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The VVA
Veteran
The Official Voice of Vietnam Veterans of America
Vol. 25 No. 1
January/February 2005
FEATURE
The Needle and the Damage Done
Vaccinating America's Soldiers
http://www.vva.org/TheVeteran/2005_01/feature_berger.htm
BY RICHARD CURREY
Army medic Michael Berger was told he would be at Walter Reed National Army
Medical Center “for a couple weeks, for a check-up and a few tests. And then,”
he said, “they told me I’d be on my way home.”
Berger reported to Walter Reed on February 17, 2004—and he has been there ever
since.
One year earlier, in February 2003, Berger reported for active duty after being
called up from his home in Marquette, Michigan. A 50-year-old staff sergeant
with 20 continuous years of service in National Guard units and the Army
Reserve, Berger was assigned to the 452nd Combat Support Hospital out of
Milwaukee and sent to Ft. McCoy, Wisconsin, where he launched into “SRP,” the
Soldier Readiness Program.
“We were headed overseas,” Berger said, “into the sand.” Although he wondered
how he might fare serving next to soldiers in their twenties, Berger was fit, a
runner, and a senior NCO with years of experience in medical care. He was fully
prepared to do his part. An enthusiastic participant in the mobilization
process, Berger volunteered for instructional duties. He met the other soldiers
in the unit, including a lively young specialist named Rachel Lacy.
In short order, the soldiers of the 452nd underwent a day of paperwork,
including a detailed medical history. With a strong family history of
cardiovascular disease, including the loss of his mother to a heart attack at
age 43 and a brother who suffered a stroke in his early forties, Berger
underwent a heart catheterization procedure in 1996. “My doctor thought I should
have the test because of my family history,” he said. “And the results were
negative. I wrote it all down on my medical history form at Ft. McCoy. But if
anybody took note of that history or thought it represented any sort of concern
or risk, I never heard about it.”
A month after arriving at Ft. McCoy, in March 2003, Berger received the standard
battery of inoculations administered to soldiers preparing for overseas
deployment. The battery included vaccines for anthrax and smallpox, as well as
several other infectious diseases.
Within 48 hours, Berger was feeling “lousy.” It was as if, he said, “I was
working on a case of the flu. Along with that, I was experiencing some shortness
of breath and a heaviness in my chest. I figured it was the vaccinations, but
just in case, I checked in for sick call at the TMC—the troop medical center.”
Doctors gave Berger a “cold pack” (a standard collection of medications to
relieve symptoms of colds and flu), and he returned to duty.
Another week passed with no significant improvement in his condition. If
anything, he was worse. In addition to chest heaviness and breathing
difficulties, Berger said he “felt constantly exhausted.” He returned to the TMC
but was merely advised to “let the medications work.”
The symptoms persisted over the next two weeks, but Berger dismissed his
discomfort as the physical stress of keeping up with younger soldiers. On April
1 he was in the field, in the midst of a training exercise and about to conduct
a class on intravenous fluid administration. Inside the tent where he was slated
to teach the class, his symptoms suddenly worsened. “I just couldn’t catch my
breath. I was feeling weak, light-headed, and dizzy.” Within another few minutes
“things got a little hazy,” and Berger said he “went down on one knee. I told
the guys around me, ‘I think I’m in trouble.’ And sure enough I was. All of a
sudden it was as if I had a thousand pounds on my chest. It was the textbook
version of a heart attack.”
Berger was evacuated to a hospital in nearby La Crosse, Wisconsin, where the
heart attack diagnosis was confirmed. He was placed in the hospital’s coronary
care unit. Tests done the following day revealed that Berger had almost complete
obstruction of a major artery supplying his heart. A stent was placed in the
clogged artery, and the attending cardiologist contacted Ft. McCoy regarding
Berger’s disposition.
The cardiologist was told that appropriate cardiac rehabilitation services were
available at Ft. McCoy, and he released Berger back to the Army’s care. But when
Berger returned to Ft. McCoy on April 4, he quickly learned there was, in fact,
no cardiac rehab program of any sort on the base. The point quickly became moot,
since Berger was placed on convalescent leave the following day. He was
instructed to call his family and “get someone to come down and pick you up.”
Berger realized there was no treatment plan, no doctor, and no rehab in store
for him. “They had no idea what to do with me,” he said. “I guess it was easier
for the Army to put me on medical leave and get me out of there. Then my health
problems were my own.”
What Berger did not know was that Rachel Lacy, the young soldier he met when he
first arrived at Ft. McCoy—and who received the same battery of vaccines—had
died following the abrupt onset of debilitating respiratory symptoms. She was,
like Berger, evacuated by ambulance to La Crosse where the first civilian
physician to see her immediately suspected she was suffering from a vaccine
reaction.
Berger, unaware of her death as he traveled north, found himself “lying on the
backseat of the car, in pain, undermedicated, five days out from a major heart
attack, on my way home to no specific care or doctor and unsure of my Army
status.” He felt rejected by an institution he had served for 20 years, and he
traveled with an anxious uncertainty about what might happen to him in the weeks
to come.
--------------------------------------------------------------------------------
There was still more Berger was unaware of at the time he huddled in the
backseat of his family car on the long ride home. On March 18—two weeks after
Berger was immunized at Ft. McCoy—an American Indian nurse named Deerheart
Cornitcher received the smallpox vaccine at Peninsula Regional Medical Center in
Salisbury, Maryland. That evening she felt nauseated and attributed it to a
minor vaccine reaction or, possibly, a mild case of food poisoning. Five days
later she was dead of a heart attack.
Cornitcher was among seven health professionals vaccinated as part of a civilian
readiness program, all of whom developed post-vaccine problems. Another vaccine
recipient suffered a heart attack but survived, two developed inflammation of
the lining around the heart, and two developed angina, the type of chest pain
associated with heart disease.
Three days after Cornitcher’s death, the Centers for Disease Control (CDC)
issued a national health advisory regarding smallpox vaccine and the apparent
risk of associated heart problems. The advisory recommended that “persons with
known cardiac disease not be vaccinated.”
Civilian smallpox vaccination efforts were suspended throughout most of the
country. On March 28, three days before Michael Berger suffered a heart attack,
the CDC issued a formal report on adverse cardiac effects in association with
the smallpox vaccine. On that same day, the Advisory Committee on Immunization
Practices (ACIP)—the nation’s presiding arbiter for policies related to vaccine
safety—held an emergency meeting. ACIP did not restrict its assessment to
civilian programs, noting that 10 cases of myopericarditis (heart inflammation)
already had been reported among the 240,000 primary military vaccinees.
ACIP called the post-vaccine rate of illness in the military “substantially
elevated,” and found “a causal relation between [heart inflammation] and
smallpox vaccination. Persons receiving smallpox vaccine should be informed that
[heart ailments] are a potential complication of smallpox vaccination and they
should seek medical attention if they develop chest pain, shortness of breath,
or other symptoms of cardiac disease within two weeks after vaccination.”
Meanwhile, the autopsy report on Rachel Lacy noted that her death was, in all
probability, related to a severe vaccine reaction. Her death certificate cites
“post- vaccination pericarditis” as an underlying cause of death. It also
includes “recent smallpox and anthrax vaccinations” as a contributing factor.
At the time Michael Berger had a heart attack, a national smallpox vaccine
advisory was in effect and the smallpox story had been carried by all wire
services, CNN, and covered in hundreds of newspapers, as well as on many
professional medical web sites. But if medical officers at Ft. McCoy knew
anything about the controversy, the newly issued directives from both the CDC
and ACIP, or the results of Rachel Lacy’s autopsy, Berger said he—a medic
assigned to a combat support hospital—heard nothing about any of it.
--------------------------------------------------------------------------------
While on convalescent leave, Berger received a call from Ft. McCoy advising him
to be back by May 6, at which time he would be transferred to Ft. Knox,
Kentucky, where, he was told, “they have the facilities to handle your kind of
case.” A good thing, he thought, because he had visited the local ER with chest
pain twice while he was home, afraid both times he was having another heart
attack.
The ride from Ft. McCoy to Ft. Knox took nine hours on a rickety Army bus, which
arrived at a barracks Berger characterized as “World War II vintage.” There
wasn’t room enough in that building for the entire group, so Berger and a few
other soldiers were taken to a second building which was padlocked—with a
condemned sign nailed to the door. Finally, at a third building, Berger was
billeted on the third floor where, despite his post-heart attack status, he had
to struggle up three flights of stairs with his duffel bag.
Although Berger had been advised that Ft. Knox was “where I would get the best
care available,” he quickly learned there was no cardiologist assigned to the
base, nor was there a cardiac rehab program. In fact, there were inadequate
numbers of Army doctors in general, and a civilian contract physician handled
Berger’s case.
Hired just days before Berger’s arrival, the doctor had received no orientation
on Army medical policies. Although sympathetic to Berger’s predicament, he felt
there was little he could do. A civilian cardiologist, however, visited the
base, although he was a specialist in heart disease in children. Still, that
doctor renewed Berger’s medications and prescribed an exercise regimen. As he
performed his examination, the doctor happened to inquire if Berger had ever
received either smallpox or anthrax vaccinations.
Berger said that he had.
“The doctor told me it looked like the vaccines that some of us soldiers got
might not be all that safe,” Berger said. The doctor added that with Berger’s
family history of heart disease, “he was surprised the Army gave me the shots at
all.” Berger had heard something to this effect when he had follow-up care in La
Crosse before shipping out to Ft. Knox, but this cardiologist seemed to speak
with greater certainty. “I asked the doctor what was going on, and he told me
there was evidence of a strong correlation between a family history of heart
problems and bad, even fatal, reactions to the smallpox vaccine.”
--------------------------------------------------------------------------------
During Michael Berger’s frustrating summer in Kentucky, medical hold living
conditions similar to those at Ft. Knox were revealed on other bases, and the
military vaccine issue became more convoluted and contentious.
In addition to the connection between smallpox and heart disease, the anthrax
vaccine was implicated in a parade of catastrophic health effects, including an
abrupt and lethal pneumonia, heart failure, and blood disorders. In May, as
Berger was en route to Ft. Knox, Judge Emmet G. Sullivan, a federal judge in
Washington, D.C., ordered the Department of Defense to stop using anthrax
vaccine on the grounds that it was an experimental drug.
The vaccine (the same one that was used in the first Gulf War) never cleared
U.S. Food and Drug Administration (FDA) standards for human use before it was
administered to thousands of military men and women. Those recipients were given
the vaccine without their awareness or consent, a flagrant violation of federal
guidelines regulating the use of experimental drugs or medicines in human
subjects. The FDA, however, outflanked the court order on a bureaucratic
technicality, solicited no public comment, and quietly reapproved the vaccine.
By late July, the military vaccine program had notched a trail of questionable
deaths and chronic illnesses, along with the outrage of those who were finding
themselves the targets of disciplinary proceedings, even courts-martial, for
refusing smallpox or anthrax vaccines. As soldiers and their families began to
alert congressmen and senators, Assistant Secretary of Defense William
Winkenwerder, Jr., reported that the Army had identified 37 cases of heart
inflammation in the wake of smallpox vaccination—but no deaths.
Rachel Lacy’s death, it seemed, was still categorized as “unexplained” by DoD.
But in early August, Rachel’s father told a UPI reporter that he was convinced a
proper investigation into the cause of his daughter’s death was being blocked by
the Army. He believed his daughter died as a result of the smallpox vaccine, and
the Army was stonewalling in an attempt to avoid the criticism such a revelation
might bring.
Rachel Lacy’s father was seconded in this opinion by Dr. Jeffrey Sartin, a
physician who cared for Rachel early in the course of her illness. Sartin, an
infectious disease specialist based in La Crosse—at the same hospital where
Michael Berger was taken after he collapsed at Ft. McCoy—said he believed that
Rachel Lacy’s illness and death should be classified as vaccine related. “If she
had been a civilian,” Sartin said, “the case would almost certainly have been
reported as such.”
At the same time, conditions in medical hold facilities at several bases were
reaching a breaking point. In the course of his stay at Ft. Knox, Berger
recalled living in a decrepit barracks some 60 years old that featured a roof
open to the elements. Buckets dotted the floor during thunderstorms. When base
authorities failed to respond to complaints, two soldiers from the company—both
on patient status— climbed onto the roof and positioned a tarp. “Before they put
the tarp up,” Berger said, “you could see the stars at night through that hole.”
Michael Berger’s living conditions at Ft. Knox proved to be symptomatic of
overwhelmed Army medical facilities in general, a system that seemed to be
grossly unprepared for the many wounded and ill soldiers who would inevitably be
returning from a combat theater—or whose illnesses, like Berger’s, would keep
them from deployment. UPI reporter Mark Benjamin, in a series of articles that
brought him a prestigious journalism prize, detailed med-hold barracks in such
poor repair that they were in danger of collapse, and waits for doctor
appointments and therapy stretching out four to six months and longer. Benjamin
wrote that “in nearly two dozen interviews” soldiers consistently “described
substandard living conditions” and interminable waits for any kind of medical
attention.
After being at Ft. Knox for nearly eight months (during which time all his heart
care was delivered by contract civilian doctors), a medical board found Mike
Berger unfit for duty. He was offered a ten percent disability. Berger objected,
noting that “a ten percent disability wouldn’t even cover the cost of
medications I have to take for the rest of my life. Plus ten percent doesn’t
entitle me to full VA care.” Berger thought that, since he had suffered his
illness in the line of duty—and very possibly in direct connection with vaccines
the Army had ordered him to take—he deserved more support in managing the
results.
“But,” Berger said, “the med board told me, in so many words, that this wasn’t
their problem.”
Berger fought the decision, but the board refused to budge. By this time he had
been officially classified as a “vaccine reactor,” and while the board
acknowledged his heart problems “could have been caused by the smallpox
vaccine,” there was clearly no chance of improving their offer. Berger
reluctantly accepted the package and returned to Ft. McCoy for his discharge.
Just two days before Berger was to pick up his discharge papers, he had a phone
call from Janette Williams, a case manager at Walter Reed’s National Vaccine
Healthcare Center. “She knew a lot about me,” Berger said. “But I’d never met
her or spoken to her. She told me that from my records it looked like I was a
possible positive smallpox reactor and the Army would like to bring me up to
Reed for a few days of study.”
Although Williams told Berger he was free to decline her offer, she also advised
him that his DD-214 “was unavailable” and his medical board decision had been
rescinded. Which meant that, despite the suggestion that Berger had a choice in
the matter, he had no real option except to report to Walter Reed. Still, Berger
recalled, “Ms. Williams said I’d only be here for a couple of weeks to a month.
Just a few tests, and I’d be on my way.”
Around this time the Army issued a statement that vaccines “might have led to
the death of Rachel Lacy,” and Sen. Jeff Bingaman (D-N.M.) introduced a Senate
resolution calling on Secretary of Defense Donald Rumsfeld to “review the
military vaccine program amid growing reports of serious side effects.”
Michael Berger enjoyed the holiday season at home with his family in Michigan,
and reported as ordered to Walter Reed on February 17, 2004, where his “two-week
stay” now approaches a year.
And in that time his heart condition continued to deteriorate.
--------------------------------------------------------------------------------
Berger has characterized his care at Walter Reed as “first rate,” even as his
medical condition worsens. Now struggling with leakage in two heart valves and
the re-closing of the artery that was stented after his heart attack, he takes
several medications and has been told by his doctor that adhering to this
regimen will give him “a normal lifestyle for three to five years.”
Mike Berger has entered the medical territory where doctors can watch, monitor,
and intervene when necessary—but do little or nothing to turn back the course of
disease.
And just when he thought he understood the medical verdict and the challenges
ahead, Berger was dealt another blow. In view of his declining health, Berger
requested a reevaluation of his earlier medical board decision. “My condition is
worse than it was at Ft. Knox,” Berger said. “Nobody denies anymore that my
problems are related to the smallpox—and possibly the anthrax—vaccines. My
doctor tells me that I can anticipate a so-called normal life for only three to
five more years.”
It seemed reasonable to revisit the disability question, and a hearing was
scheduled for November 23. But there was never any actual hearing. Berger was
never given the opportunity to offer testimony. He was never even called into
the hearing room. After Berger waited in a corridor for seven hours, his
attorney finally spoke, alone, to the hearing officer. “My lawyer told me that
my disability was sticking at ten percent, and that if I argued about it, the
board would rescind the offer and put me back on active duty.”
Berger asked his lawyer if he could accept but file an objection in writing.
That counteroffer earned the same threat to rescind the disability and return
Berger to active-duty status.
“I recognized this was probably an empty threat,” Berger said, “but the fact
that the Army thought intimidation was either needed or justified—I’ve kept the
faith, followed orders, gone where they sent me, cooperated with all medical
instructions, participated in the program here at Reed. I’ve given the Army its
due at every step of the way. But enough is enough.”
Berger signed off on the medical board’s decision, “under duress,” as he put
it—but he also contacted the office of Sen. Debbie A. Stabenow (D-Mich.), who
launched a formal inquiry into his case.
--------------------------------------------------------------------------------
Michael Berger’s continuing story is emblematic not only of an Army vaccine
program gone awry, but the deeper confusions and missteps that plague the use of
vaccines in the military at large. Service personnel are ordered to receive
immunizations that are judged to be in their best interests—and also in the best
interests of the service. This stance is rooted in the very essence of command,
where the good of the many always supercedes the good of a few, and the primacy
of the mission is all.
Yet the fact remains that, at least since the first Gulf War, vaccines have been
administered to U.S. troops that were not approved for human use and carried
significant questions about safety and even their ability to induce immunity.
Any soldier might question the wisdom of receiving vaccines that never cleared
standard FDA guidelines, or carry known health risks for a significant
percentage of individuals, or have only marginal capacities to confer immunity
to any biological agent that might conceivably be used in a combat scenario.
Michael Berger recalled what all of us who served in any branch of the military
recall: there is no written or verbal “consent to treat” in military medical
settings. There is no opportunity to discuss or opt out of “shot day” in recruit
training or during mobilization. And if all recruits are men in their late teens
or early twenties who are “vaccine-naïve” (as was often the case through the
Vietnam era) many less-adverse reactions are seen.
But times have changed. Women serve. Older men serve. People who have received
other vaccines earlier in their lives serve. And many of these servicemen and
women may well have health histories—like Michael Berger—that preclude receiving
certain vaccines. At the moment, servicemembers who refuse vaccination, even if
on solid medical grounds, are usually punished, more than a hundred so far by
court-martial.
On October 1, 2004, Rep. Christopher Shays (R-Conn.) proposed a bill that would
exempt servicemembers from punishment for refusing to take smallpox or anthrax
vaccines. An act of Congress may well be the only way to force the military to
create and promulgate the regulations and training needed to improve this aspect
of its vaccine program.
On October 28, 2004, Judge Emmet G. Sullivan (the judge who was foiled a year
earlier when the FDA hurriedly approved the anthrax vaccine under dubious
circumstances) ruled that the Department of Defense must cease anthrax
vaccination immediately, noting that FDA “acted improperly when it approved the
experimental injections for general use,” and flatly called the military’s
mandatory vaccination program (which has immunized more than a million troops in
the last six years) “illegal.”
As for the dismal inadequacies at inferior and overcrowded medical holding
facilities at Army bases, a cascade of complaints instigated a Senate
investigation from the office of Sen. Kit Bond (D-Mo.). But it remains unclear
if this Army-wide problem has been fully or adequately addressed.
“I’m not interested in playing the disgruntled soldier,” Berger said. “I’m not
looking to hurt anybody or to get even with anybody or make a lot of noise for
no reason. From what I’ve been told the Army knew there was a category of people
that should not receive the smallpox or anthrax vaccines, and I’m simply asking
for accountability on the part of the service I’ve served proudly for 20 years.”
Berger sees his situation as similar to an injury sustained in the line of duty.
“I was ordered to get the vaccines. I did so. And doing so proved to be
detrimental to my health. In what way am I personally responsible for that? If I
were wounded in combat, there’d be no questions asked—I’d be cared for until I
recovered, and if I were disabled, I’d receive a realistic disability pension.
How is my situation different?”
Michael Berger is not sure what comes next. Sen. Stabenow’s investigation is
underway, and the labyrinth of the VA medical system is waiting for him at home
in Michigan. “It’s a step at a time,” he said. “Right now, I’m just looking
forward to being back with my wife and kids.”