You Want Chicken Pox with That?

Historically, militaries have suffered as many casualties from infectious diseases as from actual combat, if not more. The U.S. military understands this quite well, which is why it has considerable in-house commands devoted to health issues.

Yet in 2008 the same political ideology of outsourcing and privatization of military logistics functions that has made a household name of Halliburton nearly caused harm to American troops, thanks to a KBR subcontractor. U.S. troops in Iraq unknowingly came close to being exposed to the varicella-zoster virus, a member of the herpes virus family. That virus is what we commonly call chicken pox. The same virus also causes herpes zoster (shingles) in adults.

While the issue of private military contractors (PMC) has received increased public and governmental attention since the U.S. invasions of Afghanistan and Iraq, the oversight and accountability of them has mostly occurred at the level of the prime contractor. When it comes to the subcontractors supporting them, it is still very much like what Winston Churchill said about Russia, that it is "a riddle, wrapped in a mystery, inside an enigma."

That enigma is hard to unravel, thanks to the sheer number of subcontractors involved in most current private military contracts being carried out today. As the Commission on Wartime Contracting in Iraq and Afghanistan noted in a July 2010 hearing:

Our co-workers on the commission's legal staff have trained us to understand that the federal government lacks privity of contract with subcontractors. In other words, the government's contractual relationship is with the prime contractor, not with subcontractors. So the government has limited visibility into subcontractor affairs and limited ability to influence their actions.

If it is true that you can't tell the players without a scorecard, the use of subcontractors means you need multiple scorecards. Speaking of which, the bad guy in this is the subcontractor. The good guy is KBR, up to a point. Yet, as we shall see, KBR also has some culinary skeletons in its closet

Thanks to information provided by a knowledgeable source close to the KBR subcontractor described below, revealed here for the first time, we learn that the good health of U.S. troops was, at one point, due as much to sheer luck as deliberate policy. That is something to ponder the next time you hear a PMC advocate claim, "[W]e have the best supported, supplied military in any military operation in history."

The story of what might be called the ghost of chicken pox future starts with Najlaa International Catering Services (NICS), a KBR contractor, headquartered in Kuwait. NICS was solicited by KBR in the spring of 2008 to provide a Request for Proposal (RFP) for approximately 32 Dining Facilities (DFAC) at various military camps in Iraq under the Army's LOGCAP (Logistics Civil Augmentation Program) III program. NICS subsequently won the contract.

Around the end of the first week of November 2008 it was discovered that NICS's temporary tent city housing camp at Victory Base Camp had a confirmed chicken pox case and 37 employees were supposed to be quarantined. NICS disputed with GlobalMed, its KBR-approved medical service provider, that it was a chicken pox case. NICS began to release the employees from the quarantine tent and put them back to work at the DFAC's.

On November 9 KBR sent an email to NICS asking it to "confirm whether you are housing quarantined Chicken Pox employees." Bear in mind that reporting an employee exposed to a potentially infectious disease is not something that is optional. NICS' contract with KBR required it to notify KBR immediately when a subcontractor employee is exposed to an outbreak of various diseases, including chicken pox.

The next day KBR emailed both GlobalMed and NICS: "Were told NAJIL had a case of chicken pox, then I was told the Quarantine was removed, KBR medical was not notified of this. I need to know who changed the diagnose and why. How is the current employee now and where is he. Is any one else suffering from 'sand flea' bites in the camp?"

In response, an assistant to NICS CEO Bill Baisey emailed a NICS regional manager in Iraq: "Bill is stating that there is one case of chicken pox reported by the medic and took him to quarantine yet that was not chicken pox.. and then the rest were quarantined for eight days and release by GM.. so please advice."

The manager replied, "I have just talked to someone from KBR and he is telling me that GM told him that Bill released the quarantine people. So now, KBR are going to round them up and re-quarantine them." At this point it seems that NICS' right hand did not know what its left hand was doing.

That day Baisey emailed GlobalMed:

The case we had was suspected for chicken Pox not confirmed.. the patient was removed sent out to the outside medic and the rest were placed in Quarantine.. all proper measures were taken to ensure proper isolation is in place.

Dr. Nofal [retained by NICS to liaison with another approved medical service provider, Al Bettar Medical Services, an Iraqi company that was approved by KBR] reported back that the case is a simple case of skin infections and insects bites. GlobalMed and NICS decided to continue with the Quarantine for another few days.. GlobalMed Medic carried out daily checks on all staff in the Quarantine tent.. when all results were normal, GlobalMed released the staff to the normal duties.

On Nov. 12 KBR emailed NICS, noting that it had received disturbing news that NICS currently had no medical team at various DFAC sites. But the truly bad news came on Nov. 21, when GlobalMed sent an email to KBR notifying it that it was terminating its contract with NICS, effective immediately. The reasons were twofold: lack of payment, and professional medical ethical concerns:

On November 10, 2008, I was asked via email by the same senior member of your management team to submit a fradulent medical report regarding the release of quarantined patients to your client KBR. This request for the fraudulent report was not entertained by GlobalMed. KBR did find out about the premature release and the NICS staff were returend to quarantine. These staff are still under quarantine as of this date. The early release of these staff, which was against out medical advice and done without our knowledge could possibly have caused a serious disease outbreak that could have had very negative impact to the health of all coalition forces. GlobalMed can not continue to put its highly respected reputation on the line by having any part in breaches of the KBR Statement of Work such as what has been illusrated in this paragraph.

Baisey replied to GlobalMed's termination letter that day. Among other points, he wrote:

I never asked you to send a fraudulent report. I sent you an email with suggested text to use for the report as per the information I have from Dr. Nofal and your Medic. And if you read my email again you will clearly read "this is a suggestion yet you can still prepare your own report". So this intentional twist of facts clearly has hidden motives.

Baisey was rhetorically correct. But, according to a NICS employee who was there at the time, this was "[t]ypical circumventing, Bill trying to mend his coy manners. I was there, when he told the medical team of GlobalMed to not report the chicken pox cases to KBR and will testify under oath to it."

People may ask if this is making a mountain of a molehill. After all, there was no chicken pox plague that happened. But it might easily have. Chicken pox is an airborne, highly contagious disease. Those with chicken pox may develop hundreds of itchy, fluid-filled blisters that burst and form crusts. NICS workers were being housed in labor camps that were so overcrowded and ill-equipped that workers in them actually rioted in fall 2008. If a worker who was still contagious had been prematurely released from quarantine, the result could have been a medical plague.

On Nov. 23 KBR sent Bill Baisey this email:

Najlaa has informed KBR that they are no long utilizing GlobalMed for medical services for their employees within the Victory Base Complex (VBC).

Due to this interruption in medical service, Najlaa International Catering Services is no longer providing proper medical care to its employees operating in DFAC's on the VBC (D&F sites) as required by their subcontracts.

Najlaa has personnel whose medicals are incomplete, shots expired, and personnel in quarantine without proper care.

In this particular case KBR acted responsibly and did what both federal law and regulations and its own internal rules required. So in the tactical sense, it was a good guy. But when looked at strategically, its way of doing business seems less than adequate. After all, as it turns out, it was not as if this type of incident was new to them.

In writing this article I asked Charles Smith for comment. Smith is very familiar with KBR. He was chief of the Field Support Contracting Division of the Army Field Support Command in Rock Island Arsenal, and one of his main jobs was to oversee the enormous Army contract with KBR during the Iraq and Afghanistan wars.

Smith replied that throughout his time as the LOGCAP program and contract manager, he received several reports of outbreaks of illness among troops, usually intestinal disturbances. For example, in December 2003, he received a call from the Commanding General at the Army's main logistics base in Iraq, Camp Anaconda. He was concerned that there had been a significant increase in sick call due to this type of illness. Smith directed KBR to take additional actions to monitor their subcontractors and requested additional contracting officer's representatives, soldiers with dining hall experience, to further monitor work.

In an email to me, Smith wrote:

During the first years in Iraq we were hindered in providing contract oversight of DFAC operations by a lack of experienced quality assurance specialists from the Defense Contract Management Agency. The troops also did not have enough experienced personnel available for this job. We were forced to rely on KBR living up to their contractual obligations to manage these subcontractors who provided all of the DFAC services.

One of the problems with LOGCAP in Iraq was that KBR subcontracted DFAC services. In Bosnia they had self-performed at an adequate level. It was our expectation that they would do so in Iraq. However, in Iraq KBR immediately issued subcontracts for all DFAC operations. It appeared to us that any firm who bid received a contract and some of these firms performed poorly. In addition, the Defense Contract Audit Agency estimated that KBR had wasted over $250 million on these subcontracts. KBR often had contentious relations with these firms. When KBR had the problem with DCAA, they cut some payments to these subcontractors, which may have led to additional performance problems. Overall, the extensive use of dining facility subcontractors, who performed at various levels of quality, which made our oversight especially difficult. Based upon some of the incidents of soldier illness I encountered, I am convinced that poor DFAC performance was a contributing factor.

What the above shows is at best a pattern of managerial ineptitude and incompetence, and at worst outright deceit, which potentially put U.S. soldiers and civilians in a war zone at physical risk of chicken pox.

It also shows that government oversight of contractors is still often missing in action. As Smith wrote, "During the first years in Iraq we were hindered in providing contract oversight of DFAC operations by a lack of experienced quality assurance specialists from the Defense Contract Management Agency. The troops also did not have enough experienced personnel available for this job. We were forced to rely on KBR living up to their contractual obligations to manage these subcontractors who provided all of the DFAC services."