Wednesday, June 23, 2010













"On September 11, 2001," declared US House Rep Harry Mitchell this morning, "we witnessed one of the greatest tragedies in American history. Still today, we all remember the horrific scenes of these terrorist attacks. Four years later, in 2005, the Gulf Coast was hit by one of the biggest natural disasters the region has ever seen, as Hurricane Katrina swept through the region killing thousands and leaving many homeless and displaced. And sadly, again today, we see Gulf states struggling with yet another major disaster, as the oil continues to spill. These types of events highlight the critical need for federal agencies to proactively prepare to effectively execute their federal obligations -- especially when called upon during emergencies." Whether a national disaster, international or regional, how does the VA intend to ensure that veterans needs are met regardless?
Chair Mitchell was opening the House Committee on Veterans Affairs' Subcommittee on Oversight and Investigations. (He also recognized veteran Terry Araman for his work in Arizona with homeless veterans, Araman is the program director of the Madison Street Veterans Association.) There were three panels. The American Red Cross' Neal Denton, the Healthcare Coalition's Darrell Henry, the American Legion's Barry A. Searle and BT Marketing's John Hennigan composed the first panel. The second panel was Capt D.W. Chen of the DoD, Christy Music (DoD), Kevin Yeskey (HHS) and Steven Woodard (Homeland Security). Panel three was VA's Jose Riojas with the VA's Kevin Hanretta and Gregg Parker. We'll note this exchange.
Chair Harry Mitchell: I have a question for anybody who would like to answer this. In reviewing the National Response plan, there's a myriad of federal resources called upon in response to a crisis. How do we determine if the agencies will be able to work together? Yes, just go ahead in any [order].
John N. Hennigan: Thank you, Mr. Chairman. I can -- I can speak from experience in Montgomery County [Texas] when we had [Hurricane] Ike occur. We first had [Hurricane] Rita hit the Gulf Coast and it was truly total confusion. And what we found Contra[-Flow] Lanes in the freeway to try to - to try to evacuate people on the Gulf Coast was a disaster. It was done too late. Communications between EMS, fire stations, police, sheriff, state police was uh, was inappropriate. Since that time, prior to Ike, we all went on same frequencies. We developed a program where Contra-Flow Lanes were done well in advance versus-versus a uh 24 hour mandate, get-out-of-town. So I think a lot of it is, can-can communities -- in this case with the VA -- can the community officials communicate to the VAs and vice-versa on the same frequency -- whether it's radio, whether there's a set plan or one organization that coordinates all the entities as we're doing in Montgomery County right now. Can that happen? And when that happens, it just makes life a lot easier for everybody because you only have one source to go to and they'll do the -- they'll delegate the appropriate things to do.
Chair Harry Mitchell: You know there's a -- again -- a myriad of agencies involved in all of the emergency preparedness. And, again, let me just ask others, how do we determine if these agencies are able to work together? Sometimes I think there's miscommunication of who has what role to play. How can we determine that? Do we determine that?
Barry A. Searle: Well, sir, as far as the DoD - VA interaction, one of the things that we see as very positive is on a day-to-day basis now in the attempt to develop the lifetime virtual records has established communications between DoD, VA and the public sector actually as far as transferring public information on veterans. The hope by the American Legion is that that will have started the -- a crack in the dyke, if you will. There's no question that stove piping exists and it has to be broken down. Through the-the-the national framework -- response framework -- and people have assigned positions, jobs and responsibilities -- For example, American Legion is not telling VA how to do that but it would be reasonable that they would be under the ESF8 as a support function, that they would not be an elite function in this case. But there is a framework there for telling people what they should be doing and feeding into it. But I think that VA has taken some serious steps into making a coordination with other entities -- be it DoD and civilian doctors, for example -- which will eventually help with the system. It's not going to solve the whole thing, but at least it's a starting point.
Neal Denton: Mr. Chairman, if you don't mind, I'd like to say something to this too. So much of this builds on exercises -- the national level exercises -- that take place in the country where we bring these groups together and have a table-top exercise in advance so that we get to know who the players are and what their capacities are, what it is, they're going to bring to the table, what it is that they thought we were going to be bringing in and we discover, "Oh, no, that's actually something we need to resolve somewhere else." So much of this really happens on a local level. You know, I mentioned in my testimony, that the event we just had at we had out at Fort Belvoir where we had a preparedness event. At that parking lot there in the PX, all of the players who would respond to a disaster in Fort Belvoir were there. It was a bright sunny day and we were handing out preparedness kits but the other thing that was going on was we were who'd be responding to a disaster if something were to happen there. Having a chance to talk to each other, connect with other and talk a little about what our roles and responsibilities are if something were to happen. The more of these that happen on a local level, I think the more success that we're going to have.
Chair Harry Mitchell: I just was looking at the federal response plan and the VA has a support role with four different agencies that have the primary response. We have a support role with DoD. There's one with the American Red Cross. There's one with the GSA also HHS. And I just hope, that's what part of this hearing is about, is to make sure that everybody understands their role -- in a support or a primary role.
Does anyone feel like there's a plan? How about a plan to have plan? We're not wasting time on the second panel. For example, Capt Chen was and Chair Mitchell stopped him and informed him of the law -- actually made it clear (nicely) that he knew the law Chen was talking around -- and how it worked and asked specifically -- again -- what VA and DoD were coordinating on and instead of a direct answer, Chen wasted several more minutes offering a historical overview. An overview that it was very clear that the Subcommittee didn't need. (And, again, hadn't asked for.) "I understand about the wartime, again, but I'm asking about the natural disasters where DoD is part of the response team," Chair Mitchell attempted for a third time with Chen. Whether DoD didn't want the issue addressed or whether Chen didn't have the information is an unknown. But it was a waste of time and Mitchell's attempts to redirect were repeatedly ignored. Christy Music noted she'd grab it -- to everyone else on the panel before she made the statement to the Chair -- and she then ignored the question to offer yet another historical overview. Chair Mitchell wanted to know when the last time the two department -- VA and DoD -- cooridnated and no one could or would answer the very clear question. Over three minutes after she began 'answering' the Chair's question, Music stated, "So to answer your question more specifically, we coordinate with them daily, certainly two to three times a week." And, no, that didn't answer his question. Coordinate with them on what? On what Mitchell was asking about? Yesterday we heard about DoD and VA coordination on health care, for example (and we'll go back to that in a moment). That's not what the Chair was asking and his question was never answered. If the plan was to run out the clock, the witnesses were successful in that.
We're going to drop back to yesterday to note Tuesday's Senate Armed Services Committee Hearing. Committee Chair Carl Levin's initial questions were noted in yesterday's snapshot. Today we'll note Senator Daniel Akaka's. Appearing before the Committee was Gen Peter Chiarelli (Army), Adm Jonathan Greenert (Navy), Gen James Amos (Marine Corps), Gen Carrol Chandler (Air Force), and the VA's Dr. Robert Jesse.
Senator Daniel Akaka: In continuing to work with you and my colleagues we can refine efforts to prevent military suicides and to look for better ways to treat the -- to detect and treat and care for those suffering from invisible wounds of war. General Chiarelli and General Amos, suicide prevention is difficult and challenging -- and for all of you on our panel, this has come about, of course, because of what we call combat stress. And as was mentioned, this includes PTSD, TBI and behavioral health issues that we are facing here. As was previously stated, the services have experienced a rise in the numbers of suicides since the wars in Afghanistan and Iraq started. And there is a need to understand suicide, look at the causes so we can understand it and prevent it. Generals Chiarelli and Amos and also Dr. Jesse, how can the VA and DoD better collaborate in the area of suicide research and prevention? This has been mentioned by General Chiarelli as a great need here and I'd like to have the three of you give your perspectives on this.
Gen Peter Chiarelli: Well I would argue --
Senator Daniel Akaka: General Chiarelli?
Gen Peter Chiarelli: -- the cooperation between the VA and the services, I believe, has never been better. I think the disability evaluation pilot that we're running at different installations is proving to be a great success for the United States Army. And the wonderful thing about this is is that when a soldier goes through the DES uh we ensure that if they're leaving the service that they're in the VA system. And this is something that has never happened before as far as I know. It is a wonderful benefit of this that when a soldier makes a decision to leave the service, he is in that VA system. Before we would in fact have soldiers separate and it would be their responsibility to work their way through the process to get in to receive both their medical benefits and other benefits through the VA system. I think that you've hit upon a key piece here and that is stressors but it's not only combat stress, it's individual soldier stress and family stress and when we look at those across a continuum. what we're seeing in the army with the high ops tempo that we're on today, that a soldier in the first six years that he or she spends in the United States Army has the cumulative stressors of an average American throughout their entire life. And that's when you combine high ops tempo, individual soldier stressors and family stressors. So this is an area we're looking at very, very hard. And when you realize that 79% of our suicides last year were soldiers in-in-in 60% in their first term, 79% one deployment or no deployment, I think it points to doing everything we possibly can to mitigate those stressors whenever possible and as we're working so hard to do in the Army, work to increase the resiliency of our soldiers -- particularly in their younger years.
Senator Daniel Akaka: Thank you. General Amos?
Gen James Amos: Senator, I'll be happy to talk about not only the relationship but the hand off between the military -- in my backyard, the Marine Corps -- and the Veterans Association. Like General Chiarelli, I have never seen it better. The entire organization is well led from the top down, from VA. They are compassionate, they are passionate about the care of our young men and women that enter their system. I've never seen it better. I'm fortunate to get to travel around and visit a lot of our VA hospitals and a lot of our wounded and I come away just completely wowed by what I see. There is a systematic handoff . In the Marine Corps, this is done by what we call our recovery care coordinators. We take some Marines -- we have them around the nation. They are not part of the federal recovery, but they are linked to it. They are US marines whose job it is in life to know everything they can about the VA system and so when a Marine transitions -- especially one of our wounded Marines -- transitions out into -- heading to VA Land, after his disability board and he's moving on to the next half of his life, that recovery care coordinator contacts the federal recovery care coordinator, the District Entrance Support Marines we have out there, our network of Marines for life, put our arms around this guy. But I've seen it first hand where the actual hand off for a needy Marine, in some cases two years after the injury, after the initial injury -- I just saw this last -- about last month down in Corpus Christie, Texas. A young Marine, TBI two years ago his life is unraveled right now and through the federal recovery coordinator and the VA in San Antonio and our care coordinator we were able to plug this Marine, get him back into a hospital right away for further care. So, I've never seen it better, Senator.
Senator Daniel Akaka: Let me ask Admiral Greenert for your comments as well as General Chandler after you.
Admiral Jonathan Greenert: Thank you, Senator. I think General Chiarelli and Amos hit the nail on the head. Cooperation is very good. In fact, we meet monthly-- with leadership of the VA and the leadership of the Dept of Defense to streamline the Defense -- the Disability -- excuse me -- Evaluation System. I would say that what we are finding in our study of suicides, the transitional period seems to be a spike in stressors and this is an area we need to watch very closely -- this transition period -- and be sure that our Sailors have the social support network that they've had as they've moved through their career in the Navy as long as it is. It's also a focus area to watch out for those stressors. Thank you.
Senator Daniel Akaka: General Chandler?
Gen Carrol Chandler: Senator, we have approximately 700 Airman in our wounded warrior program. These are young men and women whose lives have been changed forever and that we are dedicated to taking care of from the time they've been wounded until they no longer need our services in the Air Force and we make the transition to the federal system if, in fact, that's required and we're not able to bring them back to the Air Force. We use much the same system that General Amos described with recovery care coordinators that allow us to do that around the nation, to service the men and women that require that kind of treatment and that kind of handling. We're very comfortable with our relationship with the VA and the way that's working.
Senator Daniel Akaka: Well I'm glad that we've been working on what we call seemless transition and it appears that we're moving along in that. Dr. Jesse?
Dr. Robert Jesse: Thank you, sir. So as not to reiterate things that have already been said. I'd just like to point out a couple of areas where this level of integration has really become manifest. The first is in the post-deployment and health reassessment exercises. Uh, the VA generally has a presence at the exercises -- not to administer the exams but to be present to make sure that those service members are uh-uh aware of all of their benefits that the VA can provide. But also if there are immediate health and particularly mental health issues that arise, that they are there and can literally make an appointment on the spot. They can get them enrolled in VA, make an appointment and, if we need to take them into our care, we can do that. So that we participate in that -- The second is the poly-trauma networks uhm which really are while the VA has four going on five now poly-trauma centers of care those are really tightly integrated into the wounded war -- wounded warrior programs at Walter Reed and Bethesda. In fact, I had the real honor to accompany [VA] Deputy Secretary [W. Scott] Gould and Dr. Stanley on a tour of Walter Reed and them come directly down to Richmond and look at the seemless way that both patients and their information moved back and forth through those networks including the fact that VA represenatives stationed in the DoD facilities and DoD clinicians in the poly-trauma centers so that they ensure that any movement of a patient is a warm hand-off and not just being sent to another place. Finally, in the mental health area, I think there has just been an extraordinary collaboration uhm-uhm going on for some time now. There was a joint-conference in the fall of '09 that led to an integrated VA - DoD strategic plan and the real goal is to make sure that when, for instance, the -- there are evidence-based therapies for Post Traumatic Stress -- treatment of Post Traumatic Stress, the VA and the uh -- Dep -- the uh, services uh agree on how we treat those patients so that this treatment begins in the services and then transitions to the VA, we're not abruptly stopping one form of therapy and then herding them into another. And I think that is a hugely important point of collaboration that we've gotten that far.
How wonderful. There are no problems. Everyone said it worked wonderfully. So everything's perfect. And the service members have stopped taking their own lives, right? Suicide is now a thing of the past, right? Surely, it must be when it's being so wonderfully praised in a Senate hearing. Or maybe a lot of people just wanted to spin? Suicides didn't stop. And nothing raised in the above exchange really addresses the issue. Akaka clearly asked about military suicides and look at the responses. Kat offered her impressions of this hearing last night.

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