@StateDept’s Mystery Illness: The “It Depends” Treatment of Injured Personnel

Via NYT:

According to a whistle-blower complaint filed by Mr. Lenzi, the State Department took action only after Ms. Werner’s visiting mother, an Air Force veteran, used a device to record high levels of microwave radiation in her daughter’s apartment. The mother also fell ill. That May, American officials held a meeting to reassure U.S. officers in Guangzhou that Ms. Werner’s sickness appeared to be an isolated case.
[…]
But Mr. Lenzi, a diplomatic security officer, wrote in a memo to the White House that his supervisor insisted on using inferior equipment to measure microwaves in Ms. Werner’s apartment, calling it a “check-the-box exercise.”

“They didn’t find anything, because they didn’t want to find anything,” Mr. Lenzi said.

He sent an email warning American diplomats in China that they might be in danger. His superiors sent a psychiatrist to evaluate him and gave him an official “letter of admonishment,” Mr. Lenzi said.

Months after he began reporting symptoms of brain injury, he and his family were medically evacuated to the University of Pennsylvania.
[…]

The State Department labeled only one China officer as having the “full constellation” of symptoms consistent with the Cuba cases: Ms. Werner, the first evacuee. In an internal letter, the department said 15 others in Guangzhou, Shanghai and Beijing had some symptoms and clinical findings “similar to those” in Cuba, but it had not determined they were suffering from “Havana syndrome.”

Doctors at the University of Pennsylvania said they did not share individual brain scans with the State Department, so the government lacked necessary information to rule out brain injuries in China.

“It seems to me and my doctors that State does not want any additional cases from China,” Mr. Garfield wrote, “regardless of the medical findings.”

New @StateDept Bureau to Take $26 Million, Plus 98 Staffers From the Medical Services  Bureau

Updated 1:24 pm PDT 
We just learned that the Under Secretary for Management Brian Bulatao is pushing for the formation of a new bureau called Crisis and Contingency Response (CCR) under the Management umbrella. This would expand the “M” family to 14 bureaus and offices (including a more recent creation called Office of Management Strategy and Solutions (M/SS). 
We understand that Mr. Pompeo has formally signed off on this new office.  CCR will reportedly take $26 million funding from the Bureau of Medical Services (MED). It will also  pull 98 positions from MED and it will share EX and IT services with the Medical Services bureau.   
We also learned that the “7th floor loves Dr. Will Walters” because he and his Directorate of Operational Medicine are reportedly not only “providing OpMed flights during COVID, repatriation flights, logistics flights, but have also provided the Secretary with medical support during his travels.”
“Very sexy stuff, whereas what MED providers do is the more mundane day-to-day care of diplomats and their families overseas.”
Many medical providers are said to be up in arms about the rapid formation of this new Bureau — which happened in a span of just four months — with apparently no input from the field.
“Medical services to diplomats and their families abroad may suffer.”
We asked what are the potential consequences to MED and its patients, and we’re given a quick rundown by Sender A:
    • Since MED and the CCR Bureau share EX and IT, there is widespread concern that MED staffing and funding will be given short shrift in this new configuration.
    • What might happen is fewer FS medical providers whom MED is allowed to hire, leaving positions overseas unfilled.
    • Other critical “back office” functions in MED, if not supported by the new shared EX, might become understaffed.
    • If sections such as MED Foreign Programs (authorization and funding of Medevacs and hospitalizations, referrals to WDC medical providers) do not have sufficient staffing and funding, service to FSOs and EFMs abroad will certainly be noticed in terms of delayed or denied authorization and funding cables.
    • If the MED/GSO section does not receive sufficient funding/staffing, delivery of essential medications and vaccines will be delayed or nonexistent.
Our source said that a town hall was held last week concerning this new bureau.  Many medical providers reportedly submitted questions ahead of time, but “the vast majority of the one-hour time slot was taken up my monologues from Bill Todd and Will Walters.” 
Source added that “both were very good at smoothly blowing by the concerns raised by MED.”
We understand that Todd did not explain why a separate Bureau was being created, but almost everyone in MED apparently viewed this as “the ultimate bureaucratic power play.”
Bill Todd is the Deputy Under Secretary for Management (formerly Acting M, Acting DGHR going back to Tillerson’s fun times in Foggy Bottom).  He is awaiting committee and Senate vote to be the next U.S. Ambassador to Pakistan. Time’s running out. 
Dr. William Walters’ February 2020 bio posted in congress.gov says that he is a member of the Senior Executive Service (and former US Army medical officer). His bio says he is the Acting Deputy Chief Medical Officer for Operations and the Acting Executive Director for the Bureau of Medical Services. Further, it says that “As the Managing Director of Operational Medicine, Dr. Walters is responsible for the Office of Protective Medicine and the Office of Strategic Medical Preparedness and manages the care of the Secretary of State and traveling delegation while traveling abroad.”
The MED Bureau was last inspected by State/OIG in mid 2000 and the OIG issued a report in June 2006. So it is due for a new review. According to OIG, in 2006 (lordy, that’s 14 years ago!), MED had the following:

“192 health units in embassies and consulates abroad. MED’s direct-hire overseas staffing includes 45 regional medical officers (RMO), who are physicians, 16 regional psychiatrists, 72 health practitioners, 10 laboratory technicians, and three regional medical managers, supplemented by 250 locally employed staff. […] Overseas, MED serves patients from 51 U.S. government agencies. This patient population includes approximately 50,000 direct-hire employees and family members who are full beneficiaries of the program and about 70,000 locally employed staff, for whom MED provides treatment for on-the-job injury and illness. In 2004, there were 230,000 health unit visits and MED facilitated 635 medical evacuations to the United States and 350 medical evacuations to overseas centers.”

We understand that current staffing includes 250 Foreign Service Medical Specialists ( RMO, MP, RMLS, RMO/P) plus LNA nurses and Social Workers in some posts. MED’s workforce reportedly also includes around 1000 LES staff who work in health units abroad. This staffing number does not include the Civil Service employees working for MED in Washington, D.C.
Under current staffing, how many employees will be left at MED after 98 employees are pulled to staff the new CCR bureau?
What will be the direct consequences of gutting MED’s fund by $26million in order to fund the new CCR bureau?
What is the rational justification for creating a new bureau like CCR separate from MED? Why now? Is this a case of strike now why the iron is hot, there may not be another mass evacuation due to a pandemic soon?
What is the issue with keeping the Directorate of Operational Medicine as the arm for crisis and contingency response under MED? 
Why are they calling this the Crisis and Contingency Response (CCR) Bureau and not the Medical Crisis and Contingency Response (MCCR) Bureau, hmmmn? Will this new bureau be headed by an assistant secretary level appointee subject to Senate confirmation?
Hey, wait, wait a minute –is some hombre considering this new bureau as the crisis and contingency response lead in medical and non-medical crisis? The name is kind of a tell.  We’d like to hear the big picture, tell us more.
You know, we’ve heard of the Crisis Management and Strategy arm that’s operating out of Ops Center for decades. They do great work. We’ve never heard those folks start a new bureau.
Update 1:24 pm PDT: 
It looks like the State Department needs to send Congressional notification to create a new bureau. In May 2019, the State Department merged the Bureaus of Public Affairs (PA) and International Information Programs (IIP) to create the new Bureau of Global Affairs. That merger did not happen overnight:
“In the summer of 2018, a task force of PA and IIP colleagues collaborated with bureaus and offices Department-wide to design a proposal for the new merged bureau. Extensive consultation with Congress as well as key leaders and organizations both inside and outside of the Department continued throughout 2018 and early 2019. Following State Department approval and congressional notification, the new Bureau of Global Public Affairs became a reality in May 2019.”
So how fast do you think State can do all that and its congressional notification obligation for this new entity? 
It’s 13 days, 8 hours, 31 minutes to Election Day. Go VOTE!

@StateDept Spent Millions on AutoInjectors to Counteract Nerve Agent Exposure, Guess What Happened?

WaPo’s Jon Swaine has an investigative piece on a $120 million State Department contract on a treatment for nerve agent poisoning. According to the report, WaPo has “obtained internal company records, reviewed emails from Emergent staffers and government officials, and interviewed nine people involved in making, selling or buying the Trobigard injectors.”
WARNING! This will get you mad.

“In June 2017, a director of regulatory affairs at the government contractor Emergent BioSolutions told colleagues that she objected to claims the company was making in a brochure for one of its newer products: a drug injector for victims of exposure to nerve agents.

“Functionality testing has not been successful in this device,” Brenda Wolling wrote in comments obtained by The Washington Post. Regarding a claim that the injector was designed to withstand “challenging operational and logistical conditions,” she wrote, “No testing ever conducted.” Even to describe the product as a “treatment of nerve agent poisoning,” Wolling wrote, “implies that we have efficacy data showing it works.”

Three months later, the Trump administration awarded Emergent a $20 million no-bid contract to supply those very injectors to the State Department. The firm later received a second contract, worth up to $100 million, to supply the agency with more of the injectors — sold under the name Trobigard — and related treatments.”

Apparently, the State Department told Emergent that it had obtained a legal opinion from the FDA’s general counsel saying the department could buy Trobigard for use by U.S. diplomats overseas, citing a company record. The report says, the company “has not sought approval from the U.S. Food and Drug Administration — a circumstance that bars the product’s sale in the United States.”

“By September 2017, State Department officials were increasingly alarmed at chemical weapons use by the Syrian regime and the Islamic State and were anxious to boost protections for U.S. diplomats. The agency gave Emergent a one-year contract worth $20.5 million to supply auto-injectors. Under the deal, Emergent delivered 456,845 auto-injectors — enough to provide several for each of 58,000 Foreign Service officers and local employees overseas.

No bid competition was held, on the grounds that there was “unusual and compelling urgency” after Pfizer’s production halt, according to contract records. The injectors were needed to protect officials who “operate in countries with active and/or assumed chemical [redacted] programs,” the records show.
[…]
Emergent’s 2017 deal with the State Department entailed a sharp increase in spending by the department above earlier plans. In August 2015, the department had been preparing to pay Meridian $750,000 per year for five years to replace expiring devices, according to records of an abandoned deal.”

The company-funded study in the Netherlands tested the drugs on guinea pigs exposed to sarin gas. That’s right guinea pigs.

“Six weeks after the State Department signed the deal, Emergent’s first study of Trobigard’s drugs was completed. The company-funded study in the Netherlands tested the drugs on guinea pigs exposed to sarin gas and recorded positive findings. As they published their work in a scientific journal, the study’s authors warned that the results “cannot be directly extrapolated to the human situation.”

Can the embattled OIG still take this on as a special project? Can House Foreign Affairs (HFAC) or House Oversight Committee (HORC) take a look?

“In July, Emergent leaders ordered that Trobigard sales materials be scrapped and that the device be moved to a portion of the company’s website that lists products in development, the company confirmed. They also told staffer to make sure all future sales materials for Trobigard were approved by the company’s medical, legal and regulatory departments.

Emergent put together evidence that all injectors bought by the State Department were safe, former employees said. Government officials ultimately agreed. In September 2019, the State Department authorized the payment of a $10 million contract installment to Emergent.”

You need to read this in full. A State Department “no comment” is not acceptable.

Extracted data below from SAM.gov, the new fedbiz, with links to the contracts. Are there more that we’ve missed?

EMERGENT COUNTERMEASURES INTERNATIONAL LTD

  • Unique Entity ID (DUNS)220984617
  • CAGE CodeU1C03
  • AddressBUILDING 3, LONDON, W4 5YA

Registration

  • Expiration Date Jun 23, 2021
  • Purpose of Registration All Awards
  • Debt Subject to Offset  No

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FSGB Case: When “there were no mitigating circumstances” considered despite conditions identified by MED

 

Via FSGB: FSGB Case No. 2019-034, July 2, 2020
Held – The Board found that the Department of State (the “Department” or “agency”) did not establish cause to separate the charged employee from the Foreign Service because the Deciding Official (“DO”) did not consider evidence of his personality problems as a mitigating circumstance. The Board was persuaded by evidence in the record that the agency should exercise its authority to initiate, as an alternative to separation, the option of a disability retirement, pursuant to 3 FAM 6164.3(a).
Case Summary – The Department charged the employee with Improper Personal Conduct based upon a pattern of unprofessional and inappropriate conduct toward colleagues, primarily hundreds of unwanted emails and text messages with sexual content. The Department’s Bureau of Medical Services (“MED”) had conducted a mental health evaluation of the charged employee and concluded that “to a reasonable degree of certainty,” the charged employee exhibited “behavior or symptoms (which may not rise to the level of formal diagnosis) of an emotional, mental or personality condition that may impair his reliability, judgment or trustworthiness.” The DO determined that the charged employee committed the charged offenses and that there were no mitigating circumstances. In finding no mitigating circumstances, the DO attested in the separation hearing that she did not take into consideration either the charged employee’s emotional, mental or personality condition that MED identified or the charged employee’s emails to coworkers that included references to his communications with divine beings as well as references to his own possible mental illness. The DO notified the charged employee of her proposal to separate him from the Foreign Service and provided him the opportunity to reply in person or in writing. The DO recommended separating the charged employee to promote the efficiency of the Service. The charged employee did not respond in person or in writing to the DO’s notification of her proposal to separate him from the Service recommendation or participate in the separation hearing. The Board found the Department did not establish cause to separate the charged employee because the DO did not consider the so-called Douglas Factor #11 on the agency’s checklist that relates to mitigating circumstances surrounding personality problems, and did not exercise the agency’s authority under 3 FAM 6164.3(a) to initiate a disability retirement on behalf of the charged employee as an alternative to disciplinary action.

[…]

We do not claim medical or psychological expertise, but, in our perusal of the record, we found indicators that the charged employee was described as exhibiting personality problems, and possibly more serious mental impairment or illness, from the emails and text messages he sent to former colleagues. For example, in specification 84, the charged employee is charged with offering to help Ms. B draft a complaint and get himself fired and committed to a mental hospital for the rest of his life. Also, in specifications 86 and 87, respectively, the charged employee is alleged to have first made reference to someone wanting him to commit suicide, then later noted asking God if his wife would commit suicide and informing Ms. D that the Virgin Mary told him to inform Ms. D that he knew she was worried that he might kill himself. Further, the charged employee displayed unusual behavior when he emailed Ms. B on June 6, 2017 at 8:31 p.m. that he had declined to see a psychiatrist before consulting attorneys about his options to file a lawsuit.11 That suggests the possibility that someone raised with the charged employee the matter of seeking a psychological consultation or examination.
In addition, DS ROI #1 included a statement by the charged employee’s wife that she believed her husband suffered from mental impairment, requiring medical treatment. The record further contains evidence, according to the spouse, that MED had conducted a thorough mental health evaluation of the charged employee on four separate dates. Similarly, DS ROI #2 concluded that the charged employee had expressed that he heard voices and instructions from God, the Devil, and the Virgin Mary. (See Specifications 6-8, 25, 29, 38, 76 and 87).
[…]
In the instant case, while the agency has provided credible evidence that the charged employee’s conduct does not promote the efficiency of the Service, we find the decision falls short on consideration of so-called Douglas Factor #11 on the agency’s checklist that relates to personality problems as a mitigating factor. We also credit the charged employee’s 19 years of distinguished service before his display of conduct that gave rise to the LOR and the proposal to separate him from the Service.12
Moreover, the Board is unaware of a requirement that a DO must be privy to private medical information or be a medical professional to initiate an application for disability retirement. To the contrary, under 3 FAM 6164.2-3, HR/ER, in consultation with MED, can initiate an application for disability retirement on behalf of an employee if, inter alia, 1) the agency has issued a proposal to remove the employee, 2) the agency has a reasonable basis to conclude that illness may be the cause of the employee’s conduct which renders him unable to work satisfactorily, or 3) the employee is incompetent and there is no guardian willing to file an application on the employee’s behalf. The existence of any one of these three conditions is sufficient for the agency to initiate an action for disability retirement, and the Board finds that the conditions in 1) and 2), supra, are apparent in this case.
Accordingly, the Board is of the view that the agency has not considered all mitigating factors before recommending separation for cause and has not exercised its authority to initiate, as an alternative to separation, the option of a disability retirement for the charged employee where grounds for such a retirement are apparent on the record. Pursuant to 3 FAM 6164.3(a), MED then would determine whether the charged employee is incapacitated for useful and efficient service, which is the standard for disability retirement.

US Mission Saudi Arabia Now on Voluntary Evacuation After COVID-19 Cases Leaked #HoldOn

On Monday,  June 29, 2020, the State Department issued an updated Travel Advisory for Saudi Arabia announcing that on Wednesday, June 24, it authorized the voluntary evacuation of nonemergency personnel and family members from the US Mission in Saudi Arabia. This includes Embassy Riyadh, and the consulates general in Jeddah and Dhahran. The order was issued “due to current conditions in Saudi Arabia associated with the COVID-19 pandemic.”

On June 24, 2020, the Department of State authorized the departure of non-emergency U.S. personnel and family members from the U.S. Mission to Saudi Arabia, which is comprised of the Embassy in Riyadh and the Consulates General in Jeddah and Dhahran, due to current conditions in Saudi Arabia associated with the COVID-19 pandemic.  

Apparently, dozens of mission employees got sick last month, and many more were quarantined. A third country national working as a driver for the mission’s top diplomats had reportedly died. The Embassy’s Emergency Action Committee “approved the departure for high risk individuals” but the State Department “denied” the request advising post  “to do whatever it can to hold on until the Covid problem improves.”
Whatthewhat? Hold on is the plan?
Also that “more recently, officials on the embassy’s emergency action committee recommended to Mr. Abizaid that most American employees should be ordered to evacuate, with only emergency personnel staying. Mr. Abizaid has not acted on that.”
Reminds us of what happened at some posts back in March (Is @StateDept Actively Discouraging US Embassies From Requesting Mandatory Evacuations For Staff? #CentralAsia? #Worldwide?). COVID-19 Pandemic Howler: “No one in DC, to include S, gives AF about AF”.  More recently, reports of COVID-19 cases at US Embassy Kabul (US Embassy Kabul: As Many as 20 People Infected With COVID-19 (Via AP).  Where else?

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@StateDept Suspends All PCS Travel Through May 31

A couple weeks ago, the State Department issued a guidance cable to all Department personnel concerning permanent change of station (PCS) travel and home leave through May 31, due to the COVID-19 pandemic.
Citing the “myriad uncertainties” and “travel and logistics restrictions”, the State Department  suspended all overseas and domestic PCS travel with very limited exceptions, effective through May 31. Transition from one Washington, D.C. assignment to another does not appear to be affected by this suspension.
This PCS suspension will reportedly be reviewed on May 20 and that this “period may be extended if the situation does not improve.”
The guidance says that exceptions to the suspension of PCS travel may be considered for certain employees like those on curtailments related to health, or mission critical employees (approved by bureau assistant secretary for certain countries, or by the Under Secretary for Management for CDC Level 3 countries or State Department Travel Advisory for Health Level 4 countries), or employees on direct to post transfers.
Diplomatic Security and medical personnel are considered mission critical and those employees are reportedly expected to PCS to their next overseas assignment, unless the Chief of Mission (COM) at the receiving post determines that “health and safety issues outweigh security concerns and prevents their arrival to post.” DS personnel are also told that they should be ready to remain at Post beyond their tour end-date if deemed necessary by their Chiefs of Mission.
The guidance encouraged employees to take their home leave between domestic and overseas assignments. At the conclusion of the home leave, employees are told to “be prepared to telework for their onward assignment at their home leave location.” The guidance further says that all employees are expected to work with their onward post and/or bureau to be assigned suitable duties for telework/remote work following Department protocols. Reiterating a prior cable, the guidance explains what supervisor can grant “weather and safety leave” to U.S. Direct Hires for those regular duty hours for which there is insufficient remote work to assign.
Additional guidance is reportedly expected to be published in the near future.

Snapshot: @StateDept COVID-19 Cases as of April 14, 2020

Note that with the April 10 update, the State Department removed the “pending tests” category, so we no longer have a view on how many pending tests are there at our overseas posts.  DOS also replaced “positive cases” with “current cases.”  According to the State Department, a current case is “a person with a positive COVID-19 test or clinical diagnosis and not confirmed to have recovered.” 
Instead of a “self-isolating” category, State is now calling this category “Remain at home” or individuals  “advised to remain at home because of contact with a known COVID-19 case or or travel to a high-risk area.” 
On the domestic side, “persons remaining at home” are no longer tracked according to State after stay at home orders/telework instructions were broadly issued.

 

Updated: April 14, 2020, 3:00 p.m. EDT

Any diplomatic posts overseas having issues obtaining proper PPE?

 

Via Briefing With Dr. William Walters, Deputy Chief Medical Officer for Operations, and Principal Deputy Assistant Secretary Ian Brownlee, Bureau of Consular Affairs On COVID-19:  Updates on Health Impact and Assistance for American Citizens Abroad | APRIL 14, 2020

QUESTION:  Hey, thank you.  Have you heard from any of the diplomatic posts overseas that they are having issues obtaining proper PPE given kind of the global shortages, particularly those who are interacting with folks who are being repatriated? 

DR WALTERS:  Yeah, it’s Doc Walters.  So with regard to PPE overseas, our – as part of our ongoing preparedness well in advance of this pandemic, the Bureau of Medical Services has small stockpiles of PPE and other countermeasures at each post.  We have supplemented that, again, well in advance of the crush on the supply chain that’s occurred.  And so our health care providers overseas and our consular officers are provided with PPE appropriate to their interaction, understanding that there are going to be times when you come into unexpected contact with American citizens and no one’s going to stop what they’re doing in helping an American citizen.

But we – as part of the safety net, both there’s the PPE side, but there’s also the small community in each of our posts that is overseen by a medical provider from the bureau, either a direct hire or locally employed, and that – that drives the statistics that I provide at the beginning of each one of these briefs, and what we’re seeing is a fairly flat curve and no ongoing employee-to-employee transmission patterns that we’ve been able to identify.

 

COVID-19 Tracker: State Department and Foreign Service Posts (April 14 Update)

Our COVID-19 tracker has large gaps in it, but we don’t have a better alternative on breakdowns as the State Department is only releasing total numbers, not locations.  We have updated our tracker to include the two confirmed FSN deaths in Jakarta, Indonesia and Kinshasa, DRC, and one confirmed FSN death at an undeclared location. There are currently two domestic deaths, one in NYC, a contractor, and one in Washington, D.C. at an undeclared office location, a Civil Service employee.

DOS Briefing 4/14/20: The State Department continues to strongly enforce and practice the appropriate social distancing and other non-pharmaceutical interventions, and that continues to be reflected in our own disease curves.  Currently there are – we’re tracking 297 overseas cases, including 182 active with 115 recovered, holding at – thankfully holding at three overseas deaths, all within locally employed staff. Domestic cases are 71 current cases, 67 with four recovered.  Important to note that we started to see domestic cases in the second into the third week of March, and so this is the point at which we would expect to see those cases start to recover.  So I would anticipate over the next week, we’ll start to see the recovery cases start to climb. I am saddened to say that we’ve had our first – our second domestic death, our first within the U.S. direct-hire population, a civil servant serving here in Washington, D.C.  And our condolences do go out to the family and to all families that have been impacted by coronavirus.”

DOS Briefing 3/23/20 “I can tell you we’re still at single digits here in the United States with cases – one each, two each, three each in Washington; Houston; Boston; New York; Quantico, Virginia; and Seattle.  So the numbers themselves are – overseas are still double-digit.  We’re looking at less than 30 scattered over 220 posts around the world, and it remains a challenge.” 

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