Friday, July 15, 2011

Now they tell us he was lying 3 years ago





For my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that.






Daniel Williams: I was deployed to Iraq in '03, was deployed with the 4th infantry division out of Fort Hood, Texas. During that combat deployment, I suffered mental and physical injuries that will forever be part of my life. I was exposed to an improvised explosive device. I injured my body, my brain and my mind. I received a Traumatic Brain Injury, TBI, but I believe that almost as severe as my injury is the Post Traumatic Stress Disorder, PTSD, an invisible injury that no one else can see but it haunts my every move. From the moment I got injured until the time that I was honorably discharged, I received very little help from the Army or even acknowledgement of my state. I went to the base clinic at Fort Hood, Texas where I was told that I was having anxiety disorder and readjustment issues but I would need to wait six months before I could get an appointment with a psychiatrist, just an initial appointment to be looked at. In the winter of 2004, after receiving no help or any hope of help, I attempted -- I attempted suicide by putting a 45 caliber pistol in my mouth while I was locked in a bathroom. My wife begged me to let her in but I wouldn't agree. She called the police and when the police arrived, I argued with them. Then they kicked down the drawer and at that time I pulled the trigger. By the grace of God the weapon did not go off. The officer handcuffed me and put me in the seat in the back of his police car. One of the officers attempted to clear the weapon but at that moment the weapon went off. The same round that refused to kill me went off perfectly for him. Thankfully no one was injured. I was admitted to the psychiatric ward of the base hospital and remained at in patient for two weeks. At this time I was diagnosed with readjustment issues and anxiety disorder but the physicians also acknowledged that I had PTSD. I was told by the doctors that the treatment record would be kept confidential and it was not. It took me over a year to be able to be put out of the military service because of my mental illness.

Daniel Williams went on to outline problems within the VA which included that health care givers -- doctors -- tasked with helping treat his PTSD were unaware that noises and crowds were, at best, off-putting and, at worst, harmful to his treatment. Another VA doctor thought shock treatment was the way to go with PTSD. When not dealing with those extremes, he had to deal with just the hassles of getting an appointment. He had one appointment, for example, scheduled today. Clearly, he did not make that appointment. When he explained he couldn't make it because he was going to be appearing before the US Congress, he was told, no problem, they can reschedule him for four months from now. That was the earliest they could fit him in, they said.

"Good morning and welcome to today's hearing on how we can close the gaps in mental health care for our nation's veterans," declared Senator Patty Murray today as she brought the Senate Veterans Affairs Committee hearing to order. "We all know that going to war has a profound impact on those who serve. And after more than eight years of war, in which many of our troops have been called up for deployments again and again, it is very clear that the fighting overseas has taken a tremendous toll that will be with us for years to come. More than one-third of veterans returning from Iraq and Afghanistan who have enrolled in VA care have post-traumatic stress disorder. An average of 18 veterans kill themselves every day. In fact the difficult truth is that somewhere in this country, while we hold this hearing, it is likely that a veteran will take his or her own life."

The Senate Veterans Affairs Committee heard from two panels this morning. The first was composed of Iraq War veteran Daniel Williams (who is now with NAMI), caregiver Andrea Sawyer, Dave Underriner (Chief Executive of Providence Health & Services, Oregon Region) and the Assistant Inspector General for Healthcare Inspections for the Office of the Inspector General covering the VA Dr. John Daigh. The second panel was the VA's William Schoenhard.

Andrea Sawyer is married to Iraq War veteran Sgt Loyd Sawyer. He was part of the Army Mortuary Affairs team. While serving with them in Iraq, "he began exhibiting signs of mental distress."

Andrea Sawyer: Upon his return, I tried for eleven months to get him help. Ultimately, I sat in a room with an Army psychiatrist and my husband and watched Loyd pull a knife out of his pocket and describe his plan of slitting his throat. Multiple episodes of hospitalization and intensive treatment followed before he was permanently medically retired from the Army due to severe PTSD and major -- major depression. Loyd immediately enrolled in care at the Richmond polytrauma center. In October 2008, he received a 100% permanent and total disability rating from the VA. Given his urgent need for extensive help, we tried to get him into the PTSD clinic in Richmond. But the first available appointment required a two month wait. When he was finally seen, we were told that the only thing available in the clinic would be a quarterly medication management session and a once-every-six-weeks therapy appointment. Knowing that his depression was spiraling and his PTSD symptoms were worsening, we elected to use his TRICARE. He began treatment with a civilian counselor. He was able to see him once or twice a week. But over the next six months, I became increasingly concerned about the imminent possibility of suicide. Despite getting little help from our local VA, but thanks very much to our Federal Recovery Coordinator, Loyd was able to enroll in an inpatient PTSD program at the VA Medical Center in Martinsburg, West Virginia. We had high hopes for this hospitalization but it turned out to be a nightmare. The program delivered on none of its promises. His counselors and doctors there never coordinated with his local VA mental health clinician, his civilian counselor or his Federal Recovery Coordinator. He was placed on medication that made him physically and verbally aggressive despite having been taken off that same medication for the same reason while on active duty. Over the course of this 90 day program, Loyd had fewer than five individual therapy sessions and on returning home promptly discontinued all of his medication which was a step bacward as he had been completely meds compliant for eighteen months leading up to hospitalization. In calling the Richmond PTSD clinic for help, I was told it would be four weeks before they could see him. I tried to have his primary care manager intervene but was told that I and his FRC were wasting the time of his primary care manager. Eventually, again with help from our Federal Recovery Coordinator, I was able to get Loyd an appointment within a week with a VA psychiatrist outside of the PTSD clinic. She suggested that he attend the weekly thearpy group that met with the clinician inside the Richmond PTSD clinic. Feeling rather hopeless, he decided to try the therapy group and actually found great solace in being able to relate with others you were experiencing the same symptoms he was. Unfortunately, four months later, and without consultation of the patients, the medical center staff announced that the VAMC was changing its treatment model and would be disbanding the group by year's end. For those wishing to continue in a group setting, the VA would be turning them over to an untested VA program without a clinician. Despite the veterans petitioning to remain in a VA clinical program, their year long effort has been unsuccessful except to temporarily the clinician. The 40 member group has withered to an average of five to seven because now, as a support group located off the VA campus, veterans cannot take sick leave to attend their meeting. My husband is a veteran with well documented, severe, chronic PTSD who gets treatment at one of VA's major VA polytrauma centers. We have all the advantages that should guarantee him good treatment -- an excellent, caring Federal Recovery Coordinator, the priority associated with a 100% service-connected disability rating, a fabulous OIF case manager and the assistance of a super VSO. If a veteran with all these advantages cannot access timely, consistent, appropriate veteran-centered care in this system dedicated to the care of veterans, what confidence can this Committee have that a newly enrolled veteran who has recently returned from the war zone will have a greater success?

She noted, rightly, that VA "is failing." I have no idea why the White House is coasting. I have no idea how they get away with it. Andrea Sawyer had a set of statistics that you hear over and over, year after year, if you sit through these hearings. One statistic that was new to me was that approximately 20% of veterans who are diagnosed by the VA with PTSD do not get a follow up visit within 12 months of their initial diagnosis. Sawyer called it a veterans mental health care crisis and it's pretty hard to dispute that if you're paying attention to what's actually going on. Excerpt from first panel questioning.

Chair Patty Murray: Thank you very much for your testimony. And, Dr. Daigh, let me start with you. You heard the testimony. The stories that we've heard before the Committee today are not unique. I hear them everywhere I go and Congress has been listening to this. We have responded with the resources, with legislation, new programs. The IG [Inspector General] has provided the oversight. Yet here we are and these stories are still here and they're relevant again today. You mentioned a little bit in your testimony some things you thought, coordination of care, those kinds of things. I heard you talk about Altanta. They needed the clinicians but it's not that they didn't try, you said, it's just that they weren't there. Is that lack of people available to hire, is it lack of resources, is it lack of -- Tell us what we need to be doing in order to make sure that the VA has what it needs or to be telling the VA what it needs to do.

Dr. John Daigh: I think that there -- from my understanding of the situation in Atlanta and looking at the data, there was a tremendous growth in the demand for mental health services over a relatively short period of time. I'm not -- And-and-and some of the assumptions that they made about how they would provide care, their inpatient ward for example, they thought it would be functional and it wasn't. So they had to adjust. And I think they could have made better decisions about how they adjusted. And our report says that we think they could have made better decisions about how they adjusted. But part of the problem is that if you have pre-arranged relationships with universities or private practices or clinics of specialists that you know you need and can easily call on them as opposed to fee basis where you say, "I can't meet your demand, here's a chit, go get care," if you have an organized way, the records are shared, they expect to see patients --

Chair Patty Murray: Which goes to the closed system that I think Mrs. Sawyer was referring to, is that correct?

Dr. John Daigh: I think it was -- I think it was along the lines of what she was saying where she was able to go outside the system and get some help that was [turned head from microphone as he continued talking and was inaudbile]. Okay, sorry.

Chair Patty Murray: Mrs. Sawyer, tell me what your experience was.

Andrea Sawyer: We actually were not able to use the fee-based system in the VA because my husband is medically retired. We have TRICARE and so we just simply chose to exercise the TRICARE benefit. It was not in conjunction with the VA. Even requesting fee based at Richmond, even for physical or mental care is a labor intensive process. It takes months, it's not easy to get done, it's really kind of a broken system. So it's -- Even though there has been a directive that people should be able to use fee-basis care in times of wait, you still have to get it approved and it almost takes, pardon the pun, an act of Congress to get it done.

Chair Patty Murray: Well Mrs. Sawyer, in your testimony, let's talk about that. You just told us time and time again you were fighting everything to get appointments, to get attention. Dr. Daigh mentioned needing a "captain of the team." Did you ever feel like there was a captain of the team?

Andrea Sawyer: Quite honestly, I feel like I'm the captain of the team. I feel that I monitor symptoms, I see the increase in symptoms, the decrease in his quality of life and at that time I activate the chain as it is. I call the FRC, I call the clinic, I call the OIF case manager. I do everything I can. The problem is, with the VA, we have found is time and time again I have gone in and said, "We are seeing this civilian counselor." I've said it to the neuro-psychiatrist, I've said it to the person he was seeing in the PTSD clinic, I've said it to his OIF case manager. It's in his records. And yet again and again, I get comments from the PTSD clinic, "We didn't know he was seeing anyone else." I'm sorry. You can Google it and find that he was seeing someone else. We haven't stayed quiet about it. And we just can't get them -- I hand the number over, I ask them to call his counselor, I am his health care power of attorney. Also there's a flag on his chart, I'm supposed to coordinate his medical information because of the cognitive processing disorder. I constantly say, "Please call his counselor." And they don't.

Chair Patty Murray: This is a full time, 24-7 job for you.

Andrea Sawyer: Yes, ma'am.
I gave up my job. In order to keep him alive, that's what I had to do.

Chair Patty Murray: I hear that all the time and it has to have a huge impact on you. Tremendous amount of courage and I think about all the men and women out there who don't have Mrs. Sawyer as the captain of their teams. So I appreciate what you've been doing.

Andrea Sawyer: Thank you.

Chair Patty Murray: Mr. Williams, again, thank you for your service and all of what you're talking about is echoed in many other stories as well. You mentioned getting a hard time to get an appointment. I was curious from you whether any of the mental health care you receive is after hours or on weekends? That's another thing I hear from a lot of people who are trying to have a job, do other things and can't get the care because of lack of after hours or weekend services. Is that something that you've been able to access or see a need for?

Daniel Williams: There needs to be a larger amount of this care, yes. The access -- The only access I have to this is the vet center which is not communicating with the VA actual facility. This is a center where they do after hours counseling, they do marriage counseling. They're really not communicating, to be honest with you. They have no idea what's going on. There needs to be more of it, needs to be more advertised that there is this after hours care that can be used when you have -- You get off at six o'clock? Well have sessions at seven, eight o'clock at night. Uhm, you know, the family members need this care too because the family members have the same or gain the same PTSD or whatever the diagnosis may be as the veteran does. I know as Ms. Sawyer said, she gave up her -- pretty much her life to help her husband. And this is what happens not only to her but I think just about every family. Either the spouse leaves or the spouse stands behind them. And I know if it wasn't for the woman behind me, I would not have any care that I have today because she has given up her job too to take care of me. And there does need to be some more after hours. I know NAMI is partnering with the VA to do Family-Family. Family-Family is a program that helps the service member's family understand why they're doing the things that they're doing, why they're trying to get an adrenaline rush, why they're doing these little quirks that may not make sense to the family.

Chair Patty Murray: This may be a rhetorical question but it seems to me like people like both of you know this system really well, you're families have really borne the burden of this silent disorder of Post Traumatic Stess Disorder and Traumatic Brain Injury. We have a country that says "We're there for our soldiers" but you alone have borne this. Does the country understand PTSD? Do your neighbors and employers and people in the community know what you're going through or do you feel pretty alone? Either one?

Daniel Williams: To be honest with you, I feel very alone. The only other people that understand is my family. And when I say "my family," I mean my wife and other soldiers or other veterans. They're the only ones that understand the actual pain, the invisible pain I live with every day. And it's very, very hard to try to express to the nation. We get condolences, "thank you for your service" -- we hear that very often. But when was the last time someone actually said, "Alright, we need to make a change in the VA center. You need more services." That's the type thanks that I believe -- I take more to heart action than I do words. Because like I said, it's not only my suffering. I suffer from my Traumatic Brain Injury, my wife has to go through it, my kids have to go through it. So this is a never-ending cycle. My kids will have PTSD because of my actions. And if we could put peers together, family members like Ms. Sawyer and my wife together, more times the support for one another, not only for themselves but for us, it would be a stronger VA system. They've got to start looking at family oriented stuff. It's just the veteran [currently] and half the time the veteran can't even get stuff done. I mean it literally takes my wife getting to the point of getting arrested by the VA police to be able to see my psychiatric doctor because people are sitting on their phones, talking on their cell phones during business hours, telling me to hold on a minute, and I'm having a crisis where I'm fixing to honestly have a breakdown. And it takes people, like these two women, to have that. And not every veteran has that. Not everyone is fortunate enough. And I think that needs to somehow be a mentorship to veterans that don't have the support system.

Chair Patty Murray: Mrs. Sawyer, want to add anything?

Andrea Sawyer: Truly, I don't feel that the community understands. We spend a lot of time at the VA going to the VA is never just "go for an hour for an appointment." It's you go, you sit, you have a nine o'clock appointment and you might get seen by eleven. And then the doctor says, "Oh, we're only running two hours late today. That means we're on time." Then we sit for an hour. Sometimes it's not a good appointment then it takes hours for him to wind down. And get home and the neighbors say, "What do you do all day?" I talk to a lot of other caregivers who are in my situation and I've attempted to mentor some of the other caregivers because I do have a lot of time to deal with caregivers that I've met through
Wounded Warrior Project who are at different stages in their recovery. And I've been privileged that they trust me to call and ask: "Okay, we're stuck. What do we do?" We've built our own strong network outside of the VA and that's really what I use to survive. We have a community kind of all to ourselves. We've kind of been ostracized from the community. I left my job teaching. I had great scores, you know for the be-all-to-end-all test at the end of the year that all teachers are judged by whether we say they are or not, great scores. But I had missed a lot of work. It was my fourth year, my tenure year, and it was Loyd's first year after he was retired. We were spending a lot of time at the VA which meant I was spending a lot of time out of the classroom and the principal came to me and told me I had to choose between getting my husband better and teaching. So I left. So, no, the community does not understand.

Chair Patty Murray: Well thank you very much for sharing that with us and, Mr. Williams, I know your wife is sitting directly behind you, we want to thank her for being here as well and all she does for you.

We're going back to Daniel Williams because in his remarks before questioning, he was summarizing his prepared remarks. Like Senator John Kerry, I'm not big on people (mainly government officials) coming in and reading word for word their statements. Beside it being dull, they end up with a false end because the time runs out and they just have to stop or quickly come up with a conclusion in the middle of their statement. Both Daniel Williams and Andrea Sawyer summed up their remarks and did not read their prepared statements. In his oral opening statement (noted above), he noted that his medical conditions and treatment were disclosed to others without his permission. In his written statement, he went into detail on that. I think that's an important issue and understand he had to condense but wanted to include his details on that from the written testimony (prepared remarks):

I was admitted to the psychiatric ward of the base hospital and remained at in patient for two weeks. At this time I was diagnosed with readjustment issues and anxiety disorder but the physicians also acknowledged that I had PTSD. I was told by the doctors that my treatment records would be kept confidential. However, my platoon sergeant was notified and she then proceeded to tell my fellow soldiers which in turn caused much heartache and turmoil for these guys with whom I had gone through war and had shed blood, sweat and tears. They began to look down on me, because in their eyes, I was weak and they thought that I would not be able to do my job, nor could they trust me to go back to war with them if we were called to do so. I think that there needs to be more punishment for non-commissioned officers or any other soldier who has access to soldier's private mental health records and does not keep that information confidential. As in the past and still today, if a soldier has a mental health issue and fellow soldiers learn about it, then confidence is borken and military careers unquestionably are harmed. It took over a year for me to receive my medical evaluation board decision, and during the entire period I felt the effects of almost daily ridicule from members of my unit, a great pressure that affected my PTSD. I felt I let my soldiers down -- that I was of no use to them anymore. I had lost my brotherhood.

No one should have their medical confidientiality violated and it's an important issue so I wanted to include that. At his site, Mike will be covering another aspect of the hearing and Ava will be at Trina's site later tonight ("much later" she says -- we just finished the round-table for the gina & krista round-robin before I started dictating the snapshot) to report on Senator Scott Brown as she usually does. I've got a call in to Kat to see if she wants me to write at her site since she usually covers Ranking Member Richard Burr (Kat's in Hawaii). Tuesday's snapshot covered the first two panels of Monday's House VA Subcommittee on Health hearing and Mike covered the third panel that night with "House Veterans Affairs Subcommittee on Health hearing."

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