Veterans for Common Sense

April 23, 2008 – War affects different people in different ways. We know more about that because of advances in various sciences, technology and computing power. There’s still a lot left to learn. But this is certain: The price of war isn’t limited to the cost of bullets.

That’s why it’s so important to have a strong, efficient, accountable federal agency to disburse care to those among us whom our nation sent off to fight. For the first time in its modern incarnation, the Department of Veterans Affairs is led by a general who is also a doctor, James B. Peake.

Peake, a surgeon, is a decorated veteran of the war in Vietnam and formerly was Army surgeon general. He became secretary of veterans affairs late last year, in the wake of the Washington Post’s investigation of bureaucratic nightmares and scandalous conditions affecting injured war veterans.

Secretary Peake was in the Twin Cities last week to cut the ribbon on the Paralyzed Veterans of America Vocational Rehabilitation Center here, and he stopped by for a discussion with the Pioneer Press editorial board.

Earlier that day, the Rand Corp. had released a new study concluding that “fundamental gaps remain in our understanding of the mental health and cognitive needs of U.S. service members returning from Afghanistan and Iraq, the costs of mental health and cognitive conditions, and the care systems available to deliver treatment.”

The Rand study focused on post-traumatic stress disorder, major depression and traumatic brain injury. It examined their prevalence among returning soldiers, the care system available to them, the societal costs of these conditions and the cost of delivering high-quality care to all who need it.
The consequences of PTSD, major depression and traumatic brain injury, Rand Corp. said, “can have a high economic toll; however, most attempts to measure the costs of these conditions focus only on medical costs to the government. … Far higher are the long-term individual and societal costs stemming from lost productivity, reduced quality of life, homelessness, domestic violence, the strain on families and suicide.” Rand recommended more capacity for mental-health care and policies that encourage more service members and veterans to seek the care they need.

At the time we talked with Peake, he said he hadn’t yet seen the report. But he advocated for essentially the same measures — early intervention and evidence-based treatment.

Peake also talked about the professionals and caregivers he’s seen at VA hospitals, about how impressed he is “with the quality, and their passion for what they’re doing.” He talked about recognizing that some vets will need lifelong treatment but making sure that others know they will recover. “You need to have the expectation that you’re going to get better,” he said.

He talked about the efficiency and focus of the VA’s medical efforts and the urgent push to take advantage of technology to deliver more and better care. He talked about the strong, bipartisan support for the VA in Congress. “Everybody’s got their own political agenda,” he said, “but I think everybody’s sincere in wanting to do right by our veterans.”

He also talked about the differences on the home front between the Vietnam era and today. Today, in debates about the war in Iraq, we’re better at distinguishing between the soldiers and the politicians who sent them off to fight.

This week, internal e-mails released in response to a lawsuit against the VA have raised questions about how forthcoming the agency has been about the mental health of returning combat vets, about whether the agency held back information for political reasons.

Given what Peake has observed himself — skilled, dedicated caregivers at the VA, bipartisan support for doing right by our veterans, more mature public sentiment — there’s no reason for anything less than clarity about returning vets. As a retired general and a surgeon, Peake is well-prepared to deal with the facts as they are, whatever they are. We trust that he will.

Washington, DC — Two Democratic senators on Tuesday called for the chief mental health official of the Veterans Affairs Department to resign, saying he tried to cover up the rising number of veteran suicides.

Sens. Daniel Akaka of Hawaii and Patty Murray of Washington state said Dr. Ira Katz, the VA’s mental health director, withheld crucial information on the true suicide risk among veterans.

“Dr. Katz’s irresponsible actions have been a disservice to our veterans, and it is time for him to go,” said Murray, a member of the Senate Veterans Affairs Committee. “The No. 1 priority of the VA should be caring for our veterans, not covering up the truth.”

Akaka, the committee’s chairman, said in a letter to the VA that Katz’s “personal conduct and professional judgment” had been called into question by his response to veteran suicides.

Veterans, and the VA itself, “would be best served by his immediate resignation,” Akaka said.

A number of Democratic senators said they were appalled at e-mails showing Katz and other VA officials apparently trying to conceal the number of suicides by veterans. An e-mail message from Katz disclosed this week as part of a lawsuit that went to trial in San Francisco starts with “Shh!” and claims 12,000 veterans a year attempt suicide while under department treatment.

“Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?” the e-mail asks.

A VA spokesman declined to comment Tuesday.

Another e-mail said an average of 18 war veterans kill themselves each day — and five of them are under VA care when they commit suicide.

“It is completely outrageous that the federal agency charged with helping veterans would instead cover up the hard truth — that more and more Americans coming home after bravely fighting for their country are suffering from mental illnesses and in the most tragic circumstances, committing suicide,” said Sen. Tom Harkin, D-Iowa. “Anyone at the VA who is involved in this cover-up should be removed immediately.”

Harkin, Murray and Sen. Russ Feingold, D-Wis., introduced legislation Tuesday calling on the VA to track how many veterans commit suicide each year. Currently, VA facilities record the number of suicides and attempted suicides in VA facilities — but do not record how many veterans overall take their own lives. The agency, however, is reluctant to disclose specific numbers, veterans advocates complain.

The new bill would require the VA to report to Congress within 180 days the number of veterans who have died by suicide since Jan. 1, 1997, and continue reports annually. Harkin’s office said statistics provided earlier this year by the VA showed that 790 veterans under VA care attempted suicide in 2007. That figure is contradicted by the e-mail revealed this week.

Two veterans groups last year filed the class-action lawsuit against a sprawling VA system that handled a record 838,000 claims last year. A government lawyer on Monday urged a judge to dismiss the lawsuit, saying the agency runs a “world class” medical care system.

New York, NY – The American Civil Liberties Union filed a Freedom of Information Act (FOIA) request today with the Departments of Justice and Defense for the release of a report on a long-running investigation of the FBI’s role in the unlawful interrogations of detainees in Iraq, Afghanistan and Guantánamo Bay. The Justice Department’s Office of Inspector General (OIG) launched the investigation after internal government documents – uncovered by an ACLU lawsuit – revealed that FBI agents stationed at Guantánamo Bay expressed concern after witnessing military interrogators’ use of brutal interrogation techniques.

According to recent media reports, the OIG investigation has been completed for months. The Defense Department, however, has blocked the OIG from releasing it, claiming that the report still needs to be reviewed and redacted by the Pentagon.

“The Pentagon is using the classification review as a pretext to delay the release of a report that ought to have been released months ago,” said Jameel Jaffer, Director of the ACLU National Security Project. “It’s increasingly clear that the report is being suppressed not for legitimate security reasons, but in order to protect high-level government officials from embarrassment, criticism, and possibly even criminal prosecution. The report should be released immediately.”

Inspector General Glenn Fine has stated that his report was finalized months ago. In the last few weeks, Fine has taken the unusual step of publicly criticizing the Defense Department for delaying the release of the report.

The OIG investigation was initiated in 2005 after the ACLU obtained documents in which FBI agents described interrogations that they had witnessed at Guantánamo Bay.  The documents included:

• An e-mail in which FBI agents stated that Defense Department interrogators had impersonated FBI agents during an interrogation and used “torture techniques.”  The email stated that the techniques were ineffective.

•  An e-mail in which an FBI agent stated that “on a couple of occasions” he or she “entered interview rooms to find a detainee chained hand and foot in a fetal position to the floor, with no chair, food, or water,” and that on one occasion he or she entered a cell to find that “the A/C had been turned off, making the temperature in the unventilated room probably well over 100 degrees. The detainee was almost unconscious on the floor with a pile of hair next to him. He had apparently been literally pulling his own hair out throughout the night.”

• An e-mail that suggests that, although FBI agents began reporting abuse in 2002, the FBI did not initiate any comprehensive investigation of the abuse until after the Abu Ghraib photographs were published in 2004.

While the documents obtained by the ACLU were most notable for their description of illegal interrogation methods used by military interrogators, the documents also raised serious questions about the FBI’s participation in abusive interrogations, the actions of FBI personnel who witnessed abusive interrogations, and the response of FBI officials to reports of abuse. Today’s FOIA request seeking the OIG report itself as well as all documents related to the investigation is part of a broader ACLU effort to uncover information about the Bush administration’s torture policies.

In October 2003, the ACLU and the New York Civil Liberties Union – along with the Center for Constitutional Rights, Physicians for Human Rights, Veterans for Common Sense, and Veterans for Peace – filed a request under the Freedom of Information Act for records concerning the treatment of prisoners in U.S. custody abroad. To date, more than 100,000 pages of government documents have been released in response to the ACLU’s FOIA lawsuit enforcing the request – including the Bush administration’s 2003 “torture memo” written by John Yoo when he was a deputy at the DOJ’s Office of Legal Counsel.

The documents received in the ACLU’s FOIA litigation are online at: www.aclu.org/torturefoia

April 20, 2008 – Eric Hall would often pinch his lapel to his lips and whisper, as if a microphone was transmitting the cryptic message.

No one knew what to make of the gesture.

A friend would ask the baby-faced Marine whether he needed anything. Hall would release his shirt and smile, downplaying the episode. Nothing more was said.

There were other warning signs.

Hall liked to stare out the window and casually explain how he could secure the building across the street and then disappear.

At first, doctors diagnosed him with a personality disorder. Becky Hall knew it was worse.

Hall returned from Iraq in 2005 a stranger. He would not talk much about the incident that killed his best friend and left him maimed. His behavior had become erratic. He could not remember the past.

Doctors prescribed anti-depressants to ease Hall’s symptoms. But the flashbacks would not stop.

The 24-year-old Indiana native was found dead, inside a drainage pipe, March 9, more than a month after he was reported missing from his aunt’s Harbour Heights home.

Becky Hall believes the mental torture her son endured destroyed him years before the filthy pipe could.

“My son died a long time ago,” she said. “He wasn’t the same when he came back.”

Hall suffered from post-traumatic stress disorder, a condition that affects thousands of military veterans — past and present.

The illness has been reported in 60,000 of the 800,000 returning soldiers from Afghanistan and Iraq since 2002, according to the U.S. Department of Veterans Affairs. Twenty percent of that force have received preliminary diagnosis of a mental health condition.

“It’s not unexpected,” said Dr. Ira Katz, the VA’s deputy chief patient care services officer for mental health. “Any number is high, but we expect we can manage it with the funding available.”

Call of duty

Hall joined the Marine Corps in 2002, following high school graduation.

College never interested the teen from Jeffersonville, Ind., a quaint town near the Kentucky border.

By March 2004, Hall was in Afghanistan hunting al-Qaida and Taliban forces. The constant state of alertness began to wear on the young Marine.

Becky Hall noticed small differences when he returned in September.

Eric would sleep every time he sat more than 15 minutes. It was probably just fatigue, she thought.

Hall was deployed to Iraq the following March.

Family members would hear from him every other week, depending on his missions. The conversations remained optimistic. Hall would tell his father, Kevin, what he wanted to do when he returned home, and asked mom about his finances.

Everything changed June 14, 2005.

Hall was on foot patrol in Fallujah when an improvised explosive device detonated.

The explosion sent a shockwave of shrapnel through Hall’s upper left leg, disintegrating bone and muscle. His best friend, Josh, died instantly.

Recovery

Hall spent the initial weeks in and out of operating rooms and consciousness.

Doctors inserted a rod in his leg to keep the remaining bones together, and transferred muscle and skin to close the hole.

The wounded Marine became more disconnected with each passing day, annoyed by what he perceived as the military’s incompetence.

They wanted to use an airplane or a train to transport him to Indiana. Hall could not sit up straight because of his injury. He lingered in the hospital bed while the military debated travel arrangements.

In March 2006, doctors diagnosed Hall with a personality disorder. The evaluation made no mention of post-traumatic stress.

“He did not have a personality disorder when he joined the Marines,” Becky Hall said. “They would have thrown him out.”

Only later, after Hall had a confrontation with an officer, would doctors change his diagnosis to PTSD.

By May, he just wanted to go home.

But Hall still had to undergo a two-week decompression program designed to help combat veterans readjust to society. It included another mental health screening to determine if further help was necessary.

Hall told family that he was willing to tell the doctors anything so he could leave.

Diagnosing PTSD

A Marine is taught to hide his pain.

From day one, the concept is shouted into his head, until it rings. The military will weed out weak links to create this elite fighting force. And when things get tough, the Marine will not abandon his unit for personal gain.

The military does not want robots. At the same time, it will not take individuals.

This macho mentality makes it difficult to identify mental problems, since most Marines would rather repress the problem than appear fragile in the eyes of their comrades. And it might look bad on a job application.

“To be honest, it can take many months for these symptoms to appear, or for the person to trust us,” Dr. Katz said.

The Department of Veterans Affairs screens thousands of returning vets each month for signs of mental stress.

Katz said the symptoms of PTSD vary, but usually include recurring visions of the traumatic event, numbness and being startled by every day occurrences, such as a car exhaust pipe backfiring.

Veterans who receive a preliminary diagnosis of PTSD are usually prescribed anti-depressant medication and/or subjected to regular psychotherapy. Hall was given Xanax to control his flashbacks.

For some, the memories are too much.

Vietnam veteran Charlie Shaughnessy did not trust anyone after he was discharged in 1970. His attitude had become callous. He could not keep a job.

Shaughnessy, used to live in a remote wooded area of New York but now resides in Gulf Cove, tried to come to terms with himself and others.

“I went through a stage where I wanted to commit suicide,” he said.

It took years of soul-searching before Shaughnessy could return to society. But others never readjust to normal lives.

The VA tracks suicide rates among veterans of past and present wars. There have been 144 reported suicides of returning soldiers from Iraq and Afghanistan, from 2002-05. The agency is completing a study on data since 2005.

“There is no clear trend,” Katz said, indicating the rate did not differ from the regular population statistics.

Broken system?

U.S. Rep. Tim Mahoney was shocked by the poor treatment veterans had been receiving at Walter Reed Army Medical Center in Washington.

The story made national headlines, and the backlash forced corrections.

Mahoney, D-Florida, believes the problem still exists.

“During the last seven years, this administration has nickled and dimed our vets,” he said. “It seems to me if we are going to continue to call on people to serve, we need to treat them like gold.”

But the issues are not new.

Shaughnessy was denied five times by the VA before the agency processed his compensation claim in 2000 — 30 years after his military service ended. He said the agency still is backlogged with Vietnam-related cases.

Becky Hall, who is in the medical profession, took Eric to a private physician because she felt he was being treated like a number.

“They want the Band-aid fix, instead of addressing the root of the problem,” she said.

Dr. Katz said the VA recently added staff to address mental health issues. In addition, they extended the enrollment period to five years for returning veterans to be eligible for health benefits.

Mahoney said the additional personnel will not matter if the administration continues to subject soldiers to multiple tours.

Since the Iraq War started in 2002, Marine, Army and National Guard troops have faced extended deployments, with little rest in-between. Mahoney believes the additional tours increase the risk of soldiers developing mental stress later.

“We have put a burden on them that we have never asked soldiers to do before, and we are seeing the repercussions of it,” he said.

Helping others

Becky Hall thought she understood PTSD.

She worried about Eric, but the ghost of her son now sat in the living room, staring vacantly outside. The real Eric died in Iraq.

Becky Hall does not want to see the same thing happen to other young men.

The Halls are in the process of establishing the Eric Hall Memorial Fund to help veterans and their families.

Although tentative, the fund would provide money for returning soldiers to assist with their transition home. It would push for tougher legislation to increase the decompression phase to a minimum of 60 days, and allow family members to be present so they can better understand issues their son/daughter is experiencing.

Hall also wants to enact legislation so every soldier is registered with the VA for any present or future combat-related illness.

The initiative is already receiving national support. Locally, two major fund-raising events are scheduled for the summer and fall respectively.

Becky Hall returned to Harbour Heights this week to get the rest of Eric’s things. A picture of her son still hangs above the television as a reminder of her mission.

“I told myself I could do one of two things: I could wallow in my sorrow, or make a difference for others,” she said. “My son did not die for nothing.”

In Wake Of A CBS News Report Revealing The VA Withheld Critical Information, Top Mental Health Official Scrutinized  

April 22, 2008 – In the wake of a CBS News report that revealed the Department of Veterans Affairs deliberately withheld critical information about the true suicide risk among veterans, Sens. Patty Murray, D-Wash., and Daniel Akaka, D-Hawaii, today both called for the resignation of Dr. Ira Katz, the VA’s top official for mental health.

Murray, a senior member of the Senate Veterans’ Affairs Committee, says “Dr. Katz’s irresponsible actions have been a disservice to our veterans and it is time for him to go.” She continues, “The number one priority of the VA should be caring for our veterans, not covering up the truth.”

Akaka, the Chairman of the Committee, sent a letter to the VA’s Under Secretary for Health, Michael Kussman, expressing similar concerns about Dr. Katz.

For months, CBS News has been trying to obtain veteran suicide and attempted suicide data from the VA. Earlier this year, the agency provided CBS News with data that showed there were a total of 790 suicide attempts in all of 2007 by veterans who were under the VA’s care.

On February 13, however, Katz sent an e-mail indicating the total number of attempts was much higher. The e-mail was addressed to his top media advisor Everett Chasen and entitled, “Not for the CBS News Interview Request.”

Katz wrote: “Shh! Our suicide prevention coordinators are identifying about 1000 suicide attempts per month among veterans we see in our medical facilitates.” He then asked “is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?”

In another e-mail message, Katz told the VA’s Under Secretary for Health, Michael Kussman, that there are “about 18 suicides per day among America’s 25 million veterans.” This is a figure that the VA has never made public.

Yesterday, Katz told CBS News that the reason the numbers mentioned in his e-mails had not been made public was because the “results were available for only one or two months, and there were and still are questions about how consistent or reliable the findings would be.”

In other development today, Sens. Tom Harkin, D-Iowa, and Russ Feingold, D-Wisc., introduced legislation this afternoon requiring the VA to track veteran suicides. Harkin told CBS News that the e-mail controversy is what sparked the legislation. He said “anyone at the VA who is involved in this cover up should be removed immediately.”

April 22, 2008 – Last night CBS News reported on internal emails written by top officials at the Department of Veterans Affairs that appear to show how the VA tried to cover-up the true risk of suicide among our nation’s military veterans.

However, it is important to note that there are many caring health care professionals at the agency who work extremely hard everyday to take care of veterans in need.

Veterans should know the VA does offer help. We recently spoke to some vets who say counseling sessions by the VA helped them better deal with some of their emotional struggles.

The VA also has a 24-hour suicide prevention hotline (1-800-273-TALK) for those who need someone to talk to. We encourage anyone who is feeling suicidal to reach out for help.

According to the VA’s website, (http://www.mentalhealth.va.gov/) some suicide warning signs include:

• Talking about wanting to hurt or kill oneself
• Trying to get pills, guns, or other ways to harm oneself
• Talking or writing about death, dying, or suicide
• Feeling Hopeless
• Rage, uncontrolled anger, seeking revenge
• Acting in a reckless or engaging in risky activities
• Feeling trapped, like there’s no way out
• Saying or feeling there’s no reason for living
• Withdrawing from friends and family
• Anxiety, agitation, inability to sleep or excessive sleeping
• Dramatic mood swings
• Increased alcohol or drug use

April 21, 2008 – The lawsuit, filed by two non-profit agencies representing military veterans, comes in the midst of a recent study that finds one in five U.S. soldiers currently suffer from Post Traumatic Stress Disorder.

It’s an illness, which until the early 80’s, didn’t get much attention, but affects thousands; especially veterans.

And for one Fresno man, it nearly cost him his life.

Jim Doyle was just 19 when he set off to fight in the Vietnam War.

“I lost a lot of good buddies in Vietnam, had one of them die in my arms, watched people get blown up and lose limbs,” Doyle said.

He came home in 1970. But his life was anything but the way he left it.

“Went on for almost 20 years, having problems with drinking, abusing alcohol and relationships were tenuous at best,” Doyle said.

It wasn’t until the early 90’s when images from the first Iraq War infiltrated TV that Doyle’s disease raged out of control.

“It really affected me dramatically because I could see the body bags and I could smell the smell of death again,” he said.

“Post Traumatic Stress Disorder can come upon in the throws of combat or even years after,” Carolyn Hughes with the Veterans Hospital, said.

It’s common for thousands of veterans, feelings of depression, suicide, anger and isolation often a direct result of war.

“Post Traumatic Stress Disorder is real. It’s not phony. It’s not people looking for an easy way out,” Doyle said.

Hughes says they make every attempt to treat veterans with PTSD and their families.

“As soon as a veteran is in the system, the doors are open for services and support,” Hughes said.

“There’s no support system for them when they come home,” Doyle said.

And he adds that more needs to be done.

“Everyone needs to be educated on this and I think the lawsuit will force the issue more into the public eye,” he said.

Nearly 40 years after coming home from war, Jim Doyle is still adjusting. He’s been married for 32 years and raised a son.

“But it’s difficult. There are still moments when I just go tapioca,” he said.

Experts say that’s normal and although people like Jim will never forget the war, it is possible to move on.

VA officials say they have several programs available for veterans and all someone has to do is contact them for more information.

The program for PTSD typically involves psychotherapy, medication and social intervention and lasts about 60 days.

You can contact the local Vet Center at 559-487-5660 or it’s located at 3636 N. First Street in Fresno.

Paul Sullivan, the director of Veterans for Common Sense, one of the groups involved in the lawsuit, said of the department: “I’m pleased they’re responding. However, much more needs to be done so vets aren’t turned away from health care and don’t have to wait for benefits.”  

April 22, 2008, Canandaigua, NY – Nancy Nosewicz was busy fielding calls at the new national veterans hot line on a recent afternoon when someone from the Department of Veterans Affairs in Topeka, Kan., phoned. He had a 55-year-old Army veteran from the Northwest on the line who had called to complain about his benefits, but now the guy, drunk and crying, was talking about not wanting to live. Could Ms. Nosewicz pick up?

In a slurred voice, heavy from weeping, the veteran, named Robert, told her that he was homeless and wanted to “just lay down in the river and never get up.”

Ms. Nosewicz, a social worker, listened. Then in a voice firm and comforting like a big sister, she said: “We don’t want you to either. Today we’re not thinking about the alcohol or the housing, Robert. Today it’s about keeping you safe.”

She gave an assistant Robert’s phone number to find his address and alert local police to stand by. The chain of care resembled a relay race, with one runner trying not let go of the baton until the next runner had it in hand.

The veterans hot line is part of a specialized effort by the Department of Veterans Affairs to reduce suicide by enabling counselors, for the first time, to instantly check a veteran’s medical records and then combine emergency response with local follow-up services. It comes after years of criticism that the department has been neglecting tens of thousands of wounded service men and women who have returned from war zones in Iraq and Afghanistan.

On Monday, a class action suit brought by veterans groups opened in San Francisco charging a “systemwide breakdown,” citing long delays in receiving disability benefits and flaws in the way discharged soldiers at risk for suicide had been treated. Kerri J. Childress, a department spokeswoman, said Monday that there were an average of 18 suicides a day among America’s 25 million veterans and that more than a fifth were committed by men and women being treated by Veterans Affairs.

Up and running since August, the hot line tries to respond to at least some of those in crisis. Over eight months, it has received more than 37,200 calls and made more than 720 rescues — sending out, from a narrow office here in upstate New York, emergency responders all over the country to find someone on a bridge, with a gun in his hand, with a stomach full of pills.

Paul Sullivan, the director of Veterans for Common Sense, one of the groups involved in the lawsuit, said of the department: “I’m pleased they’re responding. However, much more needs to be done so vets aren’t turned away from health care and don’t have to wait for benefits.”

Mr. Sullivan says suicidal patients have not been able to get care promptly; he cited the case of Jonathan Schulze, who was turned away twice from a Veterans Affairs hospital before he killed himself in January 2007.

“More than 600,000 veterans are waiting, on average, more than six months for disability benefits,” said Mr. Sullivan, who worked at the department monitoring benefits.

Experts agree that veterans are more likely, perhaps twice as much, to commit suicide as people who have never served in the military. Meanwhile, a study released last week by the RAND Corporation estimates that roughly one in five veterans of Iraq and Afghanistan has symptoms of post-traumatic stress disorder, which heightens the risk of suicide.

Yet whatever larger failings may exist, the staff of social workers, addiction specialists and nurses who keep the hot line running — 24 hours a day, seven days a week — can count at least some victories by the end of each shift.

Unique about this hot line, said Janet Kemp, the national suicide prevention coordinator with the department, is that now the counselors have medical information at their fingertips, which they use to connect vets with counseling near their homes. The model evolved from a new research program on suicide prevention paid for by the department.

“For years people thought that asking questions about suicide put the thought in people’s mind, but now we know that’s not true,” said Dr. Kemp, who travels throughout the country training V.A. staff.

The department is spending about $3 million to start and operate the hot line during its first year, said a spokesman, Daniel Ryan, and another $2.9 million on a mental health research center at the sprawling red-brick V.A. Medical Center in Canandaigua. Referring to the hot line’s relay model, Kerry Knox, the director of the new research center, said, “You don’t want them to fall through the cracks.”

With Robert, for example — whose last name was not provided for confidentiality — Ms. Nosewicz gradually nudged him to agree to be taken to a hospital and to give his name and Social Security number so she could check his file and put him in contact with the department’s suicide prevention coordinator in his area.

Meanwhile, Denise Slocum, a health assistant, relayed questions from the local police dispatcher. “The police are asking if you’re near an elementary school,” asked Ms. Nosewicz, who then nodded her head at Ms. Slocum.

“No, no, no — no handcuffs,” Ms. Nosewicz reassured Robert. “You’re going to go to the hospital.”

“Do you have a tissue to blow your nose? Then use your sleeve.”

“When they come in, you put them on the phone with me, and I’ll tell them to treat you with respect.”

Twenty minutes later, Ms. Slocum called the police again to confirm that Robert had been taken to a hospital. Ms. Nosewicz alerted the prevention coordinator. One is at each of the department’s 156 health centers.

Robert’s name was added to a board near the doorway so that the staff could follow up to ensure a local counselor actually met with him.

Of course, sometimes a crack is unavoidable.

“He’s going to do it. He’s really going to do it,” said Terri Rose, a counselor who was working the noon-to-midnight shift. She was wiping her red-rimmed eyes. A caller from Texas, who said he was 65 and a helicopter gunner in Vietnam, said he had a suicide pact with his friend, but the friend had gone off and killed himself. Now he, too, was ready to die, saying he had even found a coffin for $150, said Ms. Rose, who is an Air Force veteran herself. The veteran hung up and had stopped answering her calls.

Sometimes veterans have a lot of trouble asking for help, said Jacalyn O’Loughlin, a counselor. “They keep saying, ‘I’m sorry, I’m sorry, I’m sorry,’ ” Ms. O’Loughlin said. “Especially marines. They feel they’re weak if they reach out.”

Mr. Ryan said about half the calls to the hot line — 1-800-273-TALK (8255) — were from veterans, split fairly evenly between Vietnam and Iraq. Family members and friends also frequently call. About 30 percent of the veterans are women.

A couple of months ago, Ms. O’Loughlin said, a distraught woman called from Oregon who was driving to the woods and then threatened to “walk and walk and walk and never come back.” Ms. O’Loughlin rang the tiny silver bell on her desk to signal the health technician. The health tech checked the area code and phoned the closest Veterans Affairs health center.

“And lo and behold, that suicide prevention coordinator knew her just by her first name,” Ms. O’Loughlin said. The tech called the police and the coordinator called the woman’s husband, getting the car’s make and model. Ms. O’Loughlin kept her on the line; when she hung up, Ms. O’Loughlin called her back. “This went on for hours,” she said. “I could hear her getting out of the car. I could hear the rustling from the leaves.”

Meanwhile, the police and her husband were driving up and down roads. They spotted the car, dashed through the trees and found her. She had a bottle of pills in her hand but had not yet swallowed them.

Sometimes, the victories are smaller but no less satisfying. That morning, Ms. Nosewicz spoke to a veteran whose house was destroyed by Hurricane Katrina; he had been relocated to a different state.

“He called crying because he can’t find a job, saying ‘my teeth are so rotten and my mouth stinks,’ ” Ms. Nosewicz said.

Dental referrals are not exactly part of the job description, but Ms. Nosewicz tried dental schools in his area until she found a school to do the work. “He was crying on the phone,” she recalled, “and said, ‘Thanks so much. Thanks so much.’ ”

All in all not a bad day’s work, Ms. Nosewicz said, as she got ready to leave. “Three rescues, four consults and one set of teeth.”

Soldiers returning from Iraq and Afghanistan who claim the Department of Veterans Affairs hasn’t provided the services they need got their day in court Monday, when a bench trial before U.S. District Court Judge Samuel Conti began in San Francisco. The case, Veterans for Common Sense v. Peake, is expected to continue through May 1.

Morrison & Foerster senior counsel Gordon Erspamer represents the two organizations that are plaintiffs in the case: Veterans for Common Sense and Veterans United for Truth. Erspamer, who is co-chair of MoFo’s energy group, also has 30 years of experience handling pro bono litigation on behalf of veterans. He says this case is the first of its kind against the DVA.

The suit claims that many disabled combat veterans are in dire need of counseling and other services they are not currently receiving from the U.S. government. Erspamer estimates that 120 veterans who served in Iraq or Afghanistan commit suicide each week. The veterans’ groups are not seeking monetary damages but want reform of a health care system in which they allege a huge backlog of cases prevents veterans from receiving timely care.

The case was initially filed last July as a class action but the plaintiffs decided not to seek class certification. “It’s hard to do a class action with veterans who have [post traumatic stress disorder],” Erspamer says. “We think we can get the relief we need through these organizational plaintiffs.”

Disability Rights Advocates, a Berkeley-based nonprofit, is serving as Erspamer’s co-counsel.

Daniel Bensing, the Department of Justice lawyer who is lead counsel for the DVA, declined to comment. A Justice Department spokesperson also declined to comment.

But in a pretrial brief filed by the DVA on April 14, the government argued that “constitutional and statutory considerations” should preclude the federal court from hearing many of the veterans groups’ claims and ordering the remedies they seek.

Several high-ranking DVA officials are expected to testify at the trial, according to a witness list included in the DVA’s brief.

Arturo Gonzalez, a partner and chair of the trial practice group at MoFo, is also working on the case with San Francisco-based associates Alexandria Amezcua, Suzanna Brickman, Jennifer Gould, Ryan Hassanein, Heather Moser, Natalie Naugle and Stacey Sprenkel. Assisting lead DRA lawyer Sidney Wolinsky are Jennifer Bezoza, Katrina “Kasey” Corbit and Ron Elsberry.

April 22, 2008 – San Francisco, CA — The Department of Veterans Affairs is struggling to meet the skyrocketing demand for medical services as an unanticipated flood of former soldiers from Iraq and Afghanistan seek help along with a parallel surge of claims from aging Vietnam veterans, according to both sides in a trial that opened Monday in federal court here.

The lawsuit was brought by two groups, Veterans for Common Sense and Veterans United for Truth, seeking to force the government to streamline its procedures for treating former soldiers, particularly those suffering from combat trauma and other mental health problems.

Opening arguments painted sharply different pictures of the department’s success. The veterans groups said the department was ignoring a mental health crisis and was so swamped that former soldiers were dying needlessly. The defense countered that the country’s largest medical care system was adding the personnel needed to cope.

“Our ultimate goal is guaranteed health care, timely health care, timely decisions on disability payments,” Gordon P. Erspamer, the lead lawyer representing the two veterans groups, said in an interview.

“The system is choking on the claims; the delays are unconscionable,” Mr. Erspamer said.

The trial, before Judge Samuel Conti, an Army veteran of World War II, does not seek monetary damages but asks the court to appoint a special master or otherwise intervene to make the department run more efficiently.

Claims for help from the department jumped 25 percent in recent years, hitting 838,000, Richard G. Lepley said in his opening statement for the government.

The defense said the jump was generated by a combination of veterans returning from Iraq and Afghanistan, where head injuries that can lead to stress problems are a signature issue, as well as an upswing of Vietnam veterans seeking help for medical conditions associated with aging. News coverage from the current wars has also led to new mental health problems among Vietnam veterans, said Kerri J. Childress, a spokeswoman for the veterans department in Palo Alto, Calif.

“I don’t think anybody had any idea how long the war was going to go on,” Ms. Childress said, referring to Iraq. She added that there was no way to fully anticipate the demand for medical care from Vietnam veterans.

The department is falling short of its goal of addressing claims within 125 days, saying that it was now closer to 180 to 185 days, Mr. Lepley said. But he said the department had added 3,700 mental health care professionals in the last two years, bringing the total to 17,000, and started a program where anyone feeling suicidal could get attention within 24 hours and a follow-up appointment within two weeks, he said. The program started last summer, he said, so it is too new to measure its effectiveness.

Over all, there are 6,600 suicides per year among the 25 million veterans of all wars, representing about one in five suicides in the country, Ms. Childress said. There are an estimated 1,000 suicide attempts per month among the 7.8 million veterans treated by Veterans Affairs, she said. The suicides tend to be more frequent among older veterans, she said, citing statistics from data collected by the Centers for Disease Control and Prevention.

The number — 126 suicides a week, higher than the 120 published in previous studies — was in a December e-mail message from Dr. Ira Katz, the head of mental health services for Veterans Affairs, to Dr. Michael J. Kussman, the under secretary for the Veterans Health Administration in the department. Mr. Erspamer displayed the message in his opening argument.

The department has long been reluctant to release specific numbers regarding suicides or suicide attempts, lawyers for the veterans groups said. “We certainly think there was a cover-up in some sense,” said Heather Moser, a lawyer for the plaintiffs.

A second department e-mail message from Dr. Katz shown at the trial starts with “Shh!” and refers to the 12,000 veterans per year who attempt suicide while under department treatment. “Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?” it asks.