Hospital delays are killing America’s war veterans.

By Scott BronsteinNelli Black and Drew Griffin, CNN Investigations
updated 11:10 PM EST, Tue November 19, 2013
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Veterans dying waiting for healthcare

  • America’s war veterans are dying because of long waits and delayed care, CNN has found
  • The VA is aware of the problems and has done little to address it, documents show
  • More than 20 are believed to have died or are dying because of waits at one VA facility

Columbia, South Carolina (CNN) — Military veterans are dying needlessly because of long waits and delayed care at U.S. veterans hospitals, a CNN investigation has found.

What’s worse, the U.S. Department of Veterans Affairs is aware of the problems and has done almost nothing to effectively prevent veterans dying from delays in care, according to documents obtained by CNN and interviews with numerous experts.

The problem has been especially dire at the Williams Jennings Bryan Dorn Veterans Medical Center in Columbia, South Carolina. There, veterans waiting months for simple gastrointestinal procedures — such as a colonoscopy or endoscopy — have been dying because their cancers aren’t caught in time.

The VA has confirmed six deaths at Dorn tied to delays. But sources close to the investigation say the number of veterans dead or dying of cancer because they had to wait too long for diagnosis or treatment at this facility could be more than 20.

“It’s very sad, because people died,” said Dr. Stephen Lloyd, a private physician specializing in colonoscopies in Columbia.

Lloyd and other physicians across South Carolina’s capital city are being affected by the delays at Dorn as veterans seek treatment or diagnoses outside the VA hospital.

Lloyd is one of the few doctors in the area willing to speak on the record about the situation at Dorn.

“(Veterans) paid the ultimate price,” he said. “People that had appointments had their appointments canceled and rescheduled much later. … In some cases, that made an impact where they went into a later stage (of illness) and therefore lost the battle to live.”

Oneal Sessions, a 63-year-old Vietnam veteran, said he was told by staff members at Dorn Medical Center this year that he didn’t need a colonoscopy. Instead, he said, they gave him a routine test that would show whether he had polyps that are cancerous or in danger of becoming cancerous.

Sessions said the VA told him to return in several years.

But he ignored that advice and had a colonoscopy in the office of his private physician, Lloyd. In that procedure, Lloyd found and removed four polyps. Two of those polyps were pre-cancerous, the physician said.

Had Sessions waited another few years, Lloyd said, he could have had colon cancer.

“There is a little problem that the VA had,” Sessions said. “My feeling is, the VA is not doing their ‘pre-stuff’ that they should do to protect the veterans.”

What happened at the Dorn hospital, however, was not just an oversight by the hospital. Government documents obtained exclusively by CNN and not made public show that the hospital knew that its growing waiting list and delays in care were having deadly consequences.

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Medical investigators reviewed the cases of 280 gastrointestinal cancer patients at Dorn and found that 52 were “associated with a delay in diagnosis and treatment.”

The government documents CNN obtained illustrate just how bad delays at Dorn got:

• In May 2011, a patient was brought into the emergency room needing urgent care after suffering multiple delays, and the documents state “that was the facility’s first realization that patients were ‘falling through the cracks.’ ”

• Another veteran had to wait nine months for a colonoscopy — “a significant delay,” according to VA records, that “would have impacted the stage at which he was diagnosed.” The record indicates that by the time this veteran had surgery, his cancer was at stage 3.

• Still another patient recommended for possible disease of the esophagus had to wait four months for an appointment and 11 months for an endoscopy, at which time he learned that he had later-stage esophageal cancer. The internal VA report says that without the delay, “his cancer would have been diagnosed much earlier.” And though the report doesn’t not say whether the veteran died, it does say that an earlier screening would have provided earlier detection “with better survival.”

• In July 2011, a hospital physician sent a warning to administrators that the backlog for Dorn patients’ gastrointestinal appointments had reached 2,500, and patients were waiting eight months — until February 2012 — for appointments.

• By December 2011, the documents show, the backlog at Dorn had grown to 3,800 patients, according to another warning e-mail from a physician.

Read the full VA investigation board report (PDF)

Little was done to effectively resolve the problems, according to expert sources and documents.

In September 2013, the VA’s inspector general affirmed details of the delays at Dorn in stark language, stating that 700 of the delays for appointments or care were “critical.”

Read the full IG report on Dorn (PDF)

Perhaps most troubling of all is that the problem at the Dorn facility had been identified, and taxpayer money was given to fix the problem in September 2011.

“We appropriated a million dollars (to Dorn) because VA asked for it,” said Rep. Jeff Miller, R-Florida, chairman of the House Committee on Veterans’ Affairs.

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The documents obtained by CNN show that only a third of that $1 million from Congress was used for its intended purpose at Dorn: to pay for care for veterans on a waiting list.

The VA “will say, ‘we redirected those dollars to go somewhere it was needed,’ ” Miller said. “Where would it be more needed than to prevent the deaths of veterans?”

At the same time, the documents show, the waiting list at Dorn kept growing to 3,800 patients in December 2011.

“These are real people that we’re talking about, that are being harmed — either made sick, will be sick in the future or have died,” Miller said.

Documents and interviews show that the problem goes beyond delayed colonoscopies and other gastrointestinal procedures at Dorn.

CNN has learned from documents and interviews that other VA facilities have been under scrutiny by officials over possible delays in treatment or diagnoses.

Shortly before CNN published this report, the VA acknowledged that there have been concerns about delay of care at some of its facilities.

At the Charlie Norwood VA Medical Center in Augusta, Georgia, the VA said three veterans died as a result of delayed care. Internal documents at that facility showed a waiting list of 4,500 patients.

The VA also acknowledged that it investigated delays at facilities in Atlanta, North Texas and Jackson, Mississippi. The VA said no “adverse outcomes” because of delays were found at the VA centers in Texas and Mississippi.

CNN also has learned that, though little publicized, the problem is not new.

“Long wait times and a weak scheduling policy and process have been persistent problems for the VA, and both the GAO and the VA’s (inspector general) have been reporting on these issues for more than a decade,” said Debra Draper of the Government Accountability Office.

Draper’s office has been reporting to Congress on the delays in care at the VA for years. It is so bad, she said, that she and her staff have found evidence that VA hospitals have tried to cover up wait times, fudge numbers and backdate delayed appointments in an effort to make things appear better than they are.

She says that just getting someone to pick up the phone to make an appointment at a VA hospital can be difficult. And getting a detailed picture of the problem is nearly impossible, she said.

“It’s unclear how long it is being delayed, because no one can really give you accurate information,” Draper said.

Despite numerous reports and subsequent recommendations by the GAO, the problems with delays persist at VA hospitals, Draper and other experts say.

“Nothing has been implemented that we know of at this point,” Draper said. “We’ve reported similar things, as well as the inspector general has reported similar findings … for over a decade.”

In fact, time and time again, even at hospitals where veterans died waiting for care, administrators got bonuses, not demotions, according to congressional investigators.

The House Committee on Veterans’ Affairs has created a website devoted to what investigators say shows ongoing problems at the VA, but the rewards system that Miller says is in place seems to encourage those problems.

CNN’s repeated requests for interviews with the VA have been denied. Even Congress has had its requests for information ignored, Miller said.

“But unfortunately, if they treat members of Congress … this way, imagine how they treat the average veteran out there,” said Miller. “I can imagine the grief they may be going through.”

The VA said in a statement to CNN, “The Department of Veterans Affairs is committed to providing the best quality, safe and effective health care our Veterans have earned and deserve. We take seriously any issue that occurs at one of the more than 1,700 health care facilities across the country. The consult delay at Dorn VAMC has been resolved.”

The statement added that cases are now tracked daily, and additional staff members were hired.

But sources at Dorn — both patients and medical staff — tell CNN that’s just not true. The problems continue, and veterans are still facing delays that could be killing them.

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CNN’s Curt Devine contributed to this report.

Watch Anderson Cooper 360° weeknights 10pm ET. For the latest from AC360° click here.


Background & Statistics



Who are homeless veterans?

The U.S. Department of Veterans Affairs (VA) states that the nation’s homeless veterans are predominantly male, with roughly 8% being female. The majority are single; live in urban areas; and suffer from mental illness, alcohol and/or substance abuse, or co-occurring disorders. About 13% of the adult homeless population are veterans.

Roughly 40% of all homeless veterans are African American or Hispanic, despite only accounting for 10.4% and 3.4% of the U.S. veteran population, respectively.

Homeless veterans are younger on average than the total veteran population. Approximately 9% are between the ages of 18 and 30, and 41% are between the ages of 31 and 50. Conversely, only 5% of all veterans are between the ages of 18 and 30, and less than 23% are between 31 and 50.

America’s homeless veterans have served in World War II, the Korean War, Cold War, Vietnam War, Grenada, Panama, Lebanon, Persian Gulf War, Afghanistan and Iraq (OEF/OIF), and the military’s anti-drug cultivation efforts in South America. Nearly half of homeless veterans served during the Vietnam era. Two-thirds served our country for at least three years, and one-third were stationed in a war zone.

About 1.4 million other veterans, meanwhile, are considered at risk of homelessness due to poverty, lack of support networks, and dismal living conditions in overcrowded or substandard housing.

How many homeless veterans are there?

Although flawless counts are impossible to come by – the transient nature of homeless populations presents a major difficulty – the U.S. Department of Housing and Urban Development (HUD) estimatesthat 62,619 veterans are homeless on any given night. Over the course of a year, approximately twice that many experience homelessness. Only 7% of the general population can claim veteran status, but nearly 13% of the homeless adult population are veterans.

Approximately 12,700 veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND) were homeless in 2010. The number of young homeless veterans is increasing, but only constitutes 8.8% of the overall homeless veteran population.

Why are veterans homeless?

In addition to the complex set of factors influencing all homelessness – extreme shortage of affordable housing, livable income and access to health care – a large number of displaced and at-risk veterans live with lingering effects of post-traumatic stress disorder (PTSD) and substance abuse, which are compounded by a lack of family and social support networks. Additionally, military occupations and training are not always transferable to the civilian workforce, placing some veterans at a disadvantage when competing for employment.

A top priority for homeless veterans is secure, safe, clean housing that offers a supportive environment free of drugs and alcohol.

Doesn’t VA take care of homeless veterans?

To a certain extent, yes. Each year, VA’s specialized homelessness programs provide health care to almost 150,000 homeless veterans and other services to more than 112,000 veterans. Additionally, more than 40,000 homeless veterans receive compensation or pension benefits each month.

Since 1987, VA’s programs for homeless veterans have emphasized collaboration with such community service providers to help expand services to more veterans in crisis. VA, using its own resources or in partnerships with others, has secured nearly 15,000 residential rehabilitative and transitional beds and more than 30,000 permanent beds for homeless veterans throughout the nation. These partnerships are credited with reducing the number of homeless veterans by 70% since 2005. More information about VA homeless programs and initiatives can be found here.

What services do veterans need?

Veterans need a coordinated effort that provides secure housing, nutritional meals, basic physical health care, substance abuse care and aftercare, mental health counseling, personal development and empowerment. Additionally, veterans need job assessment, training and placement assistance.

NCHV strongly believes that all programs to assist homeless veterans must focus on helping them obtain and sustain employment.

What seems to work best?

The most effective programs for homeless and at-risk veterans are community-based, nonprofit, “veterans helping veterans” groups. Programs that seem to work best feature transitional housing with the camaraderie of living in structured, substance-free environments with fellow veterans who are succeeding at bettering themselves.

Government money, while important, is limited, and available services are often at capacity. It is critical, therefore, that community groups reach out to help provide the support, resources and opportunities that most Americans take for granted: housing, employment and health care. Veterans who participate in collaborative programs are afforded more services and have higher chances of becoming tax-paying, productive citizens again.

What can I do?

  • Determine the need in your community. Visit with homeless veteran service providers. Contact your mayor’s office for a list of providers, or search the NCHV database.
  • Involve others. If you are not already part of an organization, align yourself with a few other people who are interested in attacking this issue.
  • Participate in local homeless coalitions. Chances are, there is one in your community. If not, this could be the time to bring people together around this critical need.
  • Make a donation to your local homeless veteran service provider.
  • Contact your elected officials. Discuss what is being done in your community for homeless veterans.

Nicole: A Portrait Of A Seattle Sex Trafficking Survivor

Nicole: A Portrait Of A Seattle Sex Trafficking Survivor

August 14, 2013

Two and a half weeks ago the FBI, in partnership with local law enforcement, conducted a cross-country sweep looking to help stop child sex trafficking. They recovered dozens of under-age victims who have been forced into prostitution, and they arrested their pimps. Three child victims were found in Washington state, and nine people were arrested here.

On Tuesday,  something very different happened at FBI offices in downtown Seattle.

In a bland, white FBI  conference room a 26-year-old woman named Nicole took a deep breath, and slowly approached the podium.

Microphones were duct-taped to it. Reporters looked on, pens at the ready.

Despite her nerves, she started cheerfully, “Hi, I’m Nicole.” The young woman’s voice was slow, but firm as she began recounting intimate details of her former life walking “the track;” living under the thumb of her pimp.

She was there to let people see a real face behind the child sex trafficking headlines, and to answer questions: What is child sex trafficking? Who are these victims the police are recovering?

“When you’re young and you kind of come from a broken home, you look for the next person that gives you the feelings that you never got at home,” she said. “My abuser was a suave kind of person. He was slick with the tongue and knew what to say to make your day look so much brighter.”

Nicole met him when she was 17. He made her feel important, rich, sophisticated.

It wasn’t long until he convinced her to walk the track, to sell herself on the street. She went along with it. And soon enough, the beatings started, too.

He’s in prison now, for a long time. Otherwise she said there’s no way she’d be doing this. She’s still scared of him, his friends and his family.

She laid out terrible, gory stories of his violence. She did tried to leave.

“I think I left my abuser three times the whole time I was with him,” she said. “And every time that I ran away, I had nothing to run to.”

She wiped away tears as she finished her sentence. She collected herself. Even made jokes. Then she got to the worst part, the last beating, the time he permanently damaged her eye.

“He had some lady, some girl drop me off at a hotel room,” she said. “And I was so bad that I was scared to fall asleep because I think if I would have fallen asleep, I don’t think I would have woken up.”

She made it to the hospital. A doctor called the police.

Federal agencies got involved. That terrified her, but in the end she did testify against him. She’s still scared of him. It’s one reason she doesn’t reveal her last name.

But she has a new life. She’s paying her own rent and going to school, studying to be a paralegal. And she’s up there at the podium, she said, because it’s actually therapeutic.

Plus, she’s encountered so many people who judge her because of her police record, including potential employers. She wants people to understand her story.

“It’s important for me to at least reach out to let them know that we’re not bad people,” she said. “It’s not that we chose to commit these crimes, you know, because it was the fun and everything. Most of the time, most of the girls end up [here] because they have nowhere else to go.”

Revenge porn’ law in California could pave way for rest of nation

Suzanne ChoneyNBC News


Sep. 3, 2013 at 4:34 PM ET


A bill that would criminalize “revenge porn” — nude or sexual photos, generally of former wives or girlfriends, posted online by an angry ex — could pave the way for other states to adopt similar laws, putting perpetrators in jail for six months if convicted a first time, and up to a year for repeat violations. The bill, already approved by the California Senate, is expected to go to the state Assembly as soon as this week, despite concerns from some lawmakers and experts who fear it could curtail First Amendment rights.

“It’s traumatized real victims; it’s a growing problem,” California state Sen. Anthony Cannella, told NBC News. “Technology moves much faster than our laws,” said Cannella, a Republican, who authored the legislation. “When we identify a problem, it’s our responsibility to deal with it.”

If passed by the Assembly, SB 255 will go to Gov. Jerry Brown for approval. It’s not clear whether Brown will support it. “Generally, we do not comment on pending legislation,” Brown press spokesman Evan Westrup told NBC News.

One supporter with whom Cannella has been working is Holly Jacobs, a Florida woman who founded End Revenge Porn after her own nightmare with the issue began more than four years ago.

Like many other couples, Jacobs and her boyfriend had private photos of intimate moments — photos not meant for public consumption. After their breakup, Jacobs saw her photos plastered everywhere on the Web, including on Facebook and several revenge porn sites. Her email address was part of what was shared, “so I had harassing emails constantly coming in,” she told TODAY’s Matt Lauer in May. “My work location was posted up and there, so I was terrified. I was so afraid that someone would physically stalk me.”

In the era of instant uploads, a slimy sub-industry of sites have emerged that are dedicated solely to such “revenge porn” shots and videos. It has become a money-making “sport,” of which one of the most notorious players is Hunter Moore, who was under FBI investigation for his controversial site, Is Anyone Up.

Though the sites often include personal information about the victims, including names, email addresses and even links to their Facebook profiles, the sites themselves are protected from liability because of Section 230 of the federal Communications Decency Act, which says that websites and Internet service providers cannot be treated as a publisher for “any information provided by another information content provider.” With little legal recourse, these victims are left feeling helpless and humiliated.

Jacobs’ fear turned to anger, and she decided she would no longer be a victim. She filed criminal and civil charges against her ex. The ex, through his attorney, has denied the charges against him, contending he is just as much a victim as Jacobs, and that the reason the photos and video were shared is that his computer was hacked.

Those who might think, “Well, you shouldn’t have taken those photos … ” aren’t living in the real world of what has become, especially for a younger generation, a cultural-technological phenomenon as normal as tweeting and texting.

“It’s absolutely just a new version of victim blaming,” Jacobs said in May. “What I would say to victims when they hear that is, just hold on to that little voice inside of you that says, ‘This is not right.’ What’s happening to me is not OK, and there need to be laws in place against this.”

The California legislation, Jacobs told NBC News, “is so important because it has the potential to set a precedent for other states considering to criminalize revenge porn.”

Precedents and objections
The state that comes closest to doing that now is New Jersey, which since 2003 has had an invasion-of-privacy law aimed at video voyeurs, people who secretly videotape others naked or having sex without their consent, according to a spokesman for the Office of the Attorney General in that state.

That law was one of those used to prosecute Rutgers University student Dharun Ravi, found guilty last year after setting up a webcam to spy on his gay roommate, Tyler Clementi, in 2010. Ravi livestreamed the video and tweeted about his roommates’s activities. Clementi, 18, committed suicide after learning about the public humiliation.

“Legislators did not discuss the issue of ‘revenge porn’ in passing this law” in 2003, Peter Aseltine, a spokesman for the New Jersey attorney general’s office, told NBC News. “Nonetheless, the language of the statute is quite broad and arguably applies to allow prosecution of an individual in a ‘revenge porn’ situation.”

Other revenge porn law efforts could soon be underway in Texas, Wisconsin and Georgia, Jacobs said.

While most everyone will agree that the revenge porn practice is reprehensible, crafting legislation that doesn’t inadvertently restrict free speech is the challenge.

In Florida, where Jacobs lives, an attempt at a revenge porn law failed this year partly because of concerns the way the law was written could interfere with free speech. Jacobs cited another concern: a requirement that personal information, such as the victim’s name and email address, also be posted as part of the photos or videos shared.

“I’m sure the revenge porn posters would have easily found a way around this,” she told NBC News. “Our personal information is already posted when our faces are in these pictures.”

Florida State Sen. David Simmons and state Rep. Tom Goodson, both Republicans, plan to try again with a new bill with different wording next spring when the legislature is back in session.

Jeff Hermes, director of the Digital Media Law Project at the Berkman Center for Internet & Society at Harvard University, said a “balance needs to be struck properly,” and he is not sure the California law will do that.

“You need to be extraordinarily careful in criminalizing privacy law because of the risk you’re going to deter legitimate speech,” he told NBC News. “With the California bill, I don’t see an exemption here for material that’s legitimately newsworthy.”

Take for example, he said, “circumstances where photographs exist of a political candidate who has run their campaign on their squeaky-clean image,” but there are photographs of that candidate in a compromising position. “The distribution of these photos could indicate (to voters) that candidate might be lying about their past.”

The revenge porn bill, Hermes said, is “responding to a significant concern, and I don’t want to downplay that. It is a law in a field which is already heavily regulated — privacy — and where there are court remedies. But the question is whether the criminal penalties are necessary to achieve the aims already provided by existing law.”

Only one California state senator, Leland Yee, a Democrat, voted against SB 255 when it came before the senate last month. His reason: “First Amendment protections are fundamental to our free society,” he said in a statement to NBC News. “While I appreciate the intent of this legislation, I feel it was too broadly drawn and could potentially be used inappropriately to censor free speech.”


2 face charges in case of Canadian girl who hanged self after alleged rape

By Stephanie Gallman, CNN
updated 9:28 PM EDT, Thu August 8, 2013
Canadian teenager Rehtaeh Parsons, who was allegedly gang-raped and bullied, has died, her family said. Parsons, 17, was hospitalized after she tried to hang herself on Thursday, April 4. The high school student from Halifax, Nova Scotia, was taken off life support three days later.Canadian teenager Rehtaeh Parsons, who was allegedly gang-raped and bullied, has died, her family said. Parsons, 17, was hospitalized after she tried to hang herself on Thursday, April 4. The high school student from Halifax, Nova Scotia, was taken off life support three days later.

(CNN) — [Breaking news update, 9:26 p.m.]

Two 18-year-old men face child pornography distribution charges in connection with the case of a 17-year-old girl who hanged herself after she was allegedly gang-raped and bullied online, Canadian authorities said Thursday.

[Original report, 6:25 p.m.]

Two arrests have been made in connection with the case of a 17-year-old girl who hanged herself after she was allegedly gang-raped and bullied online, Canadian authorities said Thursday.

Two unidentified males were arrested Thursday morning at their homes in Halifax, Nova Scotia, according to a brief statement from Royal Canadian Mounted Police and Halifax Regional Police.

They were being questioned, said authorities, without releasing further details. Officials have 24 hours to decide whether to release the pair or pursue charges.

Rehtaeh Parsons was taken off life support in April, three days after she hanged herself.

Her family said she developed suicidal thoughts after she was sexually assaulted two years before and after a picture of the incident was shared by phone and online.

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The alleged sexual assault by four boys happened in November 2011 when Rehtaeh was 15, her family said.

Authorities confirmed that a photograph was circulated to friends’ mobile phones and computers. As a result, her family said, she developed suicidal thoughts.

Police investigated, but no criminal charges were filed at that time.

When evidence goes viral

In April, police in eastern Canada announced they would reopen the case “in light of new and credible information that has recently been brought forward to police.”

Parsons’ mother told CNN affiliate CBC on Thursday that she felt “better” now that arrests have been made.

Leah Parsons said she learned of the arrests when police came to her house to tell her.

“I felt a little bit of relief, just to say, finally — like I hope — they keep saying they want to tell their side of the story, but they have never given a statement. The police have never spoken to them in all this time. So at least, here is your chance. Tell your side of the story,” she said.

News of the arrests came one day after cybersafety legislationinspired by Parsons was implemented in Nova Scotia.

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The law allows victims, among other things, to sue their alleged cyberbullies. If a bully is a minor, the bully’s parents can be held liable.

Officials said the timing of the arrests and the implementation of the legislation was merely a coincidence.

Trafficking class for men using prostitutes

August 13th, 2012
09:26 AM ET

Trafficking class for men using prostitutes

By Richard Roth and Patrick Feeeney, CNN – More than 25 men sit in an attorney’s office – each was arrested for prostitution-related offences and each is now trying to avoid jail.

But this is not a defense lawyer’s office. It’s the Brooklyn district attorney’s office and the road away from jail is a lesson in the risks of using prostitutes – Johns School.

Assistant District Attorney Grace Brainard tells them: “The crimes you were arrested for would lead to one penalty and one penalty only and that is jail time. And the next time you are arrested for prostitution, jail time will be the only offer on the table.”

The men were arrested for attempting to pay for sex from undercover policewomen posing as prostitutes on the streets of New York. Men who solicit prostitutes are so-called ‘johns’ and this gathering is known as Johns School.


It’s a program that teaches the dangers and penalties of prostitution and sex trafficking. It’s been going on for the past 10 years under the official name of Project Respect conducted by the Kings County (Brooklyn), NY District Attorney’s office.

Because of their clean record of no previous arrests, the men were given the opportunity to take the three-hour plus course – which cost them more than $300 – and avoid time behind bars. They could have had their day in court but risk of jail time was of great concern.

Rhonnie Jaus, the chief of the Sex Crimes Bureau, said the class attempts to sensitize and educate the men on the dangers of prostitution to both the John and the prostitute.

“You think you’re having sex with an adult, and it turns out it could be something quite different,” Jaus said, “It could be a trafficked child brought from China, brought from South America, so there are many different ramifications of this crime.”

Brainard emphasized that most girls enter prostitution between the ages of 11 and 14. “They were children when they entered this life,” she said.

The men also listened to a lecture from Rosetta Menifee, a former prostitute who had contracted HIV.

“Obviously the goal is not for them (the johns) to do it again,” Menifee said, “but the reality is a lot of them will, so the goal is really to talk about what the risks are so that the have the knowledge of it from different perspectives, and hopefully they’ll make better choices.”

Different speakers pointed out the different risks inherent with solicitation.

Grace Pabarue, a public health educator at the Department of Health and Mental Hygiene, highlighted sexually transmitted diseases in a photo slideshow.

Former NYPD Lieutenant Jeff Anderson said a prostitute could be a potential threat to a John. “Some of them are emotionally disturbed, some of them abuse drugs,” Anderson said. “Many prostitutes can defend themselves, many prostitutes have defended themselves.”

One of the johns who wanted only to be identified as ‘Skeeter,’ said the course showed him different perspectives about the women forced to work in prostitution.

“Some of them have drug habits, maybe some of them work for pimps,” Skeeter said. “I wouldn’t feel good knowing that I’m paying that money, and it’s going to further keep someone so they’re enslaved.”

Prosecutor Jaus said that the sessions also help develop sex trafficking cases and can encourage johns to help prostitutes escape their situation.

“We’ve had a few cases in which the John actually brought the prostitute, who told him about the fact that she was being trafficked, to the police station,” Jaus said.

“He didn’t go in with the young woman, but he dropped her off because she was crying and told him, “look, I’ve been trafficked.””

Brainard told the johns they should report any case of sex trafficking they witness, even if they were soliciting at the time.

“Taking that step to get law enforcement involved does not mean you have to report it yourself,” Brainard said. “In fact, you don’t even have to give your name.”

At the end of the session the johns are given an Adjournment in Contemplation of Dismissal. If they avoid arrest over the following six months, the arrest is wiped off their record.

Despite Menifee’s fear that many will continue using prostitutes, Jaus said the course, which started in 2002, has seen a success rate of more than 90 percent. “Over the past 10 years, we’ve had over 3,000 attendees of the John School,” Jaus said.

“So we’ve only had 26 people rearrested in Brooklyn for patronizing, who have gone through the John school.”

None of the other boroughs of New York offer such an alternative.

Why the game’s up for Sweden’s sex trade

Sweden’s innovative sex-trade laws criminalise clients, not prostitutes. The result: a 70 per cent drop in business. Joan Smith jumps in a squad car with local police to find out how it works – and whether Britain could follow suit.


I am sitting in the back of an unmarked police car on the small island of Skeppsholmen, to the east of Stockholm’s picturesque old town. Above us is the city’s modern art museum but it’s a dark February night and we’re not here to appreciate culture. “They park up there,” says the detective in the front passenger seat, pointing to a car park at the top of the hill. “We wait a few minutes and then we leap out, run up the hill and pull open the doors.”

What happens next is a textbook example of the way Sweden’s law banning the purchase of sex works in practice. The driver of the car, who’s brought a prostituted woman to the island to have sex, is arrested on the spot. He’s given a choice: admit the offence and pay a fine, based on income, or go to court and risk publicity. The woman, who hasn’t broken any law, is offered help from social services if she wants to leave prostitution. Otherwise, she’s allowed to go.

“Buying sex is one of the most shameful crimes you can be arrested for,” explains the detective, Simon Haggstrom. He’s young, black, and his appearance – shaved head, baggy jeans – suggests a music industry executive rather than a cop. But he’s in charge of the prostitution unit of Stockholm county police and he’s proud of the fact that he’s arrested more than 600 men under the Swedish law: “We’ve arrested everyone from drug addicts to politicians. Once I arrested a priest and he told me I’d ruined his life. I told him, ‘I haven’t ruined your life, you have.'”

Sweden’s decision to reverse centuries of assumptions about prostitution and criminalise buyers of sex caused astonishment when the law came into force in 1999. As arguments raged elsewhere about whether prostitution should be legalised, the Swedish government’s simple idea – that the wrong people were being arrested – was new and controversial. Detective Superintendent Kajsa Wahlberg is Sweden’s national rapporteur on trafficking in human beings. When I meet her at her office in Stockholm, she recalls that one police officer from another country actually accused the Swedes of “Nazi methods”. Wahlberg acknowledges that many Swedish officers were sceptical as well. “There was frustration and anger within the police. People were chewing on lemons,” she says with a wry laugh.

All of that’s changed dramatically since the law came into effect. “The main change I can see when I look back is we got the men on board,” says Wahlberg. “The problem is gender-specific. Men buy women. One of the keys is to train police officers. When they have understood the background, they get the picture.” She talks about why women end up in prostitution, citing research that shows a history of childhood sexual abuse, compounded by problems with drugs and alcohol.

“They have no confidence in themselves. They’ve been left out and neglected and try to get all kinds of attention. This is not about an adult woman’s choice.” In the 1990s, the Swedish government accepted the arguments of women’s groups that prostitution is a barrier to gender equality and a form of violence against women.

What’s remarkable is that public opinion, which was initially hostile, has swung round to this view; these days, 70 per cent of the public support the law. “We’ve changed the mindset of the Swedish population,” Haggstrom tells me. The change is visible among the older members of his unit.

One undercover cop, who’s been a police officer for 37 years, reveals a lingering sense of surprise when he remembers what happened 14 years ago. “When the law came into force, the streets were empty for six months,” he says.

These days he’s one of its most enthusiastic supporters, having seen for himself how the number of women in street prostitution in Stockholm has declined. Where 70 or 80 women used to sell sex outdoors, these days it’s between five and 10 in winter, 25 in summer. A small number of women work on the streets of Malmö and Gothenburg but the Swedish figures are nothing like those for Denmark, where prostitution has been decriminalised. Denmark has just over half the population of Sweden but one study suggested there were more than 1,400 women selling sex on Danish streets.

The law has brought about other changes as well. Before 1999, most women in street prostitution in Stockholm were Swedish. Now they’re from the Baltic states or Africa, and have sold sex in other countries as well. They tell Haggstrom’s officers they’re much more likely to be subjected to violence in countries where prostitution has been legalised.

“Swedish men want oral sex and intercourse, nothing more than that,” the undercover cop tells me. “They know they have to behave or they may be arrested. They don’t want to use violence.”

It’s a fascinating observation because one of the criticisms of the law was that it would make prostitution more dangerous. All the Swedish police officers I spoke to insisted this was a myth, along with the notion that prostitution would go underground. “If a sex buyer can find a prostituted woman in a hotel or apartment, the police can do it,” Haggstrom observes sardonically.

“Pimps have to advertise.” Specialist officers have been trained to monitor the internet and the police also have access to telephone intercepts, which suggest that traffickers no longer regard Sweden as a worthwhile market. “We’ve had wiretapping cases where pimps say they don’t find Sweden attractive,” Haggstrom continues. “Even if they don’t get arrested, we arrest the clients. They’re in it for the money. For me, this is not an advanced equation to understand.”

Swedish crime statistics seem to support his argument. In 2011, only two people were convicted of sex trafficking and another 11 for pimping connected to trafficking. (At the same time, 450 men were convicted and fined for buying sex, including a number of foreign tourists). Last year the figures were slightly higher: three convictions for sex trafficking and 32 for the related offence. But 40 women, mostly from Romania, had sufficient confidence in the Swedish criminal justice system to testify against the men exploiting them

Could the Swedish law work in other countries? Norway and Iceland have brought in laws banning the purchase of sex and the UK has taken tentative steps towards criminalising clients; it’s already a criminal offence to buy sex from anyone under the age of 18 or an adult who’s being exploited by pimps or traffickers. But there have been few convictions, suggesting that British police officers don’t share the robust attitudes of their Swedish counterparts. Haggstrom agrees with Wahlberg that legislation on its own isn’t enough: “You have to have enforcement resources. You have to have police officers who go out and make arrests.”

In the police car, something happens which reveals the full extent of the philosophical shift that has affected men and women in Sweden. In a brightly lit street, Haggstrom points out a couple of Romanian women who work as prostitutes. As I think about them making the journey over the bridge with a total stranger to the desolate car park on Skeppsholmen, Haggstrom turns to me. “Having sex is not a human right,” he says quietly.

‘Happy to be alive': Blast amputees confront uncertain road ahead

By JoNel Aleccia, Senior Writer, NBC News


The most severely injured patients from Monday’s bomb blasts in Boston showed up at Massachusetts General Hospital with their lower legs “completely mangled” — torn limbs hanging by skin and tissue, said Dr. George Velmahos, chief of trauma.

Faced with massive blood loss and imminent death, there was no time to discuss the only option that could save patients’ lives — amputation.

“We just completed the ugly job the bomb did,” Velmahos told reporters at a briefing. “This was not the time for talking. This was the time for doing.”

Four patients at that hospital lost their legs, plus five more at Boston Medical Center, said Dr. Peter Burke, chief of trauma surgery. The toll reportedly included two grown brothers who each lost a leg, plus the 6-year-old sister of Martin Richard, 8, who died.

All told, there have been 11 confirmations of amputations after the blasts, plus reports of several more lost or threatened limbs, hospital officials said. Overall, three people died and at least 176 were hurt in the blasts.

That makes Monday’s tragedy one of the worst sites for limb loss on U.S. soil since the terror attacks in 2001, said Ian Weston, executive director of the American Trauma Society.

“To be honest, shy of 9/11, that’s where we’ve seen this level and similar types of injury,” he said, adding that it was more like a battlefield than a civilian setting. Even emergency doctors accustomed to horrific casualties weren’t used to this, Burke told NBC News.

“We see traumatic amputations, or the need for amputation after trauma, but not generally five patients in the same day,” he said.

The Boston victims will join about 185,000 Americans who undergo amputations each year, and the nearly 2 million who live with existing loss, according to the Amputee Coalition, an advocacy group. Most lose limbs to car crashes or lawnmower accidents, or to complications of vascular problems, such as diabetes.

The new patients are very early in the process of grappling with amputation, but some are starting to heal, Velmahos said.

“They’re amazing people. Some of them woke up today with no leg; they told me they were happy to be alive,” he said.

How well they recover — both physically and emotionally — depends on the care they receive now and in the weeks to come, experts said.

“Those folks are a little lucky in that they are in Boston, which has some of the best health care facilities in the country,” said George Gondo, director of research and grants for the Amputee Coalition.

The city has multiple Level 1 trauma centers and some of the nation’s most experienced disaster management experts.

Even so, the road ahead is hard. Patients with traumatic amputations – arms, legs or feet severed by the blasts – needed immediate surgery to treat the initial wound, but they’ll probably need more surgery to prevent infections and ensure good closure, Burke said.

After that, they’ll need weeks of management to compress the limb and control swelling in preparation for an artificial limb, said Jay Tew, an expert with Hanger Inc., one of the nation’s leading makers of prosthetics and orthotics.

“They can’t be fit if the bottom of the limb is bigger than the top,” said Tew, who started a clinic for amputees in Haiti after that country’s devastating earthquake in 2010.

In addition, the patients will need therapy to desensitize their residual limbs to touch. “When you have the surgery, your body is very sensitive,” he said. “Light touch can feel like an ice pick.”

At the same time, many new amputees will need psychological support, particularly from those who’ve also lost limbs. Several programs offer “peer-to-peer” support, in which a recovered amputee will show up in the hospital room of a new patient.

“There’s something to be said about working with someone who’s been through the process,” said Weston, of the trauma society. “To see someone who’s lost a foot doing the things you want to do, it provides comfort.”

Peter Thomas, 49, is a Washington, D.C., lawyer who lost both his legs below the knee in 1974, when he was 10.  He was in a car carrying seven members of his family when a snow plow with its blade up struck the vehicle, cutting through the car – and severing the boy’s legs. Thomas’ 8-year-old brother, Eric, died.

A few days later, a double-amputee drove 300 miles to surprise the devastated child in the hospital – and changed Thomas’ views about what he could and could not do. Now, as an adult, Thomas has visited more than two dozen amputees to share his story.

“If it’s something that you’ve been through, and you’ve made it through it, you want to help someone who’s in despair,” said Thomas, a husband and father of three sons who is an avid golfer.

Several local amputee groups say they’ve already reached out to the Boston patients. It’s hard to say how the new amputees will respond, said Thomas, who chairs the Trauma Survivors Network.

Some immediately welcome the support, but for others, it’s too soon.

“Some people are hit so hard by this that they have significant psychological issues, just to get back on track,” he added.

Thomas said he tries to reassure new amputees that they’ll adjust to their new reality. Advances in prosthetics mean that artificial limbs are lighter, more flexible and more adaptable than ever before. Patients who were runners will likely run again, said Tew.

“When I started out, there were just one or two running feet. Now, you have almost a catalog,” he said.

It may not seem like it now, but both Thomas and Tew said their years of experience have shown them that the Boston amputees will come through the tragedy.

“I just know with our spirit in America and our people, in getting through these situations, I know we’re going to see people coming back and running in this event with their new arm or leg,” Tew said. “You can’t stop them.”

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Sexual Assault Victims No Longer Need to Fear Punishment for Treatment

DNI overturns clearance restrictions for sexual assault counseling


April 5, 2013 RSS Feed Print

Women who have received treatment for sexual assault while in the military will now be able to obtain security clearance easier.Women who have received treatment for sexual assault while in the military will now be able to obtain security clearance easier.

Receiving treatment for a sexual assault will no longer harangue the process for getting or keeping a security clearance, the U.S. government’s top intelligence official said Friday.

All executive departments, including the CIA and the military, will not require those who have received mental health counseling for sexual assault to answer “yes” to Question 21 on the standard form for security clearances, the Office of the Director of National Intelligence James Clapper announced Friday morning. This question is designed to weed out recipients of counseling who might not be capable of protecting classified information.

[PHOTOS: President Obama Signs the Violence Against Women Act]

Treatment for sexual assault now joins other counseling that does not preclude an applicant from passing the “Questionnaire for National Security Positions,” such as for family, grief or marital counseling, or stress from combat service.

“We are trying to get away from the fact of mental health counseling, and getting to an individual’s ability to function in the work place,” said Charles Sowell, deputy assistant director for Special Security at the ODNI. “That’s what we really care about: Can you protect national security information?”

This facet of guarding security clearances has changed roughly 10 times since the 1950s, Sowell told reporters Friday morning, to keep up with changing stigmas toward mental health treatment. Question 21 used to encompass a broad range of mental health afflictions, including hospitalization, “which is far more severe,” he said.

Then-Defense Secretary Leon Panetta said in January 2012 that as many as 19,000 sexual assaults actually take place in the military per year. Just over 3,000 were reported in 2011.

[READ: Sen. Boxer's Daughter Behind Film on Sexual Assault in Military]

Roughly 4.9 million people hold security clearances in the federal government. Those with a top secret clearance must be reinvestigated every 5 years. Secret clearances must be re-upped every 10 years.

Answering “yes” to Question 21 did not preclude an applicant from maintaining a clearance, Sowell added, but rather flagged that person for individual review. Only about .002 percent of those who answered “yes” because of mental health treatment for sexual assault became ineligible for a clearance, he said.

But a stigma persisted throughout the Pentagon and other top security positions that an affirmative answer to the question would torpedo any chances of keeping a clearance.

“The longer this went on, the more clear it was we needed to do something to create relief for the victims of sexual assault,” Sowell said. ODNI has worked with the Office of Personnel Management, the Office of Management and Budget and the Office of the Vice President to institute the change, along with multiple members of Congress.

Much of the awareness of the issue has been championed by the Service Women’s Action Network, which focuses on eliminating discrimination, harassment and assault from military culture.

“This change is a huge victory for survivors of military sexual assault,” said Anu Bhagwati, SWAN executive director and a former captain in the Marine Corps.

“From numerous calls we receive on our Helpline, we know that Question 21 has kept survivors from seeking the critical mental health services they have needed to heal in the aftermath of sexual assault,” she said, according to a media release. “We applaud Director Clapper and the Office of the Director of National Intelligence for making this sensible correction to an unjust protocol that served to further traumatize survivors, and will keep a close eye on implementation of this change.”

Friday’s announcement comes during Sexual Assault Awareness and Prevention Month at the Department of Defense.

[BROWSE: Political Cartoons on Women in Combat]

“Each of us must help the department eliminate the scourge of sexual assault from the military,” Defense Secretary Chuck Hagel said in a video statement on Tuesday. “Servicemembers, civilians and leaders at every level must work every day to instill a climate that does not tolerate or ignore sexist behavior, sexual harassment or sexual assault.”

Test takers will receive the following new language for Question 21, and will be notified of the change from test administrators or a pop-up screen for electronic versions:

“Please respond to this question with the following additional instruction: Victims of sexual assault who have consulted with a health care professional regarding an emotional or mental health condition during this period strictly in relation to the sexual assault are instructed to answer No.”

CDC: 110,197,000 Venereal Infections in U.S.; Nation Creating New STIs Faster Than New Jobs or College Grads

March 27, 2013

By Terence P. Jeffrey  CNSNews.com
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HIV, AIDSScanning electron micrograph image of HIV-1 budding from cultured lymphocyte. (Centers for Disease Control and Prevention/Cynthia Goldsmith)


(CNSNews.com) – According to new data released by the federal Centers for Disease Control and Prevention, there were 19.7 million new venereal infections in the United States in 2008, bringing the total number of existing sexually transmitted infections (STIs) in the U.S. at that time to 110,197,000.

The 19.7 million new STIs in 2008 vastly outpaced the new jobs and college graduates created in the United States that year or any other year on record, according to government data. The competition was not close.

The STI study referenced by the CDC estimated that 50 percent of the new infections in 2008 occurred among people in the 15-to-24 age bracket. In fact, of the 19,738,800 total new STIs in the United States in 2008, 9,782,650 were among Americans in the 15-to-24 age bracket.

By contrast, there were 1,524,092 bachelor’s degrees awarded in the United States in the 2007-2008 school year, according to the National Center for Education Statistics. That means the total number of new STIs in 2008 outpaced the total number of new bachelor’s degrees by nearly 13 to 1, and the number of new STIs among Americans in the 15-to-24 age bracket outnumbered new bachelor’s degrees by more than 6 to 1.

While the CDC estimates that there were 19.7 million new STIs in the United States in 2008, data published by the Bureau of Labor Statistics indicated that the total number of people employed in the country actually declined by 2.9 million during that year.

The CDC said the new venereal infections contracted each year cost the nation about $16 billion.

“CDC’s new estimates show that there are about 20 million new infections in the United States each year, costing the American healthcare system nearly $16 billion in direct medical costs alone,” said a CDC fact sheet.

The CDC study—“Sexually Transmitted Infections Among U.S. Women and Men: Prevalence and Incidence Estimates, 2008”—was published in the March edition of Sexually Transmitted Diseases, the journal of the Sexually Transmitted Diseases Association.

The study distinguishes between “incidences” of a disease, which is the number of new infections in a year, and the “prevalence,” which is the total number of new and existing infections.

“In 2008, there were an estimated 110 million prevalent STIs among women and men in the United States,” said the study. “Of these, more than 20% of infections (22.1 million) were among women and men aged 15 to 24 years. Approximately 19.7 million incident infections occurred in the United States in 2008; nearly 50% (9.8 million) were acquired by young women and men aged 15 to 24 years.”

The study focused on estimating the incidences of sexual transmission of particular diseases as opposed to other forms of transmission. For example, it did not include HIV infections that were not sexually transmitted. It also counted the number of infections rather than the number of people infected–recognizing that a single individual could have multiple infections.

“When calculating the number of prevalent and incident infections, only those infections that were sexually transmitted were counted,” said the CDC fact sheet. “In general, CDC estimated the total number of infections in the calendar year, rather than the number of individuals with infection, since one person can have more than one STI at a given time (e.g., HPV and chlamydia) or more than one episode of a single STI (e.g., repeat chlamydia infection).”

The most common sexually transmitted infection in the United States in 2008 was human papillomavirus (HPV), which caused 14,100,000 estimated infections that year.

After HPV, in order of magnitude, according to the study, new STIs in the U.S. in 2008 included 2,860,000 new Chlamydia infections; 1,090,000 new Trichomoniasis infections; 820,000 new Gonorrhea infections; 776,000 new Herpes Simplex Virus Type 2 (HSV-2) infections; 55,400 new syphilis infections; 41,400 new HIV infections; and 19,000 new Hepatitis B infections.

The total of 110,197,000 existing STIs in the United States in 2008 included 79,100,000 HPV infections, 24,100,000 HSV-2 infections; 3,710,000 Trichomoniasis infections; 1,579,000 Chlamydia infections; 908,000 HIV infections; 422,000 Hepatitis B infections; 270,000 Gonorrhea infections; and 117,000 Syphilis infections.

As noted, the number of people working in the U.S. in 2008 declined by about 2.9 million (dropping from 146,273,000 in December 2007 to 143,369,000 in December 2008). The Bureau of Labor Statistics has published historical data on the number of people employed in the U.S. going back to 1948. In no year since then has the U.S. economy created anywhere near the 19.7 million new STIs estimated for 2008.

On average during that period, the U.S. has increased employment by 1.3 million per year.