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 Congressional Updates

 Legionella Outbreak in Pittsburgh Examined by O&I Subcommittee

 Over the past two years, deadly Legionella bacteria infected 21 patients at the University Drive Campus of the Department of Veterans Affairs Pittsburgh Healthcare System. Five of those veterans died of pneumonia less than 30 days after testing positive for Legionellosis, commonly known as Legionnaires’ Disease.

 The name derives from a July 1976 outbreak in which more than 200 members of The American Legion attending their Department convention in Philadelphia were stricken by a "mystery disease" that killed 34 of them. Legionella bacteria can be found in cooling towers, central air-conditioning systems, hot-water systems and spas. Symptoms of Legionnaires’ Disease include fever, chills, coughing, muscle aches and loss of appetite. At least 50 species of Legionella have been identified, which can be carried airborne more than three miles.

 A collaborative review by VA Pittsburgh and the Centers for Disease Control (CDC) identified 29 cases of veterans with Legionella pneumonia, from January 2011 to December 6, 2012, with five of those cases proving fatal. Eight cases contracted the disease in their communities, five caught it at the University Drive Campus and the other 16 patients probably were infected at the hospital as well.

 Responding to the Pittsburgh outbreak, several members of Congress asked VA’s Office of the Inspector General to review the incidence of Legionnaires’ Disease at VA medical facilities nationwide. The review began December 20 and is expected to be completed next month.

 A February 5 hearing by the House Committee on Veterans’ Affairs Subcommittee on Oversight and Investigations focused on VA’s actions to prevent the spread of Legionella at its Pittsburgh facility. Panelists included Dr. Robert Jesse of VA, Dr. Lauri Hicks of CDC, Victor Yu, professor of medicine at the University of Pittsburgh, and Dr. Janet Stout of the Special Pathogens Laboratory in Pittsburgh,

 Stout testified that the University Drive Campus failed to recognize the Legionella outbreak and take preventive actions. "The delay may have contributed to additional cases and deaths." She also said the facility failed to operate its water disinfection system properly, and "finally, failure to communicate with physicians, staff, patients and families regarding the increase in cases. The delay in alerting physicians may have contributed to additional morbidity and mortality."

 "The only way an outbreak of this magnitude could have occurred is if the water system at the Pittsburgh VA had become heavily contaminated with Legionella," Stout told the subcommittee. "The environmental testing performed by the VA microbiology laboratory should have detected this increase."

 Yu, an expert on infectious diseases, testified that once a hospital’s water system is infected with Legionella, it stays there "for the rest of the lifetime of the hospital." He said the bacterium has been at the Pittsburgh facility since 1982. "You can suppress it pretty easily, but if you don’t maintain a system, that organism is going to come out."

 With new antibiotics, Yu said, the mortality rate for Legionnaires’ Disease has dropped effectively to zero. According to Dr. Yu, the five veterans who died "either didn’t get the antibiotic or they got it too late while they were dying.” The fact that Legionella had re-contaminated the system was not communicated to the emergency room physician...or the intensive care physician," he said.

 Hicks, a medical epidemiologist at CDC, estimated the annual number of Legionnaires’ Diseases cases to be between 8,000 and 18,000, "and a good proportion of those are health-care associated. So this is not an uncommon occurrence in hospitals, and - this will be very disturbing to many of you - I suspect that many of these outbreaks go undetected."

 Stout reminded the subcommittee of its role "to hold people in the administration accountable for the failures that led to this outbreak. And accountability needs to come from the top down, not the bottom up.... It was the responsibility of the Pittsburgh VA to be current in knowledge and vigilant in following the policies and procedures that were already in place. The system isn’t broken, so don’t fix it."

 House Subpanel Examines Problems with 100 Percent Temporary Disability Rating

 On Tuesday, February 5, the House Veterans’ Affairs Subcommittee on Disability Assistance and Memorial Affairs held a hearing to examine the 100 percent temporary disability rating. The issue stems from the fact that while veterans are at times placed on 100 percent disability for a temporary period (if, for instance, they were to get surgery and require a recovery period due to a service-connected condition), there are many cases in which the veteran is never returned to their actual disability rate, and therefore, receive benefits to which they are not entitled. This is costly to American taxpayers. Further complicating the problem, in the cases wherein these veterans are returned to their correct disability rate, they are usually asked to repay the benefits paid them which were not due, creating an undue financial burden on the veterans and their families.

 Witnesses included:Mr. Rick Weidman, Executive Director for Policy and Government Affairs, Vietnam Veterans of America; and Ms. Linda Halliday, Assistant Inspector General for Audits and Evaluations, Office of the Inspector General, Department of Veterans Affairs accompanied by Mr. Larry Reinkemeyer, Director, Kansas City Audit Operations Division Office of the Inspector General, Department of Veterans Affairs and Mr. Brent Arronte, Director, San Diego Benefits Inspection Division Office of the Inspector General, Department of Veterans Affairs, as well as Ms. Diana Rubens, Deputy Under Secretary for Field Operations, Veterans Benefits Administration, Department of Veterans Affairs.

 Subcommittee Chairman Jon Runyan (NJ) noted that “the OIG [Office of the Inspector General] stated that since January 1993, VBA has overpaid veterans a net amount of $943 million. The OIG also stated that without timely action, VBA would overpay veterans a projected $1.1 billion over the next five years.” He also stated that an OIG audit of two VA Regional Offices found that 50 percent of the temporary 100 percent disability evaluations reviewed were incorrect.

 Mr. Weidman stated that “[VVA] has analyzed all three reports looking for common threads, and much of the problem is simply failure to consistently use the procedures and tools that are in place.” That is, in the estimation of VVA, the problem is at least as much a failure by employees to properly utilize proper standing operating procedure, as it is an issue of the policy itself.

 Ms. Halliday noted that “VBA has not been aggressive, timely, or thorough in completing its national review.” She went on to note that “While electronic system fixes may resolve some issues, they do little to address the problem we continue to find with staff error in processing.”

 Ms. Rubens stated that, contrary to Ms. Halliday’s statement, “VBA has already taken significant corrective actions (including case reviews, legacy system software changes, mandatory training, increased oversight, and technology enhancements in our new VBMS paperless processing system currently being deployed) to ensure temporary 100-percent ratings are effectively monitored and adjusted.” She did recognized, however, that VBA’s “regional offices have not yet completed action on all of the individual cases requiring review” and stated that VBA would “continue to carefully monitor these cases to completion and partner with OIG to ensure we are providing our veterans with timely and accurate benefit payments.”

 Budget Update on Capitol Hill

 Even though the President missed his February 4 deadline for submitting a Fiscal Year 2014 budget to Capitol Hill, the budget dominated the news on Capitol Hill this week.

 Congressional Budget Office (CBO) – The CBO announced its projection that the federal deficit will be $845 billion in 2013, falling below $1 trillion for the first time in four years. According to the CBO’s projections, under current law, the deficit will decrease to $430 billion in 2015, but then rapidly increase as the aging population and rising health care costs grow entitlement spending. Note that these projections are based on “current law”. That means the sequestration spending cuts will occur and there will be no changes to current federal tax rates.

 President Obama – In a hastily called press conference, the President warned Congress against the propensity to “cut our way to prosperity.” He said simply cutting federal spending will primarily result in people losing jobs, which will only slow economic growth further. He requested that Congress consider passing a small package of cuts and tax reforms to delay the sequester a few months, to give themselves more time to work on a larger, more comprehensive package. He said that “we’ve made progress” in cutting the national deficit by more than $2.5 trillion, through a mix of spending cuts and higher tax rates. This is more than halfway to the $4 trillion goal required to stabilize the debt. He wants to accomplish the rest through a mix of spending cuts and additional tax reforms. Lastly, he said the deals put forward at the end of 2012 during the fiscal cliff negotiations are still valid. This includes entitlement reforms to Medicare and Social Security, as well as other programs; that the government’s bills would be reduced by reducing the cost of health care, not by shifting the cost onto older or poor people; and that the savings achieved from tax reform should be used to pay down the deficit.

 House of Representatives – The House responded to the President’s lack of submission of his budget (now expected after the Washington Conference and sometime in mid-March) by passing legislation requiring the President to submit a balanced budget to Congress. The legislation states that, if the initial budget submission does not balance, then the President must submit another one showing when spending would balance in the future. Debate has begun and the vote is expected by the end of this week. The legislation is fully expected to pass the House and to die in the Senate.

 House Committee on Oversight and Government Reform – This committee on February 5 held a hearing entitled, “Government Spending: How Can We Best Address the Billions of Dollars Wasted Every Year?” The witnesses were:

 Mr. Thomas A. Schatz, President, Citizens Against Government Waste

 Ms. Ryan Alexander, President, Taxpayers for Common Sense

 Mr. Dan G. Blair, President, National Academy of Public Administration

 Mr. Jonathan M. Kamensky, Senior Fellow, IBM Center for The Business of Government

 The witnesses criticized Congress for blocking the President’s “modest” TRICARE reforms that the Pentagon said was needed in an effort to restrain military health care program costs. They also noted that, historically, Congress has prevented the Pentagon from ending unwanted weapons systems. The Pentagon was faulted for expanding its mission beyond its charter, for not properly tracking and spending money abroad (particularly in Iraq and Afghanistan), and for sloppy contract and acquisition practices. With regard to the rest of the federal government, the witnesses said there is duplication in services across departments and agencies and they called for the creation of a commission to examine what programs are duplicative, and what services can be consolidated. Lastly, the witnesses pointed out that the across-the-board cuts under sequestration eliminate both wasteful and necessary spending. One example was that the federal workforce is in a period of transition, with older workers retiring and new ones requiring training and, under sequestration, those training dollars are the first to go, which will only wind up costing substantial amounts of money later as work is done improperly (such as contracting and acquisition).


 Preparations for Washington Conference Going Forward

 The Legislative Division continues to work diligently in preparation for the upcoming Washington Conference, being held February 25-27. Legion Family members will converge on our nation’s capital for meetings, conferences, workshops, and lobbying their members of Congress to continue the work of The American Legion.

 The Legislative Division will be in charge of the “Commander’s Call” on Tuesday morning February 26. The agenda is still being developed, and prospective speakers are being considered. Legislative Commission Chairman Ken Governor (NY) is coming to Washington in two weeks to work with staff to prepare the agenda.

 American Legion Legislative Council

 The Legislative Division continues the task of re-building the membership of the National Legislative Council for the 113th Congress. Council recommendation forms were emailed to Department leadership in December, asking for nominations for new congressional members. Completed forms were due in the Legislative Division offices in Washington, DC by January 18. To date, 31 Departments have returned their Council nomination forms.

 The importance of the Legislative Council cannot be overstated. It is an especially important voice for The American Legion family, and the way in which members of Congress can be quickly contacted when legislative action is needed. Departments are urged to complete their nomination forms and return them to the Legislative Division offices as soon as possible.

 Letters of Support

 The American Legion on February 5 sent a letter of support to Senator Barbara Boxer (CA) giving our organization’s support for S. 62, legislation entitled the Check the Box for Homeless Veterans Act of 2013. This measure would offer taxpayers the opportunity to help keep those who have served our country off the streets by making a voluntary contribution on their annual federal income tax return to support programs that prevent and combat veteran homelessness.

 This bill would establish a Homeless Veterans Assistance Fund in the Treasury Department which would supplement proven federal programs for homeless and at-risk veterans and their families. In addition, S. 62 would provide funding for innovative and relevant programs/services that would improve and expand services available to homeless veterans. [Resolution 308-2012]

 Update on Flag Amendment Bill

 On January 18, House Joint Resolution (H.J. Res.) 19 was introduced by Representative Jo Ann Emerson (MO). This legislation is a proposed constitutional amendment to protect the American flag from physical desecration. Its text states simply: “The Congress shall have power to prohibit the physical desecration of the flag of the United States.”

 The next task is finding cosponsors for this legislation. Please contact the offices of your representative and senators, and ask them to become cosponsors of the flag amendment in their respective chambers. [Res. 272-2012]