Veterans for Common Sense

Iraq War Vet Suffering Post Traumatic Stress Disorder Faces Court Martial Because He Went AWOL to Get Mental Health Care

Contact: Tod Ensign, (212) 679-2250 or (917) 647-5676 (cell)

http://www.citizen-soldier.org/
Press Conference: Monday, May 14, 2007, 10:00 am
Location: Different Drummer Internet Cafe, 12 Paddock Arcade, adjacent to Fort Drum , Watertown NY

Army Specialist Eugene Cherry, 24, of Chicago , IL , served as a combat medic in Iraq from June 2004 to June 2005 with the 10th Mountain Division from Fort Drum , NY .

Returning to the base, Cherry suffered from severe mental health symptoms associated with post-traumatic stress disorder (PTSD).  Unable to obtain treatment for his mental health condition, Cherry returned home to Chicago where he entered treatment with a local private clinical psychologist.

Since Cherry returned to Fort Drum , he was given powerful drugs such as Zoloft & Ambien but only one therapy session.  Last week, the command charged him with being AWOL and will try him at a Special Court Martial, which could impose a one year prison term and a Bad Conduct Discharge.  Cherry must be interviewed by telephone, since he’s been restricted to Fort Drum .

Dr. Hannah Frisch, PhD, is the Chicago clinical psychologist who treated Specialist Cherry and  prepared a six page medical evaluation diagnosing him with Post Traumatic Stress Disorder (Sec.309.81 of  the APA’s Diagnostic Manual, 4th ED)  Dr. Frisch will be present to discuss Cherry’s case and she will visit Fort Drum to discuss his treatment with Army mental health professionals.

Tod Ensign, Esq., Legal Director of Citizen Soldier, the GI rights group which sponsors the “Different Drummer” cafe, will discuss the project’s plans to support  Cherry and the efforts of other Fort Drum veterans to obtain prompt mental health treatment, in lieu of prosecution, for behavior linked to their PTSD.

Cindi Mercante, Army veteran and Project Director, “Different Drummer,” will describe contacts the project has had with soldiers and their family members who are seeking mental health care for Iraq or Afghan war related injuries.

CHICAGO, May 8 — For months, Gov. Kathleen Sebelius of Kansas and other governors have warned that their state National Guards are ill-prepared for the next local disaster, be it a tornado, a flash flood or a terrorist’s threat, because of large deployments of their soldiers and equipment in Iraq and Afghanistan.

Then, last Friday night, a deadly tornado all but cleared the small town of Greensburg off the Kansas map. With 80 square blocks of the small farming town destroyed, Ms. Sebelius said her fears had come true: The emergency response was too slow, she said, and there was only one reason.

“As you travel around Greensburg, you’ll see that city and county trucks have been destroyed,” Ms. Sebelius, a Democrat, said Monday. “The National Guard is one of our first responders. They don’t have the equipment they need to come in, and it just makes it that much slower.”

For nearly two days after the storm, there was an unmistakable emptiness in Greensburg, a lack of heavy machinery and an army of responders. By Sunday afternoon, more than a day and a half after the tornado, only about half of the Guard troops who would ultimately respond were in place.

It was not until Sunday night that significant numbers of military vehicles started to arrive, many streaming in a long caravan from Wichita about 100 miles away.

Ms. Sebelius’s comments about the slow response prompted a debate with the White House on Tuesday, which initially said the fault rested with her. Tony Snow, the White House press secretary, said the governor should have followed procedure by finding gaps after the storm hit and asking the federal government to fill them — but did not.

“If you don’t request it, you’re not going to get it,” Mr. Snow told reporters on Tuesday morning.

The debate was reminiscent of the Bush administration’s skirmishes with Gov. Kathleen Babineaux Blanco of Louisiana, also a Democrat, after Hurricane Katrina. But after an angry flurry of words, both sides seemed to back down a bit later Tuesday.

Ms. Sebelius said she now had enough equipment and personnel to deal with the problems in Greensburg, and the White House acknowledged that the governor had requested several items that the federal government supplied, including a mobile command center, a mobile office building, an urban search and rescue team, and coordination of extra Black Hawk helicopters.

Nonetheless, the governor and officials in other states again expressed concern that the problem could occur again as the stretched National Guard system struggled to respond to disasters at home while also fighting overseas.

As State Senator Donald Betts Jr., Democrat of Wichita, put it: “We should have had National Guard troops there right after the tornado hit, securing the place, pulling up debris, to make sure that if there was still life, people could have been saved. The response time was too slow, and it’s becoming a trend. We saw this after Katrina, and it’s like history repeating itself.”

The Federal Emergency Management Agency, which came under strong criticism after Hurricane Katrina, seemed to respond more quickly in Kansas. Several of the agency’s mobile disaster recovery centers are in Greensburg assisting residents, and the agency said it had moved in 15,000 gallons of water and 21,000 ready-to-eat meals, enough to feed 10,000 people.

State officials said the problem with the National Guard’s response had more to do with equipment than personnel.

In Kansas, the National Guard is operating with 40 percent to 50 percent of its vehicles and heavy machinery, local Guard officials said. Ordinarily, the Guard would have about 660 Humvees and more than 30 large trucks to traverse difficult terrain and transport heavy equipment. When the tornado struck, the Guard had about 350 Humvees and 15 large trucks, said Maj. Gen. Tod Bunting, the state’s adjutant general. The Guard would also usually have 170 medium-scale tactical vehicles used to transport people and supplies — but now it has fewer than 30, he said. On the other hand, General Bunting said, it had more cargo trucks than it needed.

The issue is not confined to Kansas.

In Ohio, the National Guard is short of night vision goggles and M-4 rifles, said a Guard spokesman, Dr. Mark Wayda. “If we had a tornado hit a small town, we would be fine,” Dr. Wayda said. “If we had a much larger event, that would become a problem.”

The California National Guard is similarly concerned about a catastrophic event. “Our issue is that we are shortchanged when it comes to equipment,” said Col. Jon Siepmann, a spokesman for the Guard in California. “We have gone from a strategic reserve to a globally deployable force, and yet our equipment resources have been largely the same levels since before the war.”

In Arkansas, Gov. Mike Beebe, a Democrat, echoed the concerns of Ms. Sebelius. “We have the same problem,” Mr. Beebe said. “We have had a significant decrease in equipment traditionally afforded our National Guard, and it’s occasioned by the fact that it’s been sent to the Middle East and Iraq.”

He added: “Our first and foremost consideration is to guarantee that our soldiers have the resources, including equipment, to do the job and protect themselves. Having said that, my preference would be for the federal government to provide that equipment and not strip the state’s resources, which could adversely impact the state’s mission in times of crisis, which is what happened in Kansas.”

Last year, all 50 governors signed a letter to President Bush asking for the immediate re-equipping of Guard units sent overseas. But officials in several states, including Kentucky, Minnesota and Texas, said Tuesday that they were not facing equipment shortages.

National Guard units overseas are often assigned engineering missions, and the skills and equipment — bulldozers and trucks, for example — are also what might be required to deal with a natural disaster at home.

White House officials said that the Kansas National Guard had at its disposal in the Midwest and the Plains states, everything it needed. By Mr. Snow’s count, that included 83,000 National Guard soldiers; 99 bulldozers; 61 loaders; 246 dump trucks and 59 graders.

“There’s a lot of stuff available,” Mr. Snow said. “So, again, I think this is one where the equipment was available and everybody was moving as rapidly as possible.”

In Congressional testimony, senior National Guard officials have said that since Sept. 11 units under their command had equipment shortages as forces deployed to Iraq and Afghanistan.

Responding to concerns that the National Guard would not have sufficient personnel or equipment to respond to natural disasters, Guard leaders and state officials developed plans to ensure that if a state is in short supply of people or gear when a hurricane or tornado strikes, it can borrow from other states.

But borrowing does not solve every problem, state officials said, and coordination can take time. The destruction from Hurricane Katrina ultimately required the help of 50,000 troops — and they came from all 50 states.

Training is another issue. At a Washington news conference in February, Ms. Sebelius said, “The Guard cannot train on equipment they do not have.” She added later: “And in a state like Kansas, where tornados, floods, blizzards and wildfires can seemingly happen all at once, we need our Guardsmen to be as prepared as possible.”

Two recent reports have raised questions about Guard preparedness. An independent military assessment council, the Commission on the National Guard and Reserves, released a report in March that stated: “In particular, the equipment readiness of the Army National Guard is unacceptable and has reduced the capability of the United States to respond to current and additional major contingencies, foreign and domestic.”

Another report, released in January by the Government Accountability Office, concluded that the ongoing operations in Iraq and Afghanistan have “significantly decreased” the amount of equipment available for National Guard units not deployed overseas, while the same units face an increasing number of threats at home.

Late Tuesday, in a statement, Ms. Sebelius repeated her message:

“I have said for nearly two years, and will continue to say, that we have a looming crisis on our hands when it comes to National Guard equipment in Iraq and our needs here at home.”

Susan Saulny reported from Chicago, and Jim Rutenberg from Washington. Reporting was contributed by Maureen Balleza, Steve Barnes, Malcolm Gay, Christopher Maag, Adam Nossiter, Libby Sander, Thom Shanker and Jennifer Steinhauer.

May 09, 2007 – Until recently, the press has rarely covered the U.S. military program that occasionally offers “condolence” payments to Iraqis and Afghans whose loved ones have been killed or injured by our troops. But a number of high-profile incidents involving the killing of noncombatants has drawn some long-overdue, if fleeting, attention to the subject.

On Tuesday, in the latest example, the U.S. military apologized for a not-accidental atrocity near Jalalabad back in March and agreed to make the usual maximum payment — don’t laugh — of about $2000 to survivors for each of the 19 Afghan lives lost.

That’s an improvement in some ways. Last month I titled a column on this subject, “Sorry We Shot Your Kid, Here’s $500,” referring to a documented case in Iraq.

Those 19 deaths in Afghanistan (and 50 wounded), by the way, were not the result of some unintentional air strike. Troops, angry about a bomb attack on them, carried out a rampage along a ten-mile stretch of highway, shooting villagers apparently at random. Well, we got around to saying we were sorry — two months later.

Not that we don’t kill civilians from the air. Today, AP reports that a U.S. air strike killed 21 noncombatants in southern Afghanistan, including many children, on Tuesday.

The war zone killings, the justification for most of them — we rarely apologize even as we sometimes pay up – and the amount of the restitution, are all appalling, and a debasement of our values. It’s time for the press to ponder all of this deeply as the war — and the suffering of U.S. troops and civilians in Iraq — continues with no end in sight.

This also serves to reminds us of several disturbing questions: How many innocent Iraqis have been killed or injured, accidentally or on purpose, by our troops? And what is the price of a human life — in our view, and in the view of the survivors whose hearts and minds we are attempting to win?

Reporters should also ask Gen. David Petraeus, who is directing the “surge” effort in Iraq, why he lied in responding to a reporter’s question this week concerning widespread abuse by U.S. troops.

At the Associated Press’ annual meeting in New York on Tuesday, I sat in the audience observing Gen. Petraeus on a huge screen, via satellite from Baghdad, as he answered questions from two AP journalists. Asked about a military study of over 1,300 U.S. troops in Iraq, released last week, which showed increasing mental stress — and an alarming spillover into poor treatment of noncombatants — Petraeus replied, “When I received that survey I was very concerned by the results. It showed a willingness of a fair number to not report the wrongdoing of their buddies.”

That’s true enough, but then he asserted that the survey showed that only a “small number” admitted they may have mistreated “detainees.”

That was a lie. Actually, the study found that 10{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of U.S. forces reported that they had personally, and without cause, mistreated civilians (not detainees) through physical violence or damage to personal property. So much for the claims by President Bush, military leaders and conservative pundits that 99.9{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of U.S. troops always behave honorably. Of course, that kind of record has never been achieved by any country in any war.

The survey also noted that only 47{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of the soldiers and 38{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of marines agreed that noncombatants should be treated with dignity and respect. More than 40{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} said they backed torture in certain circumstances.

Only 40 {cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of American marines and 55{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of soldiers in Iraq said they would report a fellow service member for killing or injuring an innocent Iraqi. Of course, this only guarantees that it will happen again, and again. But that’s okay, a few American dollars will make that right again.

Or maybe not. Last month I spoke with Jon Tracy, a former Army captain who helped administer and make day-to-day condolence or “solatia” payment decisions in Iraq as a Judge Advocate in 2004 and 2005. This came after I found on the Web a paper he had written about his experience which critiqued the program in a balanced way. At the time I was deeply troubled after examining files on hundreds of Iraqi claims forced into the open by the American Civil Liberties Union.

Every Iraqi he had dealt with Iraq, Tracy revealed, “expressed shock and disbelief” when he told them he could only offer them, at most, $2,500 for a precious life lost. He observed that this “limits the unit’s ability to adequately assist in the most egregious cases.” Under the rules, “the full market value may be paid for a Toyota run over by a tank in the course of a non-combat related accident, but only $2,500 may be paid for the death of a child shot in the crossfire. … The artificial limit leaves survivors bitter and frustrated at the U.S.”

In other words, it can do more harm than good. The solution, of course, is to make such payments unnecessary.

Greg Mitchell (gmitchell@editorandpublisher.com) is editor.

VA medical care ranks among the world’s best.
But the system is dogged by red tape, disrepair.
Older vets worry that the influx of veterans from Iraq could crimp benefits.

May 2007 – The report in February sparked outrage. The revelation that soldiers recovering from wounds inflicted in Iraq and Afghanistan were housed in squalid outpatient facilities at Washington’s Walter Reed Army Medical Center also exposed a divide in the care of the nation’s veterans.

Beyond the debacle at Walter Reed, which is run by the Defense Department, are the problems veterans face once they leave active duty and try to enter the health system run by the Veterans Affairs Department. That agency has come under fire for tightening eligibility rules that deny care to hundreds of thousands of vets and for long delays in processing disability claims. In March a VA review found more than 1,000 maintenance problems—such as leaky roofs, peeling paint and insect infestations—at its 1,400 hospitals, clinics and nursing homes. And last year the agency reported a laptop had disappeared with the personal information of millions of vets.

On the other side of the divide is top medical care—especially for older vets—that VA Secretary Jim Nicholson calls “the gold standard” in U.S. medicine. Outside studies also suggest that VA care exceeds anything found in the private sector.

Consider:

A 2004 RAND Corp. report found that in 294 categories of care—many of them for ailments like diabetes and heart disease—VA hospitals outperformed private facilities.

There are many medicare plans which provides good medical facility. You should check List of Medicare Advantage plans and select the best one.

With 51 percent of its patients 65 or older, the VA has pioneered research in geriatric care. In 2006 the journal Medical Care reported that Boston University and the VA reviewed 1 million records from 1999 to 2004 and found that males 65-plus who received VA care had about a 40 percent decreased risk of death compared with those enrolled in Medicare advantage plans 2021.

The VA’s cost per patient has remained steady for the past 10 years, at about $5,000, while the consumer price index for medical care—what families pay in the private sector for care—has jumped about 40 percent. VA prescription drug costs are also lower. Accendo Medicare Supplement Plans are also in the list for providing best medicare plans.

Veterans are happier with their care than patients in the private sector. In the University of Michigan’s 2006 American Customer Satisfaction Index, a survey of patients, VA hospitals scored 84 out of 100—10 percent higher than the score for private hospitals. The VA program is largely free except for small copayments from higher-income patients.

The VA is the largest integrated health care system in the United States, with electronic records of all its patients, so anywhere a person is treated, the doctor has his or her complete medical history. Well endoluten is referred by many physician/health practitioner.

Frank Walter Smith, 83, one of several Washington-area vets interviewed by the AARP Bulletin, is a World War II vet who defused unexploded bombs in the Army. While he’s disgusted by the Walter Reed scandal—”the government should be ashamed of it”—Smith says he’s been “quite satisfied” with the VA medical care he’s received. “On the whole, they do very well. I haven’t seen anything like paint falling off the walls or mold on the ceilings.”

Joseph Violante, national legislative director for the Disabled American Veterans (DAV), calls the VA medical system “excellent.” But he acknowledges that restrictions on access have kept out hundreds of thousands of veterans who’d prefer VA care over private plans.

Moreover, groups like the DAV and American Legion fear that older vets from earlier wars might see their care scaled back because of the influx of wounded Iraq and Afghanistan vets.

The VA hospitals “aren’t falling short yet,” says Peter Gaytan, director of veterans affairs and rehabilitation for the American Legion. “But they could be, and they need to be well prepared.”

So far, 205,000 of the 631,000 Iraq and Afghanistan war vets have come to VA facilities for treatment. Michael Kussman, M.D., the VA’s acting undersecretary for health care, insists they “don’t overwhelm our system,” which expects to care for 5.5 million veterans this year.

Kent Gilmore, a 56-year-old former Army medic, says VA surgeons saved his life last June when he was stricken with a perforated colon and inflammation of the abdominal cavity. While the surge of returning vets hasn’t affected his treatment and recovery, he thinks that if the VA doesn’t get more funding, “there may be cuts in everyone’s care in the future.”

Congress is expected to approve an extra $1 billion or more for the VA’s $32 billion health care budget this fiscal year to accommodate new vets, and the Bush administration has asked for $34 billion for the next fiscal year.

For now, the VA is scrambling to distance its operation from the scandal at Walter Reed and to preserve the reputation for five-star medical care it built in the 1990s. Before then, the agency, which treats mostly vets with service-related disabilities, was considered the black hole of American medicine, with more than 1 million vets warehoused in decrepit conditions.

Starting in 1994, Kenneth W. Kizer, M.D., VA health undersecretary, shook up the agency’s cumbersome bureaucracy, closed underused hospitals and plowed the money saved into opening 300 more clinics around the country. He also hired former astronaut James Bagian, M.D., who revamped the patient safety program and encouraged medical personnel to report procedures that could harm patients, without fear of reprisal.

Kizer set up cost-saving incentives and performance standards for doctors to keep patients healthy and out of the hospital. Neal Evans, 34, a physician at the VA hospital in Washington, gets an end-of-year bonus not for the business he brings in but for, say, how many of his patients have lowered their blood pressure. He writes them regularly, to remind them of their last cholesterol or blood sugar level. “If it’s still high,” he says, “I ask them to schedule an appointment.”

As word of the VA’s improved medical care spread, hundreds of thousands of vets ditched their private plans to join the VA program. Richard Niedermair, 74, a Navy machinist mate from 1951 to 1955, switched five years ago and saw his monthly drug bill drop from $400 to $65. When he visits the VA’s Greenbelt, Md., clinic, he says, “I barely get my coat off, and they call me into the doctor’s office.”

But the VA didn’t have the funding to handle the flood of new enrollees. By 2003 the list of vets waiting six months or more for their first appointment had grown to 310,000. The VA finally had to restrict access only to vets with service-related injuries or with low incomes—a move that still rankles veterans groups, which complain the VA shut the door to half a million lower-priority vets who wanted to enroll.

As of mid-March, the list of those waiting 30 days or more for their first appointment was down to 1,707.

Despite improvements in the VA system, there’s still room for more. Many facilities, for example, are showing their age (the average is 58 years old). Officials say 90 percent of the maintenance problems found in the March review were for routine wear and tear.

And sometimes medical mistakes occur. Last year a surgical team at the VA’s Tampa, Fla., hospital placed an unsterile cranial plate in the head of a wounded vet and was saved from repeating the error on another patient when the implant didn’t fit. A nurse discovered the plates hadn’t been shipped presterilized, and e-mail alerts were sent to other VA medical facilities.

But even the VA’s mistakes may prove instructive. Many private hospitals don’t report close calls or investigate them, says patient safety expert Bagian. “In most places nobody would ever tell anybody,” he says. “The VA didn’t try to cover it up.” And the patients didn’t get infections.

Douglas Waller is a former senior correspondent at Time magazine.

May 8, 2007 – Depleted uranium, which is used in armour-piercing ammunition, causes widespread damage to DNA which could lead to lung cancer, according to a study of the metal’s effects on human lung cells. The study adds to growing evidence that DU causes health problems on battlefields long after hostilities have ceased.

DU is a byproduct of uranium refinement for nuclear power. It is much less radioactive than other uranium isotopes, and its high density – twice that of lead – makes it useful for armour and armour piercing shells. It has been used in conflicts including Bosnia, Kosovo and Iraq and there have been increasing concerns about the health effects of DU dust left on the battlefield. In November, the Ministry of Defence was forced to counteract claims that apparent increases in cancers and birth defects among Iraqis in southern Iraq were due to DU in weapons.

Now researchers at the University of Southern Maine have shown that DU damages DNA in human lung cells. The team, led by John Pierce Wise, exposed cultures of the cells to uranium compounds at different concentrations.

The compounds caused breaks in the chromosomes within cells and stopped them from growing and dividing healthily. “These data suggest that exposure to particulate DU may pose a significant [DNA damage] risk and could possibly result in lung cancer,” the team wrote in the journal Chemical Research in Toxicology.

Previous studies have shown that uranium miners are at higher risk of lung cancer, but this has often been put down to the fact that miners are also exposed to radon, another cancer-causing chemical.

Prof Wise said it is too early to say whether DU causes lung cancer in people exposed on the battlefield because the disease takes several decades to develop.

“Our data suggest that it should be monitored as the potential risk is there,” he said.

Prof Wise and his team believe that microscopic particles of dust created during the explosion of a DU weapon stay on the battlefield and can be breathed in by soldiers and people returning after the conflict.

Once they are lodged in the lung even low levels of radioactivity would damage DNA in cells close by. “The real question is whether the level of exposure is sufficient to cause health effects. The answer to that question is still unclear,” he said, adding that there has as yet been little research on the effects of DU on civilians in combat zones. “Funding for DU studies is very sparse and so defining the disadvantages is hard,” he added.

May 8, 2007 – An Orthodox Jew and former petty officer in the US Navy said his civil rights were violated after a chaplain and officials at a Veterans Administration hospital in Iowa City, Iowa, tried to convert him to Christianity while he was under the VA’s care.

David Miller, 46, who is on full disability, said in an interview that his physician at the VA hospital told him last week to go home and pray or meditate in place of using medication to relieve the pain he was experiencing from kidney stones. When Miller complained to VA staffers that his physician suggested he turn to God to treat his medical condition and refused to prescribe pain medication, VA officials provided him with a new doctor.

“My doctor said that since I am a religious Jew, I should try prayer or meditation to deal with the pain,” Miller said. “I was shocked that a medical doctor would make such a suggestion. I immediately raised hell and was assigned a new physician.”

Kurt Sickels, a spokesman for the Iowa City VA Medical Center, said that he could not comment on Miller’s specific allegations against the hospital, but he said the VA does not try to convert patients to Christianity.

“We respect all religious preferences and beliefs, and we make every effort to accommodate what those beliefs may be,” Sickels said.

If that’s the case [that officials tried to convert Miller], Sickels said, the hospital staff is not adhering to its policy.

Miller dresses in the traditional attire required for Orthodox Jews. He started receiving treatment for a heart condition and kidney stones at the Iowa City VA hospital after moving back to his hometown two years ago. Since then, he said, a chaplain on duty at the hospital has tried on numerous occasions to convert him to Christianity.

“The first two visits by the Protestant (Assembly of God) chaplain were all about trying to convert me, trying to convince me that I needed Jesus, that Jesus was the Messiah of the Jews too,” Miller said. “My medical records clearly indicate that I am Jewish. However, with each admission, I have informed the nursing staff both verbally and in writing that I require kosher food and that I do not wish to be visited by anyone from the chaplain’s office. I requested they contact my rabbi, and I provided them with his name and telephone number. Despite these instructions, during all three of my hospitalizations, I have been denied kosher food and have had to endure my entire hospitalizations without eating.”

The chaplain, Miller said, provided him with a copy of a scripture from the New Testament, despite Miller’s protests that he be left alone.

After filing complaints with the hospital’s patient advocacy board, Miller and his rabbi met last week with hospital officials and the chaplain who tried to convert him. He said the hospital has agreed to provide him with kosher meals in the future, suggesting that he be more assertive in resisting the next time the VA chaplain attempts to push Christianity on him. That, Miller said, was the last straw.

Late last month, Miller contacted Iowa Senator Tom Harkin, a Democrat, about the issue. Harkin wrote a letter to Barry Sharp, the director of the Veterans Administration hospital in Iowa City, to inquire about Miller’s allegations against the VA.

“A Jewish constituent has complained that each time he is admitted to [Veterans Administration Medical Center] Iowa City, a Catholic chaplain is sent to his room to counsel ‘pray and offer communion,'” Harkin wrote. “The patient has repeatedly advised staff that he does not want a chaplain to visit. He is also concerned that he is not offered and cannot get kosher meals. Additionally, he mentioned that when new patients arrive and are given orientation, the session is conducted in a church/chapel. I would like to know the national policy regarding these issues. If this is an isolated incident or miscommunication, that guidance should be given to the … management and staff.”

In an email response to Harkin, a copy of which was obtained by Truthout, the hospital said when a patient is admitted to the VA hospital he or she is queried about religious preference at registration.

“There is a standard list which, includes Jewish as one of the religious preference options,” Sharp said in his response to Harkin, without specifically addressing Miller’s claims. “The admissions clerk should be checking with the patients to ensure that their preference or no preference is accurately indicated on the admission registration forms.”

Sharp said that in accordance with Department of Veterans Affairs guidelines, “pastoral counseling to patients” is not limited to a specific faith.

“The spiritual aspect of health and wellness is recognized by all caregivers and addressed in all patient care settings,” Sharp wrote.

In addition to contacting Harkin, Miller enlisted the help of the nonprofit Military Religious Freedom Foundation, whose founder, Mikey Weinstein, a former White House counsel who defended the Reagan administration during the Iran-Contra probe, has been waging a one-man war against the Department of Defense for what he says is a blatant disregard of the Constitution. He recently published a book on the issue: “With God on Our Side: One Man’s War Against an Evangelical Coup in America’s Military.” Weinstein is also an Air Force veteran and a graduate of the Air Force Academy. Three generations of his family have attended US military academies.

Since he launched his watchdog organization 18 months ago, Weinstein said he has been contacted by more than 4,000 active duty and retired soldiers, many of whom served or serve in Iraq, who told Weinstein that they were pressured by their commanding officers to convert to Christianity.

Weinstein said Miller’s case is just the latest example of how the military has been hijacked by a right-wing fundamentalist Christian agenda, in what appears to be a clear-cut violation of the constitutional separation between church and state, which has rippled across all four branches of the military under President Bush.

“The rise of evangelical Christianity inside the military went on steroids after 9/11 under this administration and this White House,” Weinstein said in an interview. “This administration has turned the entire Department of Defense into a faith-based initiative.”

On Thursday, Weinstein said he intends to push back. He plans on holding a news conference in Des Moines to discuss Miller’s case and draw attention to the broader issue of “religious fanaticism” plaguing the military. Weinstein added that his organization would likely file a lawsuit against the Veterans Administration hospital for violating Miller’s civil rights.

“We will rapidly explore all legal options available, and I fully intend to file a lawsuit against the VA for massive constitutional violations against Mr. Miller,” Weinstein said. “We will look at the law and lay down a withering field of fire at the feet of the VA to stop this tidal wave of unconstitutional destruction.”

Weinstein, who is Jewish, said that VA chaplains, as federal government employees, are not supposed to “proselytize or rescue souls.”

VA chaplains “are not supposed to view the VA hospitals as their own personal mission field, or the veterans as low-hanging fruit,” Weinstein said. “The VA is not the Southern Baptist Convention. In this country, we have a separation between church and state. The religious right views the separation of church and state as a myth. There is no difference between the VA hospital and a US Air Force fighter squadron. They’re both part of the federal government. It doesn’t matter if you’re an Orthodox Jew, a Buddhist or an atheist.”

VCS Note: This story has two parts — see below for second part. 

WASHINGTON – The Department of Veterans Affairs has habitually exaggerated the record of its medical system, inflating its achievements in ways that make it appear more successful than it is, a McClatchy Newspapers study shows.

While the VA’s health system has gotten very good marks for a transformation it’s undertaken over the past decade, the department also has a habit of overselling its progress in ways that assure Congress and others that the agency has enough resources to care for the nation’s soldiers.

The assurances have come at a difficult time for the agency, as a surge in mental health ailments among returning veterans over the last few years has strained the system and a spate of high-profile problems with caring for veterans in the VA and the Department of Defense’s Walter Reed Army Medical Center has provoked heightened public scrutiny.

A review by McClatchy of the quality measures the VA itself commonly cites found that:

_The agency has touted how quickly veterans get in for appointments, but its own inspector general found that scheduling records have been manipulated repeatedly.

_The VA boasted that its customer service ratings are 10 points higher than those of private-sector hospitals, but the survey it cited shows a far smaller gap.

_Top officials repeatedly have said that a pivotal health-quality study ranked the agency’s health care “higher than any other health-care system in this country.” However, the study they cited wasn’t designed to do that.

In general, the VA has highlighted what it says are superior conditions in its health system. Over the last 10 years, the agency has remade itself, boosting outpatient and preventive care in a growing network of outpatient clinics. It’s received glowing news coverage for the transformation.

“Today we’re positioned as an internationally respected force in health-care delivery, leading private and government providers across every measure,” Secretary James Nicholson said in a 2005 speech. “And we can prove it.”

On key issues of access, satisfaction and quality of care, however, other data contradict the agency’s statements.

Consider how returning soldiers with post-traumatic stress disorder – a major ailment to emerge from the war in Iraq – are cared for. The VA’s top health official, Dr. Michael Kussman, was asked in March about the agency’s resources for PTSD. He said the VA had boosted PTSD treatment teams in its facilities.

“There are over 200 of them,” he told a congressional subcommittee. He indicated that they were in all of the agency’s roughly 155 hospitals.

When McClatchy asked for more detail, the VA said that about 40 hospitals didn’t have the specialized units known as “PTSD clinical teams.” Committees in the House of Representatives and the Senate and experts within the VA have encouraged the agency to put those teams into every hospital.

Even considering that other PTSD programs are available, there are about 30 hospitals with neither PTSD teams nor any other kind of specialized PTSD programs, although all hospitals have at least one person who specializes in the ailment, VA records show.

The VA stood by Kussman’s statement. He wasn’t referring to a specific type of team, officials at the agency said, but to the fact that a collection of medical professionals will tend every veteran, whether or not his or her hospital has a PTSD clinical team.

Experts inside and outside the VA point to studies showing the agency does a good job, particularly with preventive care, and that it compares favorably with the private sector. While that may be true, McClatchy also found top VA officials buffing up those respectable results in ways that the evidence doesn’t support.

ACCESS

Secretary Nicholson told Congress in February about the VA’s “exceptional performance” in getting veterans in to see doctors. In 2006, the VA said 95 percent of its appointments “occurred within 30 days of the patient’s desired date.” In previous years, Nicholson and other VA officials have touted the department’s record on this issue.

Evidence from the VA itself indicates the record might be inflated.

According to a 2005 report from the agency’s inspector general, VA schedulers routinely put the wrong requested appointment dates into the system, often making waiting times appear to evaporate. In many cases, the scheduler checked for the next available time slot and declared it the patient’s “desired date.”

On Oct. 2, 2003, a veteran was referred to an ophthalmology clinic. On May 3, 2004, a scheduler created an appointment, saying the “desired date” was June 21. The appointment was scheduled for June 23, the inspector general said.

Actual waiting time: 264 days. Reported waiting time: two days.

Some schedulers even kept “informal waiting lists” to consult when they were ready to make formal appointments.

Investigators found that 41 percent of appointments contained errors in the desired dates, and that only 65 percent of a key type of appointment they analyzed were within 30 days of the desired dates.

After the report, the VA promised several fixes. But by December 2006, it had yet to complete them, the inspector general reported. The inspector general’s office continues to find scheduling problems similar to those it discovered in 2005, according to the VA’s Odette Levesque, who’s been briefed on an ongoing follow-up study.

One of those promised fixes was a new training program. As of the end of April, fewer than half the employees who need the training had completed it, the VA said.

The agency has made several changes since 2005 and it told McClatchy it “believes we have met the intent” of the inspector general’s recommendations; it also said that scheduling was “dependent on schedulers who do make errors.”

SATISFACTION

When he touted the VA’s quality before a Senate committee in February, Nicholson’s first bit of evidence was a customer satisfaction survey.

VA satisfaction ratings, he testified, were “10 points higher than the rating for inpatient care provided by the private-sector health-care industry. VA’s rating of 82 for outpatient care was 8 points better than the private sector.”

Kussman testified the same thing to a House committee.

But a review of data from the University of Michigan’s American Customer Satisfaction Index shows that Nicholson and Kussman compared the VA’s inpatient and outpatient scores to private hospitals’ TOTAL score. The total score combines three surveys: inpatient, outpatient and emergency room. The VA doesn’t do an emergency room survey, and that’s what drags the private-sector numbers down.

“The ER is a far less satisfying experience compared to inpatient and outpatient services,” said David VanAmburg, who directs the annual survey. Comparing the VA with the private sector’s overall score “is not necessarily an apples-to-apples comparison,” he said.

If the VA were to use the correct comparisons, it still would score higher, although the gap would be half as much – 4 points, in the case of outpatient care. If the survey were adjusted for age and gender differences between the VA and private samples, the gap would tighten even more, although it still would be about 3 points and therefore significant, VanAmburg said.

Asked about the survey, the VA at first said there were some ER patients in its outpatient survey (although not the inpatient survey), which could make the comparison with the overall hospital score valid. The VA said it didn’t know how many.

McClatchy then asked about a separate report indicating that about 1 percent of outpatient visits are coded “emergency unit.” The VA conceded that any ER survey responses would be a “small fraction” of the overall sample.

It added: “To ensure we’re providing the most accurate information possible” about the ACSI survey “we will consider improving how we articulate its results.”

QUALITY

To prove the quality of the VA’s medical care, Nicholson and others – often using identical words to Congress or the news media – repeatedly have cited a study by the nonprofit RAND Corp.

In the last two years:

_Nicholson said RAND “ranked the overall quality of VA medical care as significantly higher than any other health-care system in this country.”

_Dr. Jonathan Perlin, then the top VA health official, said in a radio interview that RAND “compared VA care to 12 other health-care organizations, some of the best in the country,” and found VA superior. Studies such as RAND’s showed the agency’s care to be “the best that you can get in the country,” he said.

_Kussman wrote in a statement to McClatchy earlier this year that RAND “recently” reported that veterans “receive better health care than any other patients in America.”

_The VA’s public affairs department wrote in a magazine that the study “was conducted by the RAND Corporation, an independent think tank,” as well as researchers from two universities.

As it turns out, the RAND study was neither fully independent nor all that recent. A VA grant helped pay for it. Two of its main authors had received VA career-development awards, and four of its nine listed authors were affiliated with the agency, according to the study’s documentation.

It was published in 2004 but used data from 1997 to 1999, when the system treated far fewer patients than it does now.

The study does show that VA patients are more likely than non-VA patients to receive a range of needed tests and procedures. In the eyes of health experts, that’s a real achievement; other studies have found similar results.

But Nicholson’s claim that the agency performed better than “any other health-care system in this country” and Perlin’s assertion that RAND compared the VA with 12 other health-care systems are wrong.

The study didn’t compare the agency with other systems; it compared patients in the VA with those who weren’t.

The non-VA patients were drawn from 12 large metropolitan areas across the country, while VA patients were drawn from two of its 21 regions. The two groups were surveyed with very different methods, and the non-VA sample had a far lower response rate than the VA sample.

Asked about the study, the VA said the agency had partially funded it but that the preponderance of money came from other sources; RAND has a long “reputation for independent evaluation,” it said.

The VA did say that Perlin’s quote was “partially inaccurate in describing the study,” which it chalked up to confusion. It stood by the other statements.

PART TWO: Record on important health outcomes is mixed

By Chris Adams, McClatchy Newspapers

May 10, 2007 — WASHINGTON – Many studies tout the quality of the Department of Veterans Affairs health system based on what researchers call the “process” of health care; for example, how regularly important tests are performed. The VA does well on those measures.

There are fewer studies documenting the outcomes of the agency’s health care. That is: Do patients in the VA system do better or live longer? There, the record is mixed.

-A 2004 study, covering patient care from the same period as the RAND Corp. study the VA often cites to prove its quality, examined survival rates among patients treated in either VA or Medicare-funded hospitals after heart attacks. It found that patients in VA hospitals had a higher death rate than those in the Medicare system, even after accounting for the severity of each veteran’s illness. Mary Beth Landrum, an associate professor at Harvard Medical School who led the study, said it had prompted the VA to change its cardiac care procedures.

Using slightly different methods, the VA said its own analysis of heart attack mortality found no difference between the VA and Medicare systems. That analysis hasn’t been published in a peer-reviewed journal, although the agency said it planned to submit it to a journal soon.

Landrum said the different results showed how difficult it was to research outcomes in health-care systems that record information in different ways.

-A separate study, from 2004, compared diabetes care among VA patients with those in private managed-care programs. It determined that the VA was superior in process issues, but the record was mixed on outcomes issues. For example, patients in the VA system had better control over their cholesterol and one type of hemoglobin than those in managed-care systems, but the VA and managed care were the same at controlling blood pressure.

-A 2005 study compared veterans who got coronary artery-bypass surgery at VA hospitals with those in private hospitals; the death rates were about the same.

-A 2006 study compared older patients in the VA system with those in the Medicare managed-care system. It started with two groups – one from the VA, one from the Medicare system – and determined how many of them died from 1998 to 2004.

After adjusting for health status, the VA patients had a lower death rate overall than those in Medicare. Donald Miller, a VA researcher and Boston University professor who co-authored the study, said the differences were big enough to be meaningful for the average veteran using the system.

But there was a caveat in the study: Once patients were pegged as either VA or Medicare users, those labels stuck; researchers didn’t track where the patients received their care. Another study, out in March, found substantial overlap between the systems: Forty-six percent of veterans in the study who were older than 65 used the VA and Medicare for outpatient care, and only 18 percent used just the VA.

-In a statement to McClatchy Newspapers, the VA made the case that a measuring system from the Joint Commission, which accredits health care organizations, demonstrates the VA’s superior care.

For about two dozen measures – mostly process measures, but some outcomes measures – the VA compared its performance with the average performance of other accredited hospitals. In its statement, the VA said its hospitals equaled or beat other hospitals 91 percent of the time.

What the agency didn’t factor in was all the times there were too few cases to make a comparison. Of 2,738 comparisons, the VA hospital was better than the average accredited hospital about 21 percent of the time, it was the same about 36 percent of the time and it was worse about 6 percent of the time. In the final 38 percent, there were too few patients to make a comparison.

On the specific issue of heart-attack care, VA hospitals and other hospitals were essentially even. On the crucial measure of death after a heart attack, the results found VA hospitals better 0 percent of the time, the same 59 percent of the time and worse 1 percent of the time. In the remaining 40 percent, a comparison couldn’t be made.

-Miller, the Boston researcher, participated in another study that detailed a possible problem with any attempt to assess the care at VA facilities.

That study, published in 2004 in the American Journal of Managed Care, looked at more than 200,000 veterans with diabetes who were enrolled in the VA and Medicare.

Researchers found that the systems’ medical records differed. Looking only at VA records, for example, indicated that 2,300 veterans had had amputations. But combining VA with Medicare records showed that there were 3,900 veterans with amputations.

The bottom line: VA records gave only a partial picture of a veteran’s total health care. Given such record-keeping gaps, the study concluded that “comparisons among national systems may not be possible until there is a single electronic medical record.”

NEWS RELEASE 

FOR IMMEDIATE RELEASE
May 8, 2007

New VA Advisory Panel to Improve Services for Returning Combat Veterans

WASHINGTON – Secretary of Veterans Affairs Jim Nicholson today announced the formation of a formal, 17-person committee that will advise him on ways to improve VA programs serving veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) and their families.

“This panel will report directly to me,” Nicholson said. “I am asking for their ideas and input on how VA can consistently ensure world-class service to America’s newest generation of heroes, particularly severely disabled veterans and their families.”

The Secretary’s announcement about the Department of Veterans Affairs (VA) panel, called the Advisory Committee on OIF/OEF Veterans and Families, comes on the heels of his presentation April 24 of recommendations from a presidential task force to improve services to the nation’s newest generation of combat veterans.

“A number of panels already have been asking tough questions about our programs for veterans transitioning to civilian life,” Nicholson added. “This committee, to be chaired by retired Lt. Gen. David Barno, consists of OIF and OEF wounded veterans, family members, survivors, leaders of the major veterans organizations and long-time veterans advocates.”

“This group of people have experienced war and our system of care and can advise me from first-hand experience on how we are doing and what we need to do better,” Nicholson added.

The new OIF/OEF advisory committee will hold a three-day inaugural meeting, beginning May 14 in Alexandria, Va.  The committee is scheduled to discuss its general work program, future meeting dates, and plans for site visits to VA facilities around the country. 
 
The schedule includes briefings by senior officials of VA’s key programs, comments by members of the public who register in advance with the committee, discussions about

Members of the VA Advisory Committee on OIF/OEF Veterans and Families are: Lt. Gen. Barno of Washington, D.C.; Dawn Halfaker of Washington, D.C.; Lonnie Moore of San Diego; Jack L. Tilley of Riverview, Fla.; Gary Wilson of Carlsbad, Calif.; Liza Biggers of New York City; Pam Estes of Dayton, Md.; Caroline Maney of Shalimar, Fla.; Kimberly Hazelgrove of Lorton, Va.; Michael Ayoub of Ashburn, Va.; Rocky McPherson of Tallahassee, Fla.; John Sommer of Annandale, Va.; Dennis Donovan of Atlanta; Frances Hackett of South Plainfield, N.J.; Paul F. Livengood of Manassas, Va.; Tim McClain of Alexandria, Va.; and Chris Yoder of Baltimore.

People seeking more information about the committee or who wish to register to make a statement of up to five minutes should contact VA’s Tiffany Glover by e-mail at tiffany.glover@va.gov.