Friday, March 15, 2013

He hungers for Iran







Chair Mike Coffman: Dr. Coughlin, on October 23rd, this Subcommittee asked VA how many veterans have self-identified as suicidal and later committed suicide in the follow up study of the national cohort of Gulf War and Gulf Era veterans? On February 19th, VA responded stating, "VA has no evidence to date that any veteran in the study has committed suicide."  Are these the same results you saw in your study?

Dr. Steven Coughlin: Yes, fortunately we did not lose any of the research participants.  As I mentioned in my testimony, my efforts to identify mental health professionals, get involved with the study as co-investigators, place these call backs to vulnerable research participants were initially blocked by my supervisors and that's why I contacted the IRB in writing and also the VA Office of Inspector General.  After a delay of two or three months, we were able to start the call back process and a team of mental health professionals at the Washington DC VA Medical Center did a fantastic job of reaching out to the veteran.  We had vets who had been told by their local VA clinic or hospital that they were not eligible for free health care but, when they called the toll free number and reached somebody in VBA or the VA central office, they were told the opposite.  So the social workers, they were able to sort this out and get them into health care.  These were vulnerable veterans, men and women who major depression or other medical and psychiatric conditions and they needed assistance to get into health care to save their lives.

Yesterday afternoon, the House Veterans Affairs Committee held a hearing on Gulf War Illness and other issues.  US House Rep Mike Coffman is the Subcommittee Chair,  US House Rep Ann Kirkipatrick is the Ranking Member.  Dr. Steve Coughlin is a whistle blower.  His statements are beyond our scope or space -- in his opening statements, he was interrupted at one point by Coffman who noted he was now over ten minutes with his opening remarks (the limit is five minutes).  But strong coverage of Coughlin's remarks can be found in reports by Steve Vogel (Washington Post), Rebecca Ruiz (Forbes), Patricia Kime (Navy Times), Bryant Jordan ( and Kevin Freking (AP).

Some background on whistle blower Steven Coughlin.  Dr. Coughlin left the VA in December.  Prior to that, he was a senior epidemiologist with over 25 years of experience whose past also included a stint at the Center for Disease Control.  He resigned in December "because of serious ethical concerns."  His work was with the VA's Office of Public Health which conducts studies on veterans and what he found was "if the studies produce results that do not support the Office of Public Health's unwritten policy, they don't release them.  This applies to data regarding adverse health consequences of environmental exposures such as burn pits in Iraq and Afghanistan and toxic exposures in the Gulf War.  On the rare occasions when embarrassing study results are released, data are manipulated to make them unintelligible."

In other words, you shouldn't trust VA's past studies on burn pits.

Under the leadership of Senator Byron Dorgan, the  Democratic Policy Committee did important work via a series of public hearings on the burn pits that helped the country and the government understand what burn pits were and what they did to veterans.  Senator Evan Bayh was among those serving on that Committee and he was the first to introduce a bill for a national burn pit registry.  It did not make it through while Bayh and Dorgan were still in the Senate.  If was picked back up and with the help of many and leadership from Senate Veterans Affairs Committee Chair Patty Murray and Ranking Member Richard Burr and House Veterans Affairs Committee Chair Jeff Miller and Ranking Member Mike Michaud, it made it through in the final days of 2012.

At a November 12, 2010 DPC hearing, Chair Byron Dorgan went over the burn pit basics.

Chair Byron Dorgan:  Today we're going to have a discussion and have a hearing on how, as early as 2002, US military installations in Iraq and Afghanistan began relying on open-air burn pits -- disposing of waste materials in a very dangerous manner. And those burn pits included materials such as hazardous waste, medical waste, virtually all of the waste without segregation of the waste, put in burn pits. We'll hear how there were dire health warnings by Air Force officials about the dangers of burn pit smoke, the toxicity of that smoke, the danger for human health. We'll hear how the Department of Defense regulations in place said that burn pits should be used only in short-term emergency situations -- regulations that have now been codified. And we will hear how, despite all the warnings and all the regulations, the Army and the contractor in charge of this waste disposal, Kellogg Brown & Root, made frequent and unnecessary use of these burn pits and exposed thousands of US troops to toxic smoke.

None of the DoD regulations were followed.

Burn pits is one of the issues we follow.  Another is suicide.

Dr. Steven Coughlin:  I wish to close with a subject of particular importance to me.  Almost 2,000 research participants from a National Health Study of a New Generation of US Veterans self-reported that they had thoughts in the previous two weeks that they would be better off dead.  However, only a small percentage of those veterans, roughly 5%, ever received a callback from a studied clinician.  Some of those veterans are now homeless or deceased.  I was unsuccessful in getting senior Office of Public Health officials to address this problem in the New Generation study.  I was successful in incorporating these callbacks in the Gulf War survey and they have saved lives. but only after my supervisors threatened to remove me from the study and attempted disciplinary action against me when I appealed the refusal for callbacks to a higher authority.

The VA has many issues and many problems.  It's biggest crisis is the number of suicides.  VA hasn't wanted to track that.  Senator Patty Murray led the effort to get them to do so.  The VA, please understand what the doctor testified too, conducted a survey of veterans of today's wars (Afghanistan and Iraq) and one of the questions clearly was about suicide.  In response to that question -- either by checking off a provided choice or via their own words in an open response -- 5% of the study group stated "that they would be better off dead."  This wasn't a, "Have you ever in your life felt you'd be better off dead?"  Instead, the time frame of the last two weeks was inserted. 

When military and veterans suicides are at a crisis level, the idea that the VA would get these responses but refuse to follow up by calling the 5% back is not just appalling, it's negligence.  And, in fact, this is a medical survey and its overseen by doctors.  That makes it even worse, that makes it medical malpractice.  In order to help the veterans, a callback should always be done.

But if help is just too 'noble' a reason for you, the VA better damn well grasp that any veteran participating in such a survey who did not receive a callback has a group of loved ones who can sue and would most likely win in a court of law.  The law is on their side.  Even more importantly, public opinion would be on their side. 

While it is the right thing, the needed thing to do, a callback is also a cover-your-ass move to prevent a lawsuit.  Who's in charge at the VA?  Is anyone in management doing their job?

"We must recognize and be prepared to address the consequences of that service and bring to bear our best efforts to ensure that they are thoroughly prepared to serve and when they return home we commit to making them whole again."  I'd love to say that was a statement from the VA officials attending the hearing.  However, that's more common sense than all the officials combined had.  Those are the words of Ranking Member Ann Kirkpatrick and the VA needs to take those words to heart.

The first panel was Dr. Lea Steele (Baylor University), Dr. Coughlin, Gulf War veteran Anthony Hardie, and the Chair of the Board of Directors of Huntington Hospital Dr. Bernard Rosof.  The second panel was VA officials: Dr. Victoria Davey, Dr. Maureen McCarthy, Dr. Stephen Hunt, Dr. Gavin West and Tom Murphy.

Chair Mike Coffman:  Dr. Coughlan, your written testimony stated that "On the rare occasions when embarrassing study results are released, data are manipulated to make them unintelligible."  Please explain and cite an example.

Dr. Steven Coughlin:  [. . .  microphone not on] examples can be cited.  The best example that comes to mind is we set out to analyze data from the National Health Study for a new generation of veterans looking at self-reported exposure to burn pits, oil well fire smoke, other inhalation hazards in relation to physician diagnosed asthma and bronchitis.  The initial exposure analyses which were produced by the writing group and statistician showed that a sizable percentage of the deployed veterans had been exposed to burn pit smoke and burn pit fumes were associated with asthma and chronic bronchitis.  Then in a later iteration of the tabulated results, those results were set aside or discarded and the focus was instead on deployment -- deployment status in relation to asthma and bronchitis.  Well those 30,000 deployed vets and those 30,000 non-deployed vets included veterans who served on ships in the Indian Ocean or Philippines or in Germany in hospitals.  In other words, people who were deployed OAF and OIF and served in the war on terror but were never in Iraq or Afghanistan on the ground and had no potential exposure to burn pits.  So the way that the refined results were tabulated, it obscured rather than highlighted the associations of interest.  And I could elaborate if you would like.

Chair Mike Coffman: Okay,   Mr. Hardie, can you explain in your opinion why the research advisory committee believes that -- why the research advisory committee in their latest Institute of Medicine report is flawed?

Anthony Hardie: Yes, thank you for that question.  First, I want to recognize that I believe the researchers -- distinguished researchers like the gentleman sitting next to me were well intentioned.  However, VA staff issued a scope of work and committee charts that radically diverged from the law that effectively prevented -- and also effectively prevented what the committee could consider.  I believe that these helped to prevent the IOM Committee from meeting the expectations of the law.  VA staff directed the panel to do a literature review rather than, as the law directed, focusing on physicians experienced in treating Gulf War Illness.  VA staff knew little such literature exists because of VA's two decades of failures to develop treatments have helped to ensure that fact.  Additionally, most of the presenters to the panel focused on psychosomatic issues, stress as cause and things like relaxation therapies as treatments.  Ill Gulf War veterans who called in to listen to that meeting were naturally outraged.  VA staff were among the presenters to that committee including at least one sitting here today.  VA staff muddied the waters by instructing IOM to include not 91 Gulf War veterans as the law directs but many others.  And, finally, all of this involvement by VA staff is a far cry from the previous claims that these panels operate independent of bias and influence from the contracting agency.

Chair Mike Coffman:  Thank you, Mr. Hardie.  Dr. Rosof, the law requires that VA's agreement with the Institute of Medicine was to "Convene a group of medical professionals who are experienced in treating individuals who served.  in the southwest Asia theater of operations of the Persian Gulf War during 1990 or 1991 and who have been diagnosed with Chronic Multiple System illness or another health condition related to service."  Of the members of your committee, how many have experience in medically treating Gulf War veterans?

Dr. Bernard Rosof: [. . . mike not on] members of my committee who had experience but all of the members of the committee had experience in dealing with Chronic Multiple System illness -- some directly with the veterans who served in those theaters of war.  In addition there are members of the Committee including myself that have been on other IOM committees that have dealt with the issues of Gulf War chronic multi-system illness or illnesses of that sort.  So there were -- There was considerable expertise sitting around the table in addition to methodological expertise to evaluate the literature on best treatments.

We're not interested in the second panel.  The lies weren't even believable.  Five speakers at one VA conference on Gulf War Illness and they all say that it's a psychiatric disorder, even though for the last eleven years the VA has (in writing) recognized that Gulf War Illness is a physical condition?  And Stephen Hunt thinks he can spin and eat up the time pretending a slide shown at that conference stating that Gulf War Illness was all in the head was somehow to provide people with a sense of how things have changed?  I don't like liars.  The VA has played cheaply with people's lives and that's offensive.  Let's stay with burn pits.  Over the weekend, Jeff Glor (CBS Evening News -- link is video and text) reported on burn pits.  Excerpt.

Jeff Glor:  LeRoy Torres was a Texas state trooper and a captain in the Army Reserves when he deployed for a year-long combat tour to Iraq in 2007.

Rosie Lopez-Torres:  The minute he got back, he was hospitalized.  Right when he got back, it was like, "Okay, it's the Iraqi crud."  That's what he kept hearing.  After a few weeks, he started having these breathing attacks and it was the scariest moment ever for us.

Jeff Glor:  LeRoy's wife Rosie says her husband's health issues resulted from exposure to open-air burn pits which the US military used in Iraq and Afghanistan to torch everything from batteries to body parts.  The Dept of Veterans Affairs acknowledged Balad, where Torres was based, disposed of "several hundred tons per day" 

LeRoy Torres: It was very close to the burn pits -- where I was housed at.  But we didn't think nothing of it.

Jeff Glor:  Today, at age 40, LeRoy is barely able to leave bed most days.  His doctors have diagnosed him with a lung disease, constrictive bronchiolitis.  He has a lesion on his brain and cysts in his spleen and groin.

LeRoy Torres:  Sometimes the headaches will last three hours. Sometimes I've had  it where I've had a headache for eight days -- eight days straight.  It's unexplainable. 

Rosie Lopez-Torres:  I remember one night thinking, "Who am I holding?  Like what happened to the man that I married?"  It was at that moment that I thought, "This is it.  I'm going to have to be his advocate."

Jeff Glor:  Rosie launched a website where those exposed to burn pits can register.  She also lobbied Congress to take action.  In January, President Obama signed a law giving the Secretary of Veterans Affairs one year to create a national registry to track potential burn pit victims.

Jeff Glor:  If it wasn't for Rosie Torres, would this law be in existence?

Dr. Anthony Szema: I don't think so?

Rosie Lopez-Torres has shared her family's story many times in an attempt to get the word out and raise awareness.  In January of last year, she wrote about the experience:

For thousands of reservists the story goes like this, the soldier returns from war and immediately the effects of toxic exposure surface like the invisible wounds that they are. The soldier begins seeking treatment at various healthcare facilities only to discover that neither DOD nor VA is acknowledging toxic exposure from particulate matter or burn pits. The only option left if you happen to be blessed with the luxury of private insurance is to seek specialized healthcare in the private sector. Desperately seeking answers to the question of why this once active and healthy soldier can no longer function at the capacity that he/she once did. Why the once healthy father/mother, husband, wife, daughter, son can no longer breathe, why the diagnosis of cancer, why the white matter and the lesions in the brain, the fertility issues, the fatigue, the parasitic infections, the list goes on and on. The family spends their life savings traveling to access specialized healthcare from the physicians they call their heroes. The only healthcare providers brave enough to stand behind the truth of how toxic chemicals affect the body.

The family exhausts all of their finances to gain answers, the soldier can no longer work due to multiple diagnosis and symptoms immediately forcing the once successful career person to give up their life-long dreams. The reservists files an LOD which can take up to two years, the veteran files a claim with the VA which will never grant a rating compensation because there is no category for toxic exposures. All of this forces the family into an abyss of darkness, mental stress, financial stress, and denial of acceptance to their new way of life. The once productive, healthy, and functioning military family is suddenly falling apart at the seams. The gap between VA and DOD for the reservist component of the military service members wounded must be bridged by identifying the needs of those affected immediately. Too many people are losing their homes, their life savings, and their hope, hope in a system that once promised to care for them once they returned.

A friend covered a Senate Veterans Affairs hearing that took place yesterday and was full of praise for Allison Hickey.  I don't like liars.  Hickey's damn lucky that people are so uninformed (that includes my friend) and that I wasn't present so I can't cover it.  If I were, I'd go into her little lie to the Committee that Agent Orange has caused backlogs.  I'd point out her lie to the committee in the previous Congress that the VA had no Agent Orange backlog.  Hickey can be very impressive . . . if you're new to her.  If you've seen her lie once though . . .  I wasn't at that hearing, yesterday morning I was at the Senate Armed Services Subcommittee on Personnel and we covered the first two panels in yesterday's snapshotKat covered the third panel in last night's "Senate hearing on assault and rape"

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