16 hours ago
WASHINGTON (AFP) — US senators on Wednesday grilled Veterans Affairs Administration (VA) officials over an email that urged staff to make fewer diagnoses of post-traumatic stress disorder (PTSD) and branded troubled soldiers seeking help as "compensation-seekers."
"Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out," read the electronic message, signed by mental health specialist Norma Perez.
The e-mail, was sent in March to staff at the VA medical center in
AFP was shown a copy of the e-mail.
"Additionally, we really don't have the time to do the extensive testing that should be done to determine PTSD," read the message.
Senator Patty Murray told a hearing of the Senate Veterans' Affairs committee that the email was "a sad reminder that this administration's attempt to hide the true cost of war has begun to affect the way VA employees view their work."
The VA "should be adding to services for our weary, traumatized veterans,"
not seeking to cut back,
Perez said the aim of her email was to urge staff to be "more sensitive to what the veterans are going through," but did not explain how the email was intended to achieve that.
Other VA officials praised the veterans' agency in their testimony, and highlighted the enormous workload that is weighing the office down as PTSD claims snowball.
The number of
Two-thirds were veterans of the Vietnam war, which ended in 1975, while the
second biggest group were 37,460 veterans of the ongoing war in
Michael Kussman, the VA under secretary for health, extolled what he said was the agency's excellent mental health care, and said Perez's email had been "taken out of context."
But the senators slammed the VA officials for not taking the "invisible" mental injuries of war as seriously as the obvious physical ones, and for "treating veterans in a cavalier manner."
"We need recognition from the VA that 'invisible' injuries are wreaking havoc
on our soldiers and their families," said Senator Bernie Sanders of
"Men and women see their lives fall apart when they come back home from this complex war and don't receive the care they deserve. We need the culture of the VA to change," he said.
Committee chair Daniel Akaka condemned the staggering numbers of soldiers returning from war with invisible wounds.
"With so many troops returning from multiple tours with various mental health issues, VA must have the credibility, resources and commitment to ensure that veterans are properly treated and compensated," Akaka said.
According to a study released in April by the RAND Corporation, about 300,000
of the 1.6 million
The study estimated the cost of treating soldiers diagnosed with PTSD or depression in the first two years following their return from war at up to 6.2 billion dollars.
The Pentagon last month issued data showing diagnoses of PTSD among troops
who served in
On Wednesday, the Pentagon said it was recruiting government public health workers to offset a shortage in mental health care providers for troops returning from war with mental problems.
By Chris Roberts / For the Sun-News
Article Launched: 06/04/2008 07:05:24 AM MDT
Director Bruce E. Stewart has
decided to retire after 34 years of service to the VA, spokesman Ray Horn said.
Stewart's decision to retire comes
soon after the
In April, the El Paso Times
reported in a copyright story that the local VA system had fared poorly in the
survey in patient care, outreach, technology and distribution of medical
equipment and supplies. It also reportedly was having problems with staff
morale, which apparently resulted in threats of "mass resignations."
At the time, Stewart said the El Paso VA was
not providing the level of customer service it should, but that, in some cases,
the way local administrators answered survey questions gave the wrong
impression. Stewart's defenders said he inherited some of the problems, and
Stewart noted that a recent infusion of money was allowing him to hire staff,
which was expected to improve the system's responsiveness.
U.S. Reps. Silvestre Reyes,
D-Texas, and Bob Filner, D-Calif., chairman of the House Committee on Veterans
Affairs, visited the facility in April. Filner said the
Reyes said that a 1.9 percent
decline in visits from 2006 to 2007 indicated that some veterans were giving up.
However, during a visit to the facility late last month, VA Secretary James
Peake said there already were improvements after the hiring of 40 new staff
members.
"The departure of Director Stewart
is not a surprising development for
Reyes said he was "encouraged" by
recent actions taken but "will continue to press for improvements."
"When I needed to talk to him
(Stewart), he was there," retired Lt. Col. John McKinney, an
"He's had his hands full,"
An interim director will be
appointed by the director of the VA network, which includes
Chris Roberts reports for the El
Paso Times, a member of the Texas-New Mexico Newspapers Partnership, and may be
reached at chrisr@elpasotimes.com;546-6136.
By ANDREW TAYLOR – 18 hours ago
WASHINGTON (AP) — After promising to veto a huge
The White House is signaling that President Bush could sign the hotly contested and long overdue war funding bill if the benefit transferability provision is added to the 10-year, $52 billion improvement to GI Bill college benefits proposed by Democrats and many Republicans.
"It's like the Yogi Berra story: 'I don't like that restaurant. Besides, the portions aren't large enough,'" House Speaker Nancy Pelosi, D-Calif., said in an interview. "They don't like it, but they want more."
"It's not a bad idea," Pelosi added. "It just costs money."
A Democratic leadership aide, who was granted anonymity in order to speak freely, said Democrats were unlikely to yield to the White House demands.
"There is a great deal of reluctance to increase the cost of the bill to accommodate the president when he is otherwise complaining that we're spending too much," the aide said.
The imbroglio over the GI Bill is the biggest remaining hurdle to getting Bush's pending $178 billion war funding requests enacted. He has vowed to veto any measure exceeding his request, but the new veterans program is extraordinarily popular, and a veto might be difficult to sustain. That's one reason why White House representatives are trying to negotiate a compromise.
Democratic leaders are likely to dump most other domestic add-ons opposed by Bush, despite a sweeping vote in the Senate last month to add significant new domestic spending to the measure.
In addition, House Democratic leaders are to drop efforts to extend unemployment benefits, House Majority Leader Steny Hoyer, D-Md., said Wednesday.
Under an unusual procedural setup, it's up to the House to vote next on the war funding bill, while also significantly scaling back a companion package of additional spending passed by the Senate last month.
In addition to the GI Bill benefits and an extension of unemployment insurance, the Senate added more than $10 billion for various other domestic programs, including heating subsidies for the poor, wildfire fighting, road and bridge repair, and health research. The Senate vote was a surprising 75-22, but the result dismayed House leaders, who are seeking to give Bush a bill he will sign.
The addition sought by Bush could cost $2 billion a year, or $20 billion to
$25 billion over a decade, assuming the right to transfer benefits to family
members involves the more generous benefits proposed by Democrats. The
Democratic GI Bill, sponsored by Sen. Jim Webb, D-Va., is aimed at guaranteeing
returning
A senior White House official said Wednesday that adding Bush's benefits transfer plan to the GI Bill provision wouldn't guarantee a presidential signature, but that it could prove to be an important element to reaching an agreement.
The two sides also are wrangling over a plan in both the House and Senate bills that would block new Bush administration rules designed to cut spending on Medicaid health care for the poor and disabled by $13 billion over the next five years.
Meanwhile, moderate to conservative Democrats continue to worry that the new veterans' benefits package will pass in violation of pay-as-you-go rules that are supposed to require that new federal benefits programs are "paid for" with new revenues or spending cuts elsewhere in the budget.
Last month, House Democrats used a one-half of a percentage point increase in tax rates on wealthy taxpayers to finance the new benefits, but the Senate rejected the idea.
http://www.lasvegassun.com/blogs/early-line/2008/jun/04/vets-health-bill-passes-senate/By
Lisa Mascaro · June 4, 2008 · 7:16
PM
The Veterans' Mental Health and
Other Care Improvements Act of 2008 would beef up care for vets, including those
returning home from
Like another vets’ bill that
recently passed the
House, the Senate legislation has a provision named after Justin Bailey, a
Marine diagnosed with PTSD who overdosed on a self-administered supply of drugs
given to him at a Veterans Affairs facility in
Sen. Daniel Akaka of
Nevada Republican Sen. John
Ensign, who signed onto the bill as a co-sponsor, issued a statement saying he
was “grateful for the work done by Justin’s parents, Tony and Mary Kaye, on
behalf of this bill.”
Ensign said, “The story of
Justin Bailey has stayed with me since I first heard of his death. As a Marine,
he served both his family and his country proudly. However, our country, in many
ways, failed to protect Justin and other veterans upon their return home from
active duty.”
Both bills must still be
approved by the other chamber before being sent to the president.
http://www.govhealthit.com/blogs/ghitnotebook/350388-1.html
Undivided attention
By Peter Buxbaum
The Defense and Veterans Affairs departments often seem like
branches of the same family: They resemble each other but have enough distance —
and differences — between them to make harmony elusive.
To overcome the frustrations of their respective members, who must
navigate two different systems, the departments have attempted a number of
projects to unite their operations. For example, they are working on seamlessly
exchanging data between their information systems, and they operate several
combined medical facilities dubbed joint ventures.
But what the two departments are attempting at the North Chicago VA
Medical Center goes beyond any previous attempt at joint operations. In this
case, DOD and VA are merging two large facilities to create a single
organization for the treatment of service members and veterans. At least, that’s
the idea.
“Unlike other joint-venture sites, this is intended to be a real,
no-kidding, integrated facility,” said Howard Green, VA’s program leader of the
project. “This concept means that a sailor may see a Navy doctor in the morning
and a VA doctor in the afternoon. The integration is opaque, so that there are
no business organizational boundaries as far as the patient is concerned.”
The business implications are enormous and include complex
organizational, technological and legal challenges. In terms of information
technology, officials aim to operate a single electronic medical record (EMR)
system and integrate big service enterprises such as human resources and
finance.
DOD and VA officials have been discussing those topics for years,
but a final vision has yet to emerge. One official said congressional action
might be necessary to help smooth the way. However, the merged facility is
scheduled to be fully operational in 2010, which is the blink of an eye in chief
information officer years.
Aims and origins Like many private-sector mergers, the impetus for
the VA/DOD venture was the opportunity for old-fashioned cost savings. The Naval
Health Clinic, Great Lakes — a 450,000-square-foot, 850-bed facility dedicated
in 1960 — was becoming obsolete and needed to be replaced or revamped.
Meanwhile, VA’s
The kicker was that the facilities are only a mile apart.
Navy officials agreed to foot the bill for expanding the VA
facility, allowing DOD to save the $8 million it would have cost to rehabilitate
the old Navy hospital.
Meanwhile, planners estimate the federal government will save about
$4 million a year in operating expenses for the combined facility. It will have
an annual budget of about $250 million and serve a regional population of about
140,000 sailors and veterans.
DOD officials see the
“We expect to learn a great deal from the experience of
integration,” said Steve Jones, principal deputy assistant secretary of Defense
for health affairs.
But the most important lessons are likely to come from jointly
managing the facility once the technical issues are resolved. “There is an
integrated chain of command that constitutes a ground-level governance structure
for IT to support the facility,” said Dr. Paul Tibbits, deputy CIO at VA’s
Office of Enterprise Development.
VA and DOD have a strategic plan for implementing the integration,
officials say, but they are still determining the details.
“We have a joint strategic plan, and an operational IT plan is
presently being developed,” Jones said.
Working groups are drafting recommendations in areas such as
continuity of care, case management, human resources, medical records an d
benefits administration. A joint executive committee will make the final
decisions.
Two systems, one screen Operating an integrated facility is
pointless if health care workers have to access medical records from the
separate EMR systems the departments run: DOD’s AHLTA and VA’s Veterans Health
Information Systems and Technology Architecture. Therefore, the developers’
vision is to make the two systems operate seamlessly.
“We want doctors and other providers to click on one screen to go
to both systems,” Jones said.
“The system must behave as if the patient has a single medical
record,” Tibbits said. “The physical [representation] can be any number of
things, and the technical issues and engineering factors need to be addressed,
but it all must behave like a single logical record.”
To make that happen, the
“We do not anticipate using a single system,” Green said. Instead,
the center will build on the DOD/VA medical record integration efforts already
under way by using tools such as the Bidirectional Health Information Exchange
and the Clinical Data Repository/Health Data Repository.
BHIE permits VA and DOD clinicians to view health care data from
each other’s systems on a read-only basis. CHDR allows DOD and VA systems to
share certain computable data, including prescription, drug allergy and
laboratory information.
“We hope to be able to expand capabilities to write to medical
records, based on credentials,” said Ken Cox, director of the DOD/VA Program
Coordination Office.
Officials must also choose financial management and human resources
systems for the center. “The facility already uses the VA financial management
system,” Tibbits said. “The system is designed to provide financial reporting
for [VA]. There will have to be some adaptations done to the system in order to
align it with whatever the Navy expects from the system.”
On the human resources front, he said, the facility’s executive
committee is leaning toward using the VA’s system — with some adjustments. “The
rules and regulations as far as staffing are still being worked out,” he said.
“Both sides have issues as far as credentialing providers,” Green
said. “The credentialing criteria for both departments must be recognized by
whichever system is adopted.”
However, nonmedical civil service workers, such as hospital
administrators, will remain employees of their respective departments.
“The question is how these employees are going to be handled and on
whose rolls they will be carried,” Green said. “We have not heard the final
outcome as to whether they will be carried separately or whether the payroll
will be combined in some sort of way.”
Picking complementary parts As far as EMR applications are
concerned, the plan is to use components of both departments’ systems, Green
said.
“For example, VA doesn’t have a system for managing the
immunization records of new sailors,” he said. “We would expect to be using the
Navy’s system in that kind of case. There may be cases where a veteran is being
treated and the provider would need to access past history. In other situations,
the treatment may be unique to the VA, and under that circumstance, the provider
would only need to access the VA system. The point would be to deliver
information as needed without regard to the tool used to record it.”
Both organizations are coming to the integrated center with
established IT infrastructures. For Green, the best solution involves combining
the two through a trusted partnershi that would allow the systems to
interoperate by building in the information protection conditions of both.
“You may have two systems running in the background but a single
and unified appearance in the foreground,” he said. “Assuming that this issue is
addressed before the opening of the facility, this could be accomplished with a
Web solution that provides a single graphical user interface.”
Cox said he believes the IT infrastructures will eventually be
incorporated into a single seamless environment. “We expect to get the proper
guidance soon from DOD and VA,” he said. “Technology is not the limiting factor.
It is strictly a policy and guidance issue.”
“There are other nuances as well, such as who will own the
equipment,” Green said. “That is another issue that we are working on.”
Jones said the joint executive committee and the working groups are
still deliberating on several major issues. “They are weighing the pros and cons
of the various options,” he said. “By the time 2010 comes around, we will have
all of them worked out.”
But Green added, “We really don’t have a lot of time left.”
Michael Victorian
American Federation of Government Employees
Communications Specialist
202.639.6405 (p)
202.639.6441 (f)
