Veterans for Common Sense

May 6, 2008, Washington, DC – A statistician told a House panel today that male U.S. veterans between the ages of 20 and 24 are three times more likely to commit suicide than non-veterans their ages.

In general, veteran suicide rates are about double those of non-veterans, Stephen L. Rathbun, interim head of the Department of Epidemiology & Biostatistics at the University of Georgia, said in testimony before the House Committee on Veterans’ Affairs.

“The pattern of higher estimated veteran suicide risk was observed for both genders and all age classes,” Rathbun said.

Rathbun said he analyzed the statistics on veteran suicides for a CBS News investigation and was not paid for his work. He said he was chosen for his impartiality, but did not have a peer review his findings. The news story aired Dec. 12.

E-mail attracts attention

U.S. Rep. Bob Filner, D-Calif., the committee chairman, called the hearing titled, “The Truth About Veterans’ Suicides,” and requested that Ira Katz, the mental health director at the Department of Veterans Affairs, explain to the committee an internal e-mail he sent to the VA public affairs office.

The subject line of the e-mail read, “shh,” which Katz said was “unfortunate.” The e-mail states that 12,000 veterans attempt suicide a year while under VA treatment. “Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?” the e-mail asks.

Filner asked the new Veterans Affairs Secretary James B. Peake – whose tenure began in December – if he was “going to assure accountability” of Katz “and anyone who participated in the cover-up of this data. I want to know if you are really going to take your role seriously. This isn’t an abstract. This is about our veterans and whether they have a life ahead of them or not.”

Filner told Katz that he seemed – in the e-mail – more concerned about managing the data than helping veterans.

Katz said that the e mail “was in poor tone” and that the “content was a dialog” about discussing the high rate of suicides, adding, “I deeply regret the subject line.”

Filner said that Katz should be fired, but Peake said after the hearing he did not plan to fire him. White House press secretary Dana Perino said that the president has “full confidence in Peake.”

The e-mail was recently disclosed during a trial in San Francisco which is still pending. Two veteran groups are asking the judge to order the VA to improve its mental health care.

Belchertown connection

In Western Massachusetts, a Belchertown couple, Joyce and Kevin Lucey, filed suit in the summer against the Department of Veterans Affairs for the wrongful death of their son, Marine Lance Cpl. Jeffery M. Lucey, 23, an Iraq veteran who returned home and within several months began having nightmares and drinking heavily.

The parents allege in their suit that the VA Medical Center at Leeds failed to give their son the medical care he needed which led to his death. The parents said the VA center refused to admit the Marine reservist on June 5, 2004. He hung himself on June 22, 2004, within a year of returning home.

May 4, 2008, Baghdad – A top Iraqi official said Sunday there was no “conclusive” evidence that Shiite extremists have been directly supplied with some Iranian arms as alleged by the United States.

Government spokesman Ali al-Dabbagh said Iraq does not want trouble with any country, “especially Iran.”

Al-Dabbagh was commenting on talks this week in Tehran between an Iraqi delegation and Iranian authorities aimed at halting suspected Iranian aid to some Shiite militias.

Asked about reports that some rockets made in 2007 or 2008 and seized in raids against militias were directly supplied by Iran, al-Dabbagh replied: “There is no conclusive evidence.”

Al-Dabbagh said Iraq wants friendly ties with Iran and stressed both countries share common interests.

“We can’t ignore or deny we are neighbors. We do not want to be pushed in a struggle with any country, especially Iran,” he told a news conference.

“We are fed up with past tensions that we have paid a costly price for because some parties have pushed Iraq (in the past) to take an aggressive attitude to Iran.”

May 5, 2008 – Suicides among veterans of wars overseas occur “just like cancer occurs,” and are not an indication of negligence by Veterans Affairs Department mental health care providers, a top VA official has argued in a lawsuit filed by two veterans groups. The official said he does not know how well VA hospitals are complying with a directive to provide 24-hour referrals to veterans with mental health problems.

Last year, two groups, Veterans for Common Sense and Veterans United for Truth, filed suit in U.S. District Court in San Francisco, charging that VA had failed to make mental health services immediately and widely available to returning veterans. Testimony in the non-jury trial ended last week.

Documents filed in the case revealed that the Justice Department tried to have the lawsuit thrown out on the grounds that language in the department’s appropriations bills and prior case law “specifically and substantially limits VA’s obligation to provide care … [and] creates no such expectation [that veterans are entitled to care] (emphasis and brackets added by Justice).”

Internal VA memos released at the trial in April disclosed that in February, the department knew it was facing 1,000 suicide attempts per month, which the veterans groups argued could have been avoided if VA had adhered to its 2004 Veterans Health Administration Mental Health Strategic Plan, which called for development of a “national, systemic program for suicide prevention.”

A deposition by a VA medical center psychiatrist caring for veterans of the wars in Iraq and Afghanistan backed up the veterans groups’ assertion that the department had not done enough to provide adequate mental health care for all veterans.

Dr. Marcus Nemuth, medical director of Psychiatry Emergency Service for VA’s Puget Sound Health Care System in Seattle, which operates three hospitals, said in his deposition on March 25 that he expected a high volume of post-traumatic stress disorder cases among veterans returning from Afghanistan and Iraq. He said he was concerned with both with the quantity and quality of care provided to those veterans.

Nemuth said during the past year he had seen such a growth in the caseload of Afghanistan and Iraq veterans seeking psychiatric emergency help at the Seattle VA hospital that he concluded the department faced a “tsunami of medical need.”

But William Feeley, the Veterans Health Administration’s deputy undersecretary for health for operations and management, said in an April 9 deposition that VA did not have a metric to track suicides or attempts. He added that he could not recall a time since he took office in February 2006 when VA had conducted a quarterly review of suicides or attempts among the department’s 21 Veterans Integrated Services Networks.

When asked in the deposition if any regional health care network directors had been disciplined or demoted because of increased rates of suicides or attempts, Feeley answered, “A suicide does not mean negligence on the part of a medical center director or a network director. Suicide occurs just like cancer occurs.”

Feeley said he did not know how many Afghanistan and Iraq veterans in VA’s care had committed suicide since February 2006. “I would consider that suicides go on with all war eras, and a particularly vulnerable population is a 55- to 65-year-old veteran as well, so I have not broken it out, or no one, to the best of my knowledge, has broken it out related to war era.”

VA spokeswoman Laurie Tranter said VA would not provide additional comment on Feeley’s remarks pending resolution of the lawsuit.

Before taking his job at VHA headquarters in Washington, Feeley served as director of the Veterans Integrated Services Network in upstate New York for three years, including 19 months after VA released its mental health action plan in June 2004. Though the plan required Veterans Integrated Services Networks take immediate action on a number of recommendations, including a requirement that the networks ensure that all community-based outpatient clinics with a population at least 1,500 veterans provide on-site, contract or telemedicine mental health services, Feeley said at his deposition that he had only read an executive summary of the plan while serving as a network director.

The plan contained 260 recommendations and mandates to be implemented in fiscal 2004, 2005, 2006 and 2007. But Feeley said in his deposition that he did not know as of June 2007 “whether [the plan] had been implemented.” He added he did not know whether the national program for suicide prevention had ever been developed and deployed throughout VHA.

In June 2007 Feeley sent out a memo to Veterans Integrated Services Network directors requiring hospitals and community-based outpatient clinics to provide an initial evaluation within 24 hours to veterans who requested or were referred for mental health evaluation and/or substance abuse treatment.

Feeley also told network directors that as of Aug. 1, 2007, follow-up to these evaluations should occur within 14 days.

In his deposition Feeley said the June 2007 memo was sent in part in response to a May 2007 VA inspector general report that found initiatives detailed in the mental health plan pertaining to 24-hour crisis availability, outreach, referral and development of methods for tracking veterans at risk had not been deployed systemwide.

The inspector general recommended that VHA facilities make arrangements for 24-hour crisis and mental health care availability, either on site or through a hot line staffed by trained personnel. In addition, the IG said, an on-call mental health specialist should be available to crisis staff.

Feeley could not say during his deposition whether the policies laid out in his memo for 24-hour mental health referral and 14-day follow-up had been adopted throughout VHA. And aside from the suicide hot line, he could not say whether VHA had complied with other recommendations contained in the IG report. He said he “would have some trust in the organization” that the memo had been met with compliance. Otherwise, he said, “we will be spending millions of dollars related to auditing procedures.”

Melvin Goldman, an attorney at Morrison & Foerster, the San Francisco law firm representing the veterans groups, asked Feeley: “If those millions of dollars resulted in the saving of one veteran’s life, wouldn’t they be worthwhile?” Feeley answered: “I think we have to make tough judgments in the industry on how to best measure success.”

Feeley said he intended to ensure compliance with his memo through random site visits, saying he had completed five or six such visits as of April. But Antonette Zeiss, deputy chief consultant for patient care services at VA’s Office of Mental Health Services, said at a pretrial hearing in March that site visits had been completed at only two VA facilities, in Los Angeles and Pittsburgh. Zeiss did not provide details on compliance in Pittsburgh, but said the Los Angeles facility was not in full compliance.

Gordon Erspamer, a Morrison & Foerster attorney, said in a trial brief that the 24-hour mental health evaluation procedures detailed in the Feeley memo as well as other suicide prevention steps taken by VA, such as the suicide hot line, amount to “nothing more than an empty promise on which too many veterans have tragically learned they cannot rely.”

Justice Department attorney Daniel Bensing in his closing argument on April 30 called the charges by the veterans’ groups “extreme and outrageous,” adding that VA is providing “world-class health care in the mental health area.”
Judge Samuel Conti is not expected to issue his ruling for a number of weeks.

The House Veterans Affairs Committee has scheduled a hearing for Tuesday on veteran suicides. The committee, chaired by Rep. Bob Filner, D-Calif., is expected to question top department leaders, including VA Secretary Dr. James Peake; Gerald Cross, principal deputy undersecretary for Health; and Dr. Ira Katz, deputy chief patient care services officer for mental health.

May 5, 2008 – The number of suicides among veterans of wars in Iraq and Afghanistan may exceed the combat death toll because of inadequate mental health care, the U.S. government’s top psychiatric researcher said.

Community mental health centers, hobbled by financial limits, haven’t provided enough scientifically sound care, especially in rural areas, said Thomas Insel, director of the National Institute of Mental Health in Bethesda, Maryland. He briefed reporters today at the American Psychiatric Association’s annual meeting in Washington.

Insel echoed a Rand Corporation study published last month that found about 20 percent of returning U.S. soldiers have post- traumatic stress disorder or depression, and only half of them receive treatment. About 1.6 million U.S. troops have fought in the two wars since October 2001, the report said. About 4,560 soldiers had died in the conflicts as of today, the Defense Department reported on its Web site.

Based on those figures and established suicide rates for similar patients who commonly develop substance abuse and other complications of post-traumatic stress disorder, “it’s quite possible that the suicides and psychiatric mortality of this war could trump the combat deaths,” Insel said.

Post-traumatic stress disorder, known as PTSD, is the failure to cope after a major shock, such as an auto accident, a rape or combat, Insel said. PTSD may remain dormant for months or years before it surfaces, and in about 10 percent of cases people never recover, he said.

Difficult to Predict

“We don’t yet know how to predict who is going to be the person to be most concerned about,” Insel said.

The Pentagon didn’t dispute Insel’s remark.

“The department takes the issue of suicide very seriously, and one suicide is too many,” said spokeswoman Cynthia Smith in an e-mail.

The department has expanded efforts to encourage soldiers and veterans not to feel stigmatized if they seek mental health treatment, Smith said.

Soldiers who’d been exposed to combat trauma were the most likely to suffer from depression or PTSD, the Rand report said. About 53 percent of soldiers with those conditions sought treatment during the past year. Half of those who got care were judged by Rand researchers to have received inadequate treatment.

Failure to adequately treat the mental and neurological problems of returning soldiers can cause a chain of negative events in the lives of affected veterans, the researchers said. About 300,000 soldiers suffer from depression or PTSD, the report said.

Treatment Options

Researchers aren’t sure whether it’s appropriate to treat such patients with selective serotonin reuptake inhibitors, a class of medications that include Prozac, and other anti- depressants, Insel said. His institute is examining that question and novel treatments for PTSD, including using so-called virtual reality technology.

The psychiatric association reported last week that a survey of 191 military members and their spouses found 32 percent said their duty hurt their mental health, and six in 10 believed seeking treatment would damage their careers.

More than 15,000 psychiatrists are attending the professional group’s meeting.

Opening Statement By Hon. Bob Filner Chairman, and a Representative in Congress from the State of California

Good morning and welcome to the Committee on Veterans’ Affairs’ hearing on “The Truth about Veterans’ Suicides.” 

On December 12, 2007, this Committee held a hearing entitled “Stopping Suicides: Mental Health Challenges within the Department of Veterans Affairs.”  Nearly five months later, we are again holding a hearing on the tragic issue of suicide among our veterans and what the VA is doing to address what is clearly an epidemic.  In November of last year, CBS News aired a story entitled “Suicide Epidemic Among Veterans.”  On April 21, 2008, CBS News aired a story “VA Hid Suicide Risk, Internal E-Mails Show.”

The first step in addressing a problem is to understand the scope and extent of the problem.  In the case of the VA and the epidemic of veteran suicides, either the VA has not adequately attempted to determine the scope of the problem, which is an indictment of the VA’s basic competence, or the VA knows the extent of the problem, but has attempted to obfuscate and minimize the problem to veterans, Congress, and the American people, which is an indictment of the leadership of the entire Department.

In December, Dr. Katz, in testimony before this Committee, stressed a low-rate of veteran suicide, stating that “from the beginning of the war through the end of 2005 there were 144 known suicides among these new veterans.”  In responding to the figures used by CBS, Dr. Katz stated that “their number for veteran suicides is not, in fact, an accurate reflection of the rates of suicide.”

Either Dr. Katz knew that the CBS figures were indeed an accurate reflection of the rates of suicide at that hearing or had a sudden epiphany only days later.

In an internal email, Dr. Kussman, on December 15, 2007, referring to a newspaper article, writes that “18 veterans kill themselves every day and this is confirmed by the VA’s own statistics.  Is that true?  Sounds awful but if one is considering 24 million veterans.”  That same day, Dr. Katz responds: “There are about 18 suicides per day among America’s 25 million veterans.  This follows from CDC findings that 20{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of suicides are among veterans it is supported by CBS numbers.”

In February of this year Dr. Katz sends an email stating  “Shh! – 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?”

There was silence from the VA.

Armen Keteyian, Chief Investigative Reporter for CBS News, characterized the VA’s internal emails as “a paper trail of denial and deceit – a disservice to all veterans and their families – [that] has rightfully been exposed.”

In an April 24, 2008, newspaper article, a VA spokeswoman stated that “there are an estimated 1,000 suicide attempts per month among the 7.8 million veterans treated by Veterans Affairs, she said.”

The VA spokeswoman may have misspoke, or this could be yet another example of the VA’s attempt to hide the true magnitude of the problem.  In the VA’s most recent budget submission, the VA claims it will treat 5.2 million veterans this year, and 5.3 million next year – 2.5 million fewer veterans than the 7.8 million quoted in the newspaper article.

In April, a Dallas Morning News editorial, describing a “recent spike in suicides among psychiatric patients treated at the Dallas VA hospital” stated that “descriptions of how four veterans committed suicide in four months – prompting the psychiatric ward to close – suggest that patients went to conspicuous and time-consuming lengths to end their own lives.  There seemed to be ample time for staffers to stop them had they been doing their jobs better.”

The Rand Corporation, in a recently published study entitled the “Invisible Wounds of War, found that since October 2001, approximately 1.6 million U.S. troops have deployed, and that “upward of 26 percent of returning troops may have mental health conditions.”  The study estimated that approximately 300,000 of those deployed suffer from PTSD or major depression.  Among those with PTSD or major depression, only half had seen a mental health provider or physician to seek help in the past 12 months, and among those who had sought help, “just over half received minimally adequate treatment.”

The study defined minimally adequate exposure to psychotherapy as consisting of at least eight visits with a mental health professional such as a psychiatrist, psychologist or counselor in the past 12 months, with visits averaging at least 30 minutes.  How does VA mental health care treatment stack up against this definition of minimally adequate care?

The Rand study also found that “the VA too faces challenges in providing access to OEF/OIF veterans, many of whom have difficulty securing appointments, particularly in facilities that have been resourced primarily to meet the demands of older veterans. 

Better projections of the amount and type of demand among newer veterans are needed to ensure that the VA has the appropriate resources to meet the potential demand.  New approaches of outreach could make facilities more acceptable to OEF/OIF veterans.”

I think many of us believe that the VA health care system has been pushed to the edge in dealing with the mental health care needs of our veterans.  And, I believe that we are witnessing either an inability to address this problem, or a purposeful attempt to minimize the problems faced by veterans and the VA and sweep the epidemic of veteran suicides, and the mental health care needs of our returning servicemembers, under the rug.

So this morning we are going to attempt to get a better idea of the scope of this epidemic, and what the VA is doing to respond to it.  What specific steps has the VA taken since December, steps not previously planned before December, to get a better idea of the scope of the problem, and what has it done to begin to address the problem? 

Finally, I believe we must also seek real accountability from the VA, and, Mr. Secretary, we look to you to provide that accountability.

May 1, 2008, Albuquerque, NM – Rep. Tom Udall has joined other Democrats calling for the resignation of the Department of Veterans Affairs mental health director in a letter to President Bush on Thursday.
The New Mexico Democrat also said that Bush and VA Secretary James Peake should get to the bottom of problems highlighted in a Veterans Affairs inspector general’s report released Thursday.

The report showed many Iraq war veterans with traumatic brain injuries are not getting adequate health care nor job assistance for their long-term recovery.

Udall, who serves on the House Veterans Affairs Committee, said Bush and Peake should immediately demand the resignation of Dr. Ira Katz, the head of mental health at the VA. Katz is accused of withholding information from Congress concerning the rising number of suicides and suicide attempts by veterans.

“The action by Dr. Katz to cover up this information and to present a false picture of the situation seriously jeopardized our government’s ability to deliver quality care to America’s veterans,” Udall said.

The release of e-mails between Katz and other VA officials showed that there have been about 12,000 suicide attempts by veterans per year, but the doctor and others were apparently trying to cover up the facts.

Sens. Patty Murray of Washington and Daniel Akaka of Hawaii, chairman of the Veterans Affairs Committee, called for Katz’s dismissal last week.

May 2, 2008 – Maybe the reason the misperception persists that there are no atheists in foxholes is that nonbelievers must either shut up about their views or be hounded out of the military.

Just ask Army Spc. Jeremy Hall, who is making a splash in the news because of the way his atheism was attacked by superiors and fellow soldiers while he was risking his life in service to his country.

Hall, 23, served two combat tours in Iraq, winning the Combat Action Badge. But he’s now stationed at Fort Riley, Kan., having been returned stateside early because the Army couldn’t ensure his safety.

There is something deeply amiss when we send soldiers on a mission to engender peaceful coexistence between Sunni and Shiite Muslims, yet our military doesn’t seem able to offer religious tolerance to its own.

Hall recounts the events that led to his marginalization in a federal lawsuit he filed in Kansas in March. He is joined by the Military Religious Freedom Foundation, a group devoted to assisting members of the military who object to the pervasive and coercive Christian proselytizing in our armed forces.

Hall’s atheism became an issue soon after it became known. On Thanksgiving 2006 while stationed outside Tikrit, Hall politely declined to join in a Christian prayer before the holiday meal. The result was a dressing down by a staff sergeant who told him that as an atheist he needed to sit somewhere else.

In another episode, after Hall’s gun turret took a bullet that almost found an opening, the first thing a superior wanted to know was whether Hall believed in Jesus now, not whether he was OK.

Then, in July, while still in Iraq, Hall organized a meeting of the Military Association of Atheists and Freethinkers. According to Hall, after things began, Maj. Freddy Welborn disrupted the meeting with threats, saying he might bring charges against Hall for conduct detrimental to good order and discipline, and that Hall was disgracing the Constitution. (Errr, I think the major has that backward.) Welborn has denied the allegations, but The New York Times reports that another soldier at the meeting said that Hall’s account was accurate.

Hall claims that he was denied a promotion in part because he wouldn’t be able to “pray with his troops.” And of course he was returned from overseas due to physical threats from fellow soldiers and superiors. Things became so bad that he was assigned a full-time bodyguard.

This is nothing new to Mikey Weinstein, founder of the Military Religious Freedom Foundation and a former Air Force judge advocate general who also served in the Reagan administration. Weinstein says that he has collected nearly 8,000 complaints, mostly from Christian members of the military tired of being force-fed a narrow brand of evangelical fundamentalism.

Weinstein, who co-wrote the book “With God on Our Side: One Man’s War Against an Evangelical Coup in America’s Military,” has documented how the ranks of our military have been infiltrated by members of the Officers’ Christian Fellowship and other similar organizations. On its Web site, the OCF makes no secret of its mission, which is to “raise up a godly military” by enlisting “ambassadors for Christ in uniform.”

Weinstein says OCF recruitment is easy in a strict command-subordinate military where the implied message is: If you don’t pray the right way, your career might stall.

Beyond the mincemeat being made of church-state separation and religious liberty, it seems particularly combustible for our armed forces to be combining “end-times” Christian theology with military might. That’s no way to placate Muslim populations around the world.

But there’s no will for change. The military’s virulent religious intolerance could be eradicated tomorrow with swift sanctions against transgressors. Instead, it’s winked at, and those caught proselytizing suffer no consequence. It appears that brave men like Hall who simply wish to follow the dictates of their own conscience will be needing bodyguards for a long time to come.