Extraordinary Claims Should Require Extraordinary Evidence (June 26, 2018)

National GuardGuest Post by Liz Ullman:

Enrique Costas comes from four generations of dignified and recognized military service. His grandfather’s name is in the history books as one of the first soldiers to join the Puerto Rico National Guard to serve the United States. His father defended this country for 32 years, earning an Air Medal for heroism in Vietnam; his nephew will be commissioned as an officer in the next week and will be going on active duty.

Costas enlisted in the Puerto Rico National Guard in 1988. In 1999 he volunteered to be assigned as a Recruiter, earning top awards and commendations throughout his almost 14 years as the Senior Non-Commissioned Officer in Charge (NCOIC) of the Puerto Rico Army National Guard Recruiting and Retention (RR) Command office in San Juan. He was also selected and participated for seven years in the Puerto Rico National Guard Honor Guard, the team responsible for carrying our Nation’s and Army Colors in the highest of the Government’s activities and celebrations.

He was responsible for achieving monthly production for the three main tenets of the Guard recruiting office: Recruiting, Retention and Attrition Management • Staff resourcing for two Army battalions covering 13 cities • Supervising and mentoring up to 10 recruiting and retention non-commissioned officers.

Costas was a champion in mission accomplishment with the highest integrity and ethics. His walls are filled awards and photos with the Guard’s top-ranking officers, including General Clyde A. Vaughn, who personally commended Costas for his service and integrity. Costas retired in 2014 after Honorably serving our Nation for over 26 years.

The biggest mistake Costas made in his career was simply being on duty during the Guard Recruiting Assistance Program also known as G-RAP, a cash incentive opportunity for civilian soldiers to bring in new recruits. With no direction from Washington D.C.’s Strength Maintenance Division, General Vaughn’s recruiters were supposed to intuit the 60 changes in the G-RAP rules over a seven-year period, while also working to fill the dwindling ranks of Guard troops.

Just before dawn, on an early October morning in 2015, Costas’s home was stormed by six Federal agents and two State police officers, in full tactical gear. Costas thought his family was under attack, and it was – by the Government he had served. Costas was arrested and taken to a Federal Courthouse where he was charged with “crimes” dating back almost ten years, during the days of G-RAP.

Costas is one of hundreds of General Vaughn’s recruiters who have been held responsible for not knowing the G-RAP rules that were never sent to them. And not just held responsible — charged with criminal intent to commit fraud against the Government. General Vaughn, who created and administered G-RAP, and who was administratively sanctioned for poor management, is enjoying full retirement in Virginia and Arizona.

Costas is going to prison.

The government’s “evidence” against Costas and other recruiters does not even meet the standard of circumstantial. In his case, the government admitted during trial to having no actual evidence, but only a “reasonable inference” that a crime could have been committed.

As a recruiter, Costas could not and did not participate in G-RAP. There were no Army regulations that governed G-RAP because the program was run by a private Alabama-based contractor called Docupak. Docupak was essentially incentivized to run a sloppy program, earning a 17% markup on every new enlistment, on top of their contract fees and administrative expenses. This lack of training stands in sharp contrast to how the Army usually operates, with manuals and rules on almost every action and procedure.

The one rule that the prosecution seized on to brand soldiers and veterans as felons regarded the relationship between the Recruiting Officer and the Docupak civilian contractors known as Recruiting Assistants (RAs). When G-RAP began, those contractors were regarded as assistants to the Recruiting Officers. The Recruiting Officers might use the RAs to give that extra push to a potential applicant considering enlisting. The Recruiting Officers were encouraged to ask the RAs to attend recruiting events and help with the finding of potential candidates. The original program outline stated that the Recruiting Officer would provide specifics for each possible enlistment to the RA, including legal name, birth date and social security number. That information was used by Docupak to verify enlistments and process payments to their RA contractors. In later descriptions of G-RAP, the social security number would go from the new recruit to the RA contractor, bypassing the Recruiting Officer, which not a single RA contractor reports ever seeing or any evidence has ever been produced by Docupak that verifies it.

This procedural change has resulted in hundred of indictments and scores of convictions for identity theft and wire fraud. Soldiers and veterans are in prison. Costas, sadly, is on his way.

After the government filed more than 50 felonies against Costas, his defense team could not overcome the wrath of the United States and he was convicted by a jury who felt that with so many felonies filed, Costas certainly had to have done something wrong.

He did not. G-RAP was a tangle of mismanagement; the soldiers who were on duty during its tenure are paying the price of administrative failures by their command. In an internal investigation done by the Puerto Rico National Guard pertaining to G-RAP in 2012, the Investigating Officer admitted that “Recruiters had no formal training on how G-RAP operated.”

Costas and his family had their hearts broken when the prosecution opened with statements calling him a “cheater, stealer and a liar.” He said these words, “pierced the core of his soul.”

Presumption of Innocence or even the “benefit of the doubt” was never given. In the end the Government spent an estimated $100,000 prosecuting Costas and the jury found Costas guilty on three charges amounting to $3,000. Although never having a criminal record and an impeccable military career, the judge sentenced Costas to prison. In the end “reasonable inference” and circumstantial evidence weighed more than 26 years of honorable service willing to sacrifice life and limb.

Recently the United States Court of Appeals for the 6th District reversed and vacated a conviction of an accused soldier involving G-RAP and determined, that the “Government did not retain a revisionary interest in the funds and that it did not exercise supervision or control over the funds”. This decision cannot be applied to Costas unless the United States Court of Appeals for the 1st District, the Supreme Court, or Congress rules on it.

“Extraordinary claims require extraordinary evidence.”
― Carl Sagan

The claims were extraordinary. The evidence was missing. And yet, a United States military hero and veteran has been sacrificed.

We respectfully request that Congress or the White House appoint a commission to review the G-RAP investigation, to identify Soldiers that have been unjustly stigmatized by it, and to recommend suitable cases for clemency and pardon.

Related Links:
Stop G-RAP Injustice | Facebook
The Conspiracy Behind the G-RAP War on American Soldiers (March 30, 2016)
If You Look at the Dollars, Guard Recruiting Assistance Program Investigations Make No Sense (July 12, 2016)
Top Ten Problems with the National Guard Recruiting Assistance Program (G-RAP) Investigations (December 15, 2016)
An Open Letter to Congress Regarding the Investigations of the National Guard Recruiting Assistance Program (June 5, 2017)

Department of Veterans Affairs Becomes First Hospital System to Release Opioid Prescribing Rates (January 11, 2018)

VA Opioid Interacive Map
Interactive map expands transparency, shows opioids dispensed among VA health care centers.

Timeline of Veteran Suicides, Legislative Efforts, and Nationwide Negligence at the Department of Veterans Affairs

Today U.S. Secretary of Veterans Affairs Dr. David J. Shulkin announced that VA has begun publicly posting information on opioids dispensed from VA pharmacies, along with VA’s strategies to prescribe these pain medications appropriately and safely.

With this announcement, VA becomes the only health-care system in the country to post information on its opioid-prescribing rates.

The disclosure is part of VA’s promise of transparency to Veterans and the American people, and builds on VA’s strong record of transparency disclosures — including on wait times, accountability actions, employee settlements and the Secretary’s travel — under the leadership of President Donald J. Trump over the past year.

“Many Veterans enrolled in the VA health-care system suffer from high rates of chronic pain and the prescribing of opioids may be necessary medically,” Secretary Shulkin said. “And while VA offers other pain-management options to reduce the need for opioids, it is important that we are transparent on how we prescribe opioids, so Veterans and the public can see what we are doing in our facilities and the progress we have made over time.”

Counselor to the president Kellyanne Conway said, “Declaring the opioid crisis a nationwide public health emergency was a call to action by the president.  His administration is exploring all tools and authorities within their agencies to address this complex challenge costing lives. Veterans Affairs Secretary Dr. Shulkin is heeding that call; the VA is now the first hospital system in the country to post information on its opioid prescribing rates.  This is an innovative way to raise awareness, increase transparency and mitigate the dangers of over-prescribing.”

The interactive map shows data over a five-year period (2012-2017) and does not include Veterans’ personal information. The posted information shows opioid-dispensing rates for each facility and how much those rates have changed over time.

It is important to note that because the needs and conditions of Veterans may be different at each facility, rates may also be different for that reason, and cannot be compared directly.

The prescribing rate information will be updated semi-annually, on January 15 and July 15 of each year.

As a learning health system using the current best evidence to learn and improve, VA continually develops and refines best practices for the care of Veterans. Releasing this data will facilitate the sharing of best practices in pain management and opioid prescribing among doctors and medical center directors.

Highlights from the data include:

  • A 41-percent drop in opioid-prescribing rates across VA between 2012 and 2017
  • Ninety-nine percent of facilities decreased their prescribing rates.
  • San Juan, Puerto Rico, and Cleveland, Ohio, top the list of medical centers with the lowest prescribing rates, at 3 percent.
  • El Paso, Texas, and Fayetteville, North Carolina, are most improved, and decreased prescribing rates by more than 60 percent since 2012. El Paso’s prescribing rate decreased by 66 percent, and Fayetteville’s decreased by 65 percent.

VA currently uses a multifaceted approach to reduce the need for the use of opioids among Veterans. Since 2012, the Opioid Safety Initiative has focused on the safe use and slow and steady decrease in VA opioid dispensing. VA also uses other therapies, including physical therapy and complementary and integrative health alternatives, such as meditation, yoga and cognitive-behavioral therapy.

Information about the VA Opioid Safety Initiative may be found here. A link to the interactive map on VA’s opioid use across the nation may be found here.

Source: VA becomes first hospital system to release opioid prescribing rates

Related Links:
VA doctors freely handed out pain medications to veterans for years.
Then they stopped. The results have sometimes turned tragic

The VA Hooked Veterans on Opioids, Then Failed Them Again
VA Says 68,000 Vets Addicted to Opioid Painkillers
Veterans Face Greater Risks Amid Opioid Crisis
How the VA Fueled the National Opioid Crisis and Is Killing Thousands of Veterans
The Best Effort To Fight Opioid Addiction May Be At This VA Hospital In The Center Of America’s Epidemic
VA OIG Releases Report on Opioid Prescribing Habits
H.R. 5829 (115th): VA Opioid Prescribing Rates Accountability Act
Missouri’s VA Medical Centers Reduced Opioid Prescriptions—McCaskill Applauds Efforts, Seeks Additional Details
Who Overdoses on Opioids at a VA Emergency Department?
VA becomes first hospital system to release opioid prescribing rates
Department of Veterans Affairs Opioid Prescribing Data
Department of Veterans Affairs Opioid Prescribing Data 2
VA Health Services Research & Development: Opioids
Progress Made Towards Improving Opioid Safety, but Further Efforts to Assess Progress and Reduce Risk Are Needed
GAO Recommendations for Executive Action at Department of Veterans Affairs
VA publicly releases opiate prescribing rates for all its hospitals for the first time
VA publicly posts opioid prescription rates for all facilities
San Diego VA cuts opioid prescribing rate from 18% to 10%
How the Military Health System Registry Targets the Opioid Epidemic
Vets on painkillers: See opioid prescribing rates at VA hospitals in NY
Fighting Pain and Addiction for Veterans | The White House
How the VA Is Battling Opioid Use Disorder | PEW
The VA is Prescribing Fewer Opioids – But Not for the Reason You Think
Watchdog: VA cuts opioid prescription rate by 41 percent in past 5 years
Study finds VA prescribes far more opioids to rural veterans than urban counterparts
Charleston VA hospital reducing opioid use for chronic pain treatment
Study shows veterans obtaining opioids from multiple health systems experience higher rates of unintentional overdose
As Opioids Kill More Veterans, Study Shows Treatment Needs
As more veterans die of opioid overdoses, study shows need to focus beyond prescription opioids
Stop persecuting doctors for legitimately prescribing opioids for chronic pain
Millions of opioid pills passed through SC as drug makers allegedly targeted veterans
Local veteran struggles to get prescribed medication in light of drug epidemic
VA mail-out pharmacy responsible for high number of opioids in Charleston Co., data shows
VA Working to Slash Opioid Use Amid New Research on Painkiller Alternatives
VA opioid prescriptions are down but there’s still work to be done
Amarillo VA has highest opioid prescribing rate in Texas, working to cut back
Data shows Roseburg VA has highest opioid prescribing rate in U.S.
El Paso VA leads US in cutting opioid prescribing
Fayetteville VA leading efforts to reduce opioid prescriptions
Opioid prescribing rate drops at Buffalo VA, other medical centers
Opioid prescriptions down at Salt Lake VA hospital since 2012
Tex. Veterans Affairs Doctors Prescribing Less Opioids
Federal Investigation Finds Tomah VA Not Prescribing Opioids ‘Like Candy’
Military veterans defy Jeff Sessions, fight for medical marijuana to kick opioid addiction
Report: Prescriptions Aren’t Causing The Opioid Epidemic
Opioid Abuse in the U.S. Military – PCSS