The VA and Shulkin: “It Shouldn’t Be This Hard to Serve Your Country”

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Dr. David Shulkin has been pushed aside (read fired) as the Secretary of the Department of Veterans Affairs (“the VA”).  Without taking sides in what appears to be yet another partisan issue, Dr. Shulkin did a reasonably good job in bailing water in a sinking ship:  the VA.

David Shulkin

As such, it was with regret that we read Dr. David Shulkin’s self-serving departure editorial in the New York Times “it should not be this hard to serve your country.”   Indeed, many Veterans poorly served by the VA have felt the same.  But these Veterans, with a legitimate claim were rarely afforded space in the editorial section of the New York Times to discuss their grievances.

The title of the New York’s editorial says it all:  “David J. Shulkin:  Privatizing the V.A. Will Hurt Veterans“.   I am not sure that Dr. Shulkin would have titled his departure editorial this way, but clearly, the New York Times, David Shulkin and J. David Fox, the President of the American Federation of Government Employees, agree that privatizing the VA will harm Veterans.

SFTT is unaware of any compelling evidence that providing “privatized” care to Veterans would jeopardize the mission of the VA or add to the difficulties of Veterans.  Indeed, J. David Fox, seems more concerned about the rights of unionized VA employees than he does about Veterans.

While it is easier to frame the discussion as a debate about the merits of public or private healthcare,  SFTT has long argued that the VA is simply Too Big to Succeed.  It never has been a question of “ownership” or “control,”  it is simply a case of an institution that has become too large to manage effectively.  With over 18 million Veterans, it is unlikely that an overwhelming majority would agree that the VA is provides services that are “second to none.”

In fact, Dr. Shulkin claims that “the percent of veterans who have regained trust in V.A. services has risen to 70 percent, from 46 percent four years ago.  This is not exactly a ringing endorsement on how well the VA is fulfilling its mission.

There are many areas of the VA that fulfill President Abraham Lincoln’s promise:  “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans.

But there are other areas in which the VA fell well short of fulfilling President Lincoln’s promise.

Specifically, SFTT has for years called into question the way the VA has treated Veterans with PTSD and TBI:  “the silent wounds of war.”  There is compelling evidence that the VA, through its administrators, has consistently lied to Veterans, their caregivers, Congress and the public on the effectiveness of treating Veterans with brain injury.

More to the point, the VA medical staff has been grossly negligent in providing Veterans with opioids to treat the symptoms of PTSD and TBI rather than offer any real treatment.  Was the VA complicit in fueling the opioid epidemic?

Political posturing on the benefits of public or private ownership doesn’t really help the hundreds of thousands of Veterans suffering from brain injury and their largely forgotten caregivers.

Changing of the guard will do little to fix the VA.  Only a true bipartisan effort to address the problems of the VA will help restore confidence in an institution with far greater promise than the actual results it delivers.

Thank you for your service Dr. Shulkin.

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Department of Veterans Affairs: Wish List for 2018

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David ShulkinAs 2017 draws to a close, SFTT is delighted with the early initiatives undertaken by Dr. David Shulkin to overhaul the Department of Veterans Affairs (“the VA”).

While SFTT still believes that the VA is “too large to succeed in its mission,”  we applaud the Herculean effort by Dr. Shulkin to regain management control of this large rudderless ship.

Our brave Veterans simply need a far more responsive system.

Found below are SFTT’s 2018 recommendations for Secretary Shulkin:

Continue Efforts to Purge the VA of Incompetent Staff

It is hardly surprising that reforms within the VA continue to be hampered by J. David Cox, President of the American Federation of Government Employees.  In fact, the President was obliged to create by Executive Decree the Office of Accountability and Whistleblower Protection within the Department of Veterans Affairs to protect “whistleblowers” from unfair retribution for reporting abuses within the VA.

VA Secretary Shulkin has the backing of the President, Congress and Veterans to weed out the “bad apples” within the VA, but will it be enough to overcome the stalling tactics of David Cox and the government labor union.  A responsive management structure focused on providing healthcare to Veterans is the goal, but will special-interest groups succeed in derailing Secretart Shulkin’s initiatives?

Focus on Improving the VA’s Core Competency

There are many areas within the VA that are providing outstanding care to Veterans.  Those areas – which need to be identified and nurtured – should be considered the core competency of the VA.  Invest in those are areas which are providing the needed health services to Veterans and question all others that may not be fulfilling that goal.

While Dr. Shulkin closed many underutilized facilities, it may be only the tip of iceberg.  Certain functions within the VA may have already outlived their usefulness and perhaps could be  better performed in the private sector.   Ridding the VA of peripheral activities will permit management to focus on its core competency.

Aggressively Partner with Private Sector

One of the major criticisms of the VA is its penchant for attempting to manage everything in-house.   While this would be wonderful if it worked, the sheer size of the VA and its inability to react quickly and efficiently fails Veterans in their time of need.  The Choice Program is clearly a response to this dilemma.

Indeed, there are plenty of areas where Veterans would be better served through partnerships with the VA.  The VA should seize the initiative to partner with “stronger” local institutions in the private sector who can provide defined services to Veterans.

Distinguish Between “Managing Symptoms” and Therapy

The President’s Commission on Combating Drug Addiction and the Opioid Crisis is a clear wakeup call to those who believe that “treating symptoms” is therapy.   It is hard to escape the Commission’s damning indictment that “the modern opioid crisis originated within the healthcare system.”  More to the point are the following observations from the Commission:

“Unsubstantiated claims: High quality evidence demonstrating that opioids can be used safely for chronic non-terminal pain did not exist at that time. These reports eroded the historical evidence of iatrogenic addiction and aversion to opioids, with the poor-quality evidence that was unfortunately accepted by federal agencies and other oversight organizations.

Pain patient advocacy: Advocacy for pain management and/or the use of opioids by pain patients was promoted, not only by patients, but also by some physicians. One notable physician stated: “make pain ‘visible’… ensure patients a place in the communications loop… assess patient satisfaction; and work with narcotics control authorities to encourage therapeutic opiate use… therapeutic use of opiate analgesics rarely results in addiction.”

Indeed, the use of opioids to treat pain and depression symptoms is hardly therapy for Veterans with brain trauma.  While VA studies on the benefits of “medicinal marijuana” may provide Veterans with a less dangerous method to cope with the pain of traumatic brain injury, it doesn’t seem to offer much benefit as a long term solution to PTSD and TBI.

The VA should clearly distinguish between medical programs which simply “manage” symptoms and those programs that offer clearly therapeutic benefits without drug dependency.

Improve Responsiveness and Administrative Efficiency

The VA is regularly criticized – and often quite rightly – for its lack of responsiveness and administrative inefficiency.  While no doubt these criticisms will continue, one must applaud Secretary Shulkin’s decision to scrap the VA’s VistA system and replace it with the Department of Defense MHS Genesis to manage electronic records.

Sure, there are many who will not be happy with this decision, but the fact remains that it is far better to upgrade and improve the efficiencies in one BIG system rather than two.  While some Veterans may be concerned about the breach in confidentiality, one system to manage healthcare records should – over time – dramatically improve efficiencies.

It remains to be seen if the “wait times” often cited in IG reports can be significantly reduced.

Summary

SFTT remains hopeful that Dr. Shulkin will continue to push his staff in 2018 to provide Veterans with the care they deserve.

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SFTT Military News: Week Ending Oct 20, 2017

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Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT at info@sftt.org.

Why You May Not Know Anyone in the Military
Active-duty military now make up just 0.4 percent of the U.S. population, down from 1.8 percent in 1968 and 8.7 percent in 1945. Military personnel also tend to come from certain parts of the country more than others. Here, from the Defense Department’s most recent annual report on population representation in the military services, are the states with the most military recruits in fiscal year 2015 as a percentage of the population aged 18 through 24.   Read more . . .

The US Military Presence in Africa
. . . the Niger operation typifies U.S. military missions underway in roughly 20 African countries, mostly in the northern third of the continent. They tend to be small, they are carried out largely below the radar, and most are focused on a specific aim: rolling back Islamist extremism. In almost all of the missions, the Americans are there to advise, assist and train African militaries — and not to take part in combat. Still, those supporting roles can often take U.S. forces into the field with their African partners, as was the case in Niger.  Read more . . .

Al-Omar Oilfield in Syria Captured from ISIS
U.S-allied fighters said they captured Syria’s largest oil field from the Islamic State group on Sunday, marking a major advance against the extremists and seizing an area coveted by pro-government forces. With IS in retreat across Syria and neighboring Iraq, the Kurdish-led Syrian Democratic Forces and the Syrian government have been in a race to secure parts of the oil-rich Deir el-Zour province along the border. The SDF, with air support from the U.S.-led coalition, said Sunday it captured the Al-Omar field in a “swift and wide military operation.” It said some militants have taken cover in oil company houses nearby, where clashes are underway.  Read more . . .

David Shulkin

Will Dr. David Shulkin Resign as the Head of the VA?
A long-awaited overhaul of veterans’ health care is being unveiled to the world. At the helm throughout the two years of developing this roadmap has been David J. Shulkin. As the U.S. Department of Veterans Affairs is finally on the cusp of rolling out its master plan to ensure every veteran has access to timely, quality care, the VA secretary reportedly is interviewing for another job. As the Wall Street Journal revealed Friday, the White House brought Shulkin in last week to discuss having him take over the Department of Health and Human Services, a post left vacant by the abrupt resignation of Tom Price. (VA did not confirm or deny the Journal’s reporting.)  Read more . . .

Are Changes in the Wind for the VA’s CARE Program?
The VA announced that it has submitted the Veterans Coordinated Access & Rewarding Experiences (CARE) Act to both the House and Senate Veterans Affairs committees. The bill would eliminate the current wait time and distance requirements under the Choice program, which limits participation to veterans who face a 30-day wait for an appointment at a VA hospital or who live 40 miles or more from a VA facility.  Instead, veterans would be able to seek care outside of the VA if they face a wait that is longer than a “clinically acceptable period.”  The changes would create options for veterans to use walk-in clinics for non-emergency needs and would place veterans and their physicians “at the center” of decisions on where to receive care, according to the VA.   Read more . . .

Virtual Therapists for Evaluating PTSD?
WHEN US TROOPS return home from a tour of duty, each person finds their own way to resume their daily lives. But they also, every one, complete a written survey called the Post-Deployment Health Assessment. It’s designed to evaluate service members’ psychiatric health and ferret out symptoms of conditions like depression and post-traumatic stress, so common among veterans. But the survey, designed to give the military insight into the mental health of its personnel, can wind up distorting it. Thing is, the PDHA isn’t anonymous, and the results go on service members’ records—which can deter them from opening up. Anonymous, paper-based surveys could help, but you can’t establish a good rapport with a series of yes/no exam questions. Veterans need somebody who can help. Somebody who can carry their secrets confidentially, and without judgement. Somebody they can trust.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops.

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Marijuana and Veterans with TBI

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Thomas Brennan, a former sergeant in the Marine Corps, is the founder of The War Horse, a veterans’ news site, and a co-author of “Shooting Ghosts: A U.S. Marine, a Combat Photographer, and Their Journey Back from War,”  makes an impassioned plea to “make pot legal for Veterans with TBI.”

Cannabis for Veterans with PTSD and TBI

In an “Opinion” piece for the New York Times of September 1, Mr. Brennan states to following:

“Most of the major veterans groups, including the American Legion, Iraq and Afghanistan Veterans of America, Veterans of Foreign Wars and Disabled American Veterans, support regulated research into the medical uses of cannabis . . .

“What I know is that it works for me. If I hadn’t begun self-medicating with it, I would have killed myself. The relief isn’t immediate. It doesn’t make the pain disappear. But it’s the only thing that takes the sharpest edges off my symptoms. Because of cannabis, I’m more hopeful, less woeful. My relationship with my wife is improving. My daughter and I are growing closer. My past is easier to remember and talk about. My mind is less clouded. More than anything, it feels good to feel again. My migraines and depression don’t control my life. Neither do pills.

“But I live in fear that I will be arrested purchasing an illegal drug. I want safe, regulated medical cannabis to be a treatment option. Just like the sedatives and amphetamines the V.A. used to send me by mail. And the opioids they still send to my friends.”

Personally, I am delighted that Mr. Brennan feels better and is recovering his life, but one man’s (or woman’s) experience with “alternative medication” hardly makes a compelling argument to justify universal endorsement.

Superficially, one could argue that pot is far less “addictive” than opium and the opioid variants currently endorsed by the FDA and the AMA, but I suggest that Mr. Brennan compelling argument touches on a far more important issue:

Officially sanctioned / LEGAL therapies to treat Veterans with PTSD and TBI are not working! 

No one should be surprised that Mr. Brennan and many other brave warriors are seeking alternative therapies – either not sanctioned or “illegal” – because the limited treatment options provided by the Department of Veterans Affairs (“the VA”) are tragically failing the needs of our heroes and their families.

Last week, Maj. Ben Richard’s commented on a disturbing series of videos that trace a widow’s tragic quest to seek help from the VA for her husband who committed suicide when denied alternative therapy.

The tragic suicide of Veteran Eric Bivins is just another example of the abuse of power at the VA that literally makes “life and death” decisions based on a long history of failed treatment programs:  Cognitive Process Therapy (“CPT”) and Prolonged Exposure Therapy (“PE”).

If the only choice for Veterans with PTSD and TBI is institutional abuse and lethal prescription drugs, why not run the risk (illegal or unsanctioned) and seek help that works?  In the case of Mr. Brennan, cannabis might be the answer, but SFTT seeks out programs that may offer life-changing therapies rather than medication that simply deals with the symptoms.

Personally, I don’t think that potentially addictive drugs are the long term answer for PTSD and TBI, but I can certainly understand why many Veterans seek relief outside the limited number of options and callous disregard currently shown by the VA.

Perhaps Secretary David Shulkin can bring about much needed reform at the VA, but the odds are firmly stacked against him.

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How the VA Callously Treats Veterans: A National Disgrace

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As we reported earlier, Veteran Eric Bivins committed suicide after being unable to find the support and care he needed from the Department of Veterans Affairs (“the VA”).

Found below are a moving – AND MOST SAD – series of videos by Kimi Bivins, Eric’s spouse which describes her experiences with the VA in attempting to find the proper care for her husband.

Kimi’s experiences with the VA are not dissimilar from my own and countless of others who have sought care from the VA. I agree with Kimi that it is a “national disgrace,” yet the VA continues to remain largely unaccountable for their callousness and disdain in treating our brave warriors.

I would encourage readers to watch these powerful videos to understand the frustration and agony of a loved-one in dealing with the VA.

Kimi’s YouTube videos are presented in a more or less chronological order, with limited commentary by me other than to clarify certain expressions.

Published on March 23, 2016. Kimi’s Initial PRIVATE Appeal for Help.

Published on March 10, 2016. Kimi’s Frustration on Getting VA Paperwork

Published on March 18, 2016. Eric in a VA Facility

Published on March 23, 2016. Eric is Coping, but Life is Still Very Difficult

Published on April 13, 2016. Eric at Independent Treatment Facility.

Published on May 15, 2016. Eric is Better, But Seeks Therapy Outside the VA

Published July 11, 2017. After Eric’s Suicide

While many will be shocked by these series of videos, it is far too commonplace within the VA.

Before Eric’s suicide he had been accepted into a program to receive hyperbaric oxygen therapy or HBOT.  I credit HBOT with saving my life and enabling me to begin the long road to recover my life.

It is sad that some uninformed doctor at the VA would shatter Eric’s dream of life-changing therapy by parroting the VA’s institutional bias against HBOT.

Dr. David Cifu and his cronies at the VA and the DoD have done their upmost to discredit HBOT and other alternative therapies to support the failed VA programs of Cognitive Process Therapy (“CPT”) and Prolonged Exposure Therapy (“PE”).

Failed VA therapy programs to treat PTSD have been documented numerous times by credible independent studies.   And yet, VA spokespeople still parrot the same stale party line.  Veterans with PTSD and TBI are not deceived and have abandoned the VA in droves.

It sickens me to watch these tragic videos of Kimi documenting her fruitless attempt to navigate the uncaring bureaucracy of the VA.  In my estimation, Kimi’s videos should be mandatory training for all employees at the VA.

While the VA provides much needed comfort to thousands of Veterans, those Veterans with PTSD and TBI need to look elsewhere for REAL therapy.

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Can Secretary David Shulkin Fix the VA?

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Can Secretary David Shulkin fix the Department of Veterans Affairs (“the VA”)?  The answer is an emphatic NO!

Department of Veterans Affairs

This is not a commentary on Dr. Shulkin’s inspired leadership or his vision for a vastly improved VA, but a consequence of competing ideologies and a dysfunctional institution.

As Stand for the Troops has stated several times over the past year: “THE VA IS SIMPLY TOO LARGE TO SUCCEED IN ITS MISSION.”

As suggested in last week’s article by Maj. Ben Richards, the care provided by the VA is far different than the “happy talk” its administrators disseminate to a gullible public and Congress.   The disturbing suicide of Veteran Eric Bivins can clearly be laid at the doors of the VA, but does anyone in authority really care?

Will the desperate pleas Eric’s spouse Kimi resonate in the corridors of power in DC?  Probably not.  And yet, Kimi’s description of the troubling treatment provided by the VA is far more accurate than the self-serving assurances that VA “change agents” dispense to the press.

Veterans are giving up hope daily and seeking treatment outside the VA.  If Congress truly wanted to know the extent of the problems in the VA, they would surely spend far more time seeking out the views of Veterans than blindly accept the assurances of its administrators.  Will this occur? Not likely – and even if it were to occur, not much is likely to change.

The VA is like an old automobile that is falling apart.  Sure, we can try fixing it with the same failed strategies that have been used in the past OR how about trying a different approach? Scrap the dysfunctional VA and build a responsive institution that truly attends to the needs of most Veterans?

How Can the VA be Fixed?

With an annual budget of over $180 billion and nearly 350,000 employees, things can easily get off-track.  More to the point, impassioned administrator can run about putting their fingers in the holes of a leaking dyke, but another leak will surface almost immediately.

As I stated previously,

NO AMOUNT OF MONEY or CHANGE IN LEADERSHIP or ENACTMENT OF NEW LEGISLATION will bring about A MORE RESPONSIVE VA.

The VA has become a bureaucracy that answers only to itself and is not responsive to the needs of Veterans.  Frankly, the VA has lost its way and very little will change unless the VA is broken down into far smaller manageable components.

While smaller components of the VA will invariably fail, A SMALLER AND LESS CENTRALIZED VA WON’T COMPROMISE THE FULL MISSION.  

The public seems relieved that Veterans now have a choice of service providers because the Choice Program has been extended by Congress, but for many thousands of Veterans like Eric Bivins and his family, there really is NO CHOICE!

Where the VA is Today

Personally, I believe that Dr. Shulkin has done a remarkable job in addressing some of the more urgent problems at the VA.  While one can argue whether he has done enough, the task he has been given is like being assigned to captain the Titanic after it has hit the iceberg.

The speed with which the VA will sink further into disrepute may be slowed, but SINK it will.

How many more reports do we need from the Office of the Inspector General (the “IG”) that the VA lacks effective governance and oversight?

How many more times to we have to fire ineffective VA employees when the Labor Union intercedes to protect  employee “rights”?

How many more infection risks do Veterans need to overcome at VA facilities?

These are just the latest “issues” that Dr. Shulkin and his staff need to deal with.  Despite evidence of much needed progress to overhaul the VA, these problems are likely to persist.

In fact, every local incidence of inefficiency or incompetence becomes magnified into a matter of national concern and raises further doubts about the VA’s ability to reform itself from within.  Frankly, there are far too many competing mandates for it to do so.

Sadly, our Veterans and their loved ones will continue to suffer until we stop posturing and enact real reform.

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SFTT Military Highlights: Week Ending Aug 11, 2017

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Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

Tensions High over North Korea
“Military solutions are now fully in place, locked and loaded, should North Korea act unwisely,” President Trump said on Friday, in his latest salvo in the exchange of rhetoric with the isolated regime. “Hopefully Kim Jong Un will find another path!”  The statement, made via Twitter, comes one day after Trump wondered whether he had been stern enough in talking about North Korea earlier this week, when he promised to meet Pyongyang’s threats with “fire and fury.”  Read more . . .

Military Food Rations Amazon

Food Rations May Become a Military Profit Center
Amazon is using everything at its disposal to take on the grocery and food delivery business. The online retailer purchased Whole Foods Market in June for $13.7 billion, announced new meal-prep boxes that challenge Blue Apron in July, and now it’s turning to the military for its next move. According to a CNBC report, Amazon wants to use military food technology to create prepared meals that don’t need to be refrigerated. This would allow the company to store and ship more food more efficiently and to offer ready-to-eat, (hopefully) tasty meals at a lower price.  Read more . .

Is the VA Planning to Close Incomplete Healthcare Applications?
A well-known whistleblower in the Department of Veterans Affairs warned Wednesday that the VA appears to be getting ready to close tens of thousands of incomplete healthcare applications, even though it’s been clear for more than a year that the VA was failing to give veterans a chance to complete these applications. Scott Davis is a public affairs officer for the VA’s Member Services in Atlanta who has testified before Congress about problems within the VA.  Read more . . .

Deja Vu All Over Again at the VA
The Department of Veterans Affairs (VA) has been forced to employ the former Washington, D.C., medical center director for the time being after the employee was fired for failing “to provide effective leadership at the medical center.” Brian Hawkins was fired in July after it was revealed he had sent sensitive information to his wife’s personal email account. However, Hawkins appealed the termination and the federal Merit Systems Protection Board issued a stay on the decision on Aug. 2, allowing Hawkins to build a defense that he was wrongfully let go. VA Secretary David Shulkin pushed back against the stay and has prohibited Hawkins from working around patients.   Read more . . .

Opioids for Veterans with PTSD

Tighter Controls Over Opioid Prescriptions at the VA?
The U.S. Department Veterans Affairs Office of the Inspector General released a report Aug. 1 that recommended non-VA health care providers being paid by the VA to provide services to veterans be required to submit opiate prescriptions directly to VA pharmacies. According to the report, veterans are one of the highest risk pools of people to become addicted to opiates and that veterans could receive treatment in the form of opiates from non-VA doctors without regard for the possibility of co-occurring mental health problems. “Veterans receiving opioid prescriptions from VA-referred clinical settings may be at greater risk for overdose and other harm because medication information is not being consistently shared,” said U.S. Department of Veterans Affairs Inspector General Michael J. Missal. “That has to change. Health care providers serving veterans should be following consistent guidelines for prescribing opioids and sharing information that ensures quality care for high-risk veterans.”  Read more . . .

Link Between PTSD and Alzheimer’s Disease and Dementia?
More and more evidence is suggesting that developing post-traumatic stress disorder early in life can raise the risk of dementia in old age. New research finds a molecular link between the two conditions, which paves the way for new therapies. An increasing number of epidemiological studies have suggested that people who develop a neuropsychiatric condition such as post-traumatic stress disorder (PTSD) in childhood are also likely to develop Alzheimer’s disease later in life.  Read more . . .

How Combat Vet’s PTSD Affects Families
Soldiers who experience the horror and terror of conflict often return home far different people than they were when they left. Many are angry, suffer from depression, harbour suicidal thoughts or attempt to isolate themselves from the world, hoping to avoid triggers that can instantly force them to relive their experiences. While increasing attention has been paid in recent years to helping armed forces members cope with post-traumatic stress syndrome (PTSD), not as much attention has been paid to the experience and grief of intimate partners and families who experience trauma in trying to deal with the changes a loved one, coping with PTSD, goes through.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

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What do the NFL and the VA Have in Common?

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Like the Department of Veterans Affairs (“the VA”), the NFL has eloquently side-stepped the effects of brain trauma caused my massive or repeated concussive events.

In a most disturbing study, the Journal of the American Medical Association has concluded that “110 of 111 NFL players were found to have chronic traumatic encephalopathy, or C.T.E., the degenerative disease believed to be caused by repeated blows to the head.”

Chronic Traumatic Encephalopathy or CTE

This should come as no surprise to most anyone who has followed repeated denials by NFL officials and team owners that repeated concussive events on the field of play lead to permanent brain damage.

Why?  The liability is simply too great and public outcry might hurt the lucrative revenue stream of the NFL, which is currently exempt from antitrust laws thanks to the largesse of Congress.

Personally, I don’t believe that the risk of brain injury will deter rabid fans from attending college or NFL games anymore than residents of Rome passed up an opportunity to attend a bloody spectacle at the colosseum.

Nevertheless, there is a strong grassroots effort to cut back on football programs for young children.  A recent news report from Tampa, Florida highlights the dilemma faced by parents whose 9 and 10 year-old children want to play contact football.

NFL Players and our Military Heroes

While NFL players have the opportunity to walk away from the sport they dearly love, the brave men and women who serve in our armed forces don’t have quite the same options.

More to the point, Veterans suffering from from PTSD and TBI have few possibilities given the VA’s limited menu of therapy options: Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT).   As the VA acknowledges, neither of these therapies has produced significant improvements in the well-being of Veterans.

To mask the their failure in treating PTSD and TBI, the VA has resorted to potent prescription drugs with unsettling side-effects.   In effect, treating PTSD and TBI has largely been a “loss loss” for Veterans with equally devastating results on their families.

What the VA and the NFL have in common is a culture of arrogance and denial based on a concerted and prolonged effort to hide the truth from those it purports to serve and protect.   In effect, the VA has told Veterans that “it is the VA way or the highway.”

Sadly, far too many Veterans have opted for the highway.

Dr. David Cifu and the Culture of Doom

Nowhere is this arrogance of the VA more manifest than in the pompous and self-serving performance by Dr. David Cifu, a consultant for the VA on PTSD and TBI, at a 2016 Congressional subcommittee:

Scholars in attendance were revolted by Dr. Cifu’s anecdotal and silly justification for why the VA’s policies and procedures for treating PTSD and TBI are so far out of touch with the latest scientific research.

Sadly, Dr. Cifu’s opinions reflect entrenched attitudes at the VA and deprive tens of thousands of brave Veterans the treatment they deserve to combat this debilitating injury.

While Dr. David Shulkin is cleaning house at the VA, he would do well to look at those like Dr. Cifu to determine if they are up to the task in reestablishing the credibility of the VA.

Veterans that talk to SFTT believe that the VA is useless in helping to address their problems with PTSD and TBI.

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Secretary Shulkin Announces Electronic Health Records for VA

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In a rather unusual setting:  the White House press room – Department of Veterans Affairs’ Secretary, Dr. David Shulkin, announced that the VA “will be overhauling its electronic health records, adopting a commercial product used by the Pentagon that he hopes will improve care for veterans and reduce wait times for medical appointments.”

Dr. David Shulkin, VA Secretary

While many have been pressing for a complete overhaul of the VA’s inefficient medical record system, Dr. Shulkin has taken on the challenging task of dispensing with the VA’s current VistA system in exchange for the Department of Defense MHS Genesis system.

Without going into too many details, Secretary Shulkin showed courage by selecting the MHS Genesis system without competitive bidding, “citing a ‘public interest’ exception. He noted that when the Pentagon did competitive bidding on its system, it took 26 months.”

While I fully agree with his rationale for accelerating the implementation process, I am quite certain that others will question the bidding process.  After-all, Secretary Shulkin claims that it would be “unrealistic” to assume that the VA’s new electronic health record would cost less than $4 billion.

Congressional approval is required for this supplemental appropriation, but this overhaul of the VA electronic health records was a key recommendation of the June 30, 2016 Commission on Care Report.    I have no doubt that Congress will pass the required appropriation.

Electronic Health Records for Veterans and the VA

On the plus side, a “cloud-based” commercial solution is far preferable to internally-developed and internally-maintained VA legacy systems.  Outdated, clunky and inefficient legacy systems at banks and insurance companies have proved to be rather ineffective at keeping pace with technology.  Systems at the VA are probably not different.

There is no question, that the VA will be able to operate far more efficiently with state-of-the-art electronic health records.  Whether Veterans will benefit from this improved information technology remains a matter of conjecture.

Dr. Shulkin claims that the transition to the MHS Genesis system will take “about 3 to 6 months at the latest.”  Recalling the delays in the rollout of the Affordable Care Act online marketplace, I suspect that this is a very ambitious target.  I hope to be proven wrong.

Furthermore, I recall that it took members of the medical profession about two years to fully implement the transition to electronic health records to receive reimbursement from Medicare and Medicaid.

While the technology may be fully deployed and implemented within six months, I suspect that it is highly unlikely that 300,000 plus employees at the VA will easily transition to the new electronic health records.

Realistically, I suspect that it will be about 24 months before the first major efficiencies make themselves manifest at the VA.

Privacy and Electronic Health Records

While it makes sense to use the common elements of the Department of Defense (“DoD”) database to populate and communicate with a similar system at the VA, access to individual records creates privacy issues.

Veterans tell SFTT that they are reluctant to share health information with the VA because of privacy concerns.  Linking the DoD and VA databases seems – on the surface – to raise additional “privacy” issues.

While the VA can use any number of filters and access restriction to protect the confidentiality of electronic health records, it is evident that a human interface will at some point be required to get actionable medical information to “the right” caregiver.

Getting a person on the phone – let alone “the right person” – has always been a problem at the VA.  In fact, SFTT reported late last year that 1/3 of the calls to the VA Crisis Center go unattended.

Is it enough to assume that things will be different this time around?

Conclusion

While the move to electronic health records is yet another great decision by Dr. Shulkin, it remains to be seen whether he has sufficient tools at his disposal to mobilize the staff of VA to reach out to Veterans and help close the divide.

On behalf of our brave Veterans, SFTT certainly hopes so.

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Meet David Cox: Dr. “No” of VA Reform

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Meet J. David Cox, who many consider “Dr. No” of badly needed reforms within the Department of Veterans Affairs (“the VA’).

J. David Cox

J. David Cox

J. David Cox is President of the American Federation of Government Employees and is the person most likely to block any meaningful reform within the VA.  SFTT has had an eye on Mr. Cox who in the run-up to last year’s Presidential election, threatened the previous secretary of the VA with physical violence:

Cox was “prepared to whoop Bob McDonald’s a – -,” he said. “He’s going to start treating us as the labor partner … or we will whoop his a – -, I promise you,”

The new VA Secretary, Dr. David Shulkin, is rightly receiving favorable media coverage and support from both parties in Congress on his forceful new leadership.  In fact, the New York Times recently referred to Dr. Shulkin as a “Hands On, Risk-Taking ‘Standout.'”

The New York Times reports the following example of Dr. Shulkin’s responsiveness (and common sense):

After he first took the job, he grew concerned that the agency was not doing enough to prevent suicide after a news report showed high rates among young combat veterans. Suicide prevention leaders told him that they would put together a summit meeting to respond, adding that it would take 10 months.

Dr. Shulkin told them to get it done in one month. When his staff members pushed back, he pulled out a calculator and began quietly tapping, then showed them that during the delay, nearly 6,000 veterans would kill themselves. They got it done in a month.

“For me it was a very important day,” he said, remembering the meeting. “It taught our people you can act with urgency, and you can resist the temptation to say we work in a system that you can’t get to move faster. I think they learned that you can.”

Indeed, SFTT has greatly admired the decisiveness with which Dr. Shulkin has attacked two chronic problems with the VA:  A bloated infrastructure and the lack of authority to manage the VA’s large workforce.

While Congressional Republicans and Democrats have largely agreed on an “accountability” bill to support the firing of VA employees, J. David Cox argues that:

“Trampling on the rights of honest, hard-working public-sector employees is not the solution to holding bad employees accountable for their actions,” American Federation of Government Employees National President J. David Cox said. He said the bill would set up different standards for VA employees and other federal workers.

In fact, just recently it was reported that “a federal appellate court overturned the firing of Sharon Helman, who presided over a Phoenix VA Health Care System that left veterans waiting for weeks or even months for care while phony records were kept to show the agency was meeting its wait-time goals.”

Dr. David Shulkin, VA Secretary

While I hope that Dr. Shulkin has the fortitude to implement the bold changes he has outlined, the entrenched bureaucracy represented by David Cox and others, such as David Cifu, will continue to undermine his efforts.

The VA has simply grown too large to manage effectively.  Dr. Shulkin is right in arguing that the lives and well-being of Veterans are far more important than defending the rights of a few “bad apples” within the VA.  David Cox should embrace the vision of Dr. Shulkin and act in a manner which reflects well on the work ethic of the vast majority of VA employees.

Veterans, Veteran organizations and our elected officials should provide Dr. Shulkin with a clear mandate to bring about the much needed reform within the VA. Our Veterans, their family and friends and an appreciate public deserve no less.

J. David Cox would do well to join forces with Dr. Shulkin in this effort rather than taunt him.

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