DOJ Says It’s Pushing Agencies on Openness

by Jennifer LaFleur, ProPublica

Associate Attorney General Thomas Perrelli told (PDF) the Senate Judiciary Committee today that the Department of Justice is pushing federal agencies to be more transparent.

In a hearing on the Freedom of Information Act, Perrelli announced guidelines for reports that FOIA officers at each agency must send to the Department of Justice annually. The instructions go "beyond the legal requirements" of FOIA, he said. Attorney General Eric Holder mandated the reports, along with the creation of a chief FOIA officer at each agency, in March, when he introduced new FOIA guidelines (PDF) to comply with President Barack Obama's call for greater transparency. Perrelli said today that 92 of 95 federal agencies have named their FOIA officer.

FOIA chiefs will be required to report how their agency is applying the administration's new presumption of openness. They must describe how their agencies are making their FOIA systems more efficient and working to make proactive disclosures, such as putting information online rather than forcing people to file FOIA requests. The reports must also address how they are working to reduce FOIA backlogs, which have plagued several agencies for years.

Meredith Fuchs (PDF), general counsel for the National Security Archive, which pushes for government transparency, said that the federal FOIA backlog was "substantial." According to reports on FOIA from 2008, there was a request that was 17 years old at the CIA. Four agencies had requests older than 15 years.

Also testifying at today's hearing was Miriam Nisbet (PDF), the newly named federal FOIA ombudsman at the Office of Government Information Services. Her office, which was created by the OPEN Government Act of 2007 and is part of the National Archives and Records Administration, will review agencies' compliance with FOIA. It will also use mediation services to resolve disputes between requesters and agencies, she said, and develop an online dispute resolution system "which holds great potential to process a high volume of cases."

Tom Curley (PDF), president and chief executive of The Associated Press urged the committee to rein in use of so-called B3 exemptions, which allow federal agencies to withhold information under other statutes like the Watermelon Research and Promotion Act, which protects information about watermelon growers from disclosure.

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Happy Birthday, Bailout: $390 Billion Outstanding

by Paul Kiel, ProPublica

This Saturday, the $700 billion TARP will be a year old. What better way to celebrate than with our monthly update on the bailout?

Our database, of course, tracks not only the TARP but also the bailout of Fannie Mae and Freddie Mac, which itself had its first birthday on Sept. 7.

In total, $389.6 billion remains outstanding to 655 recipients ($294 billion under the TARP and $95.6 billion that’s gone to Fannie and Freddie). That total doesn’t include the 39 companies that have returned a total of $71.9 billion.

Last month, we told you that there was $393 billion outstanding. The reduction is mainly due to an adjustment to the cost of the Chrysler bailout. The Congressional Oversight Panel’s report on the auto bailout showed that the Treasury has actually loaned Chrysler about $10.47 billion, not $15.2 billion, as Treasury initially reported. Chrysler ended up not needing that much.

Money continues to flow out. In September, the Treasury invested $141 million in 14 banks (see our timeline for more details).

Meanwhile, dollars are just beginning to flow for one major program: the government’s mortgage modification program. The Treasury has set aside $22.3 billion for 60 different servicers, but since funds are not released until homeowners have completed a three-month trial modification, only about $276,000 had been paid out as of last week.

AIG also continues to draw on a line of credit. Taxpayers have pumped $43.2 billion into AIG as of September, a number about $1.7 billion higher than last month. Treasury has agreed to provide AIG up to $69.8 billion total. (Here’s our full rundown on the AIG bailout.)

That’s the expense side of the ledger. How about the revenue side?

The TARP has two main sources of revenue: quarterly dividend or interest payments and warrant redemptions. Unlike returned money, which can be used again, the Treasury is obligated to use revenue to pay down the national debt.

So far, bailout recipients have paid $11.49 billion in dividends and interest, an amount that includes the $2.1 billion in dividends paid by Fannie and Freddie. (This total comes from a recent Treasury report: the tally from our database will be updated once Treasury releases the payment information for each recipient.)

So far, the Treasury, through refunded TARP investments, has collected $2.9 billion in exchange for its warrants. The stock warrants, which give the U.S. the right to buy equity in the companies at a set price, came as a condition of the investments. When companies refund the Treasury’s money, the warrants are either sold back to the company or auctioned off.
Put all that together (the dividend and interest payments along with the stock warrants), and you get a total of $14.39 billion in revenue.

The two sides of the ledger don’t quite balance out yet, to be sure. Testifying last week, the special inspector general for the TARP said you shouldn’t hold your breath until it does. It’s “extremely unlikely” that the TARP will result in a profit for the taxpayer, he testified, a statement that doesn’t even account for the nearly $100 billion invested in Fannie and Freddie.

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Obama Administration Calls for Overhaul of 32-Year-Old U.S. Toxic Chemical Law

The Obama Administration on Tuesday asked Congress for an overhaul of the law that regulates toxic chemicals.

Lisa Jackson, Environmental Protection Agency (EPA) administrator, announced that the time has come to strengthen the EPA’s authority to regulate toxic chemicals.

“...[A]s more and more chemicals are found in our bodies and the environment, the public is understandably anxious and confused. Many are turning to government for assurance that chemicals have been assessed using the best available science, and that unacceptable risks haven’t been ignored," Jackson says. "Our oversight of the 21st century chemical industry is based on the 1976 Toxic Substances Control Act [TSCA]....over the years, not only has TSCA fallen behind the industry it’s supposed to regulate -- it’s been proven an inadequate tool for providing the protection against chemical risks that the public rightfully expects.

"Today I’m announcing clear Administration principles to guide Congress in writing a new chemical risk management law that will fix the weaknesses in TSCA,” she adds.

Jackson identified chemical management reform as one of her top priorities, and stated the administration’s guiding principles for overhauling the nation’s toxic chemical law, TSCA.

First among those principles, Jackson says, is "to review all chemicals against safety standards that are based solely on considerations of risk –- not economics or other factors –- and we must set these standards at levels that are protective of human health and the environment."

Jackson also says more burden should fall on industry.

"Manufacturers must develop and submit the hazard, use, and exposure data demonstrating that new and existing chemicals are safe," she says. "If industry doesn’t provide the information, EPA should have the tools to quickly and efficiently require testing, without the delays and procedural obstacles currently in place."

The 32-year-old TSCA governs more than 80,000 toxic substances, including lead, dioxin and Bisphenol A (BPA).

Legislation to reform TSCA is expected to be introduced in Congress this fall by Sen. Frank Lautenberg (D-N.J.) and Rep. Bobby Rush (D-Ill.).

A longstanding public interest group cheered the news.

“For too long, the American public has been exposed to a barrage of toxic chemicals -- without our knowledge and certainly without our consent. Scientists have shown that this exposure has led to an increase in serious chronic ailments from learning disabilities to cancers," says U.S. PIRG Public Health Advocate Liz Hitchcock.

“With this announcement, the Obama Administration has shown that it has heard the growing drumbeat of support for safer chemicals and more information about the chemicals that we come in contact with," Hitchcock adds. "We look forward to working with Administrator Jackson, Senator Lautenberg and Congressman Rush, along with health professionals and parents groups, to pass a toxic reform law that puts public health first, and gives us the information we need to protect our families.”

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With Senate Public Option Support 'Growing,' DFA Wants To Keep TV Air War Going

A leading progressive advocacy group is looking to keep TV spots on the air to attack senators who oppose a public option in healthcare reform, as it says support for such an option is growing in the Senate.

Members of the Senate Finance Committee today killed amendments that would have added a federally run public option to the healthcare reform package the panel is putting together. In separate votes, some Democrats joined all Republicans to kill amendments by Sens. Jay Rockefeller (D-W.Va.) and Chuck Schumer (D-N.Y.) that each would have added a public option.

Finance Chairman Max Baucus (D-Mont.) voted against both public option amendments, as did moderate GOP Sen. Olympia Snowe of Maine.

"That's right; both Senators just voted the way the insurance interests who fund their campaigns wanted -- and against what voters in their states demand," says Charles Chamberlain, political director of Democracy for America (DFA), which has been running ads pushing Baucus and Snowe to back a public option. "We need to strike back right now. This is only the first of many votes these Senators have coming in the next several weeks. We must hit them hard and fast for turning their backs on Americans at home in their states who are depending on them to lead."

The DFA email solicits funds to keep both ads on the air in the senators' respective home states.

"We've raised over $90,000 to plaster Montana with our heart wrenching ad featuring Bing Perrine and his family," Chamberlain says, referring to the Montana resident featured in the spot. "But it's not going to be enough to win. We need to make sure there isn't a single Montana voter who doesn't see this ad."

DFA needs $200,000 to blanket both Montana and Maine with its ads. "We must strike back -- hard -- fast -- everywhere," Chamberlain says.

The votes on the Rockefeller and Schumer amendments prove declared support is growing in the Senate even though both measures went down to defeat, Chamberlain says.

"The good news is that Senators Bill Nelson [of Florida] and Tom Carper [of Delaware] voted yes on Senator Schumer's public option amendment," he says. "While that amendment still lost 10 to 13, these two Senators have never stated public support for any version of a public option before. So while the media is bound to claim a public option dead once again -- they'll also be wrong -- once again, because support for passing healthcare reform with a public option is actually growing."


Public Option Equals Lower Costs


Meanwhile, on the other side of the Capitol, House Speaker Nancy Pelosi and Majority Leader Steny Hoyer (D-Md.) continued to back a public option, saying a federally run health alternative would help lower costs. Lower health costs is a key driver for overall health reform among conservative Democrats.

"There are significant negotiated rates through Medicare. A public option lowers costs significantly," Pelosi says. "So I believe that we will have a public option in our bill as we go forward. The differences are not as great as you may think when you take it down to its different parts, but everybody wants to lower cost and that is a very strong option for a public option in the bill."

Speaking at a press event, Pelosi and Hoyer also dismissed the need to pass health reform on any deadline.

"This is a bill that is scheduled to be going into effect in 2013. Obviously we need a lot of lead time -- we want to do this right," Hoyer says. "So as the Speaker said, there is no pressure to do it this week or next week or the following week. We want to do it as expeditiously as possible."

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Rockefeller To Introduce Public Option In Senate Today During Finance Markup

Sen. Jay Rockefeller plans today to introduce a measure designed to add a "strong public option" to the healthcare reform package undergoing mark-up in the Senate Finance Committee.

A longtime proponent of a federally run public health coverage option, the West Virginia Democrat will attempt to add a public option via amendment to Finance Chairman Max Baucus' (D-Mont.) bill. Baucus did not include a public option in his original legislation.

“True health care reform cannot be realized without a strong public insurance option that works for American families and I intend to offer this amendment in the Senate Finance Committee next week,” says Rockefeller, chairman of the Senate Finance subcommittee on health care. “The bottom line is we need a public insurance option because it will drive down private insurance costs and help make health insurance affordable.”

Rockefeller continues, “When this happens, families win – they get to keep more of their hard earned money in their wallets and that’s a great thing for them and for the economy. Opposition to a public option is really just a vote for the insurance companies to make bigger profits and that is unacceptable to me. The American people have asked for real solutions that protect their families and their economic security – a public option does just that.”

President Obama also has long supported inclusion of a public option in healthcare reform to offer vigorous competition to private insurers to keep the private insurers "honest." Republicans, however, have howled in opposition to inclusion of a public option, calling it a "government takeover of healthcare."

The House already approved a version of healthcare reform that includes a public option, and House Speaker Nancy Pelosi has strongly pushed to include a public option in whatever final healthcare plan emerges from both the House and Senate.

Rockefeller's amedment is called the Consumers Health Care Act (S. 1278) as modified in Baucus' main bill, called America’s Healthy Future Act.

Rockefeller's amendment calls the the public health insurance option the Consumer Choice Health Plan (CCHP), and would add that plan to the health coverage purchase exchange that health reform would create to compete directly with private plans, according to a statement from Rockefeller's office.

Like private health plans, CCHP would be offered to all individuals and businesses purchasing health insurance through the national health insurance exchange. To guarantee plan availability nationwide, public program provider networks will be used, Rockefeller's statement adds.

At a minimum, CCHP would be required to follow the same insurance regulations as private plans operating in the exchange, the statement says. CCHP would also be required to offer the same type of plans as private plans participating in the exchange, it adds.

The Consumer Choice Health Plan would be financially self-sustaining -- subject to an annual third-party audit, according to Rockefeller. The plan administrator will establish and fund a contingency reserve for CCHP in a manner similar to that of the contingency reserve established by the federal Office of Personnel Management for the Federal Employees Health Benefits Plan. Funds to operate the plan shall be derived from premiums for individuals enrolled under the plan, Rockefeller's statement says.

To help enrollees afford the cost of coverage, the same premium subsidies would be provided to enrollees in CCHP as those offered to consumers enrolled in private health plans. Any additional revenue gained under this public plan option would be reinvested in CCHP in the form of reduced premiums and cost-sharing or increased benefits, the statement says.

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Researchers: Climate Change Will Make Us Sick Without More Study

The United States should spend roughly $197 million more than it currently does to research the impact of climate change on public health, according to health researchers who have published their findings.

Their analysis finds that the United States spends about $3 million in federal funds on research related to the health impacts of climate change, says Marie O'Neill, one of the commentary co-authors. This isn't nearly enough to adequately address the public health issues related to global warming, the research group concludes.

The article was inspired by another study, mandated by Congress, that assesses the importance of global climate change on health, also led by Kristie Ebi, an epidemiologist and expert on climate change and public health, who is an adjunct professor of environmental health sciences at the University of Michigan. During their research and in preparing testimony for congressional hearings on the topic, the team realized that the U.S. government is dramatically underfunding climate change health-related research.

Climate change is expected to exacerbate a number of current public health problems in the United States and elsewhere, including heat-related deaths, diarrheal diseases, and diseases associated with exposure to allergens and ozone, the researchers say. In addition, the aging U.S. population is more vulnerable to thermal extremes, as are certain demographic and geographic areas, the researchers' analysis says.

"Even disease distributions are likely to change," says Mark Wilson, a coauthor and professor of epidemiology. "Certain areas of the world could become more favorable for transmission of various infectious diseases that are associated with water, insect vectors, or non-human animal reservoirs. The challenge is to identify the critical research questions that will help inform improvements to the public health infrastructure and prepare for changing environments."

The type of research necessary to solve some of the health problems arising as the planet warms involves working with affected communities and developing concrete solutions, which include addresses the root causes of climate change by reducing fossil fuel combustion, among other measures, O'Neill says.

"Climate change is happening. It's a current problem and we need to address it as a public health priority," she says.

However, most research described in official estimates of U.S. spending on climate and health is focused on more specific diseases; for instance sun damage and skin cancer, and doesn't address larger issues posed by climate change, the researchers analysis notes.

The commentary authors concluded that federal agencies such as the Environmental Protection Agency, the National Institutes of Health and the Centers for Disease Control and Prevention, must establish large internal and external programs with funding of more than $200 million annually to adequately address the problem. The authors recommended that a standing committee within the National Academies of Sciences (NAS) oversee the programs and prioritize spending. Created by President Abraham Lincoln, NAS is an independent honorific scientific body designed to provide independent and expert advice to policymakers.

The researchers' analysis, "U.S. Funding is Insufficient to Address the Human health Impacts of and Public Health Responses to Climate Variability and Change," appears online in Environmental Health Perspectives.

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Union Defends Screening of Utah Congressman, Says Officer Didn't Recognize Chaffetz

The Transportation Security Administration (TSA) officers who selected Rep. Jason Chaffetz (R-Utah) for additional screening were acting according to TSA procedures, and had not targeted the freshman lawmaker because of his opposition to unionizing TSA officers, according to a union which represents those who work for the security agency.

Chaffetz was selected on Sept. 21 for additional screening as he was making a flight to Washington at Lake City International Airport. Chaffetz raised the issue that he was singled out because he opposes TSA unionization, according to a story in the Salt Lake Tribune.

"Congressman Chaffetz was treated as any other passenger," says Sharon Pinnock, membership and organization director at the the American Federation of Government Employees (AFGE), the union that represents more than 11,000 TSA workers. "The [transportation security officer] who administered the pat down had just returned from a tour of duty in Iraq, and did not recognize the freshman congressman. Furthermore, the screening TSO was partnered with a TSA Supervisory Job Monitor who ensured procedures were properly followed."

Part of the Department of Homeland Security, TSA was established in the wake of the Sept. 11, 2001, attacks so as to improve airport security.

How Chaffetz was screened is a matter of apparent dispute. According to the Tribune story, Chaffetz declined to be screened via a body imaging system and instead went through a standard metal detector. In a statement, the AFGE says Chaffetz went ahead and used the Image Testing Machine, which TSA is using in a pilot basis in select airports, including Salt Lake.

Chaffetz opposes such body imaging systems and has sponsored a bill banning the use of such machines as an invasion of privacy. He is a member of House Oversight and Government Reform Committee.

"It does seem odd that Congressman Chaffetz would choose to use an image machine that he would like to see banned," Pinnock says. "We are hard-pressed to understand his thinking on this since he previously had been given a tour of the [body imaging] lane to this incident and knew quite well what the process could involve.

"These TSOs [transportation security officers] involved should be heralded for doing their jobs, not admonished for following procedures," Pinnock adds. "TSOs do not set the rules for passenger screening -- they are there to enforce the rules."

Following the incident, Chaffetz released this statement: "I’ll continue doing my job by standing up for my constituents. Whole body imaging is as complete an invasion of privacy as there is. For the federal government to view passengers naked or to pressure or mislead them into believing they must enter an imaging machine before boarding a flight is flat out wrong. I fly every week, and I want airplanes to be as secure as possible. We can secure airplanes without totally surrendering our civil liberties. I suppose that’s why the legislation I introduced passed the House on a bipartisan basis with 318 votes in favor of my legislation.

"If the TSA fails to look out for a passenger by not following proper procedures I encourage them to contact my office, as they can count on me to be a loud voice for their privacy and personal freedoms."

TSA is looking into the incident, according to the Tribune story.

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Leadership PACs: Let the Good Times Roll

by Marcus Stern and Jennifer LaFleur, ProPublica

When it comes to golf, Sen. Saxby Chambliss, R-Ga., has champagne taste.

In California, he's putted with his back to the thundering surf near the 7th hole at Pebble Beach, where a round of golf costs $495. In Florida, he's driven the ball down the fairways of the Boca Raton Resort, with its signature island green on the 18th hole and its Waldorf Astoria interior.

These are among the dozen premiere resorts where Chambliss played golf in 2007 and 2008 at a cost of a quarter of a million dollars. Yet Chambliss is hardly rich. His net worth is between $181,006 and $415,000, according to his 2007 financial disclosure report, ranking him 89th in the Senate in terms of wealth.

Fortunately for Chambliss, a political fund covers the costs of his golf hobby. The fund received $692,618 during the 2008 election cycle, according to the Center for Responsive Politics. Almost all of it came from lobbyists, political action committees (PACs) and corporate leaders.

The public might be forgiven for thinking the days are gone when lobbyists and special interests could pay for a lawmaker's cross-country golf outings. After all, both the House and Senate in 2007 responded to a spate of scandals by banning members of Congress from accepting gifts of any value from lobbyists or the companies that hire them.

But those reforms preserved a major loophole: leadership PACs like Chambliss' Republican Majority Fund, which have far looser rules and get far less scrutiny than campaign committees. At first, only a few rising stars in Congress had them. Now, 70 percent of the members do. So do a dozen former members.

In the past three election cycles, lobbyists and special interests poured $355 million into these funds, making them the second-largest source of political money for sitting members of Congress.

Legally, lawmakers are free to spend the leadership PAC money pretty much as they wish.

Lobbyists and lawmakers can -- and do -- use it to travel together to play golf at Pebble Beach, ride snowmobiles in Montana's Big Sky Country and go deep-sea fishing in the Florida Keys. The lobbyists don't pay the costs directly. They contribute to the leadership PAC, which then pays the lawmaker's resort and travel bills.

Leadership PACs have grown steadily since they began cropping up in the 1970s. What separates them from campaign committees is that lawmakers are supposed to pass along the bulk of the money to other members of their party for their campaigns. That way, lawmakers with leadership PACs can earn their beneficiaries' support when it comes time to divvy up committee chairmanships and other party leadership posts.

This system helps party leaders spread money to candidates with less money or tighter races. On the other hand, it also fuels the Washington money chase, allocates power in Congress based on fundraising prowess and encourages lawmakers and lobbyists to mingle socially and recreationally as political money changes hands.

Of the $112 million that leadership PACs spent during the two-year campaign cycle that led up to the 2008 elections, less than half was passed on to candidates or party committees, according to a ProPublica analysis of Federal Election Commission data compiled by the Center for Responsive Politics. The rest paid for entertainment, administrative costs, fundraising and other categories that are so vague that it's impossible to know for sure how the money was spent.

"Some of the expenditures don't seem related to elections and politics," said Michael Malbin, executive director of the Campaign Finance Institute, a research center associated with George Washington University.

Indeed, funds have been used for visits to Churchill Downs, Disney World and the Country Music Hall of Fame. They've paid for funerals, flowers and farewell parties. Rep. Charles Rangel, D-N.Y., used $64,500 from his PAC to commission a portrait of himself.

All this is legal, even if it appears to make a mockery of the 2007 ethics reforms and the

contribution limits at the very heart of the Federal Election Campaign Act of 1971.

The Federal Election Commission (FEC), which enforces federal campaign finance laws, has no rule against politicians using the money for personal purposes. Senate ethics rules don't even mention leadership PACs. The Senate interprets that silence to mean its ethics committee has no jurisdiction over leadership PACs whatsoever. The House, on the other hand, extends the same personal spending rules it applies to campaign committees to leadership PACs -- but there are no known instances when the policy has been enforced.

Meredith McGehee, policy director at the Campaign Legal Center, says leadership PACs should be abolished.

"But that's going to be very difficult because so many members of Congress have them now," McGehee said. "Because they're such useful political slush funds, money that a politician controls totally with very few rules governing how they're used, it's very difficult to find members who want to take that on."

Former FEC Commissioner Brad Smith, who generally opposes tighter campaign finance rules, nonetheless favors getting rid of leadership PACs. He says they give incumbents an unfair advantage because challengers typically can't raise the maximum amount of money allowed for their campaign committees, much less for a leadership PAC.

"For the most part it's really kind of an incumbent racket," said Smith, who's now a professor at Capital University Law School in Columbus, Ohio.

In March, the FEC's six commissioners, three Democrats and three Republicans, sent Congress a list of legislative recommendations, including one to prohibit personal use of leadership PAC funds. Their letter went to House Speaker Nancy Pelosi and Vice President Joe Biden, in his capacity as president of the Senate. It also was sent to members of the House and Senate committees that oversee the FEC.

So far, the FEC has gotten no response. ProPublica left messages at the offices of the speaker, majority leader and chairmen of the two committees seeking comment, but got no replies.
"I am not hearing anything being done on the legislative front on leadership PACs," said Craig Holman, the legislative representative of the consumer advocacy group Public Citizen.

Party Building or Fun and Games?

Democrats and Republicans alike use leadership PAC funds for play.

Among Democrats, Senate Majority Leader Harry Reid of Nevada used his leadership PAC to entertain at Las Vegas casinos, including $32,985 at the Bellagio and $24,284 at Caesars. Sen. Charles Schumer of New York paid $32,760 to the New York Yankees and $14,490 to the New York Giants.

Among Republicans, former Sen. Gordon Smith of Oregon, who was defeated last fall for re-election, spent $91,004 at the Bandon Dunes Golf Resort. Former Rep. Thomas Reynolds of New York spent $66,378 at Pebble Beach.

The FEC disclosure forms that leadership PACs file are so cursory that lawmakers don't have to disclose who participated or contributed at a PAC fundraiser, the day the event was held or how much money was raised.

Chambliss' leadership PAC ran up a $50,394 bill at the Ritz-Carlton Naples on Jan. 25, 2008. The only note of explanation was the stated purpose, "PAC EVENT/LODGING/BANQUET/GOLF."

"The problem is that sometimes it's hard to tell the personal from the political," said FEC Commissioner Ellen Weintraub.

"If a political committee spends money on food, flowers and tickets to sporting events, it depends on what they're using them for. Those might be legitimate political expenditures in connection with a fundraising event. Or, if they used them to take their family members out to the ball game and bought flowers for their spouses then that would be personal use. But you can't tell from looking at the expenditure reports."

Former North Carolina senator and Democratic presidential candidate John Edwards used his leadership PAC to pay videographer Rielle Hunter's firm $114,000 in 2006 and 2007 to make a campaign video. Last year, he admitted he had an extra-marital affair with Hunter during that period.

More recently, Sen. John Ensign, R-Nev., admitted to having an extra-marital affair with a woman who was on his leadership PAC payroll. Cynthia Hampton received $23,138 from the PAC during the 2008 election cycle.

Chambliss' Golf PAC

Only a quarter of the more than $750,000 that Chambliss' PAC spent during the 2008 cycle -- about $200,000 -- went to help GOP candidates. The rest went for golf, including payments to resorts and transportation -- a private jet on one occasion and limos on another. In July, ABC News cameras captured shots of Chambliss and other lawmakers golfing at the five-star Greenbrier resort in West Virginia.

Chambliss declined to be interviewed for this story, but his communications director, Bronwyn Lance-Chester, said the golf outings were to raise money for his Republican Majority Fund.

"Leadership PACs are appropriate vehicles through which members support deserving candidates in their campaigns," Lance-Chester wrote in an e-mail. "Different leadership PACs have different ways of raising funds. Every fundraising event Sen. Chambliss has held has been appropriately conducted, all expenses have been closely scrutinized and all reporting has been accurate."

It is hard to determine whether some of the golf outings generated any donations. For instance, the leadership PAC made four payments totaling $10,372 to three luxury West Coast golf courses and links -- Pebble Beach Resorts, the Inn at Spanish Bay and Pasatiempo Golf Club. Lance-Chester said the payments were for a single fundraising event held Feb. 20, 2008. But no contributions were made to the leadership PAC that day. During the two-week period straddling the date, $15,000 came in, about average for a PAC that collected almost $700,000 during the election cycle but a low haul given that the period included a major fundraising event.
Lance-Chester declined to disclose who participated or made contributions in connection with any of the golf events.

"There is not a direct correlation between contributions and specific events," she explained.

"Contributors can make a contribution at any time of the year, either prior to events starting in January or months afterward and still attend events. ...Some contributors give that amount and don't go to any events. Some go to every event. Some go to two or three."

Lance-Chester did not explain how or why Chambliss hosted events at three different California golf resorts on the same day. Nor did she explain why he made two deposits for the event, one to Pebble Beach Resorts 10 months before the event and another to Pasatiempo Golf Resort two weeks after the event. She also declined to elaborate on $7,087 paid to the Belle Haven Golf Shop in Alexandria, Va., on Jan. 24, 2007. The PAC's report to the FEC said only that it was for “PAC EVENT/GOLF SUPPLIES.”

"All disbursements from the RMF account are reviewed and approved, and are made solely for RMF-related purposes," Lance-Chester said in another e-mail.

Fred Wertheimer, who has pushed to reduce the role of money in politics for more than three decades, said Chambliss could be running afoul of tax laws.

"If this comes down to using campaign money for personal use, then he is required to pay taxes on it," said Wertheimer, who now heads the campaign reform group Democracy 21. "If there's a conversion and if he isn't paying taxes, he's also potentially violating the tax laws."

Chambliss' love of golf is so legendary in Washington political circles that he has been teased for letting golf interfere with his political and legislative business.

In 2003, then-President Bush told a crowd at a golf fundraiser for Chambliss that the senator had intercepted him on his way to the dais and said, "If you keep it short, we might be able to get a round of golf in."

Chambliss also took heat for skipping a sensitive closed-door Iraq war intelligence briefing in 2005 to golf with Tiger Woods.

Defense lobbyist James Ervin, one of Chambliss' longtime friends and contributors, defended the senator's golf outings. Ervin's wife, Teresa, is Chambliss' deputy chief of staff.

"I think that it's more than appropriate for Sen. Chambliss to do whatever he wants with the leadership PAC money," Ervin said. "Certainly I think golf is completely acceptable."

Ervin and two of his clients -- defense contractors Lockheed Martin and General Dynamics -- put $30,000 into Chambliss' leadership PAC in the last election cycle. Ervin's clients also made generous contributions to Chambliss' campaign committee: Lockheed Martin, $51,800 and General Dynamics, $15,000.

As the top Republican on the Armed Services Committee, Chambliss is well-positioned to help defense firms. He has been a leading proponent of the F-22 jet fighter, which is important to Lockheed Martin and the state of Georgia.

When lawmakers leave Congress, they sometimes keep their leadership PACs or they hand them down like valuable heirlooms to their successors, with the same tight circle of lobbyists and lawmakers playing revolving roles.

Former Sen. Don Nickles of Oklahoma controlled the Republican Majority Fund from 1985 until he retired in 2005. He then passed it along to Chambliss.

Nickles now has a successful lobbying practice, Nickles Group, which along with its clients contributed $52,500 to the PAC during the 2008 campaign cycle.

ProPublica contacted Nickles and more than a dozen other contributors to the fund. Ervin was the only one to return a call. In his case, he left a brief phone message but failed to return a subsequent call.

ProPublica Director of Research Lisa Schwartz and the Brian Ross Investigative Unit at ABC News contributed to this report.

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'Not Whether We Can End Hunger, It's Whether We Will'; Aid Group Endorses Admin. Plan

The Obama administration's new plan to combat world hunger is drawing strong support from one of the oldest and most established humanitarian organizations.

Secretary of State Hillary Clinton announced the plan Friday at her husband's Clinton Global Initiative event. The plan, to improve globally what experts refer to as "food security," rests on five principles, according to the secretary of state.

"If we can build partnerships with countries to help small farmers improve their agricultural output and make it easier to buy and sell their products at local or regional markets, we can set off a domino effect," she says. "We can increase the world’s food supply for both the short and the long term; diminish hunger; raise farmers’ incomes; improve health; expand opportunity; and strengthen regional economies.

"Now, our initiative is, admittedly, ambitious, because we intend to address the root causes of hunger by investing in technologies and infrastructure that will make farming more productive and profitable in developing countries, while making it easier for food to reach the people who need it," Clinton adds. "It will enhance nutrition, so children are healthy enough to learn and adults are strong enough to work. And we’ll maintain our deep commitment to emergency food assistance, to answer the urgent cry for help when tragedies and disasters take their toll—as is happening now in the Horn of Africa, where drought, crop failures, and civil war have caused the worst humanitarian crisis in 18 years."

A leading humanitarian organization fighting global poverty founded in 1945, CARE says in a statement that the plan outlined by Clinton is closely aligned with CARE's own.

CARE also urges Congress to adopt two bills that it says would help bring the new Obama administration plan to fruition.

"We stand ready to work with the Obama administration and other partners on this critically important effort," says Helene Gayle, president and CEO of CARE. "We urge the U.S. to continue to take a leadership role in this global effort. In the near term we encourage Congress to take two actions: pass the Global Food Security Act and pass the [fiscal year] 2010 State and Foreign Operations bill, which includes over $1 billion in international agriculture development which is essential to this effort."

More than one billion people — one sixth of the world's population — suffer from chronic hunger, according to a State Department estimate. Global food supplies must increase by an estimated 50 percent to meet expected demand in the next 20 years, the State Department says.

"We are pleased that the U.S. commitment to action on global food security addresses the needs of small-scale farmers and highlights the importance of nutrition," says David Kauck, CARE senior technical advisor and an expert on food security issues. "We also must ensure that this investment helps the world's poorest and most vulnerable--the more than one billion people worldwide who are suffering from chronic hunger."

In remarks to the U.N. General Assembly, President Obama spoke of the U.S. joining with other nations to launch a $20 billion global food security initiative that will lend a hand to those who need it most and help them develop their own solutions to chronic hunger.

In its statement, CARE says it "stands firmly behind Secretary Clinton's statement, 'the question is not whether we can end hunger, it's whether we will.'"

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Capitol Idea: Sometimes, Patience Pays Off

By Scott Nance

Politicians, especially presidents, have a habit of asking voters for their patience. Voters can be capricious in return in extending that forbearance.

It doesn't matter if it's war, the economy, or another vexing bother, if things aren't going well presidents ask us to be patient.

Too often, such requests are nothing more than a dodge, a feint to put off paying some political price or other. At times, though, the appeals for a measure of national fortitude are entirely rational and justified.

Sometimes effecting change in our government — even change that seems like common sense — can be difficult. There are many reasons for this, but often, the checks and balances that the framers specifically built in to make our government slow to move by design are at the root.

But patience isn't always easy. If it were, it wouldn't be much of a virtue now, would it? (Breathing and eating, by contrast, are usually easy but rarely described as virtues). So patience may be a virtue, but in politics, it all depends upon the leader in whom we invest our collective tolerance. In other words, will our patience be rewarded?

George W. Bush asked for, and tested, our patience often. But with two mismanaged wars, the bungled Hurricane Katrina recovery, missteps and lapses of all sorts, Bush rarely delivered.

Barack Obama, too, has sought a level of patience more than once as signs loom that many are growing impatient with his leadership. While not as angry as the disquiet on the right, even the president's erstwhile allies among the left have become restive. On one level, agitation on the left is fully understandable as there is so much to be done, and the current Democratic dominance clearly presents the strongest opportunity to do so. On another level, though, impatience among progressives may be ill-timed and may be hampering Obama unnecessarily.

Case in point: the president was hammered from the left for months, accused of supporting draconian policies regarding secrecy and national security not much different than Bush's'. The administration indicated those policies were still a work in progress — stay tuned — but many progressives wouldn't give Obama any benefit of the doubt.

A funny thing happened this week, though, as the administration announced a new policy that makes it much more difficult for the government to hide state secrets, and in the process, making the government dramatically more accountable. Might progressives have been better served by the administration holding its fire on this one?

My point here isn't to call out a cheap "I told you so." Rather, it's to suggest that although reforms may not be manifesting in the chronology or the form any one of us necessarily would prefer (for all we know, they aren't even occurring the way Obama once foresaw — he may be practicing his own patience!), if we step back, we see reform is indeed taking hold.

When does Obama deserve some patience, and dare I even suggest, trust among progressives? A generation ago, Ronald Reagan succeeded in pushing his conservative agenda because the right so trusted Reagan that they showed much patience with him. That gave Reagan valuable political maneuvering room. We progressives, by contrast, seem bent on keeping Obama on a short leash. Maybe we should unleash Obama more to reach much of the success in a progressive sense that Reagan achieved on the right.

To be clear, I am not suggesting the left stand aside, a kind of passive blind faith. The challenge is to engage with the administration in a constructive way to advance policy without coming off as petulant. The end-games on health care reform, climate change, the war in Afghanistan are just the issues up now.

We have at least three more years to go (one would hope more than seven). That being the case, we on the left have to realize we may well get at least much of what we want — but we might not always get it when we want. As this week's policy announcement proves, with Barack Obama, good things do come to those who wait.

The publisher of On The Hill and its sister sites, Life, The Universe ... and Politics Live, Scott Nance has covered government and Washington for more than a decade. Capitol Idea is his regular column from Washington.

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White House Regroups on Guantanamo

by Dafna Linzer, ProPublica, and Anne E. Kornblut, Washington Post

With four months left to meet its self-imposed deadline for closing the U.S. military prison at Guantanamo Bay, Cuba, the Obama administration is working to recover from missteps that have put officials behind schedule and left them struggling to win the cooperation of Congress.

Even before the inauguration, President Obama's top advisers settled on a course of action they were counseled against: announcing that they would close the facility within one year. Today, officials are acknowledging that they will be hard-pressed to meet that goal.

The White House has faltered in part because of the legal, political and diplomatic complexities involved in determining what to do with more than 200 terrorism suspects incarcerated at the prison. But senior advisers privately acknowledge failing to devise a concrete plan for where to move the detainees and mishandling Congress.

To address these setbacks, the administration has shifted its leadership team on the issue. White House Counsel Gregory B. Craig, who initially guided the effort to close the prison and who was an advocate of setting the deadline, is no longer in charge of the project, two senior administration officials said this week.

Craig said Thursday that some of his early assumptions were based on miscalculations, in part because Bush administration officials and senior Republicans in Congress had spoken publicly about closing the facility. "I thought there was, in fact, and I may have been wrong, a broad consensus about the importance to our national security objectives to close Guantanamo and how keeping Guantanamo open actually did damage to our national security objectives," he said.

In May, one of the senior officials said, Obama tapped Pete Rouse -- a top adviser and former congressional aide who is not an expert on national security but is often called in to fix significant problems -- to oversee the process. Senior adviser David Axelrod and deputy communications director Dan Pfeiffer were brought in to craft a more effective message around detainee policy, the official said.

"It was never going to be easy, but we have worked through some of the early challenges and are on a strong course," Pfeiffer said.

In order to empty the prison, the administration will need to find facilities to house 50 to 60 prisoners who cannot be released and who cannot be tried because of legal impediments, according to an administration official. The administration must also win congressional funding for the closure process, find host countries for detainees cleared for release, and transfer dozens of inmates to federal and military courts for prosecution.

Three administration officials said they expect Craig to leave his current post in the near future, and one said he is on the short list for a seat on the bench or a diplomatic position. Craig has long made clear his desire to be involved in foreign policy, but he declined to comment on his plans.

Several White House officials remain involved in Guantanamo, including Thomas E. Donilon, the deputy national security adviser; John O. Brennan, the counterterrorism adviser; and David Rapallo, an official on the National Security Council.

"Guantanamo was everyone's part-time job," said a senior official, one of several interviewed for this article who insisted on anonymity to discuss internal deliberations. Now, the official added, Rouse is coordinating them.

Setting a Deadline

Before the election, Craig met privately with a group of top national security lawyers who had served in Democratic and Republican administrations to discuss Guantanamo. During the transition, he met with members of the outgoing administration, some of whom warned him against issuing a deadline to close the facility without first finding alternative locations for the prisoners.

Although the move was approved by all of the president's senior advisers and, ultimately, the president himself, the deadline came at the suggestion of Craig, according to two senior government officials involved in the process. Craig declined to comment on internal discussions.
Craig oversaw the drafting of the executive order that set Jan. 22, 2010, as the date by which the prison must be closed.

"It seemed like a bold move at the time, to lay out a time frame that to us seemed sufficient to meet the goal," one senior official said. "In retrospect, it invited a fight with the Hill and left us constantly looking at the clock."

"The entire civil service counseled him not to set a deadline" to close Guantanamo, according to one senior government lawyer.

In those early months, Craig was unquestionably the central figure in the effort to shut Guantanamo. In an interview with The Washington Post in February, Craig said he was managing the closure "on a day-to-day basis."

Craig began personally reviewing the cases of each detainee at the facility, and was one of the first senior officials to travel to the prison, visiting Guantanamo on Feb. 18, ahead of Attorney General Eric H. Holder Jr.

But as time wore on, congressional staffers said, they stopped hearing from Craig. Although there were periodic briefings with members of the Justice Department's task forces, there was no longer a point person from the White House who appeared to be shepherding the issue, according to one Republican aide. Craig became involved in other issues, such as vetting, ethics and the nomination of Sonia Sotomayor to the Supreme Court.

Obstacles and Setbacks

Senior administration officials said the central roadblock during those early months was the condition of the detainee files, which had been left in disarray by the previous administration.

"We assumed that for each detainee there was going to be a file somewhere," one senior administration official said. "Some of the intelligence files were not even organized by detainee.

You had to go into a mainframe database and search the name of the detainee to put together a file. So there were weeks, if not months, of putting together the files of detainees that then could be reviewed by the fresh eyes that we wanted."

As the process was getting underway in the spring, the administration began losing support for shutting the facility, in part, officials now say, because the White House did not present a concrete plan for what it would do with the remaining terrorism suspects.

After news reports that 17 detainees -- Chinese Muslims known as Uighurs -- were going to be moved to the Virginia suburbs, lawmakers balked.

Then in May, the Senate decided, by an overwhelming vote of 90 to 6, to block funding for shutting Guantanamo -- Obama's first major legislative setback as president.

Public displeasure with the decision to close Guantanamo grew. Fifty percent of those surveyed in June said they disapproved of closing the facility, according to a Washington Post-ABC News poll, up significantly from a Pew poll in February.

Republicans pounced on the Guantanamo closure, alleging that it would make America "less safe." Senate Majority Leader Harry M. Reid, D-Nev., protested that Democrats would "under no circumstances" move forward without more specifics. The following month, Congress passed an appropriations bill that required the administration to report its plans before moving any detainee out of Guantanamo and prevented it from using available funds to move detainees onto U.S. soil.

Six pending pieces of legislation would make it harder for Obama to close the prison and transfer detainees to the United States or foreign countries.

After the congressional setbacks, Craig orchestrated the release of four of the Uighurs, flying with them and a State Department official from Guantanamo to Bermuda, a self-governing British territory whose international relations are administered by Britain.

The transfer produced a diplomatic rift. British and U.S. officials said the Obama administration gave Britain two hours' notice that the Uighurs were being sent to Bermuda. "They essentially snuck them in, and we were furious," said a senior British official. The move also caused friction between Britain and China, which seeks the Uighurs for waging an insurgency against the Chinese government.

Late Thursday, White House Chief of Staff Rahm Emanuel offered a defense of Craig, saying he "played a critical role in pursuing the president's goal of ensuring that we protect our nation's security interests in a manner that is consistent with our laws and our values."

One administration official was more effusive. "Greg Craig is a hero," the official said. "He took responsibility for this policy from the beginning, and he has guts and character. If we can't get it done by the deadline, then at least we'll have done as much as we can as smoothly as we could have."

In coming weeks, officials say, they expect to complete the initial review of all the files of those held at Guantanamo.

Washington Post staff writer Peter Finn, polling director Jon Cohen and staff researcher Julie Tate contributed to this report.

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Drug Store Chain Releases Some Details About Its Transaction With Rep. Mike Ross

by Marcus Stern, ProPublica

The drug chain that bought a pharmacy from Rep. Mike Ross, D-Ark., in 2007 has released a two-page summary (PDF) of the transaction, revealing for the first time the exact amount that Ross and his wife, Holly, received -- $1,254,420.10.

Previously, public documents had only provided a range: $1 million to $1.67 million.

Ross asked USA Drug to release the information in response to a story published Tuesday by ProPublica and Politico that raised questions about the real estate portion of the sale. Ross declined to be interviewed for that story.

"This should certainly clear up any misunderstanding the press may have about our transaction," Joe Courtright, president and CEO of USA Drug, wrote in the two-page summary of the business arrangement, which was published on a business Web site.

However, the summary offered no new information about the central question raised by the ProPublica story: How did USA Drug and Ross arrive at the $420,000 price for the building and lot that house the pharmacy at a time when the county estimated the value of both at a combined $263,700?

Ross paid $10,000 for the lot in 1997, and on Tuesday he said in a news release that he had spent $316,000 in 1998 to construct the building. But the county, taking stock of the building materials and the size of the building, valued it at $225,000 in 1999 and $237,700 in 2004. A recent reassessment by the county (PDF) set the current market value for the building and the lot at $269,000. An independent appraisal (PDF) paid for by ProPublica found the current market value of the property to be $198,000.

Real estate professionals in Prescott say property values in the economically depressed community, about 100 miles southwest of Little Rock, have been flat over the past decade, largely unaffected by the wild market swings seen elsewhere in the country. A sawmill that for some 50 years provided many of the town's jobs has closed and a Firestone plant, the other major local employer, has cut its workforce in half.

Courtright's summary did provide new information about the other two components of the pharmacy sale -- the valuation of the business assets and a non-compete agreement benefiting Holly Ross.

USA Drug paid $724,420 for the assets of the business and $110,000 as part of an agreement by the Rosses not to compete in the future against the business being sold, Holly’s Health Mart.

Courtright is on the board of the National Association of Chain Drug Stores, which represents pharmacy interests in Washington, including during the current health care reform debate. Calls to Courtright at his office in Little Rock were not immediately returned.

ProPublica is an independent, non-profit newsroom that produces investigative journalism in the public interest.

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Flu Nightmare: In Severe Pandemic, Officials Ponder Disconnecting Ventilators From Some Patients

by Sheri Fink, ProPublica

With scant public input, state and federal officials are pushing ahead with plans that -- during a severe flu outbreak -- would deny use of scarce ventilators by some patients to assure they would be available for patients judged to benefit the most from them.

The plans have been drawn up to give doctors specific guidelines for extreme circumstances, and they include procedures under which patients who weren’t improving would be removed from life support with or without permission of their families.

The plans are designed to go into effect if the U.S. were struck by a severe flu pandemic comparable to the 1918 outbreak that killed an estimated 50 million people worldwide. State and federal health officials have concluded that such a pandemic would sicken far more people needing ventilators than could be treated by the available supplies.

Many of the draft guidelines, including those drawn up by the Veterans Health Administration, are based in part on a draft plan New York officials posted on a state web site two years ago and subsequently published in an academic journal. The New York protocol, which is still being finalized, also calls for hospitals to withhold ventilators from patients with serious chronic conditions such as kidney failure, cancers that have spread and have a poor prognosis, or "severe, irreversible neurological" conditions that are likely to be deadly.

New York officials are studying possible legal grounds under which the governor could suspend a state law that bars doctors from removing patients from life support without the express consent of the patient or his or her authorized health agent.

State and federal officials involved with drafting the plans say they have been disquieted by this summer’s uproar over whether Medicare should pay for end-of-life consultations with families. They acknowledged that the measures under discussion go far beyond anything the public understands about how hospitals might handle a severe pandemic.

By every indication, state and federal officials expect to weather this year’s flu season without having to ration ventilators. That assumes that the H1N1 virus will not mutate into a more serious killer, the vaccines against it and the other seasonal flus will continue to prove effective, and any dramatic surges in the number of patients in need of ventilators will occur in different parts of the U.S. at different times.

In recent months, New York officials have met three times with physicians, respiratory therapists and administrators to rehearse how their plan might play out in hospitals in a severe epidemic. In one of those “tabletop exercises,” participants suggested that the names of triage officers charged with making life and death choices among patients at each hospital should be kept secret. The secrecy would be needed, participants said in interviews, to avoid pressure and blame from colleagues caring for patients who were selected to be taken off life support.

When they posted their plan on the web in coordination with a video conference in 2007, New York officials promised to solicit public input. Since then, they have consulted with medical and legal professionals and other experts, but few members of the general public, and the plan has remained unchanged. They declined to make the comments they have gathered immediately available for review, and those comments are not published on the Health Department's Web site.

In the initial proposal, officials called public review “an important component in fulfilling the ethical obligation to promote transparency and just guidelines.”

The academic publication of the plan envisaged the use of focus groups to solicit comment from “a range of community members, including parents, older adults, people with disabilities, and communities of color.” Those have not been held.

Beth Roxland, the current executive director of the New York State Task Force on Life and the Law, said the ethicists included in the state's planning process focused largely on vulnerable populations. "Even if we didn’t have direct input from vulnerable populations," she said, "their interests have been well accounted for." Roxland said that public comment solicited when the ventilator plan was posted on the Health Department Web site was "sparse."

Dr. Guthrie Birkhead, Deputy Commissioner of the Office of Public Health for New York State said he wondered whether it was possible to get the public to accept the plans. "In the absence of an extreme emergency, I don’t know. How do you even engage them to explain it to them?"

Even so, other states, hospital systems and the Veterans Health Administration—which has 153 medical centers across all states -- have drafted protocols that are based in part on New York’s plan. The inclusion and exclusion criteria for access to ventilators, however, are different. For example, under the current drafts, a patient on dialysis would be considered for a ventilator in a VA hospital in New York during a severe pandemic, but not in another New York hospital that followed the State’s plan, which excludes dialysis patients. The VA’s exclusion criteria are looser because the patient population it is charged with serving is typically older and sicker than in other acute care hospitals. Different states, reflecting different values, have also established different criteria for who gets access to lifesaving resources.

The Institute of Medicine, an independent national advisory body, is expected to release a report on Thursday morning, at the request of the U.S. Department of Health and Human Services, that will recommend broad guidelines to help guide planners crafting altered standards of care in emergencies. At an open meeting held to inform the report on Sept. 1, participants described successful public exercises related to allocating scarce resources in Utah and in a Centers for Disease Control and Prevention study conducted in Seattle.

Questions about how hospitals would handle massive demand for life support equipment arose when New York state health department officials ran exercises based on a scenarios involving H5N1 avian influenza.

“They kept running out of ventilators,” said Dr. Tia Powell, director of the Montefiore-Einstein Center for Bioethics and former executive director of the New York State Task Force on Life and the Law, which was asked to address the problem. “They immediately recognized this is the worst thing we’ve ever imagined. What on earth are we going to do?”

Officials calculated that 18,000 additional New Yorkers would require ventilators in the peak week of a flu outbreak as deadly as the 1918 pandemic. Only a thousand machines would be available, the officials estimated. The state’s acute care hospitals in 2005 had about 6000 ventilators, 85% of which were normally in use. A moderately severe pandemic would have resulted in a shortfall of 1256 ventilators, health officials found.

In 2006, New York planners convened a group of experts in disaster medicine, bioethics and public policy to come up with a response. After months of discussion, the group produced the system for allocating ventilators. They first recommended a number of ways that hospitals could stretch supply, for example by cancelling all elective surgeries during a severe pandemic. The state has also since purchased and stockpiled 1700 Pulmonetic Systems LTV 1200 ventilators (Cardinal Health Inc., NYSE) -- enough to deal with a moderate pandemic but not one of 1918 scale.

Officials realized those two measures alone would not be enough to meet demand in a worst-case scenario. Ventilators were costly, required highly trained operators, and used oxygen, which could be limited in a disaster.

The group then drew up plans for rationing of ventilators. The goal, participants said, was to save as many lives as possible while adhering to an ethical framework. This represented a departure from the usual medical standard of care, which focuses on doing everything possible to save each individual life. Setting out guidelines in advance of a crisis was a way to avoid putting exhausted, stressed front line health professionals in the position of having to come up with criteria for making excruciating life and death decisions in the midst of a crisis, as many New Orleans health professionals had to do after Hurricane Katrina.

The group based its plans, in part, on a 2006 protocol developed by health officials in Ontario, Canada which relied on quantitative assessments of organ function to decide which patients would have preference for an intensive care unit bed. The tool, known as the Sequential Organ Failure Assessment (SOFA) score, is not designed to predict survival, and not validated for use in children, but the experts adopted it in light of the lack of an appropriate alternative triage system.

This summer, New York officials brought the state’s plan to groups from several New York hospitals for the tabletop exercises. They met behind closed doors to assess how hospitals might implement the proposed measures if the H1N1 pandemic turned unexpectedly severe this fall.

In the fictional scenario, paramedics were ordered not to place breathing tubes into patients until physicians “can assess whether they meet the criteria to be placed on a ventilator.’’

Problems were immediately apparent. Dr. Kenneth Prager, a professor of medicine and director of clinical ethics at Columbia University Medical Center, was concerned about the lack of awareness of the plan among the larger public and the majority of the medical community. Societal input “is totally absent,” he said and called for more outreach to the public. “Maybe society will say, 'We don’t agree with your plan. You may think it’s ethically OK; we don’t.'"

The protocol, he said, would also place a great burden on clinicians charged with selecting which patients would be removed from life support. Physicians were concerned doctors involved in the legitimate and painful selection processes might be inappropriately construed as "death squads."

“We facetiously dubbed them the ‘death squad’ or the ‘guys in the back room’,” Prager said. He envisioned family members breaking down and screaming when they found out their loved ones would be disconnected from ventilators. “It really is a nightmare.”

Even so, he felt that the plan – and its effort to save the greatest number of patients – was ethically appropriate. “If we don’t use triage, people will die who would have otherwise been saved,” he said, because a number of ventilators are “being used to prolong the dying process of patients with virtually no chance of surviving.”

Doctors at the exercises feared that they would be sued by angry patients if they followed the draft guidelines. “There’s absolutely no legal backing for physicians,” said Lauren Ferrante, a medical resident at Columbia University Medical Center. “Who’s to say we’re not going to get sued for malpractice?”

New York State law forbids doctors from removing living patients from ventilators or other life support except in cases where the patient has clearly stated such wishes, for example in a living will, or through his or her legal health care agent. Other sources of liability could come from federal and state anti-discrimination laws or claims of denial of due process.

New York officials said they were currently working out legal options for implementing the plans, such as gubernatorial emergency declarations or emergency legislation.

“You can take something today that’s not necessarily active and overnight flip the switch and make it into something that has those teeth in it,” said Dr. Powell, who served on the committee that drafted the plan.

Dr. Powell cautioned that it is critically important to maintain flexibility in the guidelines. Any rationing measures taken in a disaster must be calibrated to need and severity.

Guidelines can also promote investment in new technology, such as cheaper, easier to use ventilators, that would make rationing less likely. Already at least one company, St. Louis-based Allied Healthcare Products, is marketing a line of ventilators specifically for use in disasters.
Some states, including Louisiana and Indiana, have adopted laws that immunize health professionals against civil lawsuits for their work in disasters. Other states, including Colorado, have drawn up a series of relevant executive orders that could be applied to address these issues.

Dr. Carl Schultz, a professor of emergency medicine at the University of California at Irvine and co-editor of the forthcoming textbook, Koenig and Schultz’s Disaster Medicine (Cambridge University Press), is one of the few open critics of the establishment of altered standards of care for disasters. He says the idea “has both monetary and regulatory attractiveness” to governments and companies because it relieves them of having to strive to provide better care.

“The problem with lowering the standard of care is where do you stop? How low do you go? If you don’t want to put any more resources in disaster response, you keep lowering the standard.”
Federal officials disagree. “Our goal is always to provide the highest standard of care under the circumstances,” said RADM Ann Knebel , deputy director of preparedness and planning at the Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services. “If you don’t plan, then you are less likely to be able to reuse, reallocate and maximize the resources at your disposal, because you have people who’ve never thought about how they’d respond to those circumstances.”

ProPublica is an independent, non-profit newsroom that produces investigative journalism in the public interest.

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House Passes 'Lifeline' To Help More Than 1M Set To Lose Unemployment Checks

The House last night extended a "lifeline" to more than 1 million jobless Americans whose unemployment payments would expire at years' end, approving an extension of benefits on a vote of 331-83.

Lawmakers approved the Unemployment Compensation Extension Act (H.R. 3548), which would provide up to 13 additional weeks of unemployment benefits to workers in those states with the highest unemployment and will soon begin losing their checks — helping hundreds of thousands of Americans who will exhaust all of their benefits by the end of September and more than 1 million who will run out of unemployment by the end of December, according to an estimate from Speaker Nancy Pelosi's office.

"Today, the House of Representatives extended a lifeline to hundreds of thousands of workers nationwide," Pelosi says. "Extending unemployment insurance in the states hardest hit by the recession provides families with the assistance and reassurance they need to help weather the economic storm. The 314,000 Americans set to lose unemployment insurance this month – and the more than 1 million who will exhaust their benefits by the end of the year – need help to avert an even bigger financial tragedy, such as the loss of their home or a medical bankruptcy, which would ripple out into our larger economy."

Nationally, the unemployment rate stands at 9.7 percent and has climbed steadily for about a year.

Pelosi also touted the more general stimulative effects that unemployment payments produce in the economy as a whole.

“Extending these benefits is also among the most cost-effective and fastest ways to stimulate the economy – because the money is spent quickly. Every $1 spent on unemployment benefits generates $1.63 in new economic demand," she says.

The House extension is targeted to states with particularly high unemployment, or those with a three-month average total unemployment rate of 8.5 percent or a 13-week insured unemployment rate above 6 percent, Pelosi's office says. Those states include California, Illinois, Michigan, Ohio, Pennsylvania and some two dozen others.

Speaking in support of the extension bill on the House floor, Rep. Jim McDermott (D-Wash.) cast the vote one to avoid "plunging [unemployed Americans] and their families into an economic abyss and threatening to reverse the positive signs we are beginning to see in the economy."

The House measure now must pass the Senate, and be signed by President Obama in order to take effect as law.

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Mike Ross Raises Eyebrows With Healthy Haul

by Marcus Stern, ProPublica

Arkansas Rep. Mike Ross -- a Blue Dog Democrat playing a key role in the health care debate -- sold a piece of commercial property in 2007 for substantially more than a county assessment (PDF) and an independent appraisal (PDF) say it was worth.

The buyer: an Arkansas-based pharmacy chain with a keen interest in how the debate plays out.

Ross sold the real estate in Prescott, Ark., to USA Drug for $420,000 -- an eye-popping number for real estate in the tiny train and lumber town about 100 miles southwest of Little Rock.

"You can buy half the town for $420,000," said Adam Guthrie, chairman of the county Board of Equalization and the only licensed real estate appraiser in Prescott.

But the $420,000 was just the beginning of what Ross and his pharmacist wife, Holly, made from the sale of Holly's Health Mart. The owner of USA Drug, Stephen L. LaFrance Sr., also paid the Rosses $500,000 to $1 million for the pharmacy's assets and paid Holly Ross another $100,0001 to $250,000 for signing a non-compete agreement. Those numbers, which Ross listed on the financial disclosure reports he files as a member of Congress, bring the total value of the transaction to between $1 million and $1.67 million.

And that's not counting the $2,300 campaign contribution Ross received from LaFrance two weeks after the sale closed.

Holly Ross remains the pharmacist at Holly's Health Mart under USA Drug. Neither she nor her husband agreed to speak with ProPublica for this story.

At the time of the 2007 sale, the county assessor's office valued the pharmacy's building and the land on which it sits at $263,000 -- nearly $160,000 less than the Rosses got for it. Because assessors' valuations don't always reflect true market value, ProPublica hired Guthrie to appraise the property. He placed the current value of the lot and building at $198,000, substantially lower than the county's assessment, which was raised from $263,000 to $269,000 this year. Guthrie explained the difference between his appraisal and the county assessment by saying that county assessments have been running higher than actual market value.

Mike Ross frequently speaks for a coalition of House moderates known as the Blue Dog Democrats, a group that helped force changes to the version of the health care reform bill drafted by the House Energy and Commerce Committee. The role has lifted him to national prominence in recent months.

Ross, a member of the committee, told reporters on Aug. 5 in Little Rock, “We held the bill hostage in committee for 10 days to make it better. ... We protected small businesses. ... And we ensured that if there is a government option, it will be just that, an option. It will not be mandated on anybody."

Ross bristled at suggestions he was trying to kill the bill.

"I wasn't trying to kill health care reform," he said. "If I was, I wouldn't have been in negotiations for 10 days."
LaFrance has amassed a privately held chain of more than 150 pharmacies operating in five Southern and Midwestern states under a variety of names, including USA Drug. It was the 15th largest drug chain in the country in 2008 with an estimated $906 million in sales, according to Racher Press, which publishes business intelligence reports.
The pharmacy industry is aggressively lobbying Congress in an effort to protect its interests in the health care debate. Ross, who belongs to the 52-member Congressional Community Pharmacy Coalition, has introduced and supported legislation backed by pharmacy trade groups.
On Aug. 1, the National Community Pharmacist Association issued a news release thanking Ross for an amendment to the health care reform bill that would create greater transparency in the operations of pharmacy benefit managers, who act as clearing houses for insurance company reimbursements for pharmaceuticals.

In June the National Association of Chain Drug Stores issued a news release thanking Ross for introducing legislation authorizing payments to pharmacists to train patients in how to manage their medications.

Health-related interests have donated $342,475 to Ross since 2007, according to federal campaign data maintained by the nonprofit Center for Responsive Politics. No other business sector has given Ross as much.

Ross and La France declined to be interviewed for this story. LaFrance's son, Stephen L. LaFrance Jr., who helps run the chain, asked for questions to be submitted in writing but didn't respond to them.

Ross's spokesman, Brad Howard, said the real estate deal was "open, honest and by-the-books." He described Ross and LaFrance as "acquaintances" but declined to say whether they have discussed the pending legislation, adding that Ross has discussed health care reform with many of his constituents.

The $157,000 gap between the property's assessed value and the price LaFrance paid wasn't unusual, Howard said, because assessments are done for tax purposes and typically don't reflect the full market value of the real estate.

"The appraisal always differs from the assessment, and you can't really compare the two," Howard said.

In that initial interview on Sept. 2, Howard told ProPublica that the appraised value of the real estate at the time of the sale "was somewhere around where the purchase price was, which was, you know, I think was like $420,000." He said he didn't have a copy of any such appraisal and suggested obtaining it from LaFrance, who did not respond to requests for a copy. On Friday, however, Howard said he could "only assume there was an appraisal done on the property by the buyer in 2007" and that he "never said" the property was appraised at $420,000.

Nevada County, which includes Prescott, hires an outside firm -- Arkansas CAMA Technology Inc. -- to update its assessments every five years. After LaFrance bought Holly's Health Mart in 2007, someone from CAMA called the headquarters of LaFrance's pharmacy chain to verify the sale price for the lot and building, in part because "it was such an expensive sale for that area," CAMA employee Mike Shepherd told ProPublica.

Commercial property values in Nevada County "have stayed flat" in recent years Shepherd said, adding, "I would say flat or a slight increase, maybe. That would be pretty slight, though."

Brenda Williams of Nevada County Real Estate in Prescott said county property assessments tend to be slightly below market value, but usually "no more than 5 percent."

"Being in the real estate business, I know that I see the tax card every time, and it's usually assessed a little bit less than the actual value or sales price, a little bit less but not that much less," she said. Asked about the value of the lot and building housing Holly's Health Mart, she said, "It might cost $250,000 to build it. I wouldn't have a problem with that two hundred and something thousand. But not over 400."

The Rosses bought the lot in 1999 for $10,000, then constructed a building that the county assessed at $225,000.

Two months after the 2007 sale, LaFrance's concerns about health care reform were spelled out in an article in the Arkansas Democrat-Gazette.

"Universal health care will ruin our health care in America," LaFrance told the reporter.

"There'll be long lines, they won't be able to get treated, potential doctors will be afraid to go into medical school, there will be an outflux of doctors -- in my opinion. It's not broke and don't fix it."

Describing the drug industry as "very big business," he said the high prices charged for prescription drugs are possible only because insurance companies and the government underwrite about 95 percent of the cost.

"So when the customer pays $7, $10, $15, $20" for a prescription co-pay, "it doesn't hurt him. They don't realize that the insurance company is paying the other $125. That's kind of a double-edged sword; if it wasn't for insurance, the American pharmaceutical industry wouldn't be able to charge the prices it charges today, because the public wouldn't put up with it," LaFrance told the Democrat-Gazette.

"Our sales are higher, because it affects the top line of sales," he added. If the government doesn't interfere, there's "nothing but good days ahead."

ProPublica research director Lisa Schwartz and researcher Kitty Bennett contributed to this report.

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Sestak Probes Navy's Anti-Gay Abuse

Rep. Joe Sestak (D-Pa.), a former admiral and currently running for Senate, is looking for answers into the abuse of a gay sailor, and the subsequent promotion of the chief petty officer who led the abuse.

Sestak has written a letter to the Secretary of the Navy requesting an inquiry into the promotion of a chief petty officer who oversaw and participated in a two-year train of abuses against a gay sailor and other members of his unit, according to a statement by the Palm Center. Located at the University of California, the center is a think tank for matters related to gays in the military.

Sestak's letter asks the Navy to provide "any information relevant to the assault and battery of Petty Officer Third Class Joseph Rocha and the promotion of Chief Petty Officer Michael Toussaint to the rank of Senior Chief."

Rocha was brutalized for more than two years at his base in Bahrain after unit mates suspected he is gay, the Palm Center statement says. According to official military documents, Navy officials were fully aware of the role of Toussaint in perpetrating the violence. But they decided to promote him anyway, the center says.

The abuse included hog-tying Rocha to a chair and pushing him, while bound, into a dog kennel full of feces, as well as humiliating him by repeatedly forcing him to simulate oral sex with another man while on video, the Palm Center says. Rocha was also pummeled repeatedly while forcibly bent over a desk. Toussaint was implicated in other incidents as well, including handcuffing a sailor to a bed and forcing her to simulate lesbian sex with another woman, also while on video. One of the women later committed suicide, the Palm Center adds.

Rocha's abuse took place between 2004 through 2006, according to Sestak's letter.

Rocha has developed symptoms of post-traumatic stress disorder due to the abuse, and was discharged under the military's "Don't Ask, Don't Tell" policy regarding gays in the military, Sestak's letter says.

Sestak notes that Rocha served honorably and received favorable performance evaluations on duty.

Sestak, running to unseat Republican-turned-Democratic Sen. Arlen Specter of Pennsylvania, opposes the "Don't Ask, Don't Tell" policy. President Obama last year campaigned on a promise to lift the policy, but so far has not followed through in office.

Center, said social science makes clear the role of discriminatory law in encouraging abuse against minorities. "Any law or policy that singles out one group as a threat to the greater good is a green light to treat that group in demoralizing and dangerous ways," says Nathaniel Frank, a Palm Center senior research fellow and author of Unfriendly Fire: How the Gay Ban Undermines the Military and Weakens America. "The current policy is especially insidious because it allows the group to serve but casts it as a menace. It's one thing to say, 'You're too old, so you're not eligible.' But this policy says 'Gays are eligible, they're serving with you, but by the way, they're an unacceptable risk to your mission.' It's no wonder they're sometimes a punching bag."

A Palm Center study authored by legal scholar Sharon Terman shows that regardless of military leaders' intentions, the gay ban itself prevents the armed forces from deterring anti-gay abuse, the Palm Center says. Terman argues that the failure to prevent anti-gay abuse "results from the practical and conceptual problems with regulating harassment in a discriminatory institution."

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