Showing posts with label veterans. Show all posts
Showing posts with label veterans. Show all posts

Wednesday, June 13, 2018

Hepatitis C Care in the Department of Veterans Affairs: Building a Foundation for Success.

Infect Dis Clin North Am. 2018 Jun;32(2):281-292. doi: 10.1016/j.idc.2018.02.011.
Hepatitis C Care in the Department of Veterans Affairs: Building a Foundation for Success.
Belperio PS1, Chartier M2, Gonzalez RI3, Park AM4, Ross DB2, Morgan TR5, Backus LI6.

PMID: 29778256 DOI: 10.1016/j.idc.2018.02.011 

Article shared by Henry E. Chang via Twitter


Veterans Direct-acting antiviral SVR Hepatitis C Population health Innovation System redesign

Since January 2014 the Department of Veterans Affairs (VA) has made significant progress in the treatment of veterans with hepatitis C virus (HCV) and, as of December 2017, more than 100,000 veterans have been treated.

Special regional multidisciplinary Hepatitis C Innovation Teams were created that used lean process improvement and system redesign, resulting in innovative hepatitis C practice models that help to address gaps in care.

The VA has expanded access and treatment capacity for HCV-infected veterans through the use of nonphysician providers (clinical pharmacists, nurse practitioners, and physician assistants), video telehealth, and electronic technologies.

The VA continues to use population health management tools to effectively manage and track the treatment and care of veterans with HCV.

The Department of Veterans Affairs (VA) has made significant progress in treating hepatitis C virus, experiencing more than a 75% reduction in veterans remaining to be treated since the availability of oral direct-acting antivirals. Hepatitis C Innovation Teams use lean process improvement and system redesign, resulting in practice models that address gaps in care. The key to success is creative improvements in veteran access to providers, including expanded use of nonphysician providers, video telehealth, and electronic technologies. Population health management tools monitor and identify trends in care, helping the VA tailor care and address barriers.

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Sunday, March 18, 2018

Audio Story- Hepatitis C Is More Common In Vietnam Vets, But Nobody Is Sure Why

From: American Homefront Project
PRX » Station » North Country Public Radio
By Sarah Harris • Mar 15, 2018
Produced: Mar 13, 2018
Sarah Harris reports on an effort to get Vietnam vets checked and treated for Hepatitis C.


The reasons that Vietnam vets are more likely to have hepatitis C are disputed. Kaifetz blames a device called the "jet gun injector" that the military used to vaccinate service members during the Vietnam era. It generated a burst of air pressure to force the vaccine under the skin.

"It was supposed to shoot the injection through your skin cells without piercing the skin with a needle," Kaifetz explained.

Even though the gun wasn't supposed to break the skin, a lot of veterans say it made them bleed. The gun usually wasn't sterilized between each use.

This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans. Funding comes from the Corporation for Public Broadcasting and the Bob Woodruff Foundation. 

Saturday, March 10, 2018

A “paradigm shift” in the VA’s approach to hep C

Of Interest
The following full-text article shared online by Henry E. Chang via Twitter
The effect of IFN-free regimens on disparities in hepatitis C treatment of U.S. Veterans
Aim - To determine whether implementation of interferon-free treatment for hepatitis C virus (HCV) reached groups less likely to benefit from earlier therapies, including patients with genotype 1virus or contraindications to interferon treatment, and groups that faced treatment disparities: African Americans, patients with HIV co-infection, and those with drug use disorder.
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The Good Fight 
Promrat, an associate professor of medicine, says there’s been a “paradigm shift” in the VA’s approach to hep C. Rather than wait for veterans to come to them already suffering from serious liver complications, the VA seeks them out before they get sick—with screening reminders that pop up in the electronic medical records of at-risk patients, calls and letters inviting them to come in for testing, and other outreach. As of July 2017 the VA says it had tested 79.5 percent of patients born between 1945 and 1965 and nearly 90 percent of its homeless population, two groups with the highest prevalence of hep C.

By Phoebe Hall
Hepatitis C is the deadliest infectious disease in the US. The VA has a strategy to defeat it among veterans.

Homelessness, mental health disorders, and substance use can be barriers to care for patients with hepatitis C. Many state Medicaid programs, including Rhode Island’s, restrict treatment to healthy, sober individuals. But those clinical challenges aren’t stopping Veterans Administration providers in their quest to cure as many veterans with the virus as possible.

“We’ve had a veteran who came in every day to get directly observed therapy, which is something we do for tuberculosis, but we’ve never really done that for hepatitis C,” says Amanda Noska, MD, MPH, F’15, an infectious disease physician at the Providence VA Medical Center.

“That worked really well for him, and he has been cured of hepatitis C,” Noska says. “He otherwise never would have gotten treatment.”

In 2014 the VA declared war on hep C. It had 168,000 veterans in the system with the virus, and those numbers were on the rise, due not only to baby boomers who may have lived, asymptomatically, with the disease for decades, but also to injection drug use, fueled by the opioid crisis.

The agency negotiated lower prices for new, highly effective, but notoriously expensive direct-acting antivirals and has allocated more than $1 billion annually to buy them. By August 2017, the VA reports, it had treated more than 96,000 patients. The cure rate of the new drugs is about 95 percent.

“I really think we’re going to be able to wipe out hepatitis C from the VA system in the next couple of years,” says Kittichai Promrat, MD, a hepatologist at the Providence VA who heads the local arm of the nationwide initiative to treat all veterans with the virus. “They prioritize hepatitis C as an important issue that they need to address. That’s the first step. And then they allocate enough resources for us to do this type of work.”

Promrat, an associate professor of medicine, says there’s been a “paradigm shift” in the VA’s approach to hep C. Rather than wait for veterans to come to them already suffering from serious liver complications, the VA seeks them out before they get sick—with screening reminders that pop up in the electronic medical records of at-risk patients, calls and letters inviting them to come in for testing, and other outreach. As of July 2017 the VA says it had tested 79.5 percent of patients born between 1945 and 1965 and nearly 90 percent of its homeless population, two groups with the highest prevalence of hep C.

They expanded treatment capacity by allowing primary care physicians, clinical pharmacists, nurse practitioners, and physician assistants to provide care, and using telemedicine to reach more patients. “Many patients may not want to come in all the way to Providence,” Promrat says. “By having that option, it’s really helped improve treatment uptake.”

The VA’s hep C teams also collaborate with specialists in its mental health, substance use, and homeless clinics. “Many [veterans]do have issues—drug and alcohol use, mental health, homelessness—that need to be addressed at the same time,” Promrat says. “We just can’t tackle this alone.”

Noska, an assistant professor of medicine, sports a button on her white coat that reads, “Born 1945-1965? Ask me about Hep C!” (“I have a T-shirt too,” she says.) She sees veterans in the homeless clinic every Friday. “We’ve done a bunch of innovative things,” she says, like directly observed therapy. “It’s really very patient centered. … Just developing a really strong rapport with the patient is actually paramount to getting some of our veterans into care.”

Integrated, comprehensive treatment is easier when everything is under one roof—starting with the test. “In the conventional civilian population, you’d refer somebody to Rhode Island Hospital to get a liver elastography,” Noska says. “If they no-show that appointment, you’re dead in the water.” At the VA, she simply sends her patients downstairs. Similarly, she or Promrat might get a call from a primary care provider or social worker in another part of the hospital, and they’ll swing by to see the patient. “The VA makes it easier to coordinate and expedite care,” Noska says.

Experts who have been sounding the alarm about hep C, some for many years, say new approaches like the VA’s are the only way to defeat the disease, which kills more than 19,000 people in the US annually. “The world has the tools to prevent these deaths,” the National Academies of Sciences, Engineering, and Medicine noted in a press release last year, as it laid out a plan to get rid of viral hepatitis by 2030. But doing so requires a bold financial commitment in testing and treatment, as well as prevention measures like needle exchange—“a significant departure from the status quo.”

“We’re all supposed to be scaling up, revving up, moving faster,” says Lynn Taylor, MD RES’00 F’05, director of Rhode Island Defeats Hep C. “The VA is a bright spot in the state.”

Taylor helped establish colocated, integrated care—“one-stop shopping”—at The Miriam Hospital, where until recently she directed the HIV/Viral Hepatitis Coinfection Program; and at CODAC Behavioral Healthcare, a nonprofit treatment and recovery program in Rhode Island, where she’s now director of HIV and Viral Hepatitis Services.

But she says she can only do so much under the restrictions placed by the state’s Medicaid program. Rhode Island limits treatment to people who have reached a certain stage of advanced liver disease and who don’t use illicit drugs, and generally allows only certain specialists (usually GI and infectious disease docs) to prescribe treatment. “The evidence does not support withholding treatment,” Taylor says. “We need to identify [hepatitis C]early. … We need to get people treated and cured soon after diagnosis so they don’t get sicker … and so they aren’t spreading hep C.”

And then there are the “benefits beyond cure,” including decreased recidivism and substance use, she adds: “Patients tell us they think, ‘I’m worth it, they’re investing in me, they want my hep C cured,’ and they are motivated to work on other issues.”

Many challenges remain for the VA. Its success depends on continued Congressional allocations, identifying everyone who has the virus, and addressing the remaining barriers for those veterans who can’t get or don’t want treatment. The Providence hep C team is in regular contact with their counterparts at other VA hospitals, so they can share what’s worked and what hasn’t, and brainstorm new ideas. They’re also preparing for a certain proportion of patients who, after they’re cured of hep C, will develop fatty liver disease, Promrat says: “There’s still more work. That’s for sure.”

But for so many veterans, the VA is preventing liver cancer and liver failure and saving lives. “It’s a unique situation because I can’t think of a chronic viral disease that we can cure,” Promrat says. “This thing doesn’t come up probably again in my lifetime.”

Thursday, March 1, 2018

The VA Will Eliminate Hepatitis C In Veterans By Year-end

The VA Will Eliminate Hepatitis C In Veterans By Year-end
John LaMattina
Only a few years ago, stories appeared in the media about how tens of thousands of U.S. veterans were infected with hepatitis C and that the government couldn’t afford to treat them. Typical was a CBS News report headlined “VA can’t afford drug for veterans suffering from hepatitis C”

Friday, September 22, 2017

In the Battle Against Hepatitis C, the VA Takes the Lead

In the Battle Against Hepatitis C, the VA Takes the Lead

Thursday, April 6, 2017

VA Official: Use of Cape Regional by Vets May Be Announced in 30-60 Days

VA Official: Use of Cape Regional by Vets May Be Announced in 30-60 Days
By Al Campbell
WILMINGTON, DEL. – Vietnam veterans who rallied on March 25 in Wildwood and Ocean View for health care facilities in Cape May County may be within 60 days of having their demands met.

Vincent Kane, interim associate director of operations, Wilmington Veterans Affairs (VA) Medical Center, confirmed March 29 that discussions of partnership with Cape Regional Medical Center have been ongoing.

Kane said he had discussions with some of the veterans who voiced concerns at the rally. One, in particular, who told of wanting to be tested for Hepatitis C, and told he had to wait until December, got Kane's attention....
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Thursday, March 10, 2016

VA expands hepatitis C treatment to all patients with the virus

VA expands hepatitis C treatment to all patients with the virus
Patricia Kime, Military Times

The Veterans Affairs Department will begin providing hepatitis C treatment to all veterans in its health system who have the virus, regardless of their disease stage, VA officials said Wednesday.

Having received a boost in funding from Congress late last year for the costly medications needed to cure hepatitis C, the VA is now able to treat the 174,000 veterans in its health system who have the disease, according to a VA release.

VA Under Secretary for Health Dr. David Shulkin said that while the cost previously was too prohibitive to treat all but the sickest patients, VA now can treat all veterans with the virus who are eligible for VA health care, either in a VA facility or through the Veterans Choice program.

Merck Applauds the U.S. Department of Veterans Affairs (VA) for Broadening Treatment Access for Veterans with Chronic Hepatitis C Infection

KENILWORTH, N.J.--(BUSINESS WIRE)--Merck (NYSE:MRK), known as MSD outside the United States and Canada, applauds the U.S. Department of Veterans Affairs (VA) for broadening access to treatment for Veterans with chronic hepatitis C virus (HCV) infection.

“We are grateful to Congress and to pharmaceutical leaders like Merck that are committed to our Veterans who have nobly served our nation.”Tweet this

ZEPATIER (elbasvir and grazoprevir) was approved Jan. 28, 2016 by the U.S. Food and Drug Administration (FDA) for the treatment of adult patients with chronic HCV genotype (GT) 1 or GT4 infection, with or without ribavirin (RBV), following priority review by the FDA, and was recently added to the VA National Formulary.

Merck introduced ZEPATIER with a price and access strategy to broaden and accelerate access to treatment for patients covered in commercial or public plans, including our country’s Veterans. The Veteran population is disproportionally affected by chronic HCV with an estimated 180,000 Veterans infected with the virus. Despite the availability of highly effective direct acting anti-viral (DAA) regimens for more than two years, the VA estimates that only about one in five of these Veterans have been treated with these DAA regimens over that period.

“As the single largest provider of chronic hepatitis C care in the United States, our goal has been to treat every Veteran with HCV infection,” said Sloan Gibson, deputy secretary for the Department of Veterans Affairs. “We are grateful to Congress and to pharmaceutical leaders like Merck that are committed to our Veterans who have nobly served our nation.”

ZEPATIER is not for use in patients with moderate or severe hepatic impairment (Child-Pugh B or C). ZEPATIER also is not for use with organic anion transporting polypeptides 1B1/3 (OATP1B1/3) inhibitors (e.g., atazanavir, darunavir, lopinavir, saquinavir, tipranavir, cyclosporine), strong cytochrome P450 3A (CYP3A) inducers (e.g., carbamazepine, phenytoin, rifampin, St. John’s Wort), and efavirenz. If ZEPATIER is administered with RBV, healthcare professionals should refer to the prescribing information for RBV as the contraindications, warnings and precautions, adverse reactions and dosing for RBV also apply to this combination regimen.

“This is a good example of how government and industry can work together toward a shared goal in the best interests of public health – particularly for our Veterans who are so deserving. We are thankful and privileged to have worked in partnership with the VA to help accelerate access to chronic hepatitis C treatment for America’s Veterans,” said Kenneth C. Frazier, chairman and CEO, Merck. “The VA is now leading the way for the U.S. in showing what is possible in the fight against chronic hepatitis C.”

Selected Safety Information about ZEPATIER (elbasvir and grazoprevir)

Elevations of alanine transaminase (ALT) to greater than 5 times the upper limit of normal (ULN) occurred in 1% of subjects, generally at or after treatment week 8. These late ALT elevations were typically asymptomatic and most resolved with ongoing or completion of therapy. Healthcare professionals should perform hepatic lab testing on patients prior to therapy, at treatment week 8, and as clinically indicated. For patients receiving 16 weeks of therapy, additional hepatic lab testing should be performed at treatment week 12.

Patients should be instructed to consult their healthcare professional without delay if they have onset of fatigue, weakness, lack of appetite, nausea and vomiting, jaundice or discolored feces. Healthcare providers should consider discontinuing ZEPATIER if ALT levels remain persistently greater than 10 times ULN. ZEPATIER should be discontinued if ALT elevation is accompanied by signs or symptoms of liver inflammation or increasing conjugated bilirubin, alkaline phosphatase, or international normalized ratio.

The concomitant use of ZEPATIER with certain drugs may lead to possible clinically significant adverse reactions from greater exposure to ZEPATIER or concomitant drugs. Coadministration of ZEPATIER is not recommended with certain strong CYP3A inhibitors (e.g., ketoconazole or the cobicistat-containing regimens of elvitegravir/cobicistat/emtricitabine/tenofovir [disoproxil fumarate or alafenamide]). Healthcare professionals should not exceed atorvastatin 20mg/daily or rosuvastatin 10mg/daily when given with ZEPATIER. If ZEPATIER is given with fluvastatin, lovastatin or simvastatin, healthcare professionals should give the lowest statin dose necessary and closely monitor for statin-associated adverse events. If ZEPATIER and tacrolimus are coadministered, frequent monitoring of tacrolimus whole blood concentrations, changes in renal function and tacrolimus-associated adverse events is recommended.

The concomitant use of ZEPATIER and certain drugs may cause significant decrease of elbasvir and grazoprevir plasma concentrations, which may lead to reduced therapeutic effect of ZEPATIER and possible development of resistance. Coadministration of ZEPATIER is not recommended with moderate CYP3A inducers (e.g., nafcillin, bosentan, etravirine, modafinil).

In subjects receiving ZEPATIER for 12 weeks, the most commonly reported adverse reactions of all intensity (greater than or equal to 5% in placebo-controlled trials) were fatigue, headache and nausea. In subjects receiving ZEPATIER with RBV for 16 weeks, the most commonly reported adverse reactions of moderate or severe intensity (greater than or equal to 5%) were anemia and headache.

About ZEPATIER™ (elbasvir and grazoprevir) 50mg/100mg Tablets

ZEPATIER is a fixed-dose combination product containing elbasvir, a hepatitis C virus (HCV) NS5A inhibitor, and grazoprevir, an HCV NS3/4A protease inhibitor, and is indicated with or without ribavirin for treatment of chronic HCV genotype 1 or 4 infection in adults. The dosing regimens and durations for treatment with once-daily ZEPATIER for chronic HCV GT1 or GT4 infection in patients with or without cirrhosis, HIV-1 co-infection or renal impairment are as shown in the table below. For patients with chronic HCV GT1a infection, testing for the presence of NS5A resistance-associated polymorphisms (positions 28, 30, 31 or 93) is recommended prior to starting treatment with ZEPATIER to determine the optimal dosage regimen and duration.
Patient PopulationTreatmentDuration
Treatment-naïve or PegIFN/RBV-experienced* without baseline NS5A polymorphisms
ZEPATIER12 weeks
Treatment-naïve or PegIFN/RBV-experienced* with baseline NS5A polymorphisms
ZEPATIER with RBV16 weeks
Treatment-naïve or PegIFN/RBV-experienced*
ZEPATIER12 weeks
GT1a or GT1b:
ZEPATIER with RBV12 weeks
ZEPATIER12 weeks
ZEPATIER with RBV16 weeks
*Patients who have failed treatment with peginterferon alfa (PegIFN) + RBV.
†NS5A resistance-associated polymorphisms at amino acid positions 28, 30, 31 or 93.
§Patients who have failed treatment with PegIFN/RBV + HCV NS3/4A protease inhibitor (PI): boceprevir, simeprevir or telaprevir. For GT1a-infected PegIFN/RBV/PI-experienced patients with one or more baseline NS5A resistance-associated polymorphisms (positions 28, 30, 31 or 93), the optimal ZEPATIER-based treatment regimen and duration of therapy has not been established.

About Merck

Today’s Merck is a global health care leader working to help the world be well. Merck is known as MSD outside the United States and Canada. Through our prescription medicines, vaccines, biologic therapies and animal health products, we work with customers and operate in more than 140 countries to deliver innovative health solutions. We also demonstrate our commitment to increasing access to health care through far-reaching policies, programs and partnerships. For more information, and connect with us on Twitter, Facebook, YouTube and LinkedIn.

Forward-Looking Statement of Merck & Co. Inc., Kenilworth, NJ, USA

This news release of Merck & Co., Inc., Kenilworth, NJ, USA (the “company”) includes “forward-looking statements” within the meaning of the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of 1995. These statements are based upon the current beliefs and expectations of the company’s management and are subject to significant risks and uncertainties. If underlying assumptions prove inaccurate or risks or uncertainties materialize, actual results may differ materially from those set forth in the forward-looking statements.

Risks and uncertainties include, but are not limited to, general industry conditions and competition; general economic factors, including interest rate and currency exchange rate fluctuations; the impact of pharmaceutical industry regulation and health care legislation in the United States and internationally; global trends toward health care cost containment; technological advances, new products and patents attained by competitors; challenges inherent in new product development, including obtaining regulatory approval; the company’s ability to accurately predict future market conditions; manufacturing difficulties or delays; financial instability of international economies and sovereign risk; dependence on the effectiveness of the company’s patents and other protections for innovative products; and the exposure to litigation, including patent litigation, and/or regulatory actions.

The company undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events or otherwise. Additional factors that could cause results to differ materially from those described in the forward-looking statements can be found in the company’s 2015 Annual Report on Form 10-K and the company’s other filings with the Securities and Exchange Commission (SEC) available at the SEC’s Internet site (

Please see Prescribing Information for ZEPATIER (elbasvir and grazoprevir) at and the Patient Information for ZEPATIER at

Wednesday, December 3, 2014

High costs threaten veterans' access to hepatitis C drug Sovaldi

Senate Panel Probes Exorbitant Prices for Hepatitis C Drugs 

WASHINGTON--(ENEWSPF)--December 3, 2014 – The Senate Veterans’ Affairs Committee held a hearing today on exorbitant prices charged by drugmakers for new treatments for hepatitis C, a liver disease that claims about 15,000 lives a year in the United States.

Gilead, the leading manufacturer of the drugs, refused to testify at the hearing about the $84,000 it charges for a 12-week regimen of Sovaldi and the $94,500 price tag for a newer drug, Harvoni. The price per pill is about $1,000 for Sovaldi $1,125 for Harvoni.

Even with bulk-purchase discounts, the Department of Veterans Affairs spent $370 million in the past year on new treatments. Outlays are projected to soar by an additional $1.3 billion for the next two years.

“What we are looking at is a very excessive profit,” said Sen. Bernie Sanders (I-Vt.), the committee chairman. He called it “deplorable” and a “moral issue” that the life-saving drug may have to be rationed because the price makes it unaffordable for all who need it.

The treatment cost is especially significant to the VA because the disease affects veterans – particularly Vietnam-era veterans – at a rate higher than the general population. Approximately 174,000 veterans currently enrolled in VA have been diagnosed with hepatitis C.

Sovaldi is on pace to become the highest grossing drug in history. Approved by the Food and Drug Administration late in 2013, sales totaled $2.27 billion in the first quarter of 2014 and $3.48 billion in the second quarter. Gilead bought the rights to market the drug from another company, which had planned to charge less than half as much for the medication. “Did Gilead purchase the company knowing it could more than double the price and pay for its investment in one year?” asked John Rother of the National Coalition on Health Care.

Robert Weissman, president of the consumer rights group Public Citizen, testified that Gilead is making $200 million a week on Sovaldi. He said treatments are useful only if they are accessible. “We’ve now reached a point where treatments will increasingly be restricted and rationed because brand-name drug companies have used monopolies to price them out of reach.”

The introduction of the costly but effective treatments “holds the promise of eradicating this disease in infected veterans,” according to Michael Valentino, a pharmacist who is the VA’s chief Pharmacy Benefits Management consultant. But he told the committee that the cost of the new therapies “remains a major challenge.”

High costs threaten veterans' access to hepatitis C drug Sovaldi
Stars and Stripes

Published: December 3, 2014

WASHINGTON — A new drug holds the potential to cure hepatitis C in tens of thousands of veterans but will require billions in new spending to cover the cost, Department of Veterans Affairs officials told a Senate panel Wednesday....

Sen. Richard Burr, R-N.C., said companies such as Gilead take large financial risks and navigate a testing and approval “valley of death” when developing new drugs.

“Innovation is expensive … I think the one thing we agree on is we don’t want to give up innovation,” Burr said....

Instead of attacking prices, he said Congress and the VA should look at how much could be saved in the long-term by treating veterans known to have hepatitis C....

“I believe the price of this particular drug should be looked at on the macro level,” Burr said.
Still, it remains unclear how the VA will deal with the high costs of treatment. Valentino said the department expects more new hepatitis C drugs to be released this month and next year, which could provide veterans alternatives to Sovaldi...

Reducing the cost of new hepatitis C drugs
Daclatasvir, Harvoni (ledipasvir/sofosbuvir) and Sovaldi.
An index of articles & research weighing the pros and cons over the high price of hepatitis C drugs.

Friday, October 24, 2014

AHF to Gilead: Do Your Patriotic Duty and Lower Hep. C Drug Prices for Veterans

AHF to Gilead: Do Your Patriotic Duty and Lower Hep. C Drug Prices for Veterans

AIDS organization calls out Gilead Sciences for offering its Hepatitis C drugs Sovaldi and Harvoni to India and other countries for $900, yet charging the U.S. Department of Veteran Affairs nearly $50,000 per veteran. With rates of Hepatitis C nearly five-times higher among veterans than in the general population, Sovaldi and Harvoni are expected to cost the VA over $1.3 billion over the next two years.

WASHINGTON--(BUSINESS WIRE)--AIDS Healthcare Foundation (AHF), the world’s largest AIDS organization and an outspoken advocate against runaway drug pricing for lifesaving HIV/AIDS and other medications, today called on Gilead Sciences, Inc., the manufacturer of Sovaldi (and its combination form, Harvoni), a new treatment for Hepatitis C, to lower the price of this drug for the Department of Veterans Affairs (VA) to the $900 price per person for Sovaldi it charges India and other countries. Currently, the VA pays nearly $50,000 per person for Sovaldi. The price of Harvoni, a combo drug of which Sovaldi is the primary ingredient, is expected to cost the VA and other payers even more.

“Gilead’s rabid greed has now extended to extracting as much profit as possible from the care of America’s service men and women”

“Gilead’s rabid greed has now extended to extracting as much profit as possible from the care of America’s service men and women,” said Michael Weinstein, President of the AIDS Healthcare Foundation. “As a nation, we have promised the members of our armed forces – men and women who put their lives at risk protecting our freedoms – that when they come home, we will take care of them. By charging our VA system nearly $50,000 per person for the treatment of Hepatitis C, Gilead is driving up healthcare costs by billions of dollars which will ultimately lead to the rationing of care for our veterans. Even more galling, Gilead charges the VA $50,000 while it offers other countries the same treatment for approximately $900 per person per year. AHF is calling on Gilead CEO, John Martin to do his patriotic duty by offering the VA the same $900 price it charges India and other countries for Sovladi.”

Earlier this month, Senator Bernie Sanders (I-VT) raised the alarm on the impact of Hepatitis C drug pricing on the VA. In a statement, Sen. Sanders said, “My goal as chairman is to help VA provide the best quality care to our veterans. But when VA has to spend an enormous amount of money on prescription drugs – money that has not been budgeted for – other important services are put at risk. This is an issue that has to be explored because when we put money into the VA we want to make sure it goes toward making sure veterans get the best care possible, not to pad the profit margins of large pharmaceutical companies.”

According to the statement put out by Sen. Sanders’ office, the VA treats approximately 174,000 veterans with Hepatitis C, and the costly new treatment is projected to cost the Department of Veterans Affairs $1.3 billion over the next two years.

AIDS Healthcare Foundation (AHF), the largest global AIDS organization, currently provides medical care and/or services to more than 354,000 individuals in 36 countries worldwide in the US, Africa, Latin America/Caribbean, the Asia/Pacific Region and Eastern Europe. To learn more about AHF, please visit our website:, find us on Facebook: and follow us on Twitter: @aidshealthcare

AIDS Healthcare Foundation
Timothy Boyd
Director of Domestic Policy
+1.202.543.1083 (cell)
Los Angeles:
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Senior Director, Communications
+1.323.308.1833 (work)
+1.323.791.5526 (cell)

Saturday, June 21, 2014

Vietnam Veterans, HCV, and Our Troubled VA

Vietnam Veterans, HCV, and Our Troubled VA 

Happy Saturday everyone, hopefully you have time to catch up on some weekend reading. Don't forget to check out June's index of Hepatitis Newsletters, and hot topics.

Today we offer an update on our horrific VA system, recent data on HCV risk factors pertaining to Vietnam veterans, and a few links to other problems at VA medical facilities.

We begin with the study assessing HCV risk factors among U.S. Military veterans from the Vietnam era. The purpose of the study was to investigate HCV risk factors among Vietnam veterans compared to nonveterans. The authors noted past studies mostly took place within the VA system, this study looked at 4,636 HCV patients who received care outside the VA.  The study suggested;  "Vietnam War era veterans did not report a higher prevalence of common hepatitis C risk factors — including injection drug use — compared with nonveterans, but they may have faced risk factors specific to their military service." The paper was published in the Journal of Community Health last April and featured in the June issue of Healio's "HCV Next"

These findings are important on so many levels, it finally illustrates to the VA that many Vietnam veterans were infected through known military risk factors. The social stigma of living with HCV is difficult enough, but even more so for our Vietnam veterans. Sadly, for decades, veterans have reported the VA presumed they were infected through intravenous drug use - unless they could prove otherwise. 

Other risk factors associated with military service include; emergency battle-related transfusions using unscreened blood, exposure to blood/body fluid in the field, or blood exposure through the multidose vaccination process, tattoos, sharing razors or non-sterile instruments. 

Transmission Of HCV
Not until 1990 was a screening test for hepatitis C developed, many people were infected with HCV by receiving blood products or a transfusion before 1990-1992. During this time approximately 30,000 people received letters from the Red Cross saying that they were infected with hepatitis C through contaminated blood. Officials estimated two hundred and fifty thousand people were at risk through earlier blood transfusions in the 1980's.

Provided below we have a few links to previous problems at VA medical facilities, and an interesting 2013 video from The Daily Show, with comedian Jon Stewart discussing the VA, legionnaires outbreak, exposure to hepatitis and the failure to monitor mental health patients at a few hospitals. Finally, the study; Vietnam era vets may not be at higher risk for HCV than nonvets, and an update from CNN on our troubled VA health care system. 


June 2011 
VA hospitals in Miami, Murfreesboro, Tenn., and Augusta, Ga. 
First VA colonoscopy case goes to trial after Miami vet contracted hepatitis C
A Coral Gables U.S. Air Force vet who says he contracted hepatitis C from a colonoscopy done at the Miami VA hospital with improperly cleaned equipment will press his claim in a Miami federal court.
More than 11,000 U.S. veterans received colonoscopies with improperly cleaned equipment at VA hospitals in Miami, Murfreesboro, Tenn., and Augusta, Ga., between 2004 and 2009. Of the veterans who had the procedure at the three facilities, five have tested positive for HIV, 25 for hepatitis C and eight for hepatitis B. In Miami, 11 additional suits charging emotional distress have been settled out of court for undisclosed amounts, the U.S. Attorney’s office said. Nine malpractice suits have been filed in Tennessee. Officials in Georgia couldn’t say how many have been filed there. None has gone to trial until now.

Related - June 2012
Hepatitis B-Court ruled against Tennessee veteran who claims he contracted HBV at Murfreesboro VA hospital
In the latest legal setback, a federal appeals court has ruled against a Tennessee veteran who claims he contracted hepatitis B after employees at the Murfreesboro VA hospital negligently failed to properly clean colonoscopy equipment. The ruling could have an impact on similar lawsuits against the VA.

April 2011
John Cochran Veterans Medical Center in St. Louis, MO
Ohio panel wants more VA tests for clinic patients
The lack of "adherence to sterilization practices" or "inadequate practices" at VA dental center was reported in 2011. During 2009 to 2010 notification letters sent to 1,812 veterans who may have been exposed to hepatitis B, hepatitis C and HIV; when a breach in protocol instrument processing took place at the John Cochran Veterans Medical Center in St. Louis, MO. The Associated Press reported in March 2011 that most of the 1,812 veterans potentially exposed have been tested with no infections connected to the dental clinic.

Of Interest
Video: Daily Show Takes on the VA 
In this 2013 video, talk show host Jon Stewart begins with checking on the progress of the VA's backlogged benefits, however, instead the comedian discovered problems at numerous VA hospitals.

Vietnam era vets may not be at higher risk for HCV than nonvets
Boscarino JA. J Community Health. 2014;doi:10.1007/s10900-014-9863-5.

Vietnam War era veterans did not report a higher prevalence of common hepatitis C risk factors — including injection drug use — compared with nonveterans, but they may have faced risk factors specific to their military service, according to new study data.

“Vietnam era veterans may have other HCV exposure risk factors in their history, other than injection drug abuse,” study researcher Joseph A. Boscarino, PhD, MPH, a senior scientist at Geisinger Health System Center for Health Research in Danville, Pa., told Infectious Disease News.

“Most important, they do not appear to have higher rates of injection drug abuse than comparable nonveterans. Also, a number of these vets report they got HCV through their military service during the Vietnam War era. We don't know if this is true or not, and more research may be required to answer this question more definitively.”

Joseph A. Boscarino, MD, MPH
Joseph A. Boscarino
Previous studies suggest that Vietnam era veterans have higher rates of HCV infection, which is attributed to a greater prevalence of injection drug use. However, the researchers said most of these studies have been conducted among patients in the Department of Veteran Affairs health care system, which most veterans do not use.

Patients that use the VA health care system also tend to be different demographically.

To assess HCV risk factors among Vietnam era veterans vs. nonveterans, Boscarino and colleagues surveyed 4,636 HCV patients who received care in four health care systems outside the VA. Among the male respondents (n=2,638), 22.5% served in the US military at some point from 1964 to 1975. These Vietnam era veterans were more likely to be older (P<.001), more educated (P<.001), less often foreign born (P=.009), and more often married (P<.001) vs. nonveterans.

Vietnam era veterans actually had a lower prevalence of injection drug use compared with nonveterans (54% vs. 58%; P=.16). Other common risk factors for HCV infection, including occupational risk factors (P=.18), medical procedures (P=.61) and blood transfusions or organ transplantations (P=.94), were not more common among Vietnam era veterans. The researchers found that nonveterans were more likely than veterans to report sex with men (P=.013) as a risk factor for infection, but the prevalence was low (2.4% vs. 0.6%).

Analyses indicated that Vietnam era veterans were more likely to report “other” risk factors as the source of their infection (P<.001) — namely, exposure to vaccinations during their military service. The researchers said that during the Vietnam War era, service members received multiple injections, typically with pneumatic injectors, as they moved through vaccination lines, and bleeding was not uncommon. This method of vaccination was later phased out by the military.

Although more research is needed, Boscarino said clinicians can play an important role in the management of HCV in veterans.

“Clinicians need to be aware that the VA will provide disability compensation for vets for HCV, if the vet can submit a supportable claim to the VA for HCV infection related to military service,” Boscarino said.

“In some cases, clinicians may be able to help vets submit a claim to the VA related to their particular case. Ultimately, this may be difficult because these potential exposures occurred decades ago, but the veterans will appreciate this support from clinicians.” – John Schoen

Disclosure: See the study for a full list of financial disclosures.
Source - Healio

Performance reviews at troubled VA showed no bad senior managers
By Tom Cohen and Curt Devine, CNN
updated 10:08 PM EDT, Fri June 20, 2014

Washington (CNN) -- No matter what you call it -- bonuses, incentives, market or performance pay -- the Department of Veterans Affairs gave out a lot to senior managers in recent years despite sometimes deadly waits for health care and other problems faced by American veterans.

A top VA official confirmed to a congressional committee on Friday that 78% of VA senior managers qualified for extra pay or other compensation in fiscal year 2013 by receiving ratings of "outstanding" or "exceeds fully successful," and that all 470 of them got ratings of "fully successful" or better.

Such widespread laudatory performance appraisals occurred shortly before CNN started reporting in November how veterans waited excessive periods for VA health care, with some dying in the process. The VA has acknowledged 23 deaths nationwide due to delayed care.

In Phoenix, CNN reported in April that the VA used fraudulent record-keeping -- including an alleged secret list -- that covered up the waiting periods.

A fatal wait: Veterans languish and die on a VA hospital's secret list

That didn't stop the head of the Phoenix VA medical center, Sharon Helman, from getting an $8,500 bonus last year.

Helman's bonus got rescinded earlier this year after the VA controversy made headlines. She was placed on administrative leave but continues to receive her salary, said Gina Farrisee, the VA assistant secretary for human resources and administration, at a House Veterans' Affairs Committee hearing.

Questionable bonuses

Panel chairman Jeff Miller, a Florida Republican, cited numerous examples of what he characterized as unwarranted bonuses to VA officials overseeing a department with such problems in recent years:

• The medical center director in Dayton, Ohio, receiving a bonus exceeding $10,000 despite an investigation of veterans getting exposed to hepatitis B and C at the facility;

• The former director of the VA regional office in Waco, Texas, getting more than $53,000 in bonuses when the average processing time for disability claims increased to what Miller called "inexcusable levels."

• The director of the Pittsburgh health care system getting a top performance review and a regional director getting a $63,000 bonus despite a legionella outbreak in the Pittsburgh VA health care system that led to six patient deaths.

"To the average American, $63,000 is considered to be a competitive annual salary, not a bonus," Miller said.

Farrisee offered administrative explanations about the bonus system that did little to satisfy committee members. In particular, the Helman case in Phoenix got a lot of attention, with legislators from both parties asking how it could happen.

She explained how the bonus should never have been given because Helman was being investigated in connection with the problems at the Phoenix VA facility, and therefore the extra money was eligible to be rescinded.

Can't go back

However, Farrisee said in almost all other cases, a performance rating and resulting bonus can't be rescinded later on.

"If we knew what we knew today at that time, it is unlikely that their performance would have reflected what it reflected at the time the reports were written," she said when asked by Miller about going back to change the performance review results.

However, "you cannot go back and change a rating once it has been issued to an employee as the final rating," Farrisee said, adding that was the law rather than a government rule.

An exasperated Miller called it a law that needed to change as part of an overhaul of a culture throughout the VA motivated more by performance bonuses than serving veterans.

"We can't keep doing it the way it's been being done," he said, to which Farrisee responded: "I concur, Mr. Chairman."

The controversy, with multiple investigations and increasing revelations of problems with newly returned veterans getting care on a timely basis, caused retired Army Gen. Eric Shinseki to resign on May 30 as Veterans Affairs secretary.

Fear kept the VA scandal

His successor, interim Secretary Sloan Gibson, has ruled out any bonuses for senior managers in 2014 as part of initial steps intended to get more immediate care for hundreds of thousands of waiting veterans.

Updated figures

Earlier this week, an updated audit revealed about 177,000 veterans were still waiting at least two months for an appointment at VA medical centers.

Gibson said some of the delays on the audit update appeared worse than previously reported because hospital administrators were beginning to use proper scheduling procedures that accurately reflected the number of veterans waiting.

For example, the update showed more than 43,000 veterans waiting longer than 120 days for an appointment, compared to 13,000 listed earlier this month.

According to Gibson, more appointments have been added, but some VA hospitals lack the capacity to see patients quickly, which also contributed to a spike in the figures.

The VA has reached out to 70,000 veterans waiting for appointments in order to get them into clinics, he said.

At this point, the VA's Office of Inspector General is investigating 69 facilities for allegations that administrators altered appointment data or used secret waiting lists to make patient wait times appear shorter in order to earn financial bonuses.

Farrisee said Friday that schedulers sought to meet their performance goal -- and therefore qualify for bonuses -- by showing veterans got appointments within 14 days.

An internal audit by the VA called that 14-day goal implemented under Shinseki's leadership unattainable and reported 13% of schedulers were instructed to manipulate data in some form.

Gibson has eliminated the 14-day target for the Veterans Health Administration, which has more than 1,700 facilities that serve almost 9 million veterans each year.

Go the VA website

Sunday, July 14, 2013

Veterans twice as likely to be infected with chronic hepatitis C

HCV disease burden greatest among baby boomer veterans
July 15, 2013

Veterans born between 1945 and 1965 have a much greater prevalence of anti-HCV and HCV infection compared with other birth cohorts, according to recent results.

In a retrospective cohort study, researchers evaluated data from 5,415,084 veterans who made one or more outpatient visits to VA clinics during 2011, including 2,889,385 who underwent hepatitis C screening. Screening was performed in 40.6% of those born before 1945, 63.5% of those born between 1945 and 1965 and 57% of those born after 1965.
Full Story »

Veterans twice as likely to be infected with chronic hepatitis C

Published: Sunday, July 14, 2013 4:32 AM CDT
(BPT) - An estimated 3.2 million Americans have chronic hepatitis C, a potentially serious disease that, if left untreated, can damage the liver over time and lead to cirrhosis, or scarring of the liver, end-stage liver disease and liver cancer. Liver failure from chronic hepatitis C is the leading cause of liver transplants in the United States.

Many people infected with chronic hep C virus do not know they have it. Approximately 70 to 80 percent of those newly infected with the virus do not have symptoms. In many people with chronic hepatitis C, signs or symptoms may not appear for years.

Among those disproportionately affected by chronic hep C is the veteran community, a population twice as likely to be infected with chronic hep C as the general population. Veterans may be at increased risk because they may have additional risk factors, such as having had blood exposure during combat, or immunization by air gun injection. Of the six million veterans receiving care from the Veterans Affairs’ (VA) health care system in 2010, 165,005 had evidence of chronic hep C. Most veterans with the disease being treated in the VA health care system in recent years were likely infected during the Vietnam War era any time from 1964 to 1975.

Veterans in VA care with chronic hepatitis C have higher rates of related conditions that could complicate their health. Many veterans with chronic hep C already have evidence of cirrhosis, or scarring of the liver, and even more of those infected will develop cirrhosis over a span of 20 to 30 years. Since serious complications, like liver disease, usually happen years after initial infection, an increase in hep C-related deaths in veterans is expected over the next decade.

Many veterans also fall within the “baby boomer” generation, or those born between 1945 and 1965, another group disproportionately affected by the disease. It is estimated that one in 30 baby boomers has been infected with hepatitis C and they are five times more likely to be infected than other adults. More than 2 million U.S. baby boomers are infected with hepatitis C. In fact, the Centers for Disease Control and Prevention recently issued recommendations that all U.S. baby boomers should get a one-time test for the hepatitis C virus.

In an effort to raise awareness around chronic hepatitis C, Merck has joined forces with the American Liver Foundation and Grammy(R) Award-winning musicians Gregg Allman, Natalie Cole and Jon Secada on the Tune In to Hep C campaign. Tune In to Hep C is a national public health campaign created to educate people about chronic hepatitis C and the importance of taking action. Their own personal experiences with the disease have inspired them to share their stories, educate patients about the disease and encourage others to take the next step. Allman was diagnosed with chronic hepatitis C in 1999, Cole was diagnosed in 2008, and Secada lost his father to complications associated with the disease in 2011. Together, they hope to motivate others to tell their friends and family about their diagnosis and to talk to their health care provider about their options.

For more information on chronic hepatitis, please visit

Tuesday, March 15, 2011

The Revolving Door Of Crucial VA Clinic Dental Outbreaks

The Revolving Door Of Crucial VA Clinic Dental Outbreaks
The past and current lack of "adherence to sterilization practices" or "inadequate practices" at VA dental centers continues to rise. This blog has put together a summary of the VA facilities involved. We begin with the 2009 to 2010 notification letters sent to 1,812 veterans who may have been exposed to hepatitis B, hepatitis C and HIV; when a breach in protocol instrument processing took place at the John Cochran Veterans Medical Center in St. Louis, MO. The Associated Press reported in March 2011 that most of the 1,812 veterans potentially exposed have been tested with no infections connected to the dental clinic.

A Lesson Ignored ?
Noted on The Department of Veterans Affairs' website, in 2010 during the Cochran exposure was this statement, "In the past 18 months, VA has implemented more stringent oversight for reusable medical equipment to ensure a safer environment for patient care". As of this July 2010 in a press release deemed; "Lessons learned from St. Louis VA Medical Center are applied VA-wide" came this VA statement; "Under the Obama Administration, in the past 18 months, VA has implemented more stringent oversight of the safety of all its medical facilities. It is this more rigorous standard that directly led VA to identify and address problems at the St. Louis Medical Center. Additional resources have been allocated and new procedures and stricter enforcements are in place to ensure the safety of all Veterans who seek care at VA facilities. VA mandates transparency and accountability in its handling of mistakes or failures to meet VA’s high standards. VA’s processes lead the nation in terms of transparency and accountability. “VA is committed to ensuring that all our health care facilities are safe,” said Shinseki “VA will continue to investigate the actions of individuals involved and the proper administrative and disciplinary measures will be taken.”
However, sadly enough, the Dayton VA medical center must have missed that memo. The VA system may need guidance with implementing a "working" standard infection control practice at all VA centers, void of any human errors or staff and physician negligence.

Dayton VA Medical Centers Recently the Dayton VA Medical Center "dental clinic" failed to use proper sanitary procedures. As a result 535 veterans were exposed to hepatitis B , hepatitis C and HIV. Veterans who visited the dental clinic between January 1, 1992 and July, 28 2010 may be at risk. According to the Veterans Administration nine patients who received dental care at the Dayton VA Medical Center have tested positive for Hepatitis B and Hepatitis C following preliminary testing.
In part the exposure stems from Dentist Dwight Pemberton who admitted to not washing his hands between patients. The 81 year old also failed to change his latex gloves between patients and dental procedures. VA officials have initiated actions against three employees, including dentist Dwight Pemberton, all of whom may have infected patients at the VA. However,VA officials said because of Pemberton's retirement on Feb. 11, he no longer faces administrative action by the clinic.
The media coverage on both VA medical Centers has been compiled below.

John Cochran Veterans Administration Medical Center (VAMC) in St. Louis, MO and the Dayton, Ohio VA Medical Center
From OSAP;

What is OSAP?
Founded in 1984 and formally incorporated as a non-profit organization in 1985, OSAP is a unique group of dental educators and consultants, researchers, clinicians, industry representatives, and other interested persons with a collective mission to be the world’s leading advocate for the safe and infection-free delivery of oral care.

IC Compliance Breakdowns Hit The Press


An apparent breach of standardized practice related to dental instrument reprocessing occurred at the John Cochran Veterans Administration Medical Center (VAMC) in St. Louis, MO. The facility mailed notification letters to 1,812 veterans treated at the dental clinic between February 2009 and March 2010 stating their internal quality inspections determined that some instrument processing steps for dental instruments were not in compliance with their standard policies, creating a low risk of exposure to hepatitis B virus, hepatitis C virus and HIV. In a video interview, Dr. Gina Michael, a spokesperson for the VAMC, said that dental instruments were sterilized but the VA standardized sequence of instrument processing was not followed.

A article on July 1 reported the VA Under Secretary for Health Dr. Robert Petzel saying that the problem arose because workers prewashing dental equipment failed to use a detergent before the equipment was sterilized allowing for a "phenomenally remote" chance that sterilization might not have been effective. The VA issued a press release on July 1 indicating that the lessons learned from the St. Louis VAMC are applied VA-wide.

In a related story at the Dayton VA Medical Center, an employee raised concerns about infection control practices at the dental clinic while an internal VA panel was reviewing clinic operations in late July. The allegations involved improper use of protective gear such as gloves, as well as the inappropriate use of burs. The VA closed the clinic for three weeks to investigate.

CDC Guidelines and FAQ on Sterilization-Cleaning
OSAP Charts
Comparing cleaning methods
How to clean dental instruments
20 steps to proper instrument processing

Mar 10, 2011
The Associated PressPosted : Thursday Mar 10, 2011 19:28:56 EST

ST. LOUIS — Surgeries have resumed at the Veterans Affairs hospital in St. Louis more than a month after a shutdown over sterilization concerns.
The John Cochran VA Medical Center suspended surgeries Feb. 2 after surgical trays were found to be pitted with corrosion. Procedures resumed Thursday.
Hospital director Rima Nelson says investigators who examined the sterilization processing department determined it was OK to start surgeries again. Nelson says they couldn’t determine a single source for the corrosion.
The sterilization concern was the second in less than a year at the Cochran center. Faulty sterilization at the center’s dental clinic last year raised concerns that 1,812 veterans were potentially exposed to hepatitis and HIV. Most of those veterans have been tested and no such infections have been connected to the dental clinic.

Feb 10, 2011
Surgeries still on hold at St. Louis VABy Jim Salter - The Associated Press
Posted : Thursday Feb 10, 2011 16:37:39 EST

ST. LOUIS — No timetable has been set for resuming surgeries at the Cochrane VA Medical Center in St. Louis, U.S. Rep. Russ Carnahan said Thursday following a meeting with the secretary of Veterans Affairs.

The St. Louis Democrat, a member of the House Committee on Veterans’ Affairs, said he asked Veterans Affairs Secretary Eric Shinseki for a top-to-bottom review of the St. Louis hospital.

“In my years in public service, this is one of the issues that has made me madder than anything I’ve ever seen,” Carnahan said in a telephone conference call with reporters.

Surgeries at Cochrane have been on hold since Feb. 2 after potentially contaminated surgical equipment was discovered. Last year, faulty sterilization at the center’s dental clinic raised concerns that 1,812 veterans were potentially exposed to hepatitis and HIV.

Shinseki, in a statement, called the meeting “productive,” and called the sterilization problem at Cochrane an “isolated incident.”

“We must not lose sight of the fact that a VA employee had the integrity and courage to identify the problem during a routine exam and notified supervisors,” Shinseki said. “This was the responsible and right decision to assure that no veterans were put at risk.”

Sterilization problems have arisen at other VA medical facilities across the country.

Officials at the Dayton, Ohio, VA Medical Center announced Tuesday that more than 500 veterans will be offered HIV screenings to determine if they were infected by a dentist who for 18 years failed to consistently follow the infection control standard of changing latex gloves between patients. Officials said there was no indication any patients had been infected.

In 2009, the VA said 10,000 veterans treated at its hospitals in Miami, Murfreesboro, Tenn., and Augusta, Ga., were potentially exposed to HIV and hepatitis, also because of faulty sterilization of equipment used for colonoscopies and other procedures.

Carnahan said mediocrity “thrives” at the St. Louis hospital.

“That’s not good enough for our veterans,” Carnahan said. “It’s not what they deserve.”

A private sector watchdog group called The Joint Commission was inspecting the hospital Thursday.

The VA said surgeries scheduled for Cochrane have been moved to other St. Louis hospitals, with the VA paying the cost.

All but a few dozen of the veterans treated with improperly sterilized equipment in the St. Louis dental clinic have been tested or refused testing. Three veterans tested positive for hepatitis, but officials don’t know how they were infected and none of the cases have been tied to the sterilization problems. A fourth also tested positive for hepatitis, but the VA said that person’s infection occurred from another source.

John Cochran Veterans Administration Medical Center (VAMC) in St. Louis, MO
June 29, 2010
By: Mike Owens
St. Louis -- A failure in cleaning dental instruments properly at the John Cochran Veterans Administration Hospital on Grand may have but 1,812 dental clinic patients at risk. The patients started getting certified letters Tuesday, advising them they may have been exposed to viruses: hepatitis and HIV.
July 2, 2010
ST. LOUIS (AP) — The chief of dental services at the St. Louis VA Medical Center is defending his staff and says he welcomes a Veterans Affairs inquiry into a mistake that might have exposed nearly 2,000 veterans to viruses. The VA said yesterday it was placing the dental chief on administrative leave while it investigates the sterilization procedure mistake. The VA said the risk of exposure is very minimal.
Still, the agency on Monday sent letters to 1,812 veterans who had dental procedures at the St. Louis facility from Feb. 1, 2009, through March 11 of this year, when the problem was uncovered.The VA is offering free tests to screen for hepatitis B, hepatitis C and HIV. Nearly 200 people had signed up for, or already had, testing. No illnesses have been found.The VA didn’t name the dental chief, but Danny Turner came forward to the St. Louis Post-Dispatch.
Turner told the newspaper in today’s edition that he stands behind his staff and that he blames politics for distorting the situation. “I have a lot of information that proves we were doing things correctly,” Turner said.
The VA warning prompted an outcry from politicians from both Missouri and Illinois — the five VA centers in the St. Louis area serve veterans from both states. “Things are done to get votes, and that’s a shame,” Turner, 63, said.Turner denied a claim made by a former employee that she saw dental instruments with dried blood even after they had gone through the cleaning process. “Our dental instruments are never that way,” he said. “I don’t know what she was talking about.”VA Undersecretary for Health Robert Petzel said yesterday the problem arose because workers prewashing dental equipment failed to use a detergent before the equipment was sterilized. He said that allowed for a “phenomenally remote” chance that sterilization might not have been effective.

Dayton VA Medical Center
March 15, 2011
Employees’ fear may have put vets’ health at risk
By Ben Sutherly,
Staff Writer Updated 10:10 AM Tuesday,
March 15, 2011

DAYTON — A culture of fear may have kept workers and supervisors at the Dayton VA Medical Center’s dental clinic from disclosing the unsafe practices of one dentist over 18 years, a congressman said Monday.

U.S. Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, said the clinic is compact and open, so employees’ activities can be easily viewed by their coworkers.
Miller is concerned there may be a widespread culture at the VA in which employees are afraid to speak up when they see issues that affect patients’ health and safety. Dental clinic employees and supervisors had known of the dentist’s infection control lapses for several years, but it wasn’t until July 2010 that two employees reported the problem to an outside VA panel, triggering an investigation.

“For very few people to have stepped forward is troubling to me,” said Miller, who toured the facility Monday with U.S. Rep. Mike Turner, R-Centerville.
Continue Reading........

March 11, 2011
New VA hospital director an award-winning administrator
By Tom Beyerlein
, Staff Writer Updated 11:00 PM Friday, March 11, 2011
DAYTON — Department of Veterans Affairs officials on Friday said they coaxed an award-winning hospital administer out of retirement to help the Dayton VA Medical Center recover from the scandal surrounding a dentist’s unsanitary practices that may have led to hepatitis infections of nine dental clinic patients.
William Montague, who headed six VA hospitals including the Louis Stokes VA Medical Center in Cleveland, becomes the Dayton VA’s acting director Monday, replacing Director Guy Richardson, who was reassigned to a job at regional headquarters in Cincinnati.

Contact this reporter at (937) 225-7457 or bsutherly@Dayton

March 2, 2011
9 Dayton Veterans Test Positive For Hepatitis
Updated: 4:44 pm EST March 2, 2011
DAYTON, Ohio --
The Veterans Administration said Wednesday that at least nine patients who received dental care at the Dayton VA Medical Center tested positive for Hepatitis B and Hepatitis C following preliminary testing.
The Dayton VA has contacted 527 of 535 veterans seen by a dentist who failed to use proper sanitary procedures at the dental clinic.
The dentist, Dwight M. Pemberton, is accused of failing to change his latex gloves and sterilize instruments between patients.
Officials said of 375 patients tested so far, there have been seven Hepatitis C cases, two Hepatitis B cases and no cases of HIV.

February 26, 2011
Dayton VAMC Dentist Under Investigation Named
February 26, 2011 by Robert L. Hanafin ·
In early February Veterans Today (VT) reported that the Dayton VA Medical Center in Ohio was notifying Veterans who may have been exposed to Hepatitis or HIV/AIDS. Veteran’s activist Darrell Hampton has been a thorn in the side of Dayton VAMC management long before this investigation began, and he has worked closely with investigative reporters ...

November 23 , 2010
Another U.S. Department of Veterans Affairs' (VA) dental clinic has come under scrutiny for possible infection control issues.
The Dayton VA Medical Center's dental clinic in Ohio was temporarily closed from August 19 to September 10 after employees raised concerns about infection control practices during an internal VA panel review of clinic operations in July, according to Todd Sledge, a spokesman for the VA Healthcare System of Ohio. It was reopened September 19 after the staff was updated regarding infection control requirements.
"With the volume of work that goes through the Dayton clinic, we wanted to make sure the concerns were thoroughly investigated to determine if there was any basis to them and if they were accurate," Sledge told

For more information visit the VA
In late 2008 and early 2009, the VA was plagued by a rash of reports about contaminated endoscopic equipment, including devices used to perform the colonoscopy procedure.
In some cases, the VA felt there may have been a risk of infection, so they notified veterans who had specific procedures performed at some VA facilities to be tested for possible exposure to HIV, and hepatitis B and C.
Because of variations in equipment cleaning procedures and variations in VA's self-reporting guidelines on how the equipment was cleaned, questions were raised about a possible nationwide problem with contaminated equipment.
On this page, we are posting all of the articles about VA's contaminated equipment. We will add more information is at becomes available... and, we will go back and research any earlier incidents of contamination and post that information as well.

Support For Veterans
READ ME to learn about what's on the site and how to use it to develop your claim. You'll find the required small print and a few other details here. The address and instructions on how to contact your Department of Veterans Affairs Central Office is here.

Veterans Support Foundation is a 501 (c) (3) Nonprofit humanitarian and educational organization founded to improve the quality of life for deserving veterans and their families. The Foundation's office is located in Silver Spring, Maryland.

The VSO operates Veterans' Support Organization chapters that serve our nation's veterans across the United States, from Texas to Florida and north to Maine.

HCV Vets Forum
Welcome to Forum
A Message Board for People with Past/Present Military Backgrounds & Hepatitis C.

About Me

Winter Springs, Florida, United States
Wife of Vietnam veteran. Over 25 years of veterans outreach focusing on Post Traumatic Stress Disorder. Author For the Love of Jack, DAV Chapter 16 Auxiliary Chaplain, PTSD Consultant, Staff Writer Veterans Today. Editor and Publisher of Wounded Times. Also see website at . Student at Valencia Community College, Digital Media and Post Production.