Sunday, June 29, 2014

VA 'significant and chronic system failures'

This was the headline
Scathing VA review finds 'significant and chronic system failures'
By Richard Simon
Los Angeles Times
Published: June 28, 2014

WASHINGTON—The VA suffers from “significant and chronic systemic failures” that must be addressed by department leadership, according to a White House report delivered to President Barack Obama on Friday, giving urgency to congressional legislation aimed at reducing veterans’ wait times for health care and holding officials more accountable.

Among the problems cited are a “corrosive culture” that has led to personnel problems within the Department of Veterans Affairs, exacerbated by poor management and a history of retaliation toward employees raising issues.

The report is the latest stinging assessment of the VA, which operates 1,700 hospitals and clinics.
read more here


But to us, we know none of this happened overnight. It began with the failure of politicians to prepare for the wounded two wars would create and manage to care for the veterans from past wars still unable to get the care they needed.

Medically unfit forced to fight
43,000 unfit troops sent to war
More than 43,000 U.S. troops listed as medically unfit for combat in the weeks before their scheduled deployment to Iraq or Afghanistan since 2003 were sent anyway, Pentagon records show.
Most of the nondeployable service members are in the Army, which is doing most of the fighting in Iraq and Afghanistan. Between 5 percent and 7 percent of all active-duty, National Guard and Reserve soldiers slated for combat were found medically unfit due to health problems each year since 2003, according to statistics provided to USA Today.

That was from USA Today in May of 2008. The following month the UK reported they had 10,000 medically unfit forced to fight.
Nearly 40% of Army suicide victims in 2006 and 2007 took psychotropic drugs like Prozac and Zoloft.
That was what was going on in the DOD but in the VA, it was worse as more needed care.
Why might troops be medicating themselves? Well, consider that repeated deployments to the war zones also contribute to the onset of mental-health problems. Nearly 30% of troops on their third deployment suffer from serious mental-health problems, a top Army psychiatrist told Congress in March. The doctor, said that recent research has shown the current 12 months between combat tours “is insufficient time” for soldiers “to reset” and recover from the stress of a combat tour before heading back to war.

The DOD failed the troops first and then the VA failed them as veterans because members of Congress did not pay attention and failed to do their own jobs.
Snapshot of How VA Budget Shortfall is Hurting Veterans’
Prepared by the Democratic staff of the House Veterans’ Affairs Committee
Access to Safe and Timely Care across the Nation

The VA claims that by shifting funds dedicated to replace old equipment and conduct maintenance the department can address its budget shortfall and meet veterans’ demand for timely, high–quality health care. The following snapshots from across the nation reflect the stark reality of the budget shortfall on veterans’ access to safe, high quality care.

The 3 surgical operating rooms at the White River Junction VAMC in Vermont had to be closed on June 27 because the heating, ventilation, and air conditioning system was broken and had not been repaired due to the siphoning of maintenance funds to cover the budget shortfall.

The VAMC in San Antonio could not provide a paraplegic veteran with a special machine to help clean a chronic wound because the facility did not have the equipment dollars.

The VAMC in Lebanon, Pennsylvania, closed its Geriatric Evaluation and Management Unit which does extensive case management to help elderly veterans increase their functioning and remain at home.

The Community Based Outpatient Clinics (CBOCs) needed to meet veterans’ increased demand for care in the North Florida/South Georgia VA Healthcare System have been delayed due to fiscal constraints. The Gainesville facility has made progress in reducing its wait lists, but as of April there were nearly 700 service-connected veterans waiting for more than 30 days for an appointment.

VA Medical Centers in VISN 16, which includes Arkansas, Oklahoma, Mississippi and Louisiana and part of Texas, have stopped scheduling appointments for many veterans who are eligible for care, pending available resources.

Even though the VA Palo Alto, California, Health Care System has used $3 million in capital funds for operating needs, as of March 1 more than 1,000 new patients had to wait more than 30 days for a primary care appointment. A third of these new patients had to wait more than 3 months. More than 5,000 patients had to wait more than 30 days for a specialty care appointment. Roughly 1,400 had to wait more than 3 months.

The replacement of the fire alarm system at the Loma Linda VAMC in California won’t be done this year because the facility is using most of its capital funds to cover operating expenses.

The White River Junction VAMC in Vermont struggling with a $525,000 shortfall in its prosthetics budget.

Because the FY 2005 budget is inadequate, the facility has not been allowed to hire 3 additional mental health care staff and 3 additional Registered Nurses for the ICU. Nurses in the ICU have been forced to work double shifts, which this Committee has found to be an unsafe patient practice.

Even though the San Diego VAMC expects to exceed its goal in medical care cost collections, it will divert $3.5 million of non-recurring maintenance funds to partially cover operating expenses, and has delayed filling 131 vacant positions for 3 months. The facility has a waiting list for patients of 750 veterans.

Because the Iowa City VAMC had to shift maintenance funds and equipment funds to cover a FY 2004 million shortfall of $3.2 million in medical care expenses in FY 2004, the facility is facing severe infrastructure problems and a larger shortfall of $6.8 million in FY 2005 that puts patient care and safety at risk. The facility wanted to spend $950,000 in non-recurring maintenance funds last year to prevent a mechanical failure of the electrical switcher, which would close the facility, but was required to use those funds to cover a budget shortfall in medical care last year. As a result in FY 2005, the VA must divert $1.5 million of medical care funds to maintain the key electrical switchgear for the hospital.

Recently, a motor failed on a hospital bed, which the VA planned to replace but couldn’t because of the shortfall, causing a fire with the patient on the bed. Fortunately the patient was able to get out of the bed safely, but the facility was forced to expend $700,000 of medical care dollars to replace all the beds, which thanks to the diligence of VA staff lasted 7 years beyond their life expectancy. The facility could not use capital funds to replace the very old beds because the money had already been siphoned off to cover medical care.

To bring the shortfall down to $6.2 million the facility has delayed hiring staff for 4 months. The deliberate short staffing of nurses on the psychiatric ward – as a means to correct the budget shortfall -- has forced the VA to cut the beds available for treatment in half.

As a result of cost cutting measures to make up for the shortfall in FY 2005, the Portland, Oregon, VAMC is delaying all non-emergent surgery by at least six months. For example, veterans in need of knee replacement surgery won’t be treated because of the budget shortfall.

Since FY 2002, the Portland VAMC has had to use its equipment and non-recurring maintenance funds to cover medical care expenses. For FY 2005 the facility needed $13 million for medical and clinical equipment but only received $2 million.

The facility is reducing staff as a cost-cutting measure and is now short at least 150 hospital staff, including nurses, physicians, and social workers. As a result of budget cuts for staffing, the VA has cut the number of medical beds available to care for veterans.

Veterans in need of outpatient psychiatric treatment at the Portland facility are on a waiting list because of the budget shortfall.

The Biloxi, Mississippi, VAMC has diverted maintenance dollars to meet operating expenses for the past two years but the facility will not be able to balance its budget without reducing staffing levels at a time when the Gulf Coast Veterans Health Care System has approximately 100 new veterans seeking enrollment each week.

Fifty percent of all the veterans receiving home health care through the San Antonio VAMC will now have to fend for themselves. This cost-cutting measure means that some 250 veterans, including those with spinal cord injuries, will no longer be provided this care.

The VA Connecticut Healthcare System is facing a major budgetary challenge of sending veterans to non-VA facilities for hospitalizations because the VA has a shortage of beds to care for veterans and staff.

Due to the budget shortfall, the VA facility in Bay Pines, Florida, has been forced to put veterans who have a service-connected illness or disability rating of less than 50% on a waiting list for primary care appointments. As of late April, some 7,000 veterans will be waiting longer than 30 days for a primary care appointment.

Can we stop pretending this is new? Unless we do, nothing will ever be fixed for real. They talk about being able to send veterans to outside doctors. That practice was going on in the 90's. When the VA didn't have enough doctors available, they outsourced.

Can All Veterans Enroll in VA Health Care?
Not every veteran is automatically eligible to enroll in VA health care, contrary to numerous claims made concerning “promises” to military personnel and veterans with regard to “free health care for life.”

Eligibility for enrollment in VA health care has evolved over time. Prior to eligibility reform in 1996, all veterans were technically eligible for some care; however, the actual provision of care was based on available resources.

The Veterans’ Health Care Eligibility Reform Act of 1996 (P.L. 104-262) established two eligibility categories and required VHA to manage the provision of hospital care and medical services through an enrollment system based on a system of priorities.6 (See the Appendix for the criteria for the Priority Groups.) P.L. 104-262 authorized the VA to provide all needed hospital care and medical services to veterans with service-connected disabilities; former prisoners of war; veterans exposed to toxic substances and environmental hazards such as Agent Orange; veterans whose attributable income and net worth are not greater than an established “means test”; and veterans of World War I. These veterans are generally known as “higher priority” or “core” veterans. The other category of veterans are those with no service-connected disabilities and with attributable incomes above an established “means test.”

You can read more about this from the link above. I knew about it because in the 90's my husband's claim was tied up for 6 years. He had to have a private doctor evaluate his condition as part of the claims process. They didn't have enough psychiatrists back then either.

Not much has changed and that is the most revolting thing of all.

"They treated me like a crazed criminal" says defiant Major

Major Gant can't understand that bringing his girlfriend to Afghanistan and living with her among the "natives" plus drinking and popping pills, were the wrong things to do.
Green Beret brings girlfriend to Afghanistan, ‘goes native’
New York Post
By Gary Buiso
June 29, 2014


In a remote village in the dangerous northeastern Kunar province of Afghanistan, Army Green Beret Maj. Jim Gant was doing something few others had — he was making progress against the enemy.

To do so, he and his men went native — trading their body armor for traditional Afghan garb, growing long beards, speaking the local Pashto tongue, and forging close alliances with tribesmen, who would come to revere Gant as “Commander Jim.”

But when he went to bed at night, Gant had one thing his men did not — company.

Ann Scott Tyson, a Washington Post war correspondent, quit her job to live secretly with him on the front lines — where he taught her how to shoot an assault rifle for protection. They drank alcohol and made their own rules.

When his commanders got wind of the domestic bliss he carved out for himself in the heart of a war zone, Gant was quietly relieved of his command and pushed to retire in disgrace.

Once nicknamed “Lawrence of Afghanistan” by Gen. David Petraeus, Gant was now more like Col. Walter Kurtz, the Green Beret who goes native — then loony — in the 1979 film “Apocalypse Now.” Gant indulged in a “self-created fantasy world,” his commanders charged.

To this day, Gant remains as defiant as Kurtz.

“They treated me like a crazed criminal instead of who I was,” Gant, 46, tells The Post. “My expectation was only ever that I would be treated honorably, and that just did not happen.”
read more here

Saturday, June 28, 2014

Vietnam Veteran Fired From Florida Cracker Barrel For Compassion

Cracker Barrel allegedly fires Vietnam veteran for giving homeless man a muffin
Joe Koblenzer claims he was let go for giving a man a few condiment packets and a corn muffin.
UPI
By Evan Bleier
June 27, 2014

VENICE, Fla., June 27 (UPI) --A Vietnam veteran claims he was fired from a Florida Cracker Barrel for giving a homeless man some condiment packets and corn muffin.

Joe Koblenzer says he was let go from his host position at the Cracker Barrel restaurant in Venice after he gave the food items to a man who looked like he needed help.

"He looked a little needy. He asked if I had any mayonnaise and some tarter sauce. He said he was going to cook a fish," Koblenzer told WWSB. "I got it for him. As I walked out I put a corn muffin in."
read more here

Outsourced veteran shoddy care left him malnourished

This veteran was outsourced. He suffered because of non-VA doctor. He should sue the doctor.
Malnourished Veteran Pleads For Help From VA
WBKO
By: Kayla Vanover
Jun 27, 2014

BOWLING GREEN, Ky (WBKO) -- An Army veteran, living right here in Bowling Green, is being denied full benefits while suffering from a surgery that he says was performed in error.

Frank Coursey has not eaten solid food in nearly three years. As if this is not enough strain on his body, he goes to bed each night worried about the future of his family, if something were to happen to him.

"This picture is on 07-07-2007. I was 286 pounds. This picture was Father's Day of this year," said Frank Coursey, veteran.

Frank Coursey is currently 133 pounds, losing on average five pounds per week. His weight loss is the result of a gastric bypass surgery performed by a doctor in West Virginia, whom he was referred to by a his local VA physician.

Coursey says immediately following his surgery, he knew something did not feel right.

"Dr. Canterbury was there with about eight or nine students discussing the operations of the job and all that. I remember him looking at me and saying this is the worst case scenario of this surgery that we've had," said Frank Coursey, veteran.
read more here

Police unions seek recognition of PTSD as workplace illness

Post traumatic stress support group born from death of Hamilton police officer
Police unions seek recognition of PTSD as workplace illness
Hamilton Spectator
By Bill Dunphy
June 27, 2014

For the past five weeks a very small, self-selected group of Hamilton police officers has been gathering in secret to share experiences of debilitating pain, fear, isolation and withdrawal.

The officers are suffering from post traumatic stress disorder (PTSD) and for once, and finally, they're talking about it — getting help and helping each other.

It is perhaps fitting, that the Hamilton Employees Lifeline Peer Network (HELP-Net) should rise from a community shocked and torn by the very public death by suicide of Staff Sergeant Ian Matthews last December in the locker-room at police headquarters.

"It was never meant to memorialize or condone what Ian did, but to use it as a catalyst," Sergeant Helena Pereira explained, pointing out she doesn't even know if the popular detective had been suffering from PTSD.

The peer group — which is being supervised by mental health professionals from the Homewood Health Centre — is being funded by the Blarney Run, an annual fundraising effort by Matthews' friends and family that is meant to memorialize Matthews.

Pereira said Matthews's death and the public reactions seem to have helped crack open the traditionally closed police subculture, giving officers permission to come forward and admit their struggles.

"Police are so tight-lipped," Pereira said. "You have to be so calm. It all has to stay inside. You don't want to show any emotion. There's a stigma around asking for help."

But in the aftermath of that December death, many officers did just that — showed their emotion, admitted seeking and needing help.
read more here

'Corrosive culture' fueled by Congress hurt the VA

Two northwest Wisconsin VA clinics close over funding problems. VA is looking into several primary care options for more than 900 veterans who've been using the Hayward and Rice Lake clinics.

Heussner says Corporate Health and Wellness, the company under contract to run the clinics, was having difficulty meeting its financial obligations. But he says the company had never threaten to close down the clinics.

That was reported by Minnesota Public Radio in 2007.
'Corrosive culture,' weak leadership cripple VA, report says
CNN
By Ralph Ellis and John Crawley
Fri June 27, 2014

STORY HIGHLIGHTS
Report on VA medical system stems from allegations of shortcomings
It cites "significant and chronic systemic failures"

Report on builds on alarming revelations over past several months

Report was conducted by Obama administration aide who assessed VA shortcomings

(CNN) -- The Veterans Affairs health care system needs to be overhauled because of unresponsive leadership and a "corrosive culture" that affects the delivery of medical care, said a report delivered Friday to President Barack Obama.

"It is clear that there are significant and chronic systemic failures that must be addressed by the leadership at VA," said the report prepared by Rob Nabors, who is Obama's deputy chief of staff and who the President dispatched to assess the situation at the troubled agency.

The VA, a massive bureaucracy with more than 300,000 full-time employees, is under fire over allegations of alarming shortcomings at its medical facilities. The controversy, as CNN first reported, involves delayed care with potentially fatal consequences in possibly dozens of cases.

Nabors and acting VA Secretary Sloan Gibson met with Obama to discuss the findings.
read more here


Congress and veterans committing suicide not a topic from last year or a few years ago. This report was from 2007.
The hearing was prompted in part by a CBS news story in November on suicides in the veteran population that put last year’s number of veteran suicides at over 6,000. VA officials refuted that number, questioning its validity. But a VA Inspector General report released in May of 2007 found that as many as 5,000 veterans commit suicide a year—nearly 1,000 of whom are receiving VA care at the time.

Yet here we are with worse conditions for veterans and Congress will accept no responsibility of any of it. More veterans sought VA care after these old reports but the truth is, congress never intended to increase staffing to meet the rise in need.

PTSD Veteran "My shame was being alive"

Veteran Who Lost a Friend in Combat on Overcoming PTSD: "My Shame Was Being Alive"
Huffington Post
George Decker
Public Affairs Officer, VA National Center for PTSD’s Executive Division
Vicky Bippart
Producer/Director, VA National Center for PTSD
Posted: 06/27/2014

"When I get remembered, it will not have been for busting up a bar fight or even kicking in doors in Fallujah. It'll be for choosing the right path when it could have been so much easier to go down the wrong path, to let myself get bogged down by feelings of insecurity or anxiety and, ultimately, let it kill me," Laurent Taillefer said recently.

But when Laurent returned home from Iraq, where he served with the Army's 118th Infantry, he was lost in a deep funk. "When I got out, I was so sure that I was going to have a short life that I even found jobs that would create that. The guy I replaced, back when I was a bouncer at a strip club, had been shot. And if I wanted to be honest with myself, I'd say I kind of expected myself to get shot."

Laurent had been injured in Iraq and had seen some horrifying things there, but what had shaken him the most was the death of his close friend, Soto. "My friend had died in Iraq, and I was torn up ... we spent every waking hour together..." he said. "Soto was larger than life. After he died, everything was temporary; everything was so close to the end."

Laurent sought the company of fellow veterans, but hanging out with them didn't help him.
read more here

Friday, June 27, 2014

Combat PTSD and the Soul

Today is PTSD Awareness Day. Really? This is the 4th year yet there doesn't seem to be enough awareness of it. After over 22,000 posts, there doesn't seem to be anything new I can say today. PTSD hasn't changed over generations. So why is it that we are so far from saving more lives after combat?

We watched the numbers go up followed by reports that more than half of the suicides came after they sought out help. Over and over again the "stigma" of PTSD has been given as a reason too many deny they need help, yet the program the military has been pushing contributed to this harmful notion. After all, when the military tells soldiers they can train their brains to be mentally tough, what other thoughts could they have?

The truth is, Combat PTSD hits the soul more than anything else.

Beyond PTSD: Soldiers Have Injured Souls
BY DIANE SILVER
September 01, 2011
What sometimes happens in war may more accurately be called a moral injury — a deep soul wound that pierces a person’s identity, sense of morality and relationship to society. In short, a threat in a solder’s life.

Now that modern militaries accept that war creates psychological trauma, therapists wonder about its toll on the spirit.

The psychological toll taken by war is obvious. For the second year in a row, more active-duty troops committed suicide in 2010 (468) than were killed in combat in Iraq and Afghanistan (462). A 2008 RAND Corporation study reported that nearly 1 in 5 troops who had returned from Iraq and Afghanistan reported symptoms of post-traumatic stress or major depression.

Since the American Psychiatric Association added post-traumatic stress disorder, or PTSD, to its diagnostic manual in 1980, the diagnosis has most often focused on trauma associated with threats to a soldier’s life. Today, however, therapists such as Jonathan Shay, a retired VA psychiatrist and recipient of a MacArthur Foundation “genius” grant; Edward Tick, director of the private group Soldier’s Heart; and Brett Litz, a VA psychologist, argue that this concept is too limited. What sometimes happens in war may more accurately be called a moral injury — a deep soul wound that pierces a person’s identity, sense of morality and relationship to society. In short, a threat in a solder’s life.

“My colleagues and I suspect that the greatest lasting harm is from moral injury,” says Litz, director of the Mental Health Core of the Massachusetts Veterans Epidemiological Research and Information Center. He and six colleagues published an article on the topic in the December 2009 Clinical Psychological Review, in which they define moral injury as a wound that can occur when troops participate in, witness or fall victim to actions that transgress their most deeply held moral beliefs.

While the severity of this kind of wound differs from person to person, moral injury can lead to deep despair.

“They have lost their sense that virtue is even possible,” Shay says. “It corrodes the soul.”

It goes even deeper than that. It is the strength of their soul that causes the deepest wound.

Combat PTSD is different from all other causes. The type of PTSD police officers and firefighters get is close to it because they also risk their lives willingly for the sake of others.

For servicemen and women, it is in their core. That ability to care so much they are willing to die for someone else.
to rise above or go beyond; overpass; exceed: to transcend the limits of thought; kindness transcends courtesy.

Once we understand this, once we finally explain to them why they were afflicted by PTSD, we can being to truly help them heal.

This is what the military and the Congress has failed to understand. They proved they were already resilient when they signed up, survived training, separation from families and friends, sacrificed and we willing to endure deployments they knew could cost them their lives.

It is the ultimate explanation of courage because they care so deeply about the others they serve with, there are no limits to what they are willing to do for their sake.

That strength of their souls comes with a price. The ability to care that much also allows them to grieve so deeply.

Thursday, June 26, 2014

Congress unaccountable for VA failures

The press has a habit of letting people think nothing had ever been reported on before they managed to write a story. This has allowed members of congress to get plenty of coverage complaining about how bad things are for veterans, as if they really care.
Bill to spotlight issues for female veterans
Army Times
By Kelly Kennedy - Staff writer

Sen. Patty Murray, D-Wash., is expected to announce legislation next week aimed at increasing the focus on female veterans at Department of Veterans Affairs facilities.

Since the wars in Iraq and Afghanistan began, Murray has spent many hearings questioning VA officials about female veterans with histories of sexual trauma, whether research has been done to determine their health needs and whether VA hospitals are so focused on men’s health issues that women get left behind.

Though VA officials say they are conducting a survey on women’s experiences at their facilities, as well as offering programs specifically for women, proponents of the proposed bill say it would target areas VA has not addressed. It follows a similar House bill proposed by Stephanie Herseth Sandlin, D-S.D., and Ginny Brown-Waite, R-Fla.

Murray’s bill will ask for:

• Assessment and treatment of women who have suffered sexual trauma in the military.

• More use of evidence-based treatment for women — particularly in areas such as post-traumatic stress disorder, where responses may be different or involve different issues than it does for men.

• A long-term study on gender-specific health issues of female veterans.

“One of the things we started to see early on is that there’s a lot we don’t know,” said Joy Ilem, assistant national legislative director for Disabled American Veterans.

That isn't a headline from today. It is from Saturday Mar 1, 2008 8:11:43 EST
What is the headline today?

Veterans Affairs falls short on female medical issues
Associated Press
June 25, 2014

SAN FRANCISCO — Already pilloried for long wait times for medical appointments, the beleaguered Department of Veterans Affairs has fallen short of another commitment: to attend to the needs of the rising ranks of female veterans returning from Iraq and Afghanistan, many of them of child-bearing age.

Even the head of the VA’s office of women’s health acknowledges that persistent shortcomings remain in caring for the 390,000 female vets seen last year at its hospitals and clinics — despite an investment of more than $1.3 billion since 2008, including the training of hundreds of medical professionals in the fundamentals of treating the female body.

According to an Associated Press review of VA internal documents, inspector general reports and interviews:

Nationwide, nearly one in four VA hospitals does not have a fulltime gynecologist on staff. And about 140 of the 920 community-based clinics serving veterans in rural areas do not have a designated women’s health provider, despite the goal that every clinic would have one.
read more here

Daytona Beach Budget Inn Express Denies Veteran Room Over PTSD Service Dog

Veteran denied motel room in Daytona Beach because he had service dog
WFTV News
June 25, 2014

DAYTONA BEACH, Fla. — A Daytona Beach motel owner who refused to welcome a vacationing veteran and his service dog is now facing a possible misdemeanor charge.

Former Army Sgt. Robert Price has a service dog named Walker. Price suffers from post-traumatic stress disorder and a brain injury after facing bomb attacks for years in the Middle East.

When he went to check in at the Budget Inn Express on Tuesday, he told the desk clerk as a courtesy that he had a service dog and the woman immediately told him that dogs weren’t welcome.

Price said it took time to accept the idea of having a service dog, but now he and Walker are inseparable. He said when they were denied a room at the Budget Inn Express, he started recording the confrontation with his cellphone.

"Because I have a service dog, I can't have a room?" he asked.

"Service dog or whatever. Dog is dog," said motel owner Bina Patel.

Price wasn’t alone on Tuesday as police officers escorted him to the La Quinta, where they not only welcomed him but gave him a very generous discount on his room.
read more here