In June 2011, nine months into her assignment as a Peace Corps paramedic in the Central Asian republic of Turkmenistan, Caitlyn Hogan was run over by a car while crossing a gravel road near her apartment.
Her ankle was crushed, but, as she tells it, her ordeal had just begun. Instead of receiving help from federal agencies because of being hurt while on duty overseas, Hogan said, she got caught in a bureaucratic maze that has haunted her life ever since. Her requests for disability payments were ignored. On top of that, she is fearful that she will be stuck with many of her unpaid medical expenses, which so far total $17,000. Meanwhile, the collection-agency calls keep coming.
"It's kind of devastating really. Peace Corps was something I wanted to do forever, and I get this chance to go," Hogan, 27, said. "I can't even feel positive about the stuff I got accomplished because it's so overshadowed just by the lack of care by Peace Corps and their disinterest in helping."
Hogan's feelings of abandonment by the Peace Corps are hardly unique. Volunteers who serve in impoverished, dangerous countries all too often endure sexual and other assaults, psychological trauma and physical injuries, as well as exotic diseases. Yet, former volunteers-turned-activists say the government workers' compensation program that is supposed to provide medical care and disability payments for the injured is rife with troubles. Even Peace Corps officials, while declining to comment on any specific cases, acknowledge some of the problems.
Interviews by FairWarning, a Los Angeles-based journalism nonprofit, with more than a dozen former Peace Corps personnel - about half of them members of Health Justice for Peace Corps Volunteers, an advocacy group - highlighted the struggles of harmed volunteers. Many failed to gain government-paid medical care when they returned to the U.S. because they couldn't find doctors registered with FECA. What's more, they say, claims for medical insurance reimbursements often bog down or are rejected because of bureaucratic bottlenecks and the lack of information provided to volunteers.
Volunteer Jessica Gregg, for example, said she was drugged and sexually assaulted in October 2007 by a young man she met at a restaurant in Mozambique, where she had served for 13 months as an English teacher. Afterward, Gregg returned home to Tucson to recover. But after she had several psychological counseling sessions, the Labor Department denied her health-care claim, and she went without further therapy or medication for six months, until she obtained private insurance through a new job.
"There was never a person I could talk to specifically about workers' compensation that seemed competent," Gregg said. She explained that her claim was denied because she found out too late that the Labor Department required a doctor, not a psychologist, to perform her initial medical examination.
"My PTSD symptoms and depression were crippling," Gregg testified in an affidavit submitted in February 2011 to the House Committee on Foreign Affairs, which looked into cases of volunteers who were raped or otherwise assaulted after ABC News reported on the issue. "I went without psychological care for an extended amount of time simply because I could not afford treatment or even navigate the system on my own."
The program's flawed management was underscored by a Government Accountability Office report issued in November. The assessment was required by the Kate Puzey Peace Corps Volunteer Protection Act of 2011, named after a volunteer who was murdered while working in the West African nation of Benin.
The narrowly focused report faulted both the Peace Corps and the U.S. Labor Department, which administers the workers' compensation program known as FECA, after the Federal Employees' Compensation Act. "The agencies generally do not work together to use available information to monitor the accessibility and quality of FECA benefits for volunteers," according to the assessment.
The report, which noted that FECA serves about 1,400 Peace Corps volunteers a year and spent $36 million in benefits on them from 2009 through 2011, did not examine actual examples of the hardships resulting from the program's flaws. Nor did the Government Accountability Office note that it found similar problems when it examined FECA 21 years ago.
But the report gave a clue of how difficult it may be for returning volunteers to get proper treatment. Using the government's online search tool to look for doctors registered with the program, the report's authors did not find any mental-health specialists in California, New York, Texas or any of the other 10 states with the most Peace Corps veterans.
As the cautious language of the report put it, "volunteers may face some challenges accessing registered providers." Beyond that, the report noted the possibility that there may be volunteers who are assaulted but are too ashamed or fearful to report the incidents while overseas and, as a result, may lack the documentation to file FECA claims later on.
peace corps adding staff
Although the Peace Corps covers medical costs for volunteers while they are on duty, once they return home volunteers are expected to turn to the agency's "Post-Service Unit" to receive medical examinations. After that, the Post-Service Unit largely steps aside, and its only continuing involvement is providing assistance in filing a FECA claim with the Labor Department.
Like federal employees, Peace Corps volunteers with job-related injuries can file claims to cover medical bills and, if they can't return to work, to secure disability payments. Since volunteers are considered to be on the job around the clock when they are on foreign soil, any injury they suffer while on assignment is eligible for coverage.
But Peace Corps officials admit the system is flawed. "Unfortunately, this system has failed" returned volunteers, "and that is truly disheartening," Peace Corps acting director Carrie Hessler-Radelet wrote in a recent blog post.
To improve the situation, Peace Corps officials told the Government Accountability Office that they are adding staff and giving case managers authority to provide "care coordination for some catastrophic illnesses or injuries."
But the agency says it has limited authority to make reforms, and points the finger at the Labor Department for the way it runs the workers' compensation program.
Still, Labor Department figures show that the Peace Corps sometimes falls down in handling its part of the job. For instance, the Peace Corps delivered its paperwork for wage-loss claims on time in only 42 percent of the cases in the 2012 fiscal year.
And critics doubt that the Peace Corps pushes the Labor Department very hard to approve more claims because the Peace Corps, like any other federal agency, would wind up having to foot the bill. "Peace Corps has a financial incentive to get the Department of Labor to deny claims," said Kevin Clark, a former volunteer from Canaan, N.H., who was one of the founding members of Health Justice for Peace Corps Volunteers.
Another former volunteer, Chuck Ludlam of Washington, D.C., said, "The transition between the Peace Corps medical system and the Department of Labor medical system is of no interest to the Peace Corps. As long as you get the volunteers off the books, they're happy."
injured workers blamed
Geoffrey Shapiro, a workers' compensation lawyer in Warrensville Heights, Ohio, who has represented injured Peace Corps volunteers, said the Labor Department - which would not comment for this story - also is to blame. He said it wants to protect federal agencies by holding down workers' compensation costs, "so they blame the injured workers" and deny many of their claims for benefits.
In September 2008, Peace Corps volunteer Christie-Anne Edie started teaching women and adolescents about family planning, sexually transmitted diseases and sanitation. But by spring of the following year, while she was in the West African nation of Burkina Faso, Edie said, she contracted a mysterious gastrointestinal infection. It was so severe that by December 2009 the Peace Corps sent her back home to Fort Collins, Colo.
When the Post-Service Unit turned her case over to the Labor Department, she said, it felt as though the Peace Corps was saying, "We wash our hands of you. There is nothing we can do."
Since then, according to records Edie provided FairWarning, the Labor Department has rejected her more than $25,000 in medical bills. "They always come up with some sort of excuse not to pay," Edie said.
Getting help from either the Peace Corps or the Labor Department, she said, has proved futile. In addition to sending several letters, Edie said, she has left 16 voicemail messages with the Labor Department that have never been returned.
The shortcomings of the Peace Corps' Post-Service Unit have been a concern for more than two decades. In 1991, the Government Accountability Office (then known as the General Accounting Office) said the unit's officers often were unable to answer volunteers' questions about FECA. Many returned volunteers weren't even told they were entitled to health-care benefits.
Former volunteers for years pressed, unsuccessfully, for Congress and the Peace Corps to set up an ombudsman office where the injured could turn to for help.
By 2008, Christopher Dodd, then a U.S. senator from Connecticut and chairman of the subcommittee on Western Hemisphere, Peace Corps and narcotics affairs, was spurred to write to the Peace Corps director at the time, Ronald A. Tschetter. Dodd said he had been contacted by a "significant number of Returned Peace Corps volunteers who have expressed deep concerns with the performance of Office of Workers' Compensation Program."
Dodd suggested that the Peace Corps establish an "information center" that could track the handling of workers' compensation claims. But that request, too, failed.
When it comes to getting medical care back in the U.S., injured volunteers often have few options. Dr. John Ellis, an Oklahoma City, Okla., physician who specializes in treating injured workers, said federal employees from all over the country travel to see him because they can't find anyone else who will treat them. "It just blows my mind that no one will see these people," Ellis said.
Toby Rubenstein, who for more than 20 years was a claims handler and supervisor for the Labor Department's workers' compensation program, said physicians lack a financial incentive to treat Peace Corp volunteers or federal workers.
The program is "not paying very much, and yet the billing process is a nightmare, so that's why the doctors don't want to see them," Rubenstein said.
Jack Saul, a psychologist based in New York City and an assistant professor at Columbia University's Mailman School of Public Health, said he has treated two or three volunteers for free. "My experience has been that the process was so complicated that I eventually just gave up in trying to be compensated for work that I had done with some people who had been in the Peace Corps," he said.
When it comes to getting paid, "it's literally a word game," said Howard L. Graham, an attorney in Tacoma, Wash., and author of the "Federal Employees' Compensation Act Practice Guide." "They require the perfect medical report."
No one has struggled more, however, than injured volunteers like Hogan, the volunteer whose ankle was crushed while on duty in Turkmenistan. After being treated at a hospital in the capital city of Ashgabat, Hogan said, she spent six weeks sleeping on the floor of the local Peace Corps office trying to recuperate. Then, suddenly, she was shipped home to the Pittsburgh, Pa., area, when a doctor back in the U.S. saw an MRI of her injury and realized she wasn't recovering properly.
Hogan continues to suffer from traumatic arthritis. Because her leg gives out on her at least once a day, she often uses a cane. Her bad ankle has led to other injuries, like a recent fall that hurt her back and neck. She also is being treated with electroshock therapy for anxiety issues. And she carries on the battle to get her medical bills paid by the Labor Department.
"I guess I'm kinda stuck with being 27 and being crippled for life," she said.
FairWarning (www.fairwarning.org) is a nonprofit, online investigative news organization focused on safety and health issues. Myron Levin of FairWarning contributed to this story.