Tag Archives: SNEA

State/MED: Kathy Gallardo No Longer Deputy Chief Medical Officer For Mental Health Programs

September 20, 2019 By in Controversies, Foreign Service, MEDical, Org Life, Realities of the FS, State Department, U.S. Missions Tags: , , , , , , ,

 

We understand that as of this week, Dr. Kathy Gallardo is no longer the State Department’s Deputy Chief Medical Officer – Mental Health Programs (MED/MH Director) at the Bureau of Medical Services (State/MED). Unconfirmed reports that she will be taking an overseas posting, post unknown as of this writing.

Dr. Charles Lilly will reportedly serve in an acting capacity  until a replacement is identified. We could not locate any bio for Dr. Lilly. Also for some reason, none of the employees under the Directorate for Mental Health Programs (MED/MH) are listed on DOS directory. The Bureau of Medical Services (MED) web page on state.gov is also pretty sparse; the only individual identified on its leadership page is Chief Medical Officer Dr. Mark Cohen.  

Via FSJ:

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Under Secretary Bulatao on Enhancing Support for Employees with Children with Special Needs

June 30, 2019 By in Allowances, Foreign Service, Org Life, Realities of the FS, State Department, Top Ranks Tags: , , , , , ,

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According to State/OIG which is conducting a review of the State Department’s Special Needs Education Allowance (SNEA), “By law, for employees serving in foreign areas, the Department must provide a Special Needs Education Allowance (SNEA) for children who meet the requirements of the Individuals With Disabilities Education Improvement Act.”]

Also from state.gov’s FAQ on SNEA:

Is the State Department required to meet the requirements of the Individuals with Disabilities Education Improvement Act (IDEIA) with regard to the education of special needs children overseas? If so, how does it do that?

No. The Individuals with Disabilities Education Act (IDEA) and its 2004 reauthorization, the Individuals with Disabilities Education Improvement Act (IDEIA), are federal funding laws ensuring a free and appropriate education to children with disabilities in the United States. IDEA/IDEIA governs how states and public agencies provide early intervention, special education and related services to eligible children and youth. While existing law does not require DOS to replicate what a public school would provide to a student in the United States, our goal is to approximate what a child would receive in a good US public school system. Per the Overseas Differentials and Allowances Act and the Department of State Standard Regulations (DSSR), the IDEA/IDEIA framework is the basis for the allowable reimbursable services for the Special Needs Education Allowance (SNEA). DOS is committed to assisting employees in meeting the necessary expenses incurred when deployed overseas in providing adequate education for their school-age children. The education allowances are designed to assist parents in defraying those costs necessary to obtain educational services which are ordinarily provided free of charge by public schools in the United States.

In 2018,  a group representing employees with special needs children warned that the State Department Bureau of Medical Services was taking “deleterious actions” to restrict funding access for benefits the department is required to offer under U.S. disability law according to reporting from FP. Some internal battles with MED made it to the public sphere but there were a lot more stories that stayed under wraps out of fear of retaliation, or in at least one case we are aware of, due to an expressed threat from MED. More recently, there was reportedly a no-confidence letter related to a specific MED official, circulated and signed by Foreign Service employees and family members.

Last Friday. the new Under Secretary For Management Brian Bulatao issued new guidance on SNEA.

I am pleased to announce the Department has begun to implement a series of revisions and clarifications to policies and procedures that improve how we support our families who have children with special educational needs. These reforms are the result of a review by a Department-wide working group convened last fall by Deputy Under Secretary Bill Todd.  

Key Points: 

·         A new FAM section for the Special Needs Education Allowance has just been published. It will be updated over the next few months as we implement additional reforms. 

·         Guidance in this FAM chapter includes revisions to where a service can be provided. 

·         Separately, the Summer 2020 bid cycle will include changes to simplify bidding for employees with children with Class Two medical clearances. 

New FAM Section:  Overseas educational support is governed by DSSR 270 and 5 U.S.C. 5924 (4), which are complex interagency regulations. We have just published a new FAM section – 3 FAM 3280 –  to ensure that these regulations, especially those pertaining to the Special Needs Education Allowance (SNEA), are interpreted consistently and to make clear the intent of SNEA. Additional changes are in interagency clearance, and any resulting changes would be added to the appropriate FAM section(s) and announced via ALDAC and Department Notice. 

The new FAM makes clear the Department’s policy intent regarding SNEA: 

By assisting employees with the fulfillment of the educational needs of their children, SNEA encourages employees who have children with special educational needs to bid on and serve in foreign assignments. It is in the Department’s interest to take care of its employees and maximize their ability to serve in foreign assignments.

International schools vary in their ability to match the support structure, special education environment, or services found in U.S. public schools. For this reason, the Department should authorize SNEA as flexibly as possible in order to accommodate the unique and often challenging circumstances of overseas operating environments and foreign-area assignments.

Implementation guidance for the new FAM section and bidding rules will be sent separately. 

I am excited about these changes. We have an obligation to equip and engage our team to meet mission needs. Providing support to our people so they can get the job done is the best way to ensure we deliver on the Department’s goals.  

AFSA has reportedly reviewed and commented on the new FAM guidance. 

The SNEA issue and problems with MED should have been resolved soonest instead of being allowed to linger this long. We are pleased to see that Under Secretary Bulatao addressed this issue soon after he assumed charge as “M.”

John Naland, the President of the Foreign Service Youth Foundation said that “These are important reforms towards creating a transparent program that rests on a solid interpretation and consistent application of law and regulations to allow Foreign Service parents of children with special educational needs to take care of their families while simultaneously fulfilling their overseas service obligations as Foreign Service members.”

Now, we’ll have to watch and see what MED is going to do about this.

Below is an excerpt from 3 FAM 3285  which spells out in ints entirety the Department policy

(CT:PER-949;   06-27-2019)
(State)
(Applies to Foreign Service & Civil Service Employees)

a. The purpose of SNEA is to assist employees serving at posts abroad with obtaining for their children with special educational needs special early intervention, kindergarten, elementary, and secondary educational services, including such educational services as are provided in the United States under the Individuals with Disabilities Education Improvement Act, that public schools in the United States ordinarily provide without charge.

b. By assisting employees with the fulfillment of the educational needs of their children, SNEA encourages employees who have children with special educational needs to bid on and serve in foreign assignments.  It is in the Department’s interest to maximize employees’ ability to serve in foreign assignments. 

c.  International schools vary in their ability to match the support structure, special education environment, or services found in U.S. public schools.  For this reason, the Department should authorize SNEA as flexibly as possible in order to accommodate the unique and often challenging circumstances of overseas operating environments and foreign-area assignments.

d.  Ideally, special education services should be provided in a school setting as part of a child’s educational curriculum.  However, recognizing that educating children with disabilities in overseas settings often involves unique challenges, in circumstances when special education services cannot be provided directly in a school setting but are available as services offered outside school or school hours, or via the internet (e.g., online speech therapy), SNEA will cover special educational services required by the child’s IEP or equivalent which are provided outside of school and/or outside normal school hours, when consistent with the DSSR.  SNEA reimbursements may be made directly to employees who have used their personal funds for these services.  Parents may not be reimbursed for special therapeutic services that they personally provide, although, in accordance with DSSR regulations, they may be reimbursed for eligible Home Schooling expenses.

e.  Because most children of Department of State employees would be enrolled in one of the school districts of Washington, DC, Virginia, or Maryland if their employee parent were assigned domestically, school districts in these areas will generally be the point of reference when determining what special educational services are “ordinarily provided without charge by public schools in the United States.” Within this context, services named in a child’s IEP, or equivalent document, may be eligible to be covered by SNEA.

f.  SNEA is an education allowance. It is subject to other applicable legal authorities and policies that govern education allowances in general.

Read the whole thing here.

 

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FSGB finds no merit in argument that @StateDept has “unfettered discretion” to grant or deny SNEA benefit

May 8, 2019 By in Allowances, Foreign Service, Grievance, MEDical, Realities of the FS, State Department Tags: , , , ,

Via FSGB Case No. 2018-016:

“The Department next argues that its granting a SNEA under section 5924 is “discretionary,” and in any event must be paid in accordance with the DSSRs. As we have previously stated, the prior authorization the grievants sought, for reimbursement after their arrival at post, is fully consistent with the DSSRs. Further, we find no merit to the argument that the Department has unfettered discretion under section 5924 to grant or deny a SNEA benefit to employees in any way it may see fit. Rather, law and regulation must limit its discretion.”

Via giphy.com

FSJ: MED’s Focus on Clearances and Restricting Access to SNEA #NotSupportForFamilies

September 24, 2018 By in Foreign Service, Huh? News, MEDical, Oversight, Pompeo, Realities of the FS, Rex Tillerson, Secretary of State, Spectacular, Staffing the FS, State Department, Trends Tags: , , , , ,

We’ve blogged previously about the problems encountered by Foreign Service families with the State Department’s Bureau of Medical Services (see StateDept’s MED Services Drive Employees with Special Needs #FSKids Nuts; Also @StateDept’s Blackhole of Pain Inside the Bureau of Medical Services (MED). The latest issue of the Foreign Service Journal features a piece by James Brush who previously worked as a child psychologist at the State Department.

Via FSJ: James Brush, Ph.D., is a child and adolescent psychologist in private practice in Washington, D.C. He worked at the State Department as a child psychologist with the Child and Family Program division of MED Mental Health from January 2013 through March 2016. Prior to his work at State, he had a private practice in Cincinnati, Ohio, for 26 years. A past president of the Ohio Psychological Association, he continues to be involved as a committee chair. 

Below is an excerpt from The Demise of MED’s Child and Family Program (FSJ)

The Child and Family Program within the Bureau of Medical Services’ Mental Health program was constituted in 2013, when the full team was finally in place after years of planning. I was brought onto the team as one of two child psychologists. By March, we had on board a child psychiatrist director, two child psychologists and three clinical social workers who had experience in treating and managing the needs of children and adolescents.

I was on the ground floor of this program, and our mission was both exciting and challenging. This was the first extensive effort within the State Department to support the specific mental health and developmental needs of children, adolescents and their families living abroad.
[…]
By 2015, three of the psychiatrists who were opposed to the CFP functioning as a comprehensive support program ended up having leadership roles in MED. Dr. Stephen Young took over as the director of mental health. Dr. Kathy Gallardo took over as deputy director of mental health, and Dr. Aleen Grabow was brought in as a child psychiatric consultant. Together, they worked toward limiting the scope of the CFP, limiting the SNEA program and reducing the opportunities for families with disabled children through more restrictive use of child mental health clearances.

Within a year of their tenure in leadership, we lost our child psychiatrist director, the two child psychologists and one clinical social worker. I and the other providers left because Drs. Young and Gallardo changed the mission and scope of the CFP. It became an unpleasant place in which to work, with the emphasis being on clearances and restricting access to SNEA. Support for families was no longer the focus. Rather, support services were being cut and the clearance process was being used to restrict the opportunities of those with disabled children.

The program is now a skeleton of what it was previously, with only one social worker, one child psychologist and one retired Foreign Service psychiatrist. Telemedicine is forbidden. The program now basically performs an administrative function, processing clearances and SNEA requests.

Read the entire piece here.

We understand that State/OIG is aware of some allegations related to the special needs education allowance (SNEA) and is doing “exploratory work”. Well, Dr. Brush’s account should be instructive.  This is not one of the employees battling the bureaucracy on behalf of their children, this is one of the people who used to work at MED.

While we might be tempted to think that the troubling response could be some form of retaliation for blowing this issue up in the media, it is hard to imagine that MED’s policy and focus on restricting access to SNEA and the medical clearance do not have the full blessings of the State Department leadership all the way to the 7th Floor. After all, if State really wanted to resolve these cases, it would have worked with these FS families to accommodate their needs, avoid forcing people into taking loans to pay/repay for special ed needs expenses, and it would have afforded families an appeals process (IT. DOESN’T).

And they certainly would not/not have threatened people who pursue this issue, right? RIGHT?

Perhaps, this is what they mean when they talk about the new Department of Swagger? Take it or leave?

(Thought bubble: How long before the proponents of this policy get promotions, Superior Honor Awards or Presidential Rank Awards?)

While the State Department has lifted the hiring freeze, and the A-100 classes are no longer on a hit and miss schedule, it is not clear to us what the new secretary of state’s position on the previously planned 8% shrinkage of the agency workforce. If that was a WH imperative as opposed to Tillerson’s, it would be hard to imagine Secretary Pompeo going against it.

The CRS report on the Department of State, Foreign Operations and Related Programs: FY2019 Budget and Appropriations dated April 18, 2018 and updated on August 9, 2018 notes the following:

The Department of State released guidance in May 2018 lifting the hiring freeze and allowing the department to increase staffing to December 31, 2017, levels. Subsequent press reports indicate that the department intends to hire 454 new employees beyond end of year 2017 levels but also suggest that hiring must be circumscribed by previous commitments former Secretary of State Rex Tillerson made to reduce its workforce by 8%.

So this brings us to the “take it or leave” scenario for FS employees with special needs children. Since these kids are given limited medical clearances with no appeals (which precludes most if not all overseas assignments), Foreign Service families will be forced to serve either in domestic assignments in order to stay together; serve separately with employees going overseas, while their families stay in the United States, or employees may opt to pay everything out of pocket and not ask for SNEA to avoid getting snared in MED’s clutches.

Begs the questions: 1) How many career employees would stay on when their employer talk the talk about supporting FS families but know it’s just a gum chewing exercise? And 2)  Is this what a slow walk to 8% looks like??

By the way, if there’s an alternate reasonable explanation for all this that does not require our relocation to the parallel universe, Earth, Too, send us an email, we’d love a good chat.

 

Related items:

 

 

What did we miss?

July 5, 2018 By in Allowances, Ambassadors, Confirmations, Contractors, Corruption, Court Cases, Foreign Service, Media, MEDical, Retirement, Senate Hold, State Department, Top Ranks, U.S. Missions, U.S. Senate Tags: , , , , , , , , , , , , , , , , , ,

 

Ambassador Steve Mull Back in Foggy Bottom

In June, former Ambassador Steve Mull was appointed Acting Under Secretary for Political Affairs (P) at the State Department. Until this appointment, he was a Resident Senior Fellow at Georgetown University’s Institute for the Study of Diplomacy.  Props to Secretary Pompeo for bringing him back to Foggy Bottom. Unless.  a new crop of career ambassadors were nominated and confirmed while we were gone, Ambassador Mull is the last remaining career ambassador in active service as of this writing.

EAP’s Susan Thornton to Retire After 27 Years in the Foreign Service

EAP’s Acting Assistant Secretary Susan Thornton is set to retire at the end of July after a 27-year career with the U.S. Foreign Service. The retirement was reported by Reuters on June 30.  (see Career Diplomat Susan A. Thornton to be Asst Secretary for East Asian and Pacific Affairs (EAP); Tillerson Signals No Career Nominees For Regional Bureaus? #FoggyBottomBlues). Senator Rubio was reportedly prepared to place a hold on the Thornton nomination.

Still No Nominee for Director General of the Foreign Service?

So hey, it’s now July, and the U.S. Foreign Service still does not have a nominee for Director General. U.S. law dictates the nominee must be a member of the career Foreign Service.

US Ambassador to Estonia James Melville Pens Resignation on FB Over Trump Policies

On June 29, U.S. Ambassador to Estonia, Jim Melville, announced on Facebook his intent to retire from the Foreign Service after 33 years of public service. Ambassador James Desmond Melville, Jr., of New Jersey, a Career Member of the Senior Foreign Service, Class of Minister-Counselor was nominated by President Obama as U.S. Ambassador to the Republic of Estonia in the spring of 2015. He was  confirmed by voice vote on August 5, 2015. Prior to his appointment in Estonia, Ambassador Melville was the Deputy Chief of Mission at the U.S. Embassy in Berlin, Germany.  Previous to that, he served as Executive Director of the Bureau of European and Eurasian Affairs and the Bureau of International Organization Affairs from 2010 to 2012. Ambassador Melville also served at the U.S. Embassies in London, Moscow, Paris, and at the North Atlantic Treaty Organization in Brussels.  His earlier positions with the Department of State include service as a Foreign Service Examiner, Senior Watch Officer in the Executive Secretariat Operations Center, and Legislative Management Officer in the Bureau of Legislative Affairs.  Ambassador Melville received a B.A. from Boston University and a J.D. from Rutgers University. He joined the Foreign Service in 1985 during the Reagan Administration. Below via Eesti Ekspress:

 

Confirmations

On June 28, the U.S. Senate confirmed the following nominees:

  • Robin S. Bernstein, of Florida, to be Ambassador Extraordinary and Plenipotentiary of the United States of America to the Dominican Republic.
  • Joseph N. Mondello, of New York, to be Ambassador Extraordinary and Plenipotentiary of the United States of America to the Republic of Trinidad and Tobago.
  • Gordon D. Sondland, of Washington, to be Representative of the United States of America to the European Union, with the rank and status of Ambassador Extraordinary and Plenipotentiary.
  • Harry B. Harris, Jr., of Florida, to be Ambassador Extraordinary and Plenipotentiary of the United States of America to the Republic of Korea
  • Ronald Gidwitz, of Illinois, to be Ambassador Extraordinary and Plenipotentiary of the United States of America to the Kingdom of Belgium
  • Brian A. Nichols, of Rhode Island, a Career Member of the Senior Foreign Service, Class of Career Minister, to be Ambassador Extraordinary and Plenipotentiary of the United States of America to the Republic of Zimbabwe
  • Tibor Peter Nagy, Jr., of Texas, to be an Assistant Secretary of State (African Affairs)
  • Francis R. Fannon, of Virginia, to be an Assistant Secretary of State (Energy Resources)

On May 24, U.S. Senate confirmed the following :

  • James Randolph Evans, of Georgia, to be Ambassador Extraordinary and Plenipotentiary of the United States of America to Luxembourg
  • Jonathan R. Cohen, of California, a Career Member of the Senior Foreign Service, Class of Minister-Counselor, to be the Deputy Representative of the United States of America to the United Nations, with the rank and status of Ambassador Extraordinary and Plenipotentiary, and the Deputy Representative of the United States of America in the Security Council of the United Nations.
  • David B. Cornstein, of New York, to be Ambassador Extraordinary and Plenipotentiary of the United States of America to Hungary

On April 26, the U.S. Senate confirmed the following nominees:

  • Andrea L. Thompson, of South Dakota, to be Under Secretary of State for Arms Control and International Security
  • Yleem D. S. Poblete, of Virginia, to be an Assistant Secretary of State (Verification and Compliance)
  • Kirsten Dawn Madison, of Florida, to be an Assistant Secretary of State (International Narcotics and Law Enforcement Affairs).
  • Thomas J. Hushek, of Wisconsin, a Career Member of the Senior Foreign Service, Class of Minister-Counselor, to be Ambassador Extraordinary and Plenipotentiary of the United States of America to the Republic of South Sudan
  • Richard Grenell, of California, to be Ambassador Extraordinary and Plenipotentiary of the United States of America to the Federal Republic of Germany.

 

US Embassy Germany: New Ambassador’s Rocky Start

On June 25, Politico Magazine did a lengthy piece on the new U.S. Ambassador to Germany Richard Grenell and his rocky start. “It is hard to overstate just how brashly he has charged onto the Berlin political scene during his first month in town.” Read Letter From Berlin: “‘He Does Not Understand What the Role of an Ambassador Should Be’

 

State/FSI’s Digital Media Administrator Pleads Guilty of Child Pornography Production

On July 2, Skydance MacMahon, 44, of Alexandria, Virginia, pleaded guilty to production of child pornography. During the time he committed these offenses, MacMahon was a Digital Media Administrator at the Foreign Services Institute of the U.S. Department of State in Arlington.  According to court documents, over at least a two year period, MacMahon, 44, conspired with an adult in Canada to produce over a thousand sexually explicit images and videos of minor children in Canada. These images and videos were produced at the direction of MacMahon using Skype and hidden cameras. MacMahon distributed these image and video files to other users and consumers of child pornography by providing access to the files on his cloud storage services and also by directly sending the files to other users.  In addition to the child pornography images and videos MacMahon himself created, he also received and possessed thousands of images and videos of child pornography. See more State Department Employee Pleads Guilty to Producing Child Pornography.

US Embassy London’s Inside the American Embassy Airs on Channel 4

The American Embassy, the previous TV series set at the U.S. Embassy in London in 2002 had six episodes but the show was canceled by Fox after only 4 episodes being broadcast.

It looks like the new show is only up for three episodes. Radio Times reports that Channel 4 has roughly 300 hours of behind-the-scenes footage and says in part: “Perhaps the most surreal part of the documentary comes when the cameras follow various British MPs attempting to garner Johnson’s attention, apparently unaware of the small mic attached to the ambassador’s lapel.” Whatthewhat?!

One TV review says: “Woody’s big problem, like everybody else’s, is the mad badger in the White House”. HIDE EVERYTHING!

US Embassy Costa Rica Sub-Contractor Pleads Guilty to Theft of $2Million Visa Fees

On June 14, a Department of State contractor pleads guilty to theft of government funds after evidence established that he stole more than $2 million of government funds that were supposed to be transferred to a bank account maintained by the Department of State’s Global Financial Services Center in Charleston. Evidence presented at the change of plea hearing established that Mauricio Andulo Hidalgo, age 43, of Costa Rica used his position as President of SafetyPay-Central America to steal over $2,000,000 of government funds.  SafetyPay-Central America had been hired as a subcontractor to handle the processing of visa application fees for the United States Embassy in Costa Rica.  As part of the scheme, Hidalgo diverted the funds from a SafetyPay bank account in Costa Rica to another Costa Rican account under his sole control. See more Department of State Contractor Pleads Guilty to Theft of Government Funds.

 

USCG Guangzhou Security Engineering Officer Mark Lenzi Disputes State Department Statement on Mystery Illness

On June 6, WaPo wrote about Mark Lenzi and his family who  started noticing noises in April 2017 at the U.S. Consulate General in Guangzhou, China. “A few months later, the headaches started — pain that lasted for days at a time. Lenzi and his wife experienced the same symptoms, which soon included chronic sleeplessness as well. Lenzi says he asked his superiors for help but they dismissed his concerns. Consulate doctors prescribed painkillers and Ambien, which did nothing to address the underlying causes of the problem. And then, last month, Lenzi was shocked to learn another neighbor, a fellow Foreign Service officer, had been evacuated from their building and flown back to the United States for a thorough medical assessment, which soon determined that the person in question was suffering from “mild traumatic brain injury.”  

They gave him painkillers and Ambien but medevaced the FSO next door?

The State Department reportedly issued a statement but said it is unaware of any other cases — a point “strongly disputed by Lenzi, who insists he had repeatedly informed both the embassy in Beijing and State Department headquarters in Washington of his family’s predicament.”  Lenzi, who has reportedly called for the resignation of the US Ambassador to Beijing  told WaPo that the State Department “restricted his access to the building where he normally worked after he began to speak up more forcefully about the treatment of his family, essentially neutralizing his capacity to continue his work at the consulate”.

We understand that Mark Lenzi is a specialist who was assigned as a Security Engineering Officer (SEO) in Guangzhou until he and his family were evacuated from post. Given the reported restriction to post access for speaking out about this incident, this is a case that bears watching.

State/ECA Official Pleads Guilty to Theft of Government Funds in Sports Visitors Program

On May 25,  Kelli R. Davis, 48, of Bowie, Maryland, pleaded guilty to one count of conspiracy to commit theft of public funds and engage in honest services wire fraud before U.S. Senior District Judge T.S. Ellis III of the Eastern District of Virginia.  Sentencing is scheduled for Aug. 24.

According to admissions made in connection with her plea, Davis was a Program Specialist for the State Department’s Bureau of Educational and Cultural Affairs, Office of Citizen Exchanges.  She also served as the Program Manager and Grants Officer Representative for the Sports Visitors Program, which sponsored foreign exchanges for emerging youth athletes and coaches from various countries.  The exchange program was managed by George Mason University in Fairfax, Virginia, through a federal grant and cooperative agreement with the State Department.  See State Department Official Pleads Guilty to Honest Services Wire Fraud and Theft of Federal Funds

Forced Repayment of Previously Approved Special Needs Education Allowance (SNEA)?

There were lots of talk some weeks back about people being forced to pay back special needs funding for their children that was already previously authorized and paid.  Folks were wondering if MED’s Office of Child and Family Programs (MED/CFP) previously highlighted by media reporting is responsible in getting this rolling. Anybody got some special insights on the whys and hows of this?

 

Who owns your medical and mental health records?

It has come to our attention that the State Department’s Medical Bureau can deny/restrict employees and family members overseas assignments over erroneous entries in their medical/mental health records. Of particular note is access to mental health records.  Employees can ask for an amendment to their records but how does one go about doing that without access to those records?

Apparently, State’s internal guidance doesn’t say that employees have the right to have inaccurate information removed – just that they can make the request to have it removed: “If you believe that the information we have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as we maintain this information. While we will accept requests for amendment, we are not required to agree to the amendment.”

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