Tuesday, July 14, 2009

White House maintains it was suicide








"Aloha and good morning to all of you," greeted US Senator Daniel Akaka after calling to order the Senate Committee on Veterans Affairs hearing this morning. "Welcome to this important hearing on VA's health care services for women veterans. We will be looking at programs already in the works to improve access to and the quality of care and other unique issues facing women veterans. Women veterans are the fastest growing segment of veterans. In 1988, when VA first began providing care to women, they were only 4% of the veteran population. Today the percentage of women veterans is nearing 8% and expected to rise substantially over the next two decades. So it is appropriate that we ask now, 'Is VA meeting the needs of women veterans?'" Appropriate and, as Senator Roland Burris put it, "long overdue." Last week, the Boston Globe's Bryan Bender wrote of the topic . . . by speaking to one man after another (one female veteran was also spoken to). It's always interesting when the media finally gives attention to an issue effecting women to see whether or not women are allowed to speak? Women spoke to the committee today. The hearing was broken up into two panels. The first panel was composed of the GAO's Randall B. Williamson and the Veterans Affairs Dept's Patricia Hayes. The second panel was composed of women veternas: Grace After Fire's Kayla Williams, Iraq Veteran Project Swords to Plowshares' Tia Christopher, the VFW's Jennifer Olds, American Women Veterans' Genevieve Chase and Disabled American Veterans' Joy J. Ilem.

Akaka is the Chair of the Committee, Senator Richar Burr is the Ranking Member. Burr noted, "North Carolina is no stranger to this growth. My home state ranks 6th in the total number of women veterans with just over 67,000 residing there." And we'll stay with that theme a moment to note a few basics before getting into the witness testimony. Senator Burris declared at the hearing, "Tremendous progress has been made already but I am concerned that only one-third of the veterans health facilities provide for the one-stop approach, an approach which shows the highest level of customer satisfication." By contrast, the outdated approach of the VA demands women go here, go there, go to a contracted physician while male veterans generally are able to go to one facility and have their basic primary health care needs addressed. The June 3rd snapshot covered the House Committee on Veterans Affairs committee for the hearing entitled "A National Commitment to End Veterans' Homelessness" and Vietnam Veterans of America's Marsha Four addressed the ways homelessness effects women veterans differently than male veterans and she noted "that there are very few programs in the country that are set up and designed specifically for homeless women veterans that are seperate [from male programs]. One of the problems that we've run into in a mixed gender setting is sort of two-fold. One, the women veterans do not have the opportunity to actually be in a separate group therapy environment because there are many issues that they simply will not divulge in mixed gender populations so those issues are never attended to. The other is that we believe, in a program, you need to focus on yourself and this is the time and place to do your issue, your deal. Many of the veterans too come from the streets so there's a lot of street behavior going on. S ome of the women -- and men -- but some of the women have participated in prostitution and so there's a difficult setting for any of them to actually focus on themselves without having all these other stressors come into play." At the May 21, 2008 Senate Committee on Veterans Affairs, Senator Patty Murray observed that in today's conflict, "Some units, including military police, are using an increased number of females to fill jobs that were traditionally held by male personnel. And because of the conflicts of today, we have no clear frontlines and women, like all of our service members, are always on the frontline -- riding on dangerous patrols, guarding pivotal check opints and witnessing the horrows of war first hand." Murray also noted that despite there being 1.7 million women veterans, for some reason "only 255,00 of those women actually use the VA health care services." Why was that? In her town halls in Washington (state), Murray found out, "Some told me they had been intimidate by the VA and viewed the VA as a male only facility. Others simply told me that they couldn't find someone to watch their kids so they could attend a counseling session or find time for other care." At that hearing, the VA's Dr. Gerald Cross objected to the bill (Murray and Senator Kay Bailey Hutchison's bill, S. 2799, Women Veterans Health Care Improvement Act of 2008) stating that including the child care option for female veterans seeking "mental health care or other intensive health care services at the VA" would "divert funds." Senator Murray pointed out that in his own opening remarks, Cross was observing that lack of child care prevents some women from access "for mental health or other intensive services -- so you identified the lack of child care as a barrier [. . .] but you're unwilling to do anything about it?" Which was the case. And, for the record, the bill, though introduced two years in a row, has never been voted on in the full Senate. This year it has passed the Committee. July 6th of this year, Murray's office noted "that she has included $2 million to begin planning and design of a Women and Children's Center at Madigan Army Medical Center. The Women and Children's Center is necessary to provide health care and services to Fort Lewis' large and growing population of women and newborns. The facility would be the Army's first Women and Children's Center."

Staying with statistics, the VA's Patricia Hayes and the GAO's Williamson both broke down the numbers in their opening remarks.

* Over 1.8 million women veterans (as of October 2008)

* Over 102,000 are veterans of the Afghanistan War and the Iraq War

* 281,000 women veterans received some form of VA healt care in Fiscal Year 2008

* Estimated median age for male veterans 61; for women 47.

Hayes further broke down what the median age of 47 means, that female veterans "are younger and have health care needs distinct from their male counterparts. [. . .] Nearly all newly enrolled women veterans accessing VA care are under 40 and of child bearing age. This trend creates a need to shift how we provide health care. [. . .] Some women report that lack of newborn care and child care forces them to seek care elsewhere." In her written testimony, but not stated in her opening remarks, Hayes noted, "VA has identified that 37 percent of women Veterans who use VA health care have a mental health diagnosis; these rates are higher than those of male Veterans. Women Veternas also present with complex mental health needs, including depression, post-traumatic stress disorder (PTSD), military sexual trauma (MST), and parenting and family issues." Williamson did make a passing reference to MST in his opening remarks but to round that out, this is a fact sheet on MST from NOW on PBS:

27% of men have experienced military sexual trauma 60% of women have experienced military sexual trauma 3.5% of men have experienced military sexual assault 23% of women have experienced military sexual assault 11% of women have experienced rape 1.2% of men have experienced rape Service branch with the highest percentage of women reporting sexual trauma: Marine Corps 20% of women seeking care at VA facilities have experienced sexual trauma 1% of men seeking care at VA facilities have experienced sexual trauma 8.3 percentage of women report lifetime PTSD related to MST More than half of the incidents took place at a military work site and during duty hours The majority of the offenders in these cases were military personnel Factors that increase risk of sexual assault for active duty females include presence of officers who condone or allow sexual harassment and unwanted sexual attention

For more information on the topic, the May 23, 2008 broadcast of NOW on PBS featured a report by Maria Hinojosa (produced by Karla Murthy) on MST. VETVOW is an organization that addresses MST. From today's hearing, we'll note the following exchange.

Chair Daniel Akaka: Dr. Hayes, thank you for your testimony. VA is poised to make some important changes to how care is delivered to women but in fairness, we seem to have a a bit of a disconnect between mandates and what is actually happening. I'm going to ask you a series of questions about this. First, VA has mandated that all VA medical centers appoint a full time Women Veterans Program Manager. Does every VA medical center have one in place?

Patricia Hayes: VA has reported, as you know, that there are 144 out of the 144 sites that have a full time Women Veteran Program Manager. I'm in actively now in the process of verifying that. What we do know that my office has trained -- over the last three months we held three different trainings -- we trained 142 Women Veteran Program Manager over the last three months. We think it's very important to train folks, not take these brand new folks and make sure that they know what they're doing in this plan to develop health care for women.

Chair Daniel Akaka: Dr. Hayes, hopefully you've read the testimony of the second panel. Jennifer Olds details her battle with PTSD and specifically makes a case for cognitive therapy. Congress passed a law last year requiring that these state of the art therapies be available to all veterans. I suppose this is something you need to take for the record, but are all veterans with PTSD able to receive this kind of treatment?

Patricia Hayes: You're right, Mr. Akaka, that I will have to take that specifically for the record in terms of the issues about access to PTSD treatment. I think that, you know, one of the things that was pointed out in the GAO report about where there's access, it's very important that we first ask veterans what they need and that's why it's important to hear from veterans about what their struggles are and to, I think, make sure that we're addressing what that veteran needs in terms of her care. So, for example, there's been a lot of questions about residential treatment and I think when we look at women veterans we have to be aware that, for example, women with children aren't necessarily interested in going off, leaving their children and going to a residential site. So that every time we look at what we have available, we have to make sure we have available for each veteran what she might need -- whether it's intensive outpatient or residential or these tele-health, tele-medicines. Some of our veterans have rated that as very highly successful for them to be in that type of treatment. So we will take the question for the record in terms of the exact issue of where PTSD treatment is available. But I think that it needs to be couched in asking the veteran what they need and that particular issue for this veteran who is very important.

Chair Daniel Akaka: Mr. Williams, your testimony lays out that none of the facilities reviewed had fully implemented VA's policies for women's health care. Could you determine the reasoning behind this non-compliance? Was it funding, lack of training or anything else?

Randall Williamson: Thank you, Mr. Chairman. It's very difficult sometimes to understand the reason uh -- the area referred, for example, on privacy -- assuring privacy of women veterans. Part of its due to facilities in terms of the layout that currently exists -- in trying to convert and modify that. But also, I think part of it comes down to committment at the local level. There's no doubt, I think, that the Secretary and Dr. Hayes and oterhs at the top are very committed to implementing VA policies and improving overall health care for women. But simple things -- as we visited the facility -- simple things that are easy to do like placing exam tables so the foot is away from the door, putting sanitary products in bathrooms for women, those things are easy and if they're not being done, part of that reason may come back to is there a committment at the - at the local level to ensure these policies are done?

Chair Daniel Akaka: Several witnesses on the second panel are quite critical of VA care for women. Let's take these one by one. Do you agree, as most concerned, that some service connected women veterans are without access to VA health care. Miss Williams detailed a lack of understanding on the part of VA providers. Miss Christopher found that community care is easier to access than VA care. And Miss Chase finds that generally VA plays catch up to meet the needs of VA veterans. Dr. Hayes, what is at the root of all these issues and how can we rectify them?

Patricia Hayes: I think that what is at the root of these issues really is a system that has not been responsive to the needs of women veterans. I came a year ago and launched an initiative specifically to make VA more inclusive of women veterans, to establish primary care that meets their needs so that they don't have to come for multiple visits, to make sure we reach out to those who do not have health care -- what research has shown us over and over again is that women don't know that they have VA services but it's not good enough if we reach them but we don't have the right care when they get in our front door. So we have a very intensive effort going on which started, as you saw, last year but is rolling up August 1st with every facility giving us an implementation plan for how to fix primary care for women veterans, how to make the facilities respond to environment of care issues and to develop services going forward that will meet women veterans' needs. And I think that until we do that, until we make sure that it's right, then we begin to reach out to our women veterans and welcome them back we will have a specific initiative which we identified: the need for service connected women to get their health care. And that's the first on our list when we can be sure that there's primary care for them when they walk in the door.

Ranking Member Burr caught a discrenphancy in Patricia Hayes' written testimony and oral testimony. He noted that her written testimony asserted that every facility had a Women Veteran Program Manager but she stated in her testimony that she was in the midst of verifying that, "Which is accurate, do we have them or are you in the process of verifying them?" She stated she's verifying to ensure that it's accurate prompting Burr to ask, "How long does that take?" It shouldn't take very long at all for someone in her position. It's not as if she's going to be told, "Call back." She or her staff dials each of the 144 facilities stating Hayes needs to speak to the Women Veteran Program Manager. The reply then is either to forward her call on or explain why not and if why not is "We don't have one," the count is done right then. This shouldn't take days. It shouldn't even take a full eight hour work day. "I think," she told Burr, "that we want to make sure that the person is full time and that" they are qualified "to do that job." Well, you ask them on the phone, "Are you full time?" You also ask for a resume. And you also check to see if you did, in fact, train them since Hayes claims she's been doing three months of training. She's making this far more difficult than it is and that's either because she's not grasping the task or she's attempting to mislead the Comittee. Burr pointed out that this is a VA mandate and that "I would take for granted that listed in that dictate is 'permanent, full time,' it spells out exactly what program managers are going to do." Burr also pointed out that her written testimony said that they plan to have gynecologists on site at every facility by 2012. "Why is it," he asked, "2012 and not 2009?" She strung some words together but she didn't answer the question. And again, this isn't difficult. You start hiring. The money is in the VA's budget for these positions. You start hiring. Hayes had a lot of words and they said very little.

Senator Patty Murray: Dr. Hayes, as you know, the military currently bars women from serving in combat. We all know, however, that in today's wars there is no front line on the battlefield, we know that women are serving right along side of male colleagues and they are engaging in combat with the enemy. But unfortunately the new reality of this modern warfare isn't well understood here at home including by some in the VA. This knowlege gap obviously impacts the ability of women veterans to receive health care and disability benefits from the VA. What are you doing, Dr. Hayes, to ensure that all VA staff -- both in the VHA and in the VBA -- are aware that women are serving in combat and that they're getting the health care and benefits that they've earned?

A long string of words including that providers are trained but all the staff needs to be "we have a staff sensitivity module" -- excuse me? A sensitivity module? Murray's speaking of basic facts and how they're being imparted. Hayes is talking about sensitivity training. I'm not ridiculing sensitivity training. It exists for many reasons and is needed in the work environment. But we're not talking about that. Murray raised that the DD2 14s are not being documented and that "we have people who say, 'You weren't in combat, you're a woman.'" Hayes says it saddened her that reports of that had emerged. That reports had emerged or that it took place? Murray wanted to know if the VA was working with the Defense Dept to ensure that women veterans DD2 14s were being properly documented and Hayes referred it to a colleague who babbled on. Murray stopped her to get her back on track at which point the woman stated that maybe Congress could help them because they weren't able to note combat experience for women due to guidelines. In other words, the woman always had the answer but only offered it when pressed by Murray.

The bulk of the hearing was the first panel. Moving on to the second panel. "Women need not only more gender specific care," Tia Christopher declared in her opening remarks, "but also care that is appropriate for their needs. It is essential that women who do need inpatient treatment for PTSD, whether combat or sexual assault related, receive care in a safe treatment space. A coed environment can truly be the worst thing for a woman suffering from Military Sexual Trauma (MST) and PTSD. Just having the resources is not enough, again, the quality, quantity and accessibility of that care is vital. For those who are uncomfortable receiving treatment at a VA facility, for whatever reason, funding needs to allotted for culturally competent care within the community." Geneviever Chase testified today. She was also part of last Wednesday's Voices of Honor press conference. She's also straight because Voices of Honor is gays, lesbians and straight service members coming together to stamp out the discrimination. In her opening remarks today, she explained something many men and women in the Reserves have experienced, "The reserve soldiers I served with were discharged from active service with a five-minute out-briefing and a single sheet of paper listing websites to access for VA services. What I recall from that time was being focused on overwhelming issues like finding a job and figuring out how I was going to make it in a civilian world that had become somewhat foreign to me -- not on the service related health isseus I would face in the months to come or how I would seek care for those issues." Jennifer Olds stated she experienced a similar lack of advise and information regarding what you were qualified for and she emphasized the need to get people into the VA system immediately. Kayla Williams noted several issues in her opening remarks but we'll zoom in on this because only she touched on it in opening remarks, "Other barries may disproportionately affect women. For example, since women are more likely to be the primary caregivers of small children, they may require help getting childcare in order to attend appointments at the VA. Currently many VA facilities are not prepared to accomodate the presence of children; several friends have described having to change babies' diapers on the floors of VA hospitals because the restroom lacked changing facilities. Another friend, whose babysitter cancelled at the last minute, brought her infant and toddler to a VA appointment -- the provider told her that was 'not appropriate' and that she should not come in if she could not find childcare. Facilities in which to nurse and change babies -- as well as childcare assistance or at least patience with the presence of small children -- would ease burdens on all veterans with small children."

Senator Akaka wondered how to get the message out regarding the fact that women veterans are seeing combat. Chase noted that public testimony/sharing, standing up in front of others was one way to get the word out. Williams noted PBS' Lioness documentary being shown at VAs and Joy Ilem agreed with that. Chase stated that there are many other women "serving outside the wire in combat today" and not just the one specific team documented in Lioness. Christopher noted, "To be quite frank, trainings can be very boring. Whether you're wathcing a power point or a video or listening to someone talk. I mean -- I think for it to be truly effective there needs to be dialogue and it needs to be proactive. And I think a Q&A portion when we train for Swords to Ploughshares, we open ourselves up for questions, we actually refer to it as the uncomfortable questions panel."
Senator Murray wanted to know if the panel "found that this combat experience is reflected in DD2 14s?"

Kayla Williams: My own certainly was reflected in my DD2 14. But I was awared the service medal for my time in Operation Iraqi Freedom. And also, if it ever were to become a question, I also received army medals and the paperwork that supports that details the experiences they were earned for and the way that people can show their experience. But I know that that isn't usually the case, I was just lucky enough that that was true for me.

Genevieve Chase: We, during our -- our -- when we get our DD2 14s it's on there whether or not you served and in what theater. It also states what was your job. And I was also awarded the Combat Operation Badge. That is not an automatic award. It's not an automatic entitlement. And that's submitted by your chain of command and if it's not submitted or the paperwork is lost or doesn't go through then you don't get that as well. And it also isn't a qualifer -- a lot of people don't perceive it to mean that you were actually in combat or directly engaging the enemy. So that policy needs to be changed [. . .] to reflect that women are in fact serving in combat and they are in fact on missions outside the wire. And regardless of whether or not they're going outside the wire [. . .] when you have mortars every day and you have no idea where they're coming from, that's combat.

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