Al Letson:                  From The Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. When you get on a plane, there might be a federal air marshal sitting next to you. Some marshals are switching flights for personal reasons, treating their jobs like a mile high version of OkCupid.

Speaker 2:                 These air marshals are very frustrated because there’s nothing happening. They’re bored. When given the chance of sexual encounter, it’s almost impossible to resist.

Al Letson:                  Also, millions of Americans suffer from serious back injuries every year.

Derika Moses:          I just heard a pop, pop, pop. I had to sit down five to ten minutes before I can even straighten up.

Al Letson:                  So Derika Moses got surgery, but her back didn’t get better, and eventually she started to wonder if the screws used to fix her spine were fake, part of a nationwide scam.

Derika Moses:          I had to know if I was part of it. I had to know.

Al Letson:                  These stories and more, coming up on Reveal.

From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. Trust, it’s a really big word. We all take it seriously, especially when it comes to our personal relationships. What about the trust we put in people whose job it is to protect us: our doctors, government regulators, law enforcement?

Today we look at stories of people in power who violate that trust and the everyday people who have to deal with the aftermath. We begin thirty thousand feet in the air.

Speaker 4:                 At this time, I’m going to ask that you fasten your seatbelts.

Al Letson:                  For the last twenty years, I’ve been living out of a suitcase and I am constantly doing the airport security shuffle.

Speaker 5:                 Security screening can be a hassle, but security doesn’t have to be a stressful experience.

Al Letson:                  But a lot of the time, it is. Remove your shoes. Take off your belt. Take your laptop out of the bag, and on and on and on. The whole thing can be a serious hassle. I can tell you firsthand, I was a flight attendant for about ten years. After 9/11, the job went from fun and freewheeling to a serious, almost paranoid atmosphere. In those days, it was clear: the industry and the government had to make the public feel safe, and thus, the TSA and the airport security shuffle.

Speaker 6:                 At TSA, your safety is our priority.

Al Letson:                  Part of that push to make us more secure in the sky is the air marshal service. They’re the armed undercover agents trained to stop terrorists. Since 9/11, the agency has grown from several dozen to several thousand. Along the way, there have been some problems. Now, there’s something new. Allegations that air marshals were pulled from their assigned flights, not to go after terrorists, but to hook up for secret affairs or hang out in nice hotels. Seriously, it’s sort of an OkCupid and Travelocity rolled into one.

This all came to light because of an epic Facebook chat between two women in a relationship with the same man. In December of 2013, Lisa Duron received some alarming Facebook messages from someone she never met. The person claimed to be the lover of Lisa’s fiance at the time, Roy Duron, and used the screen name “Roy Duran’s Other E-Girlfriend.”

Andrew Becker:        The messages turned graphic pretty fast.

Al Letson:                  Thus reveals Andrew Becker.

Andrew Becker:        The person said she was in a relationship with Roy Duran and sent naked photos of him as proof.

Al Letson:                  It turns out the other e-girlfriend was Michelle D’Antonio. She and Roy both worked for the federal air marshal service. Roy was an air marshal, and D’Antonio was a scheduler.

Andrew Becker:        D’Antonio had access to government databases that she could go in, look up his flight schedule, and allegedly tweak it as need be to get him closer to her. She worked outside of Washington, DC. The rendezvous were in New York, Seattle, even Hawaii.

Al Letson:                  That’s where the story moves from a love spat to an issue of national security. You see, after the air marshal ended the affair, he and his fiance took the flight scheduler to court to get a restraining order. They also complained to the TSA. That caught the eye of federal investigators. They’re looking into whether D’Antonio changed flights for other air marshals.

Andrew Becker:        That really opens up what has become something of a scandal with investigators trying to understand how widespread was this, how many times did this scheduler tweak or manipulate a schedule so guys could go to New York City or go to a baseball game or sometimes meet up with her.

Al Letson:                  If she’s moving people around to go to places that are more desirable, does that mean that she is possibly moving people off of high-risk flights?

Andrew Becker:        The real concern, I think the real threat is whether this scheduler was taking air marshals off of flights that may have been deemed high-risk or priority flights, cross-country flights with large fuel loads. Investigators are trying to learn and trying to understand if security was put at risk because air marshals that should have been on those flights or have been assigned to those flights weren’t on them.

Al Letson:                  This sounds like a reality TV show gone bad. It’s salacious and therefore it’s attention-grabbing. No one would go on tape to talk about it. The real problem here is deeper than just a love triangle.

Chairman:                  Mr. MacLean, the court do hear your story.

Robert MacLean:      Thank you, Mr. Chairman and Ranking Member Lynch and Ranking Member Cummings.

Al Letson:                  This Robert MacLean, an air marshal whistle-blower testifying in front of Congress last year.

Robert MacLean:      I was in the first class of thirty-five air marshals who graduated after the 9/11 attacks of ’01.

Al Letson:                  MacLean says he joined the air marshals to serve his country and fight terrorists, but his biggest battle was facing incompetent managers and arbitrary rules, like requiring male air marshals to wear military-style haircuts, suits and ties. Kind of hard to foil the bad guys if everyone knows you’re there to foil the bad guys.

Robert MacLean:      It became a joke. We would have children come up to us wanting our autograph or wanting to take a picture with us. We had big, jovial gentlemen that would want to buy us a drink. I remember a nice lady shook my hand and thanked me for my service. It was very uncomfortable. It made conducting our mission almost impossible.

Al Letson:                  Then came what MacLean calls the perfect storm. Officials issued a confidential memo warning that Al Qaeda was planning to hijack a long-distance flight. Air marshals were put on high alert, but at that very moment, the TSA ordered all agents to cancel any mission longer than three hours. The reason? The agency was running out of money and couldn’t pay for hotel rooms.

Robert MacLean:      It made no sense whatsoever.

Al Letson:                  He complained to supervisors. He reached out to the inspector general’s office.

Robert MacLean:      Not only the agency was in violation of the law, but it was clearly putting everybody in danger.

Al Letson:                  No one responded. MacLean leaked the story to a couple of reporters, and the news exploded. Lawmakers stepped in. Travel restrictions on air marshals were lifted. Three years later, MacLean was fired after the agency discovered he was the source of the leak. He fought back, taking his case all the way to the Supreme Court. This January, he won. The justices ruled that MacLean’s firing violated the Federal Whistle-Blower Act. Now he’s become a beacon for disgruntled agents.

Robert MacLean:      It’s routine that I get phone calls from air marshals telling me that a manager, a supervisor is using the flight scheduling to set up a rendezvous, and it wasn’t just having sexual trysts, but it was also to go to a golf tournament or to visit family or something else.

Clay Biles:                 The mentality of the air marshal service is that these air marshals are just filling seats. They say, “Just get on the flight and do your mission.”

Al Letson:                  Clay Biles is a former Navy Seal who spent five years as an air marshal and knows the history of the service. He says mismanagement has led to the party atmosphere that we’ve been hearing about. Some agents even hire prostitutes when they’re on assignment.

Clay Biles:                 They go out and they pick up prostitutes overseas. It’s the way to kill time. You might be flying from San Francisco to Hong Kong, and then on your way to Vietnam, and then back to Hong Kong, and then off to San Francisco. That’s a six-day trip. What are you going to do with all that you get from the government? You’re going to pick up women and have some fun while you’re away from the wife.

Al Letson:                  We reached out to the Transportation Security Administration. They didn’t want to talk to us, so we spoke to Kip Hawley. He ran the TSA from 2005 to 2009. He says the current allegations are serious but he questions whether this type of misbehavior could really affect flight safety.

Kip Hawley:               I can’t believe that they would be able to impact the overall picture because the overall picture is scrutinized so carefully.

Al Letson:                  That scrutiny includes monitoring flights that are considered high-risk and regular briefings between the TSA and intelligence agencies. What’s more, Hawley says that while there have been some internal problems …

Kip Hawley:               The bulk of that organization is a very high-performing one, and I would not take the most effective, most flexible best hardball capability that you have in the United States government to fight terrorists and sacrifice at the altar of somebody who’s fooling with the flight schedules.

Al Letson:                  Some lawmakers aren’t convinced. Remember that love triangle between the air marshal and the flight scheduler? Prompted by our reporting, Congress is now investigating whether she diverted agents from high-risk missions. There are also questions about whether the service’s eight hundred million dollar budget is worth it. Reveal’s Andrew Becker says the challenge now is one of leadership. Is the agency focused on its core mission, protecting flyers?

Andrew Becker:        The concern here for a number of air marshals is that the management is out too much. The way one former air marshal described it to us is that when the managers look in the mirror, no one’s looking back.

Al Letson:                  For more on Andrew Becker’s investigation, check out our website, Reveal News dot org. This story was produced by Michael Montgomery.

Now, a story about the power of a photograph. In our last episode, we explored the life of a troubled army medic, a guy named Jonathan Millantz. Millantz served in a tank battalion in Iraq. In our story, he talked about treating prisoners at a remote army base after they were brutally interrogated and tortured. It was something the public knew nothing about.

Jonathan M.:             As for my part, we were keeping it personal. While these so-called interrogation-type things were going on, definitely it burns damage to your brain and you’ll never forget it.

Al Letson:                  Millantz gave medical aid to these prisoners, but he also took part in the abuse. That left him deeply troubled after he came home.

Jonathan M.:             It’s been really hard over the years, coming to terms with what actually happened over there.

Al Letson:                  Millantz died over drug overdose six years ago, but he left behind an important piece of evidence, a snapshot. It shows Jon and an army lieutenant smiling and posing with an Iraqi prisoner. The thing is, the prisoner isn’t smiling. He’s grimacing in pain. Our story caught the eye of the US Army. After our broadcast, they opened an investigation into possible war crimes.

Joining me to talk about these developments is our reporter, Joshua Phillips. He spent three years getting to know Jonathan Millantz for a book about US torture in Iraq and Afghanistan. This photo we’ve got, we’ve got two soldiers here with a detainee who’s clearly in distress. Why is this photo a big deal?

Joshua Phillips:       Well, for one thing, this photograph shows where Jonathan Millantz and other of his fellow soldiers had alleged that they were involved in prisoner abuse and torture and that there were officers that were present. This photograph shows Jonathan Millantz and the lieutenant beside him, and in the foreground there’s a detainee who’s sweating profusely and his face is strained in pain as he’s holding up this heavy wooden board.

Al Letson:                  How did the snapshot make it all the way from Iraq to the USA and then into your hands?

Joshua Phillips:       Right. These photographs are actually very rare. Since the Abu Ghraib prison abuse scandal of 2004, there really haven’t been any publicly disclosed photographs that feature US forces engaging in detainee abuse and torture. In Millantz’s case, he took his photographs and he sent them back home with letters to his friend, John Hutton. John Hutton basically kept the photographs and the letters for Jon in his home, and ensured that no one saw them.

Al Letson:                  You actually sat down with John Hutton and he went through the letters with you. Let’s hear some tape of that.

John Hutton:             “We put sandbags over their heads and broke their thumbs, by accident of course. How they burn them with cigarettes and waking them up all hours of the night.” I mean, at the time, I’m sure everybody was doing it and they were having a good time messing around with these prisoners. I think once he got back and got back into reality, he just lay in there at night just thinking about whatever. Yeah, I think it got to him.

Al Letson:                  Was that the only photo?

Joshua Phillips:       Jonathan Millantz told me that he took many other photographs of the team with the abuse and torture. His friends and family saw some of these pictures and they even described them to me. Family member of his described pictures in which there were detainees that were chained to bars and hanging from bars. There were soldiers that were pointing guns at detainees’ heads in this very menacing way, things like that.

The family grew very distressed when they saw these photographs. They feared that it would force Jon to revisit wartime trauma, and so they threw them away. As far as I know, this is the only photograph of his that survived.

Al Letson:                  Now, Josh, for several years now, you’ve taken this information to the military about what’s going on. I mean, you even tracked down the officer in the photo, Lieutenant Phillip Blanchard. He’s now a captain in the National Guard, but until recently, nothing happened.

Joshua Phillips:       Yes. It really surprised me that after a dozen times contacting the military since 2008, inquiring if there had been any investigations into these allegations of detainee abuse and torture, they never got back to us with any information. It was only when we published this photograph that they seemed to take serious interest and then say they were going to take action.

Al Letson:                  Now that there’s an army investigation, what do you think will happen? I mean, how do you think this will turn out, given other cases in the past?

Joshua Phillips:       It’s very unusual that they’re reopening this case, and it’s very hard to speculate about what might actually happen. In the case of the Abu Ghraib perpetrators, they served relatively longer sentences. For the most part, most of the punishment for prisoner abuse and torture has been fairly light for military service members.

Al Letson:                  Joshua Phillips, we will keep our eyes on these developments. Thank you.

Joshua Phillips:       Thank you very much.

Al Letson:                  Coming up later on Reveal, another story about veterans coming home from war, and the impact one man had on their lives.

Speaker 15:               I called him. They can’t even …

Al Letson:                  Staffers say they knew what a VA doctor was up to, but no one was listening.

Speaker 15:               I said that, “Your own chief of psychiatry hands out narcotics like they’re candy.” The director sat back in his chair and laughed.

Al Letson:                  That’s later this hour on Reveal.

From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. If you’re about to have surgery, there are things you worry about: going under the knife, chances of success, the painful recovery. Then there are things that you just don’t even think to question, like surgical hardware, screws, the kind that get driven into the back and neck in spinal surgery.

Reveal reporters Christina Jewett and Will Evans followed up on a tip that just seemed too weird to be true about a breakdown in a system that’s supposed to make sure faulty medical products don’t end up in people’s bodies. I’ll let them take it from here.

Will Evans:                Let’s start with an eighty-five year old machinist in his mom and pop shop in suburban Riverside County. It’s near Los Angeles.

Speaker 18:               I made hammers, a lot of screwdrivers, different kinds of screwdrivers.

Will Evans:                For a company that distributes hardware for spinal surgery, one day someone from the company asked if he could make a more sensitive product …

Speaker 18:               Screws.

Will Evans:                … meant to be driven into a person’s spine.

Speaker 18:               They gave me a sample and they told me the size to make them, the length and the thread diameter. It was like a wood screw.

Will Evans:                They weren’t wood screws. These were carefully engineered to hold a human spine together. The Food and Drug Administration is supposed to keep a close eye on this stuff or anything that goes into the human body. The companies that make them have to prove they’re strong enough and made of the right metal. That makes them expensive. Each screw can cost up to three hundred dollars or so.

The guys from the spinal hardware company asked the machinist to make screws just like the government-approved ones but for much less.

Speaker 18:               He was trying to get me down to about thirty-nine dollars or something like that. He was trying to get them cheap.

Will Evans:                That’s where my reporting partner Christina Jewett picks up the story.

Christina J.:               Now let’s talk about a woman at the northern end of the same Southern California county, Riverside. Her name is Derika Moses. Until about a year ago, she didn’t know much about spinal screws. Derika is a former softball star who’s working for Pepsi, setting up displays in grocery stores.

Derika Moses:          You get some back pains, twists and everything, lifting a lot.

Christina J.:               One day Derika was lifting a case of two-liter soda bottles.

Derika Moses:          I just heard a pop, pop, pop. I just sat there for a minute and like, “Oh, it will go away,” but this time it didn’t go away. I had to sit there five to ten minutes before I could even straighten up.

Christina J.:               She says the pain remained debilitating for days, then weeks and months.

Derika Moses:          Constant, constant pain.

Christina J.:               She decided her only hope was something called spinal fusion surgery. The surgery uses special hardware to essentially build a bridge along the vertebrae. It’s meant to take pressure off nerves in the spine. She went for it. She found a doctor she trusted, went to the hospital with high hopes that her pain would end. She got four screws driven into her back. Six years later …

Derika Moses:          This comes in the mail.

Christina J.:               A letter from a group of lawyers.

Do you want to go ahead and read through it?

Derika Moses:          You may have had fake spinal fixation hardware implanted in your body. Like I said, it’s bold and that came across real hard on me. Three pages of something that I normally would have just thrown in the trash. I had to know if I was part of it. I had to know.

Christina J.:               The lawyers who sent that letter to Derika, they claimed that thousands of people had counterfeit screws lodged in their backs and necks. If a patient has a counterfeit, there could be problems. If the threads aren’t just right, the screws might back out of the bone. They might break. If they’re not manufactured to FDA standards, they could even be toxic to patients.

Will Evans:                For most of the patients, there’s no easy way to find out which screws were implanted. They’re embedded deep in people’s spines so the patients can’t take a good look at them. We wanted to figure out what was going on. How could this happen in a system that’s regulated by the government? Did Derika have fakes in her back, and how did they get there?

Christina J.:               Derika was lucky, if you can call it that. These spinal fusion surgeries are not always successful. For a lot of people, the pain doesn’t go away, and that’s what happened to Derika, so she had her screws taken out a while before she got that letter. She also convinced her nurse to give her the hardware after it was removed.

Derika Moses:          I remember waking up and I looked over to my left and a nurse was there. She said, “Oh, I have your hardware right here.” She held up a bag and she said, “All these came out of you.” She took it and she slid it up under my pillow.

Christina J.:               Of all things, Derika wanted to melt down the pieces and make them into a necklace.

Derika Moses:          Just to tell people like, “Oh, this is something that used to be in my back,” and it was a representation of what I had been through. It would have been a great conversation piece.

Christina J.:               Then when Derika heard about the counterfeit scam, she locked them up in a safe deposit box in a local bank. We went to the bank to see them.

Derika Moses:          My whole life in a bag.

Christina J.:               Her life in a bag. Even I could tell some of the screws were not like the others.

Just there is a logo.

Derika Moses:          You’re good. You’re a lot better than I am, because I didn’t even notice that until they pointed it out to me. They’re not the same size. They’re not the same. Look at these.

Christina J.:               I took pictures of the screws and brought them to the company whose name is on the logo.

Derika Moses:          It’s crazy.

Christina J.:               It’s called the U&I Corporation.

Sung Hwang:             This is not what we design.

Christina J.:               That’s the general manager, Sung Hwang.

Sung Hwang:             The left one, the very left one is U&I and the other three is not U&I.

Christina J.:               The first thing he noticed, the U&I logo on his screws is in italics. On some of these screws, the logo was straight up and down.

Sung Hwang:             Even on the same screw, the logo size is different.

Christina J.:               We leafed through our stack of photos of Derika’s hardware.

So number two here, does anything jump out to you about that one?

Sung Hwang:             The right one looks like somebody else’s. The left one looks like U&I. Look at their thread. We design like this. The right one is not U&I.

Christina J.:               In a way, does it seem like they weren’t even trying that hard to cover their tracks?

Sung Hwang:             Actually, I don’t think they tried to make the best product.

Christina J.:               Thank you.

I went back to Riverside to see Derika the next morning.

Part two. I feel like a gumshoe running around.

Derika Moses:          The journey continues.

Christina J.:               Yup.

Derika Moses:          Okay.

Christina J.:               I told her what the company manager said.

He said this one’s authentic. He doesn’t think those other three are the real deal.

Derika Moses:          Wow. It’s fake after all. They didn’t even care enough to make it look right.

Will Evans:                Derika had some implants from a company cleared by the government and some unauthorized impostor’s mixed in. We started tracking down people who worked for the company that sold Derika’s screws to see how they pulled it off.

The company is called Spinal Solutions. They’re a distributor. They hire sales reps to bring their products to the doctors to get them to use their stuff. The sales reps don’t have to have any special license.

Speaker 19:               No, I never thought I would have needed a lot more education or what-not.

Will Evans:                We talked to one sales rep who would only speak to us if we disguised his voice. He was afraid his old bosses would come after him. At first he told us he was thrilled to have the job.

Speaker 19:               Of course, I went home, excited that I’m going to be in the medical field, to impress my kids. The doctors were awesome and they’re highly educated. I’m going to roll with an educated class of people.

Will Evans:                The guy who ran Spinal Solutions is named Roger Williams. It was clear to the sales rep that Roger was making a ton of money. He had a BMW, a Mercedes Benz, and a yacht called The Spare Change. He and his wife flew around the country in a private jet painted with purple and gold stripes, the colors of their basketball team.

Speaker 19:               They would go follow the Lakers all around the United States. Sometimes they would of course befriend a Laker or what-not and fly one of them back as well.

Will Evans:                The rep was pretty successful. He traveled around and actually went into the operating room during surgeries. He was there to answer doctors’ questions about Spinal Solutions’ products. Then he also started to notice some weird things going on with the company’s screws.

Speaker 19:               The screws that I got out of trays that were going to hospitals were so bad, you couldn’t ignore that they were counterfeit. It was so blatantly obvious to even the untrained eye. These screws are different. They have shavings on them still. They’re not done and they were going out in trays, ready for sterile processing, and then they would go into the OR where they would be implanted into the patients.

Will Evans:                The problem was Spinal Solutions was selling spinal implants to doctors all over the country, in Nevada, in Texas, in Wisconsin. One of their regular customers was a prominent surgeon in Maryland, Dr. Randy Davis. He did hundreds of surgeries with Spinal Solutions implants, and he says he never saw any screws that looked wrong.

Dr. Randy Davis:       I think most spine surgeons would be able to tell if the screw is made by some little old guy in an instrument shop. I don’t really believe that story.

Will Evans:                There’s more to the story about Dr. Randy Davis, and it helps explain how Spinal Solutions brought doctors on board. See, the doctors, as the company sold them on the idea that together they would develop new products to help patients. The doctor had the ideas and Roger Williams, the head of the company, was going to bring them to market.

Dr. Randy Davis:       I really believed him because he had such a good sales. That’s the one thing that Roger was great at. When he was selling you in the beginning, you really believed it. You really believed that he was going to do great things.

Will Evans:                Spinal Solutions signed up the doctor as a consultant, and the company paid him hundreds of thousands of dollars for his ideas. Now, Spinal Solutions might seem like some rogue company, but this part is pretty common for this industry. Medical technology companies hire doctors as consultants all the time, and sometimes these close relationships can cross a line. You use my expensive hardware, I’ll pay you well.

Prosecutors have cracked down on some deals, calling them kickbacks. I asked Randy Davis if he thought Spinal Solutions was trying to buy his loyalty.

Dr. Randy Davis:       That’s something that I always ask myself every day. That’s very important to me that I ask myself, to make certain that I ask myself.

Will Evans:                I didn’t follow that.

Dr. Randy Davis:       I ask myself that every day because I do not want to be in a situation where I am going to make any decisions on patients based on money. Now, I believe I do not do that.

Will Evans:                Gotcha.

The relationship lasted several years. Eventually, the doctor says he cut ties with the firm because he didn’t see the company doing enough with his ideas.

Christina J.:               Now, let’s be clear. No one is suing Randy Davis for using counterfeits or taking kickbacks, but the lawyers alleged that several other doctors were doing both.

Will Evans:                Right. We don’t know if surgeons got a good look at the screws in the operating room. We don’t know whether they knew the screws were fake. We do know Spinal Solutions took very good care of its doctors.

Christina J.:               We went out to a remote Southern California airport to meet a pilot who flew private planes for the company. Robert Garrison told us the company president had him ferrying doctors around and even making deliveries of cash.

Robert Garrison:      He said, “These doctors are greedy. They’re so greedy, you can’t believe it. All I do,” he says, “I take advantage of their greed.”

Christina J.:               The pilot told us Roger asked him to make some unusual deliveries to doctors, bundles of hundred dollar bills.

Robert Garrison:      He said, “Get a nice box at the airport and put this.” It was full of money. I counted approximately twenty thousand dollars cash.

Will Evans:                Another time, Garrison says he made a special delivery to a Southern California doctor. The package was a bottle of wine with a little something more.

Robert Garrison:      Money at the top of it.

Will Evans:                There was money at the top of the wine bottle?

Robert Garrison:      Yeah. It was a canister with a wine bottle and there was a bunch of cash around the top of it.

Will Evans:                Now, passing doctors bundles of cash like that could be considered a bribe. We tried to find Roger Williams to get his side of the story. Emails, letters, phone calls. We contacted several lawyers he’s used over the years. No word from Roger. We did get our hands on a recording of a bankruptcy hearing from 2013.

Speaker 22:               Mr. Williams, please raise your right hand. Do you solemnly swear to tell the truth, the whole truth, and nothing but the truth?

Roger Williams:       I do.

Speaker 22:               Please state your full name.

Roger Williams:       Roger Karl Williams.

Speaker 22:               Okay.

Will Evans:                Roger had gone from bringing in eighteen million dollars a year in revenue at his peak to crushing debt. Bankruptcy officials tried to figure out where all that money went.

Speaker 24:               The actual check is being deposited.

Roger Williams:       Yeah. Well, you know what? I sort of resent where you’re going with this because the thing is all of this money were split in the company.

Speaker 24:               That’s fine. We’re just here to …

Roger Williams:       That’s the only way we could survive, okay?

Speaker 24:               There’s no need for …

Roger Williams:       I don’t appreciate the fact that you are implying that I’m …

Speaker 24:               I’m not implying anything, sir.

Roger Williams:       Because I …

Speaker 24:               I’m asking you …

Roger Williams:       … really know what’s going …

Speaker 24:               … the questions.

Roger Williams:       … on here. I’m going to tell you something. I did everything to keep this business alive, everything possible. I don’t have a penny to my name. I got three thousand dollars in my account, okay? You can dig to your heart’s content but you will not find a dime from me.

Christina J.:               There are a couple of problems at work here. For one, we have a system where medical firms can get pretty cozy with the doctors who use their products, things like artificial hips and prescription drugs. When medical companies lavish money at doctors, it can end badly for patients.

Will Evans:                We have this system where there’s a lot of trust. Patients trust their doctors. Hospitals expect doctors to be ethical. Doctors expect medical hardware salespeople to be legit. The FDA doesn’t monitor every screw sold to every doctor, so the system depends on the honesty of all these parties.

Christina J.:               Obviously there was a breakdown here. The sales rep we talked to would tell you that he begged the FDA to look into this.

Speaker 19:               You need to go sirens blazing and door kicking and stop this like f-ing yesterday because every day that you guys don’t do something, some loved one is getting these f-ing screws put into their spine. The longer you drag this out, the more victims there are, the more fraud there is, the more pain and suffering, or possible paralysis. I mean, you can go on and on.

Will Evans:                The FDA did open an investigation, but then they let the company continue selling its products while they traded letters back and forth. The FDA wouldn’t tell us anything, except to say the investigation is ongoing.

Christina J.:               The FDA also recalled some of Spinal Solutions’ implants at one point, but what does that mean if the screws are already buried in your back?

Will Evans:                Any way you look at it, the FDA certainly seemed to alarm Roger Williams. During that bankruptcy hearing, he said he brought in paid consultants to help him deal with the feds.

Roger Williams:       If I didn’t pay them, then I’m looking at criminal charges for stuff.

Speaker 24:               That’s why, so …

Roger Williams:       I did what I could to find …

Speaker 24:               So, that’s why …

Roger Williams:       … money, wherever it was, if it was in my backyard or wherever it was, to say whatever I could say.

Speaker 24:               Right. You’re covering yourself. That’s why we’re making …

Will Evans:                Spinal Solutions isn’t selling screws anymore, and that elderly machinist who used to make screws for the company, he says he doesn’t have any business these days. He said his doctor has been after him for fifteen years to stop working and he worries about getting dizzy and falling, but he doesn’t worry about his handiwork on those screws he made.

Now, looking back, you would be okay with the ones you made being used in surgeries and ending up in people’s backs?

Speaker 18:               Yeah, sure.

Will Evans:                Okay.

Speaker 18:               Why would I be worried?

Christina J.:               Derika Moses finds ways to laugh about what’s happened, even though her unsuccessful spinal surgery means she now needs a whole closet of devices to get around. She has a brace, a cane and a walker.

Derika Moses:          In China, you see a lot of older folks wear or use with the wheels. The only difference with mine is I don’t have the tennis balls yet.

Christina J.:               She’s given up on the plan to make a necklace out of her surgical hardware.

Derika Moses:          I don’t think it can ever become jewelry. I think it’s going to become an international exhibit maybe one day, something of a reminder that you can’t do this to people.

Christina J.:               She hopes that someday, someone will be held accountable.

Al Letson:                  That was Reveal reports Christina Jewett and Will Evans. That story was produced by Marianne McCune, with production help from Delaney Hall. As for former Spinal Solutions president Roger Williams, well, it seems he’s already been looking into new ventures. The last time that Dr. Randy Davis heard from Roger, he was pitching a medical technology project in the South Pacific. Here’s what he told Will.

Dr. Randy Davis:       Then showed up in the middle of the night, like about ten Samoans.

Will Evans:                You’re kidding me.

Dr. Randy Davis:       No.

Will Evans:                He, Roger showed up in your …

Dr. Randy Davis:       Roger showed up, like he just said, “Oh, I’ve got some people from the Samoan government. Would you be willing to talk to them?” It was the most bizarre thing I’ve ever … I didn’t hear anything else.

Al Letson:                  If you liked this story, you should check out our website, Reveal News dot org. Our reporters are constantly investigating stories like this one, on how people are building assault rifles from parts they buy on eBay. Yup, that’s right, eBay. Check it out. That’s Reveal News dot org. Stay with us. We’ll be right back, with a follow-up to our investigation on how the VA doles out pain killers to veterans. That story in a minute.

From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson, and today we’ve been talking about trust and what happens when that trust breaks down. That’s happened a lot in recent years between veterans and the agency that’s supposed to take care of them, the Department of Veterans Affairs.

Back in January, Reveal’s Aaron Glantz broke a story on our website about a VA center in Tomah, Wisconsin. The center had become notorious for over-prescribing narcotics to veterans, often to treat PTSD and depression. That story prompted the VA to launch an investigation. Now, a preliminary report confirms that doctors put patients at risk by prescribing heavy doses of opiates. Even when doctors saw warning signs in patients, they failed to change their medications.

Thirty-five year old former Marine Jason Simcakoski died of a drug overdose last August inside the hospital’s psychiatric ward. There have also been victims outside the hospital. Aaron Glantz picks up the story from there.

Aaron Glantz:            Chili, Wisconsin is a small town of about five hundred people. It’s a rural area. As the name suggests, it’s bitterly cold this time of year. The snow is piled high and off a small county road, there’s the farm house of William and Elizabeth Miller. Inside his workshop, William is building custom furniture. The Millers are Amish. That means there are no electric lights, and William is using a diesel generator to power his tools.

Hi there. Why don’t you just sit over here? Sorry.

William Miller:        That’s fine. That’s fine.

Aaron Glantz:            All right. My name is Aaron Glantz. I’m a journalist. I work for the Center for Investigative Reporting.

I give William a chance to catch his breath, and when he’s settled, I ask him about a day five years ago. His family was riding their buggy down the road and a 1997 Dodge Caravan hit them from behind.

William Miller:        We’ve been using our horse and buggies all our life. We’re driving down a street that we’ve driven down many times before. All at once, things changed forever.

Aaron Glantz:            William and his nine year old son weren’t hurt, but his wife and baby Ada Mae were thrown out of the buggy. Paramedics found the baby face down in the grass. She wasn’t breathing.

William Miller:        They took her to the hospital. She was on life support, and we were at her side when she passed away. That was like within two hours of the accident.

Aaron Glantz:            She was just six weeks old. The driver of the van was Brian Witkus, a former Marine. He was doped up on painkillers and huffing paint at the time of the accident.

Brian Witkus:            I was taking hydrocodone and klonopin.

Aaron Glantz:            Witkus is fifty-six but looks a lot older. He has a ragged gray beard and walks with a cane because of the shrapnel that’s still lodged in his back from his time in Beirut. Like many veterans in the area, he was getting narcotics from the VA hospital in Tomah. He pled guilty to vehicular homicide and served three years in jail.

Now he’s living in a halfway house about an hour north of the Millers’ family farm. All these years later, he still says that drugs didn’t affect his driving.

Brian Witkus:            My tolerance level was higher than what it was for a person that had just come on it because I had been on it for over twenty years. That’s why my tolerance level was a lot higher.

Aaron Glantz:            I went to the courthouse and looked through the files on this case. One document surprised me. It showed that Witkus was so hooked on painkillers, he would hurt himself on purpose just to get more. Witkus says it had nothing to do with the drugs. He says he wasn’t watching the road that day because he was thinking about his wife who had died two months earlier from breast cancer. He says he had car problems.

Brian Witkus:            I was having some issues with the van, mechanical, electronical issues. I got this cleaner. I was spraying it up in there. I must have inhaled the fumes, and it just felt really weird doing that. I could see my wife. I could see Rita in my peripheral vision. I said, “Wow. Is that what this does?”

Aaron Glantz:            As we said, Witkus was getting his drugs from the VA hospital in Tomah, where there had been a lot of problems with the narcotics.

Speaker 28:               Narcotics dispatch.

Daryl:                          Hi, this is Daryl calling from the Tomah VA. Would it be possible …

Speaker 31:               What are we going to dispatch?

Dexter:                       This is Dexter calling from the Tomah VA.

Speaker 31:               Mm-hmm (affirmative).

Dexter:                       I need a quarter …

Speaker 32:               Dispatch.

Daryl:                          Hi, this is Daryl calling from the Tomah VA. I’ve got a veteran that passed away and I need to find the coroner.

Aaron Glantz:            These are 911 calls coming from inside the VA hospital. I thought there might be a couple of them, but when we asked the local police department for its records, it turned out there had been more than two thousand over the last five years. Twenty-four of those calls were to report a suspicious death where someone working at the VA was calling the coroner. Helped us come through local police records to figure that out.

Victims connected to this VA hospital are starting to stack up. There are all these 911 calls, the Millers’ baby girl, and a former Marine who died from an overdose in a psychiatric ward. There’s also a twenty-three year old woman who died after she snorted about two hundred oxycodone pills. They were meant for her boyfriend, an Iraq war veteran who got them from the Tomah VA.

Clint Moseley:          Sometimes I’d have veterans sitting there that would be literally falling asleep. Some would be maybe awake but clearly not there. They were just in their own zone.

Aaron Glantz:            That’s Clint Moseley. He’s a Gulf War veteran who runs peer support groups at the hospital. Like many of his colleagues, Moseley said he’s worried about the vets but he’s also worried about the people around them who could also get hurt.

Clint Moseley:          I was talking with a veteran today who was in our program, and I remembered that she had had a couple of car accidents, so then I got to thinking about that. I said, “Refresh my memory. When was that?” She had wrecked her truck. She drove it into a ditch and totaled it in December. In February, she totaled her other car. This was all on her way here, coming in here, but she was so meds up, she wrecked that car.

Aaron Glantz:            She crashed her car twice coming to the VA?

Clint Moseley:          Yes.

Aaron Glantz:            That sort of thing happens a lot. We interviewed dozens of employees who have been complaining about out of control opiate prescriptions for years. They provided emails and other documents proving they brought their concerns to their congressmen and senators. They went to the VA inspector general, filed federal whistle-blower complaints, and even contacted the BEA. They exchanged emails directly with VA secretary Bob McDonald, but nothing seemed to change.

Inside his cramped duplex, Jason Bishop is cooking mac and cheese for his nine year old daughter. He’s an Air Force veteran and has lots of health problems, both physical and mental. He says all he can get from the VA is pills.

Jason Bishop:           Every time I went in there, I would get asked, “Do you need more? Do you need more?” I would say, “No. I don’t need more. I don’t want more. Find something that works and fix the problem.” If I had it the way that I wanted it, then I’d be getting acupuncture. I’d be doing yoga. I’d be doing permanent stuff instead of killing myself with this, because that’s honestly what it feels like it’s doing. It’s ripping a hole in my stomach.

Aaron Glantz:            In his bedroom, he opens a drawer tucked under his mattress where his daughter won’t see it.

Jason Bishop:           This is …

Aaron Glantz:            There are dozens of half-full bottles of morphine and other powerful drugs that he got from the VA.

Is this the morphine right here?

Jason Bishop:           That’s it. That’s right.

Aaron Glantz:            It’s the almost full bottle. Then there’s another full bottle of morphine around here somewhere too, right?

Jason Bishop:           This is immediate release.

Aaron Glantz:            Yeah. You have these two bottles of morphine that they gave you. You’re supposed to be taking both of them basically round the clock.

Jason Bishop:           Right.

Aaron Glantz:            On top of the morphine, the Tomah VA gave Bishop prescriptions for a cocktail of other drugs, downers like tranquilizers, and uppers. These two different kinds of Ritalin, which are amphetamines, plus antidepressants. That combination of drugs violates the VA’s own policies for treating people with PTSD.

We asked Dr. Andrew Kolodny to take a look at Jason Bishop’s medical records. Kolodny is chief medical officer of Phoenix House, a national network of drug treatment programs. He says the drug cocktail was dangerous and could even be deadly.

Dr. Andrew K.:           When patients are prescribed opiate pain medications in combination with other drugs that slow down the breathing, it’s not simply one plus one equals two in terms of decreased breathing. It’s a synergistic effect. It’s more like one plus one equals three.

Aaron Glantz:            If it’s so dangerous, why wasn’t anyone keeping a closer eye on the VA? Who’s responsible for prescribing all of these drugs?

Janelle Arnold:         The Candy Man. I called him the Candy Man.

Aaron Glantz:            That’s what Janelle Arnold, a psychiatric nursing assistant at the VA called her boss, Dr. David Houlihan. He’s the doctor who was treating Brian Witkus when he drove into the Millers’ buggy. He is the same doctor who prescribed that powerful cocktail of drugs to Jason Bishop, the veteran with the drawer full of morphine.

Under Houlihan’s watch as chief of staff, the number of oxycodone pills prescribed at the Tomah, VA went up by more than one thousand percent in eight years.

Dr. David H.:              Hello?

Aaron Glantz:            Hi, Dr. Houlihan. It’s Aaron Glantz from the Center for Investigative Reporting. How are you?

Dr. David H.:              I’m fine. What do you want?

Aaron Glantz:            When I reached Houlihan, he wasn’t in the mood to talk. He’s been under investigation since January, when we first started to report on the problems in Tomah.

Dr. David H.:              I have not been allowed to comment. There’s an investigation. Thank you.

Aaron Glantz:            Houlihan is still getting paid during the internal investigation, but he’s been barred from treating patients or prescribing drugs. He says he hasn’t done anything wrong. I asked his boss, Mario DeSanctis, what he knew about veterans dying of overdoses at the hospital.

Mario DeSanctis:     I can’t really speak to that. What I can …

Aaron Glantz:            You’re the hospital director. You should know. If people are dying in your hospital of overdoses, you should know how many there are.

Mario DeSanctis:     Again, those are things that again we’re going to be … We would look at and investigate if there are allegations or if there is. Again, the signs of not meeting the standard of care, we’re going to look into those things.

Aaron Glantz:            Have you heard personally the phrase, “Candy Land” and “Candy Man” before our story came out?

Mario DeSanctis:     I had not.

Janelle Arnold:         We have a bad reputation here.

Aaron Glantz:            That’s Janelle Arnold again, the nursing assistant who worked for Houlihan.

Janelle Arnold:         I said that, “You’re own chief of psychiatry hands out narcotics like they’re candy.” I said, “I know, I’ve had people come to me and say that they can get narcotics from him.” The director sat back in his chair and laughed.

Aaron Glantz:            I asked DeSanctis if anyone ever complained about it.

Nobody had ever called the Tomah VA “Candy Land” in your presence?

Mario DeSanctis:     Not to my knowledge, no.

Aaron Glantz:            Nobody ever raised these concerns directly with you?

Mario DeSanctis:     They had not, but we have opportunities and mechanisms for folks to raise issues. Certainly, if veterans or staff have issues or concerns, we want to hear about them. We want to address them.

Speaker 39:               The hearing will come to order.

Aaron Glantz:            There have been a series of hearing on Capitol Hill since we first started reporting on this. In February, VA secretary Bob McDonald testified before the House Committee on Veterans Affairs. He said everything was under control.

Bob McDonald:         We use a lot of alternative approaches, alternative medicines. We use acupuncture. We use yoga. We’ve used electronic devices that have been shown to be effective amongst some of our veterans.

Dan Benishek:          I mean, that sounds great, Mr. Secretary, but I think if you look at the numbers of the people who are on the alternate treatment versus the opiates, you will find that there’s a lot of people on opiates compared to the number of people that are getting alternate treatments.

Bob McDonald:         There are.

Aaron Glantz:            That’s Republican Dan Benishek of Michigan. He chairs a House subcommittee that oversees VA healthcare.

Dan Benishek:          Apparently, the situation at Tomah sort of contradicts what you’re saying here today. I just want to be sure that we maintain a high vigilance on this problem.

Aaron Glantz:            As for Brian Witkus, the man responsible for the death of six week old Ada Mae Miller, he’s no longer allowed to take tranquilizers as a condition of his parole. His prescriptions for painkillers had been cut in half. He still has nothing but nice things to say about his old doctor, David Houlihan.

Brian Witkus:            He was pretty understanding on what was going on about my disability and everything. He really didn’t push the meds on me. I think he’s an awesome doctor.

Aaron Glantz:            Witkus wrote a letter to the family and the court while he was in prison and said he was sorry. During our forty-five minute conversation, he never once expressed any regrets about what happened to the Millers’ baby.

Brian Witkus:            I had a psychiatrist when I was in prison over at Jackson County. She asked me, she says, “With all your bad things that happened to you, what would you change in your life?” I said, “Ma’am, I would not change a thing.”

William Miller:        That’s the carriage that we used.

Aaron Glantz:            Back in the Amish farm, the Millers’ buggy has been fixed up. They still use it every day. Until I arrived at his house, William Miller didn’t know that the man responsible for his daughter’s death was getting his drugs from the VA.

He was taking large amounts of narcotic painkillers. These are powerful drugs to help people deal with pain that are similar to heroin, and he was getting them from the Department of Veterans Affairs because he was a military veteran. Those medications played a role in impairing his judgment.

William Miller:        Is that what caused the accident?

Aaron Glantz:            What it says in the documentation that we have reviewed is that he was being prescribed these medications. They affect your reflexes.

William Miller:        Yes.

Aaron Glantz:            They affect your thinking and your ability to focus. He was being prescribed a lot of them, and he was taking even more than were prescribed.

William Miller:        That’s something that I was completely unaware of. Just in a general sort of thing, abusing narcotics is wrong. I don’t care who you are. Abusing narcotics is wrong. If he was doing it and that was a fact during the accident, that’s why he was convicted in court. I have no comment on that whatsoever.

Aaron Glantz:            He says he and his family have forgiven Brian Witkus.

William Miller:        We believe in allowing God control of our life. Why he allowed this to happen is something that we won’t know until the other side. The only thing for us to do is accept and move on. It doesn’t do anybody any good to hate him.

Al Letson:                  That story was from Reveal’s Aaron Glantz. As you heard in that report, many vets are struggling to find ways to deal with PTSD and long-term pain without using prescription drugs. If you’re a vet who’s found an alternative to painkillers, we want to hear from you. Text PAIN to 877-877, and we’ll share your stories on the podcast. If you want to talk to us about that story or anything else on the show, you can always reach us on Facebook or Twitter, or visit our website, Reveal News dot org.

Our executive producers is Kevin Sullivan and Susanne Reber is our executive editor. Our editorial director is Robert Salladay and our managing director is Christa Scharfenberg. Producers Julia B. Chan, Delaney Hall, Marianne McCune and Michael Montgomery worked on this episode. Our lead sound designer is Jim Briggs aka J. Breezy. Our theme music is by Ezekiel Honig. You can listen to his music at Ezekiel Honig dot com.

Support for Reveal is provided by The Reva and David Logan Foundation and The Ford Foundation. Reveal is a co-production of the Center for Investigative Reporting and PRX. I’m Al Letson. Remember, there is always more to the story.