicine notes that “Encephalopathy is a very common neurological complication of dengue fever. Dengue encephalopathy is usually secondary to multisystem derangement like shock, hepatitis, coagulopathy, and concurrent bacterial infection.”  Encephalitis is the irritation and swelling of the brain that can be mild and short and results in full recovery. Or it can be severe with permanent impairment or death as a possibility.  For more on encephalitis, see the National Institute of Health.

In an email to this blog, Ms. Wurr writes:

“I think there is a huge gap in what State can do statutorily and what morally they should do.  If employees and the public realized this I think they would be outraged.  I want to do all I can to publicize because there are simple changes they can do that don’t depend on legislation.  I am retiring six years earlier than expected.  State refuses to advocate for me with Department of Labor Workers Comp.  I am receiving no compensation for my $500+ medical bills each month or for wages lost.”

Ms. Wurr said that she had been to the Office of Medical Services and the Bureau of Human Resources, who “were kind and welcoming, but eventually they admitted they had nothing to offer me.” She had also been to the Office of Casualty Assistance twice, and told this blog, “They said there was nothing they could do.”

She had filed a claim at the Labor Department’s Office of Workers’ Compensation Programs last year. It was denied. She had refiled that claim, it was denied for the second time. The reason for the denials, “I could not convince Labor that my illness was caused by being in India as an employee of the Department of State.”

She’s up for a third filing, and has now hired a lawyer.

If this story sounds familiar, it’s because it happened before.

Remember Frank Pressley who was wounded in the East Africa bombing and had filed for permanent disability? The  Office of Workers’ Compensation Programs and the State Department’s Office of Casualty Assistance (OCA) both made the news:

Compensation claims examiners questioned the precise percentage of Pressley’s handicap. Two non-government doctors administered tests and said the arm was 78 percent disabled, permanently. The Office of Workers’ Compensation Programs said it was only 40 percent disabled.

Hoping to minimize runarounds, he contacted Kendall B. Montgomery, director of the State Department’s Office of Casualty Assistance, which was established in 1999 in response to the embassy bombings.

“I get no assistance, no options, no real help,” he e-mailed last summer. “I’m afraid that nothing is going to happen unless I get a lawyer. That would be very sad for me. I trust the system, my country.”

“Frank, I understand — and share — your frustration,” Montgomery told him in a December e-mail. The federal workers’ compensation program “is just not meeting its obligations to you and many others. The system is broken, but there is no will to fix it.”

After The Washington Post inquired about the status of Pressley’s disability compensation, government officials including the State Department’s Office of Casualty Assistance suddenly got their Minute Maid:

The State Department’s Kendall Montgomery vowed she would push for “speedy approval” of medical treatments for injured employees mired in the federal compensation system.

“We’re putting a very high priority on it,” she told The Post while a public affairs official monitored her words. “We’re once again trying to start a new round of discussion between ourselves and the Department of Labor. . . . We do hope they’re fruitful discussions.” 

Soon after, the Department of Labor stopped disputing Mr. Pressley’s claim to a 78 percent disability in his left arm and paid up.

But whatever “fruitful discussions” the State Department conducted with the Department of Labor back in 2002, the result is clear.  We sent email inquiries to the Office of Casualty Assistance (OCA) and the Family Liaison Office (FLO) asking what type of assistance their offices provide to cases like Ms. Wurr’s in ensuring that sick/injured employees mired in the federal compensation system are not stuck there. We also wanted to know more information about the State Department and specifically OCA’s role in advocating for cases before DOL’s Office of Workers’ Compensation Programs.

Today, we received a one-sentence response to our email and a non-response to our questions from Kirk A. Leach, the director of the State Department’s Office of Casualty Assistance.

“The Department is fully supportive of Ms. Wurr’s case and is actively engaged in advocating her position with the Department of Labor’s Office of Worker’s Compensation.”

That’s the same office, who according to Ms. Wurr, gave this response: “They said there was nothing they could do.” After learning of  OCA’s response to our inquiry, Ms. Wurr was surprised.  If they are working on her behalf, she said, “they kept it secret from me.” LOL!

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