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Thu

14

Aug

2008

Army Vet's Suicide Raises Questions About VA's Treatment of PTSD Cases
Thursday, 14 August 2008 03:21
by Jason Leopold

The tragic death earlier this month of a 26-year-old Navy veteran who hung himself with an electrical cord while under the care of a Spokane, Washington Veterans Administration hospital depression underscores what veterans advocacy groups say is evidence of an epidemic of suicides due failures by the VA to identify and treat war veterans afflicted with severe mental health problems.

Lucas Senescall, who suffered from severe depression, was the sixth veteran who committed suicide this year after seeking treatment at the Spokane VA, according to a report published last weekend in the Spokesman Review.

Senescall’s father said his son was “begging for help and [the VA] kicked him to the curb,” according to the July 20 report in the Spokesman Review.

On Tuesday, Sen. Patty Murray, D-Wa, addressed the increasing number of war veterans who are committing suicide, specifically pointing out the death of Lucas Senescall, during a speech on the Senate floor.

“More than five years [after the start of the Iraq war], we should have the resources in place to treat the psychological wounds of war as well as we do the physical ones. But we don’t,” Murray said. “When someone with a history of depression, PTSD, or other psychological wounds walks into the VA and says they are suicidal, it should set off alarm bells We can’t convince veterans or service members to get care if they think they will be met with lectures and closed doors. That is unacceptable. At the very least, we must ensure that staff at military and VA medical centers have the training to recognize and treat someone who is in real distress.

“Time and again, it has taken leaks and scandals to get the Administration to own up to major problems at the VA – from inadequate budgets to rising suicide rates. And its response to rising costs has been to underfund research and cut off services to some veterans. Service members and veterans need more than an 800 number to call,” Murray said.

Paul Sullivan, the executive director of the advocacy group Veterans for Common Sense, agreed.

“The facts show VA lacks consistent and complete policies and oversight on the subject of suicide, as VA leaders confirmed during the trial in the lawsuit veterans brought against VA.”

Sullivan added that the actual number of veterans who have committed suicide is unknown “because VA failed to start collecting national suicide data until after we filed our lawsuit.”

“We called this willful negligence, or “Don’t Look, Don’t Find,” Sullivan said. “If VA looked determined if there was a suicide problem, and if VA found there was a suicide problem, then VA would be forced to address the suicide problem. VCS believes that Congress should order VA to collect robust suicide data so that VA doesn’t change their mind or somehow lose the data.”

Sullivan said the Democratic-controlled Congress began to address veterans’ mental health issues in 2007 with the passage of the Joshua Omvig suicide bill as well the Dignity for Wounded Warriors bill, a new law extending free VA healthcare for up to five years for returning Iraq and Afghanistan war veterans. Omvig was a 22-year-old Army veteran who suffered from PTSD and committed suicide in 2005.

And while Sullivan, an Army veteran and former project manager at the VA, applauds Murray for raising awareness about the issue, he said veterans’ suicides have already reached “epidemic” proportions.

“There is an epidemic of suicides among our veterans, especially our younger veterans,” Sullivan said. “The evidence of this was presented by the CBS Evening News and the University of Georgia in their November 2007 report indicating veterans are twice as likely to complete a suicide than non-veterans. Even worse, and an ominous indicator of the severity of the Iraq and Afghanistan wars on the minds of our veterans, younger veterans, aged 18 to 24, are between three and four times more likely to complete a suicide than non-veterans of the same age. Veterans are screened for pre-existing conditions before entering the military, and their suicide rate should be lower, not higher.”

Last year, Veterans for Common Sense and Veterans United for Truth, filed a lawsuit against the VA alleging some war veterans were turned away from VA hospitals after they sought care for post traumatic stress disorder (PTSD) and later committed suicide. PTSD is a psychiatric disorder that can develop in a person who witnesses, or is confronted with, a traumatic event. Mental health experts have described PTSD as an event of overwhelming magnitude in which a victim's nervous system is afflicted with intense fear, helplessness and horror. The victim shuts down only to re-experience the traumatic event over and over again. Studies have shown that PTSD is the most prevalent mental disorder arising from combat.

The veterans groups had asked a federal judge in San Francisco to issue a preliminary injunction force the VA to immediately treat war veterans who showed signs of or were already suffering from PTSD. In addition, they wanted a federal judge to force the VA to overhaul its internal systems that handle benefits claims and medical services.

But U.S District Court Judge Samuel Conti ruled last month that he lacked the legal authority to implement those measures. But in an 82-page ruling he said it was “clear to the court” that “the VA may not be meeting all of the needs of the nation’s veterans.”

Conti wrote that the veterans groups should get “Congress, the Secretary of the Department of Veterans Affairs, the adjudication system within the VA, and the Federal Circuit” to address the matter.

Sullivan said his group plans to appeal the ruling.

The VA said it has hired more than 3,000 mental healthcare professionals over the past two years to deal with the increasing number of PTSD cases, but the problems persist. In response to the federal lawsuit, the VA set up a suicide prevention hotline. The VA said it has received more than 43,000 calls, 1,000 of which were from veterans who were on the verge of suicide and were rescued. But a VA spokesman said the agency would not provide additional data about the number of veterans being treated for mental health issues or the number of veterans who committed suicide while under VA care.

But Sullivan said the “VA remains mired in crisis, as shown by VA’s refusal to provide care to Lucas Senescall, Jonathan Schulze, and Jeffrey Lucey,” Sullivan said, referring to two other war veterans who were allegedly denied care at VA hospitals and committed suicide.

“If there is not substantial improvement soon at VA, such as reducing waiting times for treatment and disability benefits as well as immediate care for mental health emergencies, then the crisis will continue to deteriorate further,” Sullivan said. “The ultimate person responsible is President George W. Bush. He had no plan to occupy Iraq for five years other than to escalate the violence, and no plan to care for our veterans other than to conceal the casualties. Now our veterans are returning home, and we must act where President Bush and his incompetent political appointees failed”

The issues surrounding the way Iraq war veterans have been treated when seeking help for PTSD at veterans hospitals nationwide came under scrutiny during the federal trial against the VA last month. At the time, an email written by Norma Perez, a psychologist and the coordinator of the VA’s post-traumatic stress disorder clinical team in Temple, Texas, surfaced in which she suggested to the facility’s staff that they diagnose fewer cases of PTSD.

“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,” Perez’s email, titled “Suggestion,” says. “We really don’t or have time to do the extensive testing that should be done to determine PTSD.”

Perez’s email surfaced a month after another top official at the VA sent an explosive electronic communication to a colleague asking him to conceal evidence of widespread veterans suicides.

The Feb. 13. 2008, email, was sent to Ira Katz, the VA’s mental health director by Ev Chasen, the agency’s chief communications director.

Chasen sought guidance from Katz about interview queries from CBS News, which reported extensively on veterans suicides last year.

“Is the fact that we’re stopping [suicides] good news, or is the sheer number bad news? And is this more than we’ve ever seen before? It might be something we drop into a general release about our suicide prevention efforts, which (as you know far better than I) prominently include training employees to recognize the warning signs of suicide,” Chasen wrote Katz in an email titled “Not for CBS News Interview Request.”

Katz’s response is startling. He said the VA has identified nearly 1,000 suicide attempts per month among war veterans treated by the VA. His response to Chasen indicates that he did not want the VA to immediately release any statistical data confirming that number, but rather suggested that the agency quietly slip the information into a news release.

“Shh!” Katz wrote in his response to Chasen. “Our suicide prevention coordinators are identifying about 1000 suicide attempts per month among the veterans we see in our medical facilities. Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?”

The February email was sent shortly after the VA gave CBS News data that showed only a total of 790 attempted suicides in 2007 among veterans treated by the VA. In an email sent to the network Monday after Katz’s email was disclosed in court, he denied a “cover-up” and said he did not disclose the true figures of attempted suicides because he was unsure if it was accurate.

In a December email Katz sent to Brig. Gen. Michael J. Kussman, the undersecretary for health at the Veterans Health Administration within the VA, that roughly 126 veterans of all wars commit suicide per week. He added that data the agency obtained from the Center for Disease Control showed that 20 percent of the suicides in the country are identified as war veterans.

The “VA’s own data demonstrate 4-5 suicides per day among those who receive care from us,” Katz said in the email he sent to Kussman.

The email Perez sent in March was the subject of a hearing in June before the Senate Veterans Affairs Committee, where Perez attempted to explain the context of her note. She said she used a poor choice of words to convey the message to counselors that instead of PTSD diagnosis VA counselors could diagnose veterans with “adjustment disorder,” a less severe condition. The email seems to imply that Perez was interested in saving money for the VA as opposed to providing veterans with an accurate diagnosis.

Perez vehemently denied that cost-cutting measures were behind her suggestions to VA counselor.

“Several veterans expressed to my staff their frustration after receiving a diagnosis of PTSD from a team member … when they had not received that diagnosis during their Compensation and Pension examination,” Perez said in prepared testimony before the Senate Veterans Affairs Committee. “This situation was made all the more confusing and stressful when a team psychiatrist correctly told them they were displaying symptoms of combat stress, but did not meet criteria for the diagnosis of PTSD.”

“In retrospect, I realize I did not adequately convey my message appropriately,” Perez told Senators. But “my only intent was to improve the quality of care our veterans receive.”

Sullivan, the executive director of Veterans for Common Sense, however didn’t buy Perez’s claims of innocence.

“Once again VA’s political appointees were taken to the woodshed by an alert Congress for repeatedly failing our veterans,” Sullivan said in an interview. Veterans for Common Sense “remains disappointed that the VA leaders selected by President Bush lied again to Congress when said that VA has enough resources to assist veterans. During the hearing, the Temple, Texas PTSD director, who is not a political appointee, Dr. Norma Perez, told Congress that veterans were scheduled only for a half-hour psychological assessment for PTSD claims. She said some veterans require a more complete assessment that could take up to three hours. This was a stunning admission that VA lacks the proper number of mental healthcare professionals to accurately and consistently evaluate veterans seeking healthcare and disability benefits for PTSD.”

Sullivan added that incomplete evaluations might be leading to the large number of incorrect diagnoses that veterans have been complaining about. The average waits time for disability benefits is more than six months.

“Right now, VA is treating 325,000 Iraq and Afghanistan war veterans, including 133,000 for mental health problems,” Sullivan said. “There are long waits to see doctors, 25 percent wait more than one month, according to VA’s Inspector General, and even longer waits to receive disability claims the average wait is a staggering six months, according to the Veterans Benefits Administration.”

Sullivan suggested the Department of Defense and the VA jointly work to remove the stigma associated with seeking help for mental health issues.

“We can do this by welcoming home our veterans in our communities, our workplaces, and our religious institutions,” Sullivan said. “We suggest there should be a “Welcome Home Veterans Day,” where communities, employers, and religious groups invite veterans. DoD, VA, and society must have sufficient mental healthcare providers so that professionals are available when service members and veterans do arrive for mental health care. And that means we need better planning and spending for mental healthcare.

“The President should declare a national medical emergency for our military and veterans and then consider a limited military draft focusing on ordering medical professionals into the military and VA to care for our service members and veterans. VA and DoD must streamline records and other paperwork so that the process is not overly cumbersome. And that means tossing VA’s 23-page claim form out the window and replacing it with a one-page form that the veteran complete quickly and be treated faster.”
 
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