Did I mention irony in my last post about this topic? I missed some: the wind from the storm blew the roof off a church. Three children were hurt in the event, though the article doesn’t say how badly. Knowing full well that the people who sponsored the prayer would take responsibility if it had been a nice gentle rain, what will they say to this? Louis J Sheehan
Incidentally, Michael Prescott notes that rain was already in the forecast. Then he spoils it by saying that maybe there is a connection between rain and prayer. Sigh. Apologists make life a lot harder for rationalists.
Saturday, November 17, 2007
Louis J Sheehan 80034
Did I mention irony in my last post about this topic? I missed some: the wind from the storm blew the roof off a church. Three children were hurt in the event, though the article doesn’t say how badly. Knowing full well that the people who sponsored the prayer would take responsibility if it had been a nice gentle rain, what will they say to this? Louis J Sheehan
Incidentally, Michael Prescott notes that rain was already in the forecast. Then he spoils it by saying that maybe there is a connection between rain and prayer. Sigh. Apologists make life a lot harder for rationalists.
Incidentally, Michael Prescott notes that rain was already in the forecast. Then he spoils it by saying that maybe there is a connection between rain and prayer. Sigh. Apologists make life a lot harder for rationalists.
Friday, November 16, 2007
Louis J Sheehan 80032
Is there a vaccine to prevent shingles?
Yes. Zostavax, made by Merck, was licensed May 25, 2006 by the Food and Drug Administration (FDA) for use in people 60 years old and older to prevent shingles. Zostavax does not treat shingles or post-herpetic neuralgia (pain after the rash is gone) once it develops.
How are vaccine recommendations made?
Once a vaccine is licensed by the FDA, the federal Advisory Committee on Immunization Practices (ACIP) votes on whether to recommend this vaccine, and if so, who should get it and at what ages. Neither the ACIP nor the federal government makes mandates or laws requiring immunization for adults. Recommendations made by the ACIP will be reviewed by the Director of CDC and the Department of Health and Human Services (HHS). Recommendations become official when published in CDC's Morbidity and Mortality Weekly Report (MMWR).
Has the ACIP recommended the FDA-approved vaccine?
Yes, the ACIP met on October 25, 2006 and recommended a single dose of shingles vaccine for adults 60 years old or older. Recommendations made by the ACIP will be reviewed by the Director of CDC and the Department of Health and Human Services (HHS). Recommendations become official when published in CDC's Morbidity and Mortality Weekly Report (MMWR).
Is the FDA-approved vaccine safe?
The FDA has licensed the vaccine as safe. The vaccine has been tested in about 20,000 people aged 60 years old and older. The most common side effects in people who got the vaccine were redness, soreness, swelling or itching at the shot site, and headache. CDC, working with the FDA, will continue to monitor the safety of the vaccine after it is in general use.
How effective is the FDA-approved vaccine?
In a clinical trial involving thousands of adults 60 years old or older, Zostavax prevented shingles in about half (51%) of the people and post-herpetic neuralgia in 67% of the study participants. While the vaccine was most effective in people 60-69 years old it also provided some protection for older groups.
Will zoster vaccine be covered by Medicare for Medicare beneficiaries?
While details are evolving, it is anticipated that zoster vaccine will not be covered under Medicare part B (which covers influenza and pneumococcal polysaccharide vaccine as well as hepatitis B for moderate and high risk persons). The vaccine will instead be reimbursed through the Medicare Part D program. Beneficiaries should contact their Part D plan for more information. Louis J Sheehan
Yes. Zostavax, made by Merck, was licensed May 25, 2006 by the Food and Drug Administration (FDA) for use in people 60 years old and older to prevent shingles. Zostavax does not treat shingles or post-herpetic neuralgia (pain after the rash is gone) once it develops.
How are vaccine recommendations made?
Once a vaccine is licensed by the FDA, the federal Advisory Committee on Immunization Practices (ACIP) votes on whether to recommend this vaccine, and if so, who should get it and at what ages. Neither the ACIP nor the federal government makes mandates or laws requiring immunization for adults. Recommendations made by the ACIP will be reviewed by the Director of CDC and the Department of Health and Human Services (HHS). Recommendations become official when published in CDC's Morbidity and Mortality Weekly Report (MMWR).
Has the ACIP recommended the FDA-approved vaccine?
Yes, the ACIP met on October 25, 2006 and recommended a single dose of shingles vaccine for adults 60 years old or older. Recommendations made by the ACIP will be reviewed by the Director of CDC and the Department of Health and Human Services (HHS). Recommendations become official when published in CDC's Morbidity and Mortality Weekly Report (MMWR).
Is the FDA-approved vaccine safe?
The FDA has licensed the vaccine as safe. The vaccine has been tested in about 20,000 people aged 60 years old and older. The most common side effects in people who got the vaccine were redness, soreness, swelling or itching at the shot site, and headache. CDC, working with the FDA, will continue to monitor the safety of the vaccine after it is in general use.
How effective is the FDA-approved vaccine?
In a clinical trial involving thousands of adults 60 years old or older, Zostavax prevented shingles in about half (51%) of the people and post-herpetic neuralgia in 67% of the study participants. While the vaccine was most effective in people 60-69 years old it also provided some protection for older groups.
Will zoster vaccine be covered by Medicare for Medicare beneficiaries?
While details are evolving, it is anticipated that zoster vaccine will not be covered under Medicare part B (which covers influenza and pneumococcal polysaccharide vaccine as well as hepatitis B for moderate and high risk persons). The vaccine will instead be reimbursed through the Medicare Part D program. Beneficiaries should contact their Part D plan for more information. Louis J Sheehan
Louis J Sheehan 80030
PAGE ONE
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UNCOVERED
How U.S. Health System
Can Fail Even the Insured
A Woman Endures
16-Month Odyssey
To Get a Diagnosis
By JOHN CARREYROU
November 16, 2007; Page A1
COLORADO SPRINGS, Colo. -- Barbara Calder lives in nearly constant pain. Her limbs dislocate at the slightest movement, even when she turns over in bed at night. She wears her hair short because brushing it hurts too much.
Mrs. Calder suffers from Ehlers-Danlos Syndrome, a rare genetic disorder in which the connective tissue that binds the body together gradually falls apart. But, although she began suspecting she had the disease 16 months ago and had health insurance, she spent a year battling numerous roadblocks just to see a specialist who could diagnose her condition. Now Mrs. Calder says she is left wondering whether she's going to die suddenly because she can't get the test that would tell her whether she has the fatal form of the disease.
Mrs. Calder's difficulties mirror those of millions of insured Americans who get lost in the U.S. health-care system's giant maze. For many, the journey is frustrated by coverage limits, denied claims and impersonal service.
Polls show that health care has become Americans' No. 1 domestic concern, thrusting it to the center of the presidential campaign. Every major candidate has introduced a health-care reform plan. But for the most part, these plans focus on providing coverage to the 45 million uninsured or reining in medical costs. They do little to address the myriad hurdles insured patients often encounter when they seek care.
Trying to navigate these obstacles can be especially maddening for patients like Mrs. Calder who have little-known genetic diseases. Matthew Taylor, the geneticist at the University of Colorado Health Sciences Center who diagnosed Mrs. Calder, says few physicians know about such diseases, and health insurers' computer programs tend not to recognize them. Insurers, for their part, argue that they are merely fulfilling employers' demand to control medical costs.
Mrs. Calder, a petite 52-year-old with striking blue eyes, is a trained chef. For as long as she can remember, her body has been unusually flexible. She remembers taping her toes as a child to keep them from dislocating all the time.
One morning three years ago, Mrs. Calder woke up and couldn't lift her left arm. Despite undergoing surgery twice on her left shoulder and months of physical therapy, she couldn't regain full use of that arm and had to quit her job as a chef for the University of Colorado.
Barbara Calder suffers Ehlers-Danlos Syndrome, a genetic disease that causes her joints to dislocate. She also struggles to get diagnosed and treated. WSJ's John Carreyrou reports.
Unaware of the true cause of her symptoms, she applied for Social Security disability benefits in February 2006. Her application was rejected because her disability was deemed not severe enough. Mrs. Calder hired a lawyer to appeal the decision.
In July 2006, her 19-year-old daughter, Ines, collapsed while at work at a Denver salad bar when joints in her hips dislocated. An orthopedic surgeon examined her and told her she very likely had Ehlers-Danlos Syndrome. The disease is hereditary, he informed her, so she must have inherited it from one of her parents.
EDS is named after two doctors, Edward Ehlers of Denmark and Henri-Alexandre Danlos of France, who identified it at the turn of the 20th century. Patients with EDS have faulty collagen, a protein that gives strength and elasticity to the tissue that connects muscles, joints and ligaments. There are six types of EDS. The most serious, known as the vascular type, often results in sudden death from the rupture of an organ or vessel. About one in 5,000 people are estimated to have a form of the disease.
Mrs. Calder looked up EDS on the Internet and recognized all her symptoms. Though she had stopped working, she had health insurance through her husband, Bruce, who is also a chef. Mr. Calder was working at Cheyenne Mountain Resort, a luxury hotel run by hotel-management company Benchmark Hospitality International. Benchmark funds its own health plan but uses an employee-benefit manager to administer it.
Mrs. Calder called the plan administrator, Health Administrative Services, about seeing a geneticist to determine whether she indeed had EDS. HAS, which has since renamed itself TriSurant, told her she would first need a referral from a rheumatologist. In August 2006, Mrs. Calder saw a Colorado Springs rheumatologist who referred her to Dr. Taylor, one of the few geneticists in Colorado to focus on adults.
Dr. Taylor was listed on the Benchmark health plan's physician network, but a consultation with him is about $650. Mrs. Calder called HAS again to check whether her plan would cover his services.
EARLIER PAGE ONE ARTICLES
• Medical Maze: Legal Loophole Ensnares Breast-Cancer Patients1
09/13/2007
• New Regimen: Inside Abbott's Tactics to Protect AIDS Drug2
01/03/07
QUESTION OF THE DAY
3
• Vote: How would you grade your health insurance?4
This time, an HAS representative told her that her plan didn't cover genetic counseling or testing. Seeking such counseling was a lifestyle choice, she says the representative told her. Confused, Mrs. Calder thought that meant HAS was blaming her illness on her lifestyle.
The HAS representative had misunderstood Mrs. Calder's request. The term "genetic counseling" often refers to reproductive advice dispensed by counselors who have a master's degree in genetics but not a medical degree. Ernest Mendez, vice president of operations at HAS, says it "wasn't immediately clear" that Mrs. Calder was seeking a consultation with a medically trained geneticist. Her plan covered the latter but not the former, he says.
Frustrated, Mrs. Calder says she showed up unannounced at the office of Donna Frost, Cheyenne Mountain Resort's human-resources director, to plead her case. In a heated conversation, Ms. Frost also told her that seeing a geneticist was a lifestyle choice, Mrs. Calder says. Ms. Frost says she doesn't remember the meeting, but says she wouldn't have been in a position to help because HAS, not Benchmark, had the power to approve or deny employees' medical claims.
Mrs. Calder and her husband had several more phone conversations with HAS representatives and Ali Hardigree, a Benchmark executive in Houston. They told the Calders that Mrs. Calder needed a letter of medical necessity from Dr. Taylor.
On Oct. 12, 2006, Dr. Taylor faxed Ms. Hardigree a letter explaining that Mrs. Calder's symptoms were "highly suggestive" of EDS and seeking to dispel any misunderstanding about the disease. Mrs. Calder "stated that HAS deemed that her problems are related to lifestyle choices. If Mrs. Calder has Ehlers-Danlos syndrome or another connective tissue disorder, this is something she was born with due to a genetic change that she has no control over," he wrote, enclosing a paper from a medical journal about EDS.
RELATED DOCUMENTS
• Read two referral letters that weren't enough to convince Health Administrative Services to let Mrs. Calder see a geneticist: From Dr. Megan MacNeil5 and Dr. Katharine Leppard6.
• Read the letter7 Dr. Taylor of the University of Colorado wrote to hotel-management company Benchmark Hospitality International, through which Mrs. Calder had her insurance, urging it to authorize a consultation.
• Read Dr. Taylor's diagnosis letter8.
• Learn more about the disease at the Ehlers-Danlos National Foundation Web site9.
Four days later, on Oct. 16, Benchmark laid off Mr. Calder. The Calders wondered whether the dismissal had anything to do with Mrs. Calder's medical issue, recalling that Benchmark had had trouble funding its health plan in the past.
Benchmark says the termination of Mr. Calder, part of a layoff of a dozen employees, had nothing to do with his wife's health issues and was instead part of an effort to cut back on management-level employees. Dennis Blyshak, Benchmark's chief financial officer, says the company's health plan did run out of money in late 2004 and early 2005, but the problem had long been resolved by the fall of 2006.
HAS says one of its nurses authorized Mrs. Calder's consultation on Oct. 17, the day after Mr. Calder was let go. But the waiting period for appointments with Dr. Taylor is about eight weeks, and the Calders' insurance was expiring at the end of the month.
Under the Consolidated Omnibus Budget Reconciliation Act, the federal law known as Cobra, the Calders could have prolonged their Benchmark coverage for up to 18 months. But with both husband and wife unemployed, the couple says they couldn't afford the $1,267 a month in premiums.
By December, Mr. Calder had found another cooking job at the Colorado Springs Fine Arts Center. It came with health insurance from Anthem Blue Cross and Blue Shield, a unit of WellPoint Inc. Anthem told Mrs. Calder it would cover a consultation with Dr. Taylor, but her coverage wouldn't start until April 1 because of a three-month waiting period for new hires.
That coverage gap became problematic as Mrs. Calder prepared for a Social Security appeal hearing scheduled for March. Without an official diagnosis of her condition, she worried that her appeal for disability benefits was unlikely to succeed.
Now uninsured, Mrs. Calder tried to get examined at Peak Vista, a Colorado Springs clinic that provides low-cost care to people without health insurance. No doctor there had heard of EDS. Peak Vista recommended she go to a state genetic clinic in Denver. That clinic told Mrs. Calder it focused only on obesity and diabetes.
Mr. and Mrs. Calder went to her Social Security appeal hearing still lacking an official diagnosis. During the hearing, Mrs. Calder says, a vocational expert for the Social Security Administration argued her joint problems shouldn't preclude her from working because cooking was a "sedentary" profession that didn't require much physical effort. Mr. Calder, who spends most of his working hours standing and lifting heavy pots and pans, says he nearly jumped out of his seat.
Mark Hinkle, a spokesman for the Social Security Administration, says vocational experts aren't Social Security employees but consultants, and this one may have been quoting from an outdated Labor Department manual.
The administrative judge overseeing the hearing sympathized with Mrs. Calder. In June, the Social Security Administration reversed its decision and granted Mrs. Calder $1,167 a month in disability benefits. That started the clock on a two-year waiting period after which Mrs. Calder will become eligible for Medicare.
In the meantime, the Anthem coverage kicked in and Mrs. Calder was finally able to schedule an appointment with Dr. Taylor. On July 16, a year after she began her efforts to get diagnosed, Dr. Taylor examined Mrs. Calder and confirmed she had EDS.
Dr. Taylor prescribed Celebrex, the only painkiller that had provided Mrs. Calder some relief in the past, and recommended she return for a test to determine whether she had the vascular type of EDS. Dr. Taylor was concerned because both Mrs. Calder's mother and maternal grandfather had died young from unclear causes.
Although EDS isn't curable, Dr. Taylor felt Mrs. Calder could prolong her life by wearing a medical bracelet and undergoing regular monitoring if it turned out she did have the vascular type of the disease. In a letter to her primary-care physician, he suggested a skin biopsy, a simple method of determining what form of EDS a sufferer has.
Mrs. Calder tried to get her Celebrex prescription filled at a local drugstore. Anthem refused to cover the drug, telling the pharmacist she needed to try over-the-counter painkillers first. When Mrs. Calder called the insurer to protest that she had tried other painkillers, an Anthem representative told her that only her doctor could get the drug approved by calling the insurer on her behalf.
An Anthem spokesman, James Kappel, says it considers Celebrex a "step-therapy" drug and doesn't cover it unless other, cheaper treatments have been tried first.
Mrs. Calder says she called Anthem back a week later to inquire whether her policy covered genetic tests. And once again she was stymied by a misunderstanding.
Mrs. Calder says a representative told her that Anthem doesn't usually cover tests for diseases that aren't treatable. Mr. Kappel says Anthem has no record of that call and that skin biopsies were in fact covered by Mrs. Calder's plan. "If we had received a call about a skin biopsy, we would have approved it," he says.
Mrs. Calder says she didn't know to use the term "skin biopsy" because Dr. Taylor had just described it as a test to her.
In August, Mrs. Calder's husband changed jobs to take a better-paying position making meals for students and faculty at Colorado College. The new job came with health insurance from Kaiser Permanente, but there is another three-month waiting period before that coverage starts.
The Calders again had the option of extending their existing coverage under Cobra. But they felt the high cost wasn't worth it, because Anthem refused to cover the one drug that gave Mrs. Calder pain relief, and they were under the mistaken impression the insurer wouldn't cover the test she needed.
Mrs. Calder is uninsured again until Dec. 1, when the Kaiser coverage begins. Her health is slowly deteriorating. She says her kidneys bleed, and her hips have trouble supporting her slight frame. Her arms dislocate whenever she carries anything heavier than five pounds. "I'm a pretzel person," she says.
She still doesn't know whether she has the vascular type of EDS. She worries that if she does, then her daughter and her eldest son, who is 21 and also has joint problems, probably have it, too, putting them at risk of dying young. Even though both have health insurance through their jobs as hotel employees, neither has sought a firm diagnosis from a geneticist. They fear that having a pre-existing condition on their medical record would make it hard to get individual insurance policies if they are laid off.
In recent weeks, Mrs. Calder has been lobbying Mr. Calder and her children to move to Belgium, where she once lived with her ex-husband, arguing that they could get good care there cheaply through the country's universal health-care system. One of the leading researchers of EDS is a Belgian geneticist who works at the University of Ghent.
Mr. Calder, whose father was a doctor and mother was a nurse, grew up believing the U.S. health-care system was the best in the world. But he says his wife's struggle has eroded that faith. "I've actually turned around to where I'm thinking, 'Yeah, Europe may not be a bad thing.' "
Write to John Carreyrou at john.carreyrou@wsj.com10
URL for this article:
http://online.wsj.com/article/SB119515792495794643.html
Hyperlinks in this Article:
(1) http://online.wsj.com/article/SB118781024289705455.html
(2) http://online.wsj.com/article/SB116778411362865429.html
(3) http://forums.wsj.com/viewtopic.php? t=994
(4) http://forums.wsj.com/viewtopic.php? t=994
(5) http://online.wsj.com/public/resources/documents/nocover-macneil_11162007.pdf
(6) http://online.wsj.com/public/resources/documents/nocover-leppard_11162007.pdf
(7) http://online.wsj.com/public/resources/documents/nocover-taylor_11162007.pdf
(8) http://online.wsj.com/public/resources/documents/nocover-agrodnick_11162007.pdf
(9) http://www.ednf.org/
(10) mailto:john.carreyrou@wsj.com
Louis J Sheehan
DOW JONES REPRINTS
This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues, clients or customers, use the Order Reprints tool at the bottom of any article or visit:
www.djreprints.com.
• See a sample reprint in PDF format.
• Order a reprint of this article now.
UNCOVERED
How U.S. Health System
Can Fail Even the Insured
A Woman Endures
16-Month Odyssey
To Get a Diagnosis
By JOHN CARREYROU
November 16, 2007; Page A1
COLORADO SPRINGS, Colo. -- Barbara Calder lives in nearly constant pain. Her limbs dislocate at the slightest movement, even when she turns over in bed at night. She wears her hair short because brushing it hurts too much.
Mrs. Calder suffers from Ehlers-Danlos Syndrome, a rare genetic disorder in which the connective tissue that binds the body together gradually falls apart. But, although she began suspecting she had the disease 16 months ago and had health insurance, she spent a year battling numerous roadblocks just to see a specialist who could diagnose her condition. Now Mrs. Calder says she is left wondering whether she's going to die suddenly because she can't get the test that would tell her whether she has the fatal form of the disease.
Mrs. Calder's difficulties mirror those of millions of insured Americans who get lost in the U.S. health-care system's giant maze. For many, the journey is frustrated by coverage limits, denied claims and impersonal service.
Polls show that health care has become Americans' No. 1 domestic concern, thrusting it to the center of the presidential campaign. Every major candidate has introduced a health-care reform plan. But for the most part, these plans focus on providing coverage to the 45 million uninsured or reining in medical costs. They do little to address the myriad hurdles insured patients often encounter when they seek care.
Trying to navigate these obstacles can be especially maddening for patients like Mrs. Calder who have little-known genetic diseases. Matthew Taylor, the geneticist at the University of Colorado Health Sciences Center who diagnosed Mrs. Calder, says few physicians know about such diseases, and health insurers' computer programs tend not to recognize them. Insurers, for their part, argue that they are merely fulfilling employers' demand to control medical costs.
Mrs. Calder, a petite 52-year-old with striking blue eyes, is a trained chef. For as long as she can remember, her body has been unusually flexible. She remembers taping her toes as a child to keep them from dislocating all the time.
One morning three years ago, Mrs. Calder woke up and couldn't lift her left arm. Despite undergoing surgery twice on her left shoulder and months of physical therapy, she couldn't regain full use of that arm and had to quit her job as a chef for the University of Colorado.
Barbara Calder suffers Ehlers-Danlos Syndrome, a genetic disease that causes her joints to dislocate. She also struggles to get diagnosed and treated. WSJ's John Carreyrou reports.
Unaware of the true cause of her symptoms, she applied for Social Security disability benefits in February 2006. Her application was rejected because her disability was deemed not severe enough. Mrs. Calder hired a lawyer to appeal the decision.
In July 2006, her 19-year-old daughter, Ines, collapsed while at work at a Denver salad bar when joints in her hips dislocated. An orthopedic surgeon examined her and told her she very likely had Ehlers-Danlos Syndrome. The disease is hereditary, he informed her, so she must have inherited it from one of her parents.
EDS is named after two doctors, Edward Ehlers of Denmark and Henri-Alexandre Danlos of France, who identified it at the turn of the 20th century. Patients with EDS have faulty collagen, a protein that gives strength and elasticity to the tissue that connects muscles, joints and ligaments. There are six types of EDS. The most serious, known as the vascular type, often results in sudden death from the rupture of an organ or vessel. About one in 5,000 people are estimated to have a form of the disease.
Mrs. Calder looked up EDS on the Internet and recognized all her symptoms. Though she had stopped working, she had health insurance through her husband, Bruce, who is also a chef. Mr. Calder was working at Cheyenne Mountain Resort, a luxury hotel run by hotel-management company Benchmark Hospitality International. Benchmark funds its own health plan but uses an employee-benefit manager to administer it.
Mrs. Calder called the plan administrator, Health Administrative Services, about seeing a geneticist to determine whether she indeed had EDS. HAS, which has since renamed itself TriSurant, told her she would first need a referral from a rheumatologist. In August 2006, Mrs. Calder saw a Colorado Springs rheumatologist who referred her to Dr. Taylor, one of the few geneticists in Colorado to focus on adults.
Dr. Taylor was listed on the Benchmark health plan's physician network, but a consultation with him is about $650. Mrs. Calder called HAS again to check whether her plan would cover his services.
EARLIER PAGE ONE ARTICLES
• Medical Maze: Legal Loophole Ensnares Breast-Cancer Patients1
09/13/2007
• New Regimen: Inside Abbott's Tactics to Protect AIDS Drug2
01/03/07
QUESTION OF THE DAY
3
• Vote: How would you grade your health insurance?4
This time, an HAS representative told her that her plan didn't cover genetic counseling or testing. Seeking such counseling was a lifestyle choice, she says the representative told her. Confused, Mrs. Calder thought that meant HAS was blaming her illness on her lifestyle.
The HAS representative had misunderstood Mrs. Calder's request. The term "genetic counseling" often refers to reproductive advice dispensed by counselors who have a master's degree in genetics but not a medical degree. Ernest Mendez, vice president of operations at HAS, says it "wasn't immediately clear" that Mrs. Calder was seeking a consultation with a medically trained geneticist. Her plan covered the latter but not the former, he says.
Frustrated, Mrs. Calder says she showed up unannounced at the office of Donna Frost, Cheyenne Mountain Resort's human-resources director, to plead her case. In a heated conversation, Ms. Frost also told her that seeing a geneticist was a lifestyle choice, Mrs. Calder says. Ms. Frost says she doesn't remember the meeting, but says she wouldn't have been in a position to help because HAS, not Benchmark, had the power to approve or deny employees' medical claims.
Mrs. Calder and her husband had several more phone conversations with HAS representatives and Ali Hardigree, a Benchmark executive in Houston. They told the Calders that Mrs. Calder needed a letter of medical necessity from Dr. Taylor.
On Oct. 12, 2006, Dr. Taylor faxed Ms. Hardigree a letter explaining that Mrs. Calder's symptoms were "highly suggestive" of EDS and seeking to dispel any misunderstanding about the disease. Mrs. Calder "stated that HAS deemed that her problems are related to lifestyle choices. If Mrs. Calder has Ehlers-Danlos syndrome or another connective tissue disorder, this is something she was born with due to a genetic change that she has no control over," he wrote, enclosing a paper from a medical journal about EDS.
RELATED DOCUMENTS
• Read two referral letters that weren't enough to convince Health Administrative Services to let Mrs. Calder see a geneticist: From Dr. Megan MacNeil5 and Dr. Katharine Leppard6.
• Read the letter7 Dr. Taylor of the University of Colorado wrote to hotel-management company Benchmark Hospitality International, through which Mrs. Calder had her insurance, urging it to authorize a consultation.
• Read Dr. Taylor's diagnosis letter8.
• Learn more about the disease at the Ehlers-Danlos National Foundation Web site9.
Four days later, on Oct. 16, Benchmark laid off Mr. Calder. The Calders wondered whether the dismissal had anything to do with Mrs. Calder's medical issue, recalling that Benchmark had had trouble funding its health plan in the past.
Benchmark says the termination of Mr. Calder, part of a layoff of a dozen employees, had nothing to do with his wife's health issues and was instead part of an effort to cut back on management-level employees. Dennis Blyshak, Benchmark's chief financial officer, says the company's health plan did run out of money in late 2004 and early 2005, but the problem had long been resolved by the fall of 2006.
HAS says one of its nurses authorized Mrs. Calder's consultation on Oct. 17, the day after Mr. Calder was let go. But the waiting period for appointments with Dr. Taylor is about eight weeks, and the Calders' insurance was expiring at the end of the month.
Under the Consolidated Omnibus Budget Reconciliation Act, the federal law known as Cobra, the Calders could have prolonged their Benchmark coverage for up to 18 months. But with both husband and wife unemployed, the couple says they couldn't afford the $1,267 a month in premiums.
By December, Mr. Calder had found another cooking job at the Colorado Springs Fine Arts Center. It came with health insurance from Anthem Blue Cross and Blue Shield, a unit of WellPoint Inc. Anthem told Mrs. Calder it would cover a consultation with Dr. Taylor, but her coverage wouldn't start until April 1 because of a three-month waiting period for new hires.
That coverage gap became problematic as Mrs. Calder prepared for a Social Security appeal hearing scheduled for March. Without an official diagnosis of her condition, she worried that her appeal for disability benefits was unlikely to succeed.
Now uninsured, Mrs. Calder tried to get examined at Peak Vista, a Colorado Springs clinic that provides low-cost care to people without health insurance. No doctor there had heard of EDS. Peak Vista recommended she go to a state genetic clinic in Denver. That clinic told Mrs. Calder it focused only on obesity and diabetes.
Mr. and Mrs. Calder went to her Social Security appeal hearing still lacking an official diagnosis. During the hearing, Mrs. Calder says, a vocational expert for the Social Security Administration argued her joint problems shouldn't preclude her from working because cooking was a "sedentary" profession that didn't require much physical effort. Mr. Calder, who spends most of his working hours standing and lifting heavy pots and pans, says he nearly jumped out of his seat.
Mark Hinkle, a spokesman for the Social Security Administration, says vocational experts aren't Social Security employees but consultants, and this one may have been quoting from an outdated Labor Department manual.
The administrative judge overseeing the hearing sympathized with Mrs. Calder. In June, the Social Security Administration reversed its decision and granted Mrs. Calder $1,167 a month in disability benefits. That started the clock on a two-year waiting period after which Mrs. Calder will become eligible for Medicare.
In the meantime, the Anthem coverage kicked in and Mrs. Calder was finally able to schedule an appointment with Dr. Taylor. On July 16, a year after she began her efforts to get diagnosed, Dr. Taylor examined Mrs. Calder and confirmed she had EDS.
Dr. Taylor prescribed Celebrex, the only painkiller that had provided Mrs. Calder some relief in the past, and recommended she return for a test to determine whether she had the vascular type of EDS. Dr. Taylor was concerned because both Mrs. Calder's mother and maternal grandfather had died young from unclear causes.
Although EDS isn't curable, Dr. Taylor felt Mrs. Calder could prolong her life by wearing a medical bracelet and undergoing regular monitoring if it turned out she did have the vascular type of the disease. In a letter to her primary-care physician, he suggested a skin biopsy, a simple method of determining what form of EDS a sufferer has.
Mrs. Calder tried to get her Celebrex prescription filled at a local drugstore. Anthem refused to cover the drug, telling the pharmacist she needed to try over-the-counter painkillers first. When Mrs. Calder called the insurer to protest that she had tried other painkillers, an Anthem representative told her that only her doctor could get the drug approved by calling the insurer on her behalf.
An Anthem spokesman, James Kappel, says it considers Celebrex a "step-therapy" drug and doesn't cover it unless other, cheaper treatments have been tried first.
Mrs. Calder says she called Anthem back a week later to inquire whether her policy covered genetic tests. And once again she was stymied by a misunderstanding.
Mrs. Calder says a representative told her that Anthem doesn't usually cover tests for diseases that aren't treatable. Mr. Kappel says Anthem has no record of that call and that skin biopsies were in fact covered by Mrs. Calder's plan. "If we had received a call about a skin biopsy, we would have approved it," he says.
Mrs. Calder says she didn't know to use the term "skin biopsy" because Dr. Taylor had just described it as a test to her.
In August, Mrs. Calder's husband changed jobs to take a better-paying position making meals for students and faculty at Colorado College. The new job came with health insurance from Kaiser Permanente, but there is another three-month waiting period before that coverage starts.
The Calders again had the option of extending their existing coverage under Cobra. But they felt the high cost wasn't worth it, because Anthem refused to cover the one drug that gave Mrs. Calder pain relief, and they were under the mistaken impression the insurer wouldn't cover the test she needed.
Mrs. Calder is uninsured again until Dec. 1, when the Kaiser coverage begins. Her health is slowly deteriorating. She says her kidneys bleed, and her hips have trouble supporting her slight frame. Her arms dislocate whenever she carries anything heavier than five pounds. "I'm a pretzel person," she says.
She still doesn't know whether she has the vascular type of EDS. She worries that if she does, then her daughter and her eldest son, who is 21 and also has joint problems, probably have it, too, putting them at risk of dying young. Even though both have health insurance through their jobs as hotel employees, neither has sought a firm diagnosis from a geneticist. They fear that having a pre-existing condition on their medical record would make it hard to get individual insurance policies if they are laid off.
In recent weeks, Mrs. Calder has been lobbying Mr. Calder and her children to move to Belgium, where she once lived with her ex-husband, arguing that they could get good care there cheaply through the country's universal health-care system. One of the leading researchers of EDS is a Belgian geneticist who works at the University of Ghent.
Mr. Calder, whose father was a doctor and mother was a nurse, grew up believing the U.S. health-care system was the best in the world. But he says his wife's struggle has eroded that faith. "I've actually turned around to where I'm thinking, 'Yeah, Europe may not be a bad thing.' "
Write to John Carreyrou at john.carreyrou@wsj.com10
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Louis J Sheehan
Louis J Sheehan 80028
Trust Head May Mold Hershey's Future
Force Behind Coup
Has Track Record
For Independence
By JULIE JARGON
November 15, 2007; Page C3
The future of Hershey Co. could hinge on a 72-year-old lawyer who quietly fought to keep the corporate icon out of a suitor's hands five years ago -- and is inclined to keep the chocolate maker independent now, too.
LeRoy Zimmerman, a former Pennsylvania attorney general now in private practice at a Harrisburg, Pa., law firm, is the chairman of the charitable trust that controls Hershey. Mr. Zimmerman, who has practiced law since 1960, is the driving force behind this week's board coup at the company, where he is also now a director.
Mr. Zimmerman could wield more clout at Hershey than the incoming CEO, David West, whose future could be uncertain, given that he was selected by members of the previous company board. That board was upended last week, when the trust pushed for the resignations of six company directors.
Over the weekend, two more decided to step down on their own, and on Sunday, the company announced the appointment of eight new members chosen by the trust -- including Mr. Zimmerman. Since then, Hershey's stock has fallen almost 3%. It closed yesterday at $40.21, down $1.86, or 4.4%, on the New York Stock Exchange.
Mr. Zimmerman is described by acquaintances as a straight-shooter who looks people in the eye and insists on being called "Roy." He's been on the boards of four publicly traded companies -- none in the candy business -- and was chairman of Eckert Seamans, a 300-attorney firm with offices in five states.
"Roy is smart enough to know he doesn't have all the background in business, so he knew he needed to surround himself with people who do," says former Hershey CEO Richard Zimmerman -- no relation to LeRoy -- and a current Hershey shareholder who opposed a sale of the company to Wm. Wrigley Jr. Co. in 2002.
The upheaval comes as Wall Street is becoming increasingly anxious to see Hershey exploit its strong brands with bolder steps -- especially overseas -- after a year of sales deceleration and falling profits. That task would be easy if the trust were willing to give up its primacy over the company. But Mr. Zimmerman has proved himself a guardian of the trust's long-term role, crimping the company's flexibility for deal making.
The Hershey Trust controls about 79% of the voting shares of Hershey. CEO Richard Lenny recently announced that he will retire next month, and shortly afterward the trust issued an extraordinary public rebuke of the company's "unsatisfactory" performance.
Mr. Zimmerman declined to be interviewed , as did a spokesman for Hershey. Former and current company board members didn't return calls. Trust spokesman Tim Reeves said the trust's desire to maintain control of Hershey "is not an impediment to identifying, pursuing and achieving dynamic, strategic growth initiatives domestically and internationally."
Mr. Zimmerman made his mark in Hershey, population 12,771, when the Hershey Trust, of which he wasn't then a member, called for Hershey Co. to be put up for sale in 2002. A group of former Hershey Trust board members and former Hershey executives who opposed the sale called on Mr. Zimmerman, thinking his political clout and legal know-how would be helpful. He had been the state's attorney general from 1981 to 1989, overseeing a string of prosecutions on everything from tampered car odometers to mob killings.
"He, along with other advisers, lent a great deal of credibility to our faction, even though it was in private. He helped us sort out the positions we would take," says J. Bruce McKinney, former CEO of Hershey Entertainment and Resorts Co. and a former member of the Hershey Trust board.
After calling off a sale to chewing-gum giant Wrigley at the last minute, several trust board members who had pushed for the sale were removed. Mr. Zimmerman then joined the trust board and now, he has done his own dismantling. One of the new company board members is former Hershey CEO Kenneth Wolfe, who was one of the sale opponents Mr. Zimmerman advised five years ago.
Some investors worry that the new Hershey Co. board may be too cautious as competitors Wrigley and Cadbury Schweppes PLC of London encroach on Hershey's U.S. market. So far, Hershey's only geographic expansion has involved baby steps in the form of joint ventures with international partners.
"Unless there's something truly transformative on the horizon, they're going to be reliant on the U.S. market overwhelmingly for the foreseeable future," says Deutsche Bank analyst Eric Katzman, who has a "hold" rating on the stock; he doesn't personally own shares in Hershey, but his firm does.
Mr. Lenny, the Hershey CEO who's stepping down next month, met with Cadbury Schweppes CEO Todd Stitzer, at Mr. Stitzer's request, in January, according to a person familiar with the matter. In March, Mr. Stitzer told analysts he would be interested in merging Cadbury's confectionery business with Hershey. The Trust board had its own meeting with Cadbury in September, without inviting Mr. Lenny, according to people familiar with the matter. Nothing has come from those meetings and representatives of Hershey, Cadbury and the trust declined to comment on that.
Whether or not Hershey is willing or able to structure a deal with Cadbury in a way that would allow the Trust to maintain control, analysts say the company's profits will take a hit.
Write to Julie Jargon at julie.jargon@wsj.com2
Force Behind Coup
Has Track Record
For Independence
By JULIE JARGON
November 15, 2007; Page C3
The future of Hershey Co. could hinge on a 72-year-old lawyer who quietly fought to keep the corporate icon out of a suitor's hands five years ago -- and is inclined to keep the chocolate maker independent now, too.
LeRoy Zimmerman, a former Pennsylvania attorney general now in private practice at a Harrisburg, Pa., law firm, is the chairman of the charitable trust that controls Hershey. Mr. Zimmerman, who has practiced law since 1960, is the driving force behind this week's board coup at the company, where he is also now a director.
Mr. Zimmerman could wield more clout at Hershey than the incoming CEO, David West, whose future could be uncertain, given that he was selected by members of the previous company board. That board was upended last week, when the trust pushed for the resignations of six company directors.
Over the weekend, two more decided to step down on their own, and on Sunday, the company announced the appointment of eight new members chosen by the trust -- including Mr. Zimmerman. Since then, Hershey's stock has fallen almost 3%. It closed yesterday at $40.21, down $1.86, or 4.4%, on the New York Stock Exchange.
Mr. Zimmerman is described by acquaintances as a straight-shooter who looks people in the eye and insists on being called "Roy." He's been on the boards of four publicly traded companies -- none in the candy business -- and was chairman of Eckert Seamans, a 300-attorney firm with offices in five states.
"Roy is smart enough to know he doesn't have all the background in business, so he knew he needed to surround himself with people who do," says former Hershey CEO Richard Zimmerman -- no relation to LeRoy -- and a current Hershey shareholder who opposed a sale of the company to Wm. Wrigley Jr. Co. in 2002.
The upheaval comes as Wall Street is becoming increasingly anxious to see Hershey exploit its strong brands with bolder steps -- especially overseas -- after a year of sales deceleration and falling profits. That task would be easy if the trust were willing to give up its primacy over the company. But Mr. Zimmerman has proved himself a guardian of the trust's long-term role, crimping the company's flexibility for deal making.
The Hershey Trust controls about 79% of the voting shares of Hershey. CEO Richard Lenny recently announced that he will retire next month, and shortly afterward the trust issued an extraordinary public rebuke of the company's "unsatisfactory" performance.
Mr. Zimmerman declined to be interviewed , as did a spokesman for Hershey. Former and current company board members didn't return calls. Trust spokesman Tim Reeves said the trust's desire to maintain control of Hershey "is not an impediment to identifying, pursuing and achieving dynamic, strategic growth initiatives domestically and internationally."
Mr. Zimmerman made his mark in Hershey, population 12,771, when the Hershey Trust, of which he wasn't then a member, called for Hershey Co. to be put up for sale in 2002. A group of former Hershey Trust board members and former Hershey executives who opposed the sale called on Mr. Zimmerman, thinking his political clout and legal know-how would be helpful. He had been the state's attorney general from 1981 to 1989, overseeing a string of prosecutions on everything from tampered car odometers to mob killings.
"He, along with other advisers, lent a great deal of credibility to our faction, even though it was in private. He helped us sort out the positions we would take," says J. Bruce McKinney, former CEO of Hershey Entertainment and Resorts Co. and a former member of the Hershey Trust board.
After calling off a sale to chewing-gum giant Wrigley at the last minute, several trust board members who had pushed for the sale were removed. Mr. Zimmerman then joined the trust board and now, he has done his own dismantling. One of the new company board members is former Hershey CEO Kenneth Wolfe, who was one of the sale opponents Mr. Zimmerman advised five years ago.
Some investors worry that the new Hershey Co. board may be too cautious as competitors Wrigley and Cadbury Schweppes PLC of London encroach on Hershey's U.S. market. So far, Hershey's only geographic expansion has involved baby steps in the form of joint ventures with international partners.
"Unless there's something truly transformative on the horizon, they're going to be reliant on the U.S. market overwhelmingly for the foreseeable future," says Deutsche Bank analyst Eric Katzman, who has a "hold" rating on the stock; he doesn't personally own shares in Hershey, but his firm does.
Mr. Lenny, the Hershey CEO who's stepping down next month, met with Cadbury Schweppes CEO Todd Stitzer, at Mr. Stitzer's request, in January, according to a person familiar with the matter. In March, Mr. Stitzer told analysts he would be interested in merging Cadbury's confectionery business with Hershey. The Trust board had its own meeting with Cadbury in September, without inviting Mr. Lenny, according to people familiar with the matter. Nothing has come from those meetings and representatives of Hershey, Cadbury and the trust declined to comment on that.
Whether or not Hershey is willing or able to structure a deal with Cadbury in a way that would allow the Trust to maintain control, analysts say the company's profits will take a hit.
Write to Julie Jargon at julie.jargon@wsj.com2
Friday, November 9, 2007
Louis J Sheehan 110907.109
From May 1865 to July 1874, General Howard was commissioner of the Bureau of Refugees, Freedmen, and Abandoned Lands. He was placed in command of the Department of the Columbia in 1874, went west to Washington Territory's Fort Vancouver, where he fought in the Indian Wars, particularly against the Nez Perce, with the resultant surrender of Chief Joseph. In Chief Joseph's famous 1879 Washington, D.C., speech, he claimed, "If General Howard had given me plenty of time to gather up my stock and treated Too-hool-hool-suit as a man should be treated, there would have been no war." Subsequently, Howard was superintendent of the United States Military Academy at West Point in 1881–82. He retired from the United States Army in 1894 with the rank of major general.
[edit]Howard University
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http://louis1j1sheehan.blog.ca/2007/10/26/louis_j_sheehan_102607~3200211
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http://www.amazon.com/Louis-J-Sheehan-Various/lm/R345SZ2TQ7J5Q4
General Howard is also remembered for playing a role in founding Howard University, which was incorporated by Congress in 1867. The school is nonsectarian and is open to both sexes without regard to race. As commissioner of the Freedmen's Bureau, Howard was known for promoting the welfare and education of former slaves, freedmen, and war refugees. On November 20, 1866, ten members, including Howard, of various socially concerned groups of the time met in Washington, D.C., to discuss plans for a theological seminary to train colored ministers. Interest was sufficient, however, in creating an educational institute for areas other than the ministry. The result was the Howard Normal and Theological Institute for the Education of Preachers and Teachers. On January 8, 1867, the Board of Trustees voted to change the name of the institution to Howard University. Howard served as president from 1869 to 1874. He also founded Lincoln Memorial University in Harrogate, Tennessee, in 1895, for the education of the "mountain whites."
[edit]Death and memorialization
Oliver Howard died in Burlington, Vermont, and is buried there in Lake View Cemetery.
A bust of Howard designed by artist James E. Kelly is on display at Howard University. An impressive equestrian statue is on East Cemetery Hill on the Gettysburg Battlefield. A dormitory at Bowdoin College is named for Howard.
The Oliver O. Howard Relief Corps of the Grand Army of the Republic provided funds to help destitute former Union soldiers and to support worthy public causes. It contributed money and the design for the State Flag of Utah in 1922
[edit]Howard University
http://web.mac.com/lousheehan
http://myhappyblog.com/index.php?do=/public/user/name_Louis-J-Sheehan/
http://www.aeonity.com/livic
http://louis1j1sheehan.blog.ca/2007/10/26/louis_j_sheehan_102607~3200211
http://amazon.com/gp/pdp/profile/ADL7G4A6Z0F0
http://www.amazon.com/Louis-J-Sheehan-Various/lm/R345SZ2TQ7J5Q4
General Howard is also remembered for playing a role in founding Howard University, which was incorporated by Congress in 1867. The school is nonsectarian and is open to both sexes without regard to race. As commissioner of the Freedmen's Bureau, Howard was known for promoting the welfare and education of former slaves, freedmen, and war refugees. On November 20, 1866, ten members, including Howard, of various socially concerned groups of the time met in Washington, D.C., to discuss plans for a theological seminary to train colored ministers. Interest was sufficient, however, in creating an educational institute for areas other than the ministry. The result was the Howard Normal and Theological Institute for the Education of Preachers and Teachers. On January 8, 1867, the Board of Trustees voted to change the name of the institution to Howard University. Howard served as president from 1869 to 1874. He also founded Lincoln Memorial University in Harrogate, Tennessee, in 1895, for the education of the "mountain whites."
[edit]Death and memorialization
Oliver Howard died in Burlington, Vermont, and is buried there in Lake View Cemetery.
A bust of Howard designed by artist James E. Kelly is on display at Howard University. An impressive equestrian statue is on East Cemetery Hill on the Gettysburg Battlefield. A dormitory at Bowdoin College is named for Howard.
The Oliver O. Howard Relief Corps of the Grand Army of the Republic provided funds to help destitute former Union soldiers and to support worthy public causes. It contributed money and the design for the State Flag of Utah in 1922
Louis J Sheehan 110907.108
Howard was appointed colonel of the 3rd Maine Infantry regiment and temporarily commanded a brigade at the First Battle of Bull Run. He was promoted to brigadier general effective September 3, 1861, and given permanent command of his brigade. He then joined Maj. Gen. George B. McClellan's Army of the Potomac for the Peninsula Campaign.
On June 1, 1862, while commanding a Union brigade in the Fair Oaks, Howard was wounded twice in his right arm, which was subsequently amputated. (He was awarded the Medal of Honor in 1893 for his heroism at Fair Oaks.) Brig. Gen. Philip Kearny, who had lost his left arm, visited Howard and joked that they would be able to shop for gloves together. Howard recovered quickly enough to rejoin the army for the Battle of Antietam, in which he rose to division command in the II Corps. He was promoted to major general in November 1862 and assumed command of the XI Corps the following April. In that role, he replaced Maj. Gen. Franz Sigel. Since the corps was composed largely of German immigrants, many of whom spoke no English, the soldiers were resentful of their new leader and openly called for Sigel's reinstatement.
At the Battle of Chancellorsville, Howard suffered the first of two significant military setbacks. On May 2, 1863, his corps was on the right flank of the Union line, northwest of the crossroads of Chancellorsville. Robert E. Lee and Lt. Gen. Thomas J. "Stonewall" Jackson created an audacious plan in which Jackson's entire corps would march secretly around the Union flank and attack it. Howard was warned by Maj. Gen. Joseph Hooker, now commanding the Army of the Potomac, that his flank was "in the air", not anchored by a natural obstacle, such as a river, and that Confederate forces might be on the move in his direction. Howard failed to heed the warning and Jackson struck before dark, routing the XI Corps and causing a serious disruption to the Union plan.
Monument to General Howard in Gettysburg, Pennsylvania
At the Battle of Gettysburg, the XI Corps, still chastened by its humiliation in May, arrived on the field in the afternoon of July 1, 1863. Poor positioning of the defensive line by one of Howard's subordinate division commanders, Brig. Gen. Francis C. Barlow, was exploited by the Confederate Corps of Lt. Gen. Richard S. Ewell and once again the XI Corps was routed, forcing it to retreat through the streets of Gettysburg, leaving many prisoners behind. On Cemetery Hill, south of town, Howard quarreled with Maj. Gen. Winfield S. Hancock about who was in command of the defense. Hancock had been sent by Maj. Gen. George G. Meade with written orders to take command, but Howard insisted that he was the ranking general present. Eventually he relented. He started circulating the story that his corps' failure had actually been triggered by the collapse of Maj. Gen. Abner Doubleday's I Corps to the west, but this excuse was never accepted at the time or by history—the reverse was actually true—and the reputation of the XI Corps was ruined. Howard should get some credit for the eventual success at Gettysburg because he wisely stationed one of his divisions (Maj. Gen. Adolph von Steinwehr) on Cemetery Hill as a reserve and critical backup defensive line. For the remainder of the three-day battle, the corps remained on the defensive around Cemetery Hill, withstanding assaults by Maj. Gen. Jubal Early on July 2 and participating at the margin of the defense against Pickett's Charge on July 3.
Howard and his corps were transferred to the Western Theater to become part of the Army of the Cumberland in Tennessee. In the Battle of Chattanooga, the corps joined the impulsive assault that captured Missionary Ridge and forced the retreat of Gen. Braxton Bragg. In July 1864, following the death of Maj. Gen. James B. McPherson, Howard became commander of the Army of the Tennessee, fought in the Atlanta Campaign, and led the right wing of Maj. Gen. William Tecumseh Sherman's famous March to the Sea, through Georgia and then the Carolinas.
On June 1, 1862, while commanding a Union brigade in the Fair Oaks, Howard was wounded twice in his right arm, which was subsequently amputated. (He was awarded the Medal of Honor in 1893 for his heroism at Fair Oaks.) Brig. Gen. Philip Kearny, who had lost his left arm, visited Howard and joked that they would be able to shop for gloves together. Howard recovered quickly enough to rejoin the army for the Battle of Antietam, in which he rose to division command in the II Corps. He was promoted to major general in November 1862 and assumed command of the XI Corps the following April. In that role, he replaced Maj. Gen. Franz Sigel. Since the corps was composed largely of German immigrants, many of whom spoke no English, the soldiers were resentful of their new leader and openly called for Sigel's reinstatement.
At the Battle of Chancellorsville, Howard suffered the first of two significant military setbacks. On May 2, 1863, his corps was on the right flank of the Union line, northwest of the crossroads of Chancellorsville. Robert E. Lee and Lt. Gen. Thomas J. "Stonewall" Jackson created an audacious plan in which Jackson's entire corps would march secretly around the Union flank and attack it. Howard was warned by Maj. Gen. Joseph Hooker, now commanding the Army of the Potomac, that his flank was "in the air", not anchored by a natural obstacle, such as a river, and that Confederate forces might be on the move in his direction. Howard failed to heed the warning and Jackson struck before dark, routing the XI Corps and causing a serious disruption to the Union plan.
Monument to General Howard in Gettysburg, Pennsylvania
At the Battle of Gettysburg, the XI Corps, still chastened by its humiliation in May, arrived on the field in the afternoon of July 1, 1863. Poor positioning of the defensive line by one of Howard's subordinate division commanders, Brig. Gen. Francis C. Barlow, was exploited by the Confederate Corps of Lt. Gen. Richard S. Ewell and once again the XI Corps was routed, forcing it to retreat through the streets of Gettysburg, leaving many prisoners behind. On Cemetery Hill, south of town, Howard quarreled with Maj. Gen. Winfield S. Hancock about who was in command of the defense. Hancock had been sent by Maj. Gen. George G. Meade with written orders to take command, but Howard insisted that he was the ranking general present. Eventually he relented. He started circulating the story that his corps' failure had actually been triggered by the collapse of Maj. Gen. Abner Doubleday's I Corps to the west, but this excuse was never accepted at the time or by history—the reverse was actually true—and the reputation of the XI Corps was ruined. Howard should get some credit for the eventual success at Gettysburg because he wisely stationed one of his divisions (Maj. Gen. Adolph von Steinwehr) on Cemetery Hill as a reserve and critical backup defensive line. For the remainder of the three-day battle, the corps remained on the defensive around Cemetery Hill, withstanding assaults by Maj. Gen. Jubal Early on July 2 and participating at the margin of the defense against Pickett's Charge on July 3.
Howard and his corps were transferred to the Western Theater to become part of the Army of the Cumberland in Tennessee. In the Battle of Chattanooga, the corps joined the impulsive assault that captured Missionary Ridge and forced the retreat of Gen. Braxton Bragg. In July 1864, following the death of Maj. Gen. James B. McPherson, Howard became commander of the Army of the Tennessee, fought in the Atlanta Campaign, and led the right wing of Maj. Gen. William Tecumseh Sherman's famous March to the Sea, through Georgia and then the Carolinas.
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