May212013
Hearing Transcript on Healing the Physical Injuries of War.
|
HEALING THE PHYSICAL INJURIES OF WAR
HEARING BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION JULY 22, 2010 SERIAL No. 111-93 Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE For sale by the Superintendent of Documents, U.S. Government Printing Office
|
|
|
|||||
|
|
CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
|
||
|
|
|||||
|
|
Malcom A. Shorter, Staff Director SUBCOMMITTEE ON HEALTH
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined. |
|
|||
C O N T E N T S
July 22, 2010
Healing the Physical Injuries of War
OPENING STATEMENTS
Chairman Michael H. Michaud
Prepared statement of Chairman Michaud
Hon. Henry E. Brown, Jr., Ranking Republican Member
Prepared statement of Congressman Brown
WITNESSES
U.S. Department of Defense, Jack Smith, M.D., MMM, Acting Deputy Assistant Secretary for Clinical and Program Policy
Prepared statement of Dr. Smith
U.S. Department of Veterans Affairs, Lucille B. Beck, Ph.D., Chief Consultant, Rehabilitation Services, Office of Patient Care Services, and Director, Audiology and Speech Pathology Service, Veterans Health Administration
Prepared statement of Dr. Beck
American Legion, Denise A. Williams, Assistant Director for Health Policy, Veterans Affairs and Rehabilitation Commission
Prepared statement of Ms. Williams
Blinded Veterans Association, Thomas Zampieri, Ph.D., Director of Government Relations
Prepared statement of Dr. Zampieri
Disabled American Veterans, Joy J. Ilem, Deputy National Legislative Director
Prepared statement of Ms. Ilem
Iraq and Afghanistan Veterans of America, Tom Tarantino, Legislative Associate
Prepared statement of Mr. Tarantino
Paralyzed Veterans of America, Carl Blake, National Legislative Director
Prepared statement of Mr. Blake
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Questions and Responses for the Record:
HEALING THE PHYSICAL INJURIES OF WAR
Thursday, July 22, 2010
U. S. House of Representatives,
Subcommittee on Health,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 9:59 a.m., in Room 334, Cannon House Office Building, Hon. Michael H. Michaud [Chairman of the Subcommittee] presiding.
Present: Representatives Michaud, Donnelly, McNerney, Halvorson, Perriello, Brown of South Carolina, and Bilirakis.
OPENING STATEMENT OF CHAIRMAN MICHAUD
Mr. MICHAUD. I will call the Subcommittee on Health to order, and I would like to thank everyone for coming this morning.
The purpose of today's hearing is to explore how we can best serve our veterans who have sustained severe physical wounds from the wars in Iraq and Afghanistan.
Today we will closely examine the U.S. Department of Veterans Affairs' (VA's) specialized service for the severely injured, which include blind rehabilitation, spinal cord injury (SCI) centers, polytrauma centers, and prosthetic and sensory aids services.
With advances in protective body armor and combat medicine, our servicemembers are surviving war wounds which otherwise would have resulted in casualties. Many servicemembers who are severely injured in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) will require sophisticated, comprehensive, and often lifelong care.
We know that the blast injuries from improvised explosive devices (IEDs) are the most common cause of injuries and death among our OEF/OIF servicemembers. Blast injuries often include combinations of traumatic brain injury (TBI), blindness, spinal cord injuries, burns, and damage to the limbs, which results in amputations.
Today, we will examine whether VA is meeting the needs of our severely injured, and whether the veterans have access to the most current therapies for treating their physical war injuries. We will identify what VA is doing well and what areas they need improvement in. We will also explore how VA ensures that the quality of care is consistent and standardized across the VA health care system so that veterans receive the same high quality care regardless of which VA facility they visit. Finally, we will review VA's current efforts to coordinate specialized services for the severely injured with the U.S. Department of Defense (DoD) and how we can achieve improved coordination between the two Departments.
I look forward to hearing the panels this morning, and I would turn it over to my good friend Ranking Member Mr. Brown for any opening statement he may have.
[The prepared statement of Chairman Michaud appears in the Appendix.]
OPENING STATEMENT OF HON. HENRY E. BROWN, JR.
Mr. BROWN. Thank you, Mr. Chairman, and good morning all.
Yesterday we reached a milestone. It was 80 years ago on July the 21st, 1930, that President Herbert Hoover first established what we now know as the Department of Veterans Affairs. Since that day, VA has endeavored to fulfill their mission to care for those who have borne the battle and for those who return carrying the very worst wounds of war, including spinal cord injury, traumatic brain injury, amputations, and blindness.
The VA has developed specialized services to meet the unique rehabilitative needs of our veteran population. Providing these types of services to our very highest priority veterans is the backbone of the Department.
Since 1996, Congress has mandated that the VA maintain capacity for these specialized rehabilitative services, and in 2004, Congress enacted legislation to provide comprehensive services for severely injured servicemembers suffering with complex injuries resulting from blast injuries. This came to be called VA's Polytrauma System of Care.
More than 2.1 million servicemembers have been deployed since October 2001. As of April the 3rd, 1,552 had suffered amputations in Iraq or Afghanistan. Countless others have suffered TBI, SCI, eye trauma, hearing loss, or other severe combat wounds.
These young heroes are going to require a lifetime of rehabilitation and highly skilled medical services and support. They have risked life and limb in our name, and in return, it is our responsibility to provide them with the care they require and so dearly deserve.
As the battles in Iraq and Afghanistan persist, the specialized caregiver in VA medical, polytrauma, spinal cord injury, and blind rehabilitation centers continue to take on increasing importance.
We must diligently prioritize investments in specialized services, medical research, and recruitment to have all the tools necessary to provide all veterans, and especially our most severely wounded veterans, with an active and full life characterized by independence, functionality, and achievement.
I am grateful to our panelists and audience members for being here this morning, and I yield back.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Brown appears in the Appendix.]
Mr. MICHAUD. Thank you very much, Mr. Brown.
I would like to call the first panel forward, and while they are coming forward I will introduce them. We first have Dr. Thomas Zampieri who represents the Blinded Veterans Association (BVA), Carl Blake, of the Paralyzed Veterans of America (PVA), Joy Ilem, from the Disabled American Veterans (DAV), Tom Tarantino who is with Iraq and Afghanistan Veterans of America (IAVA), and Denise Williams who is from the American Legion.
I want to thank all of you for coming this morning and look forward to hearing your testimony today. We will start with Dr. Zampieri.
STATEMENTS OF THOMAS ZAMPIERI, PH.D., DIRECTOR OF GOVERNMENT RELATIONS, BLINDED VETERANS ASSOCIATION; CARL BLAKE, NATIONAL LEGISLATIVE DIRECTOR, PARALYZED VETERANS OF AMERICA; JOY J. ILEM, DEPUTY NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; TOM TARANTINO, LEGISLATIVE ASSOCIATE, IRAQ AND AFGHANISTAN VETERANS OF AMERICA; AND DENISE A. WILLIAMS, ASSISTANT DIRECTOR OF HEALTH POLICY, VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION
STATEMENT OF THOMAS ZAMPIERI, PH.D.
Dr. ZAMPIERI. Mr. Chairman, Members of the Subcommittee, the Blinded Veterans Association appreciates this opportunity to present our testimony today, and I appreciate that the Committee is taking a look at the specialized programs in regards to the returning servicemembers with a variety of injuries.
I also appreciate the fact that that you highlighted that oftentimes in this town we don't hear a lot about the other injuries. Most of the research papers and scientific papers on these types of wounded coming back clearly demonstrate that they all have multiple injuries. It is rare you ever just have somebody that comes back with just quote “TBI.” They have a variety of injuries. Burns, fractures, amputations, psychosocial problems associated with the multi-trauma that they have sustained, and so it is just good that this is being done today.
The VA, I want to start off on some good news, you know, the blind rehab service has expanded services throughout the system. Ironically back in 2004, they developed the plans for a continuum of care based on the idea that the aging population of veterans would need a lot of low-vision and blind rehabilitative services. Little, I think did they realize back then, that the plans that they were making to expand services would suddenly be immediately useful for the returning servicemembers with eye trauma and traumatic brain injuries with vision impairments associated with the TBIs.
And so what we have is now the VA has expanded, they have had ten in-patient blind centers, which offer comprehensive rehabilitative services for those with blindness, but they also have all the specialized staff in those centers such as consultants with the general surgeons, neurologists, psychiatrists, pharmacologists, occupational therapists, physical therapists, speech pathologists. The list goes on and on.
So those individuals referred into the ten blind centers get, I think, excellent care, but the VA has also expanded and they now have 55 sites where they have either low vision specialists or advanced blind rehabilitative centers, and those centers have specialized staff. They have actually hired about 250 staff, including about 60 low-vision optometrists, and they are screening these patients with vision problems and visual impairments. And so that is the good news.
I want to compliment the Chairman, because actually the number of blind rehabilitative outpatient specialists (BROS) that you helped sponsor and Congressman Brown helped support, doubled the number of blind rehab specialists that were in the system. Again, it is just good timing. So we went from about 25 blind rehabilitation specialists to 75 in the system. They are at all of the VA polytrauma centers. And so that is the good news this morning I guess.
The other thing that I want to touch on is there is a problem. The BROS that are assigned to the military treatment facilities have a problem in getting credentialed and privileged. It is something that has been worked on by the VA and they have had meetings with DoD representatives, but the problem is DoD has never had the credential or privilege. Anyone who is a BROS, an orientation mobility specialist, who has a master's degree, that category of occupation doesn't exist and it is been a problem, because the BROS are unable to actually do the training inside the military treatment centers, even though they can visit the patients, explain the training that they need, they are restricted, and that is an issue that I wanted to include in my testimony today.
Last, I want to talk about—there is problems, though, with the Vision Centers of Excellence. It is been slow to get it started to say the least. It is been slow in getting the staffing. It is been difficult to get any accurate budgets in the last couple years. Budget requests that come over from the Pentagon rarely have included any special request for funding, even though it has been identified as an area where there is a shortage of funding. It has taken a long time to get the staffing for the Vision Centers of Excellence, and also the electronic registry, which is important for tracking all of the eye injured has been not operational yet. The VA Information Technology (IT) Department and Department of Defense IT people have done a lot of work on the registry, but again, I hear stories about problems with finding the funding for the registry.
With that I will try to end this by thanking you again for having this hearing, and be glad to answer any questions you have on my testimony that I have submitted.
Thank you.
[The prepared statement of Dr. Zampieri appears in the Appendix.]
Mr. MICHAUD. Thank you very much, Doctor.
Mr. Blake?
Mr. BLAKE. Thank you Chairman Michaud and Members of the Subcommittee, on behalf of Paralyzed Veterans of America I would like to thank you for the opportunity to be here today to present our views on how the Department of Veterans Affairs is doing in caring for severely injured veterans, including Operation Enduring Freedom and Operation Iraqi Freedom veterans.
My comments will be limited primarily to veterans who have incurred spinal cord injury or dysfunction while on active duty.
It is important to emphasize that specialized services are part of the core mission and responsibility of the VA. For a long time, this has included spinal cord injury care, blinded rehabilitation, treatment for mental health conditions, including post-traumatic stress disorder, and similar conditions. Today, traumatic brain injury and polytrauma injuries are new areas that the VA has had to focus its attention on as part of their specialized care programs.
The VA's specialized services are incomparable resources that often cannot be duplicated in the private sector.
For PVA there is an ongoing issue that has not received a great deal of focus. Some active-duty soldiers with a new spinal cord injury or dysfunction are being transferred directly to civilian hospitals in the community and bypassing the VA health care system. This is particularly true of newly injured servicemembers who incur their spinal cord injury in places other than the combat theaters of Iraq and Afghanistan. This violates the Memorandum of Agreement between the VA and DoD that was effective January 1, 2007, requiring that care management services will be provided by the Military Medical Support Office, the appropriate Military Treatment Facility, and the admitting VA Medical Center as a joint collaboration, and that whenever possible the VA health care facility closest to the active-duty member's home of record should be contacted first.
In addition, it requires that to ensure optimal care, active-duty patients are to go directly to a VA medical facility without passing through a transit military hospital, clearly indicating the critical nature of rapidly integrating these veterans into an SCI health care system.
This is not happening. For example, PVA found that some servicemembers who incurred a spinal cord injury while serving in Afghanistan and Iraq were being transferred to Sheppard Spinal Center, a private facility located in Atlanta, when VA facilities are available in Augusta. When we raised our concerns with the VA regarding Augusta in a recent site visit report, the VA responded by conducting an information meeting at Sheppard to present information and increase referrals. However, reactionary measures such as this should not be the standard for addressing these types of concerns.
Of additional concern to PVA it was reported that some of these newly injured soldiers receiving treatment in private facilities are being discharged to community nursing homes after a period of time in these private rehabilitation facilities. In fact, some of these men and women have received sub-optimal rehabilitation and some are being discharged without proper equipment.
PVA is greatly concerned with this type of process and treatment. There is a serious need to reinforce compliance by DoD regarding the Memorandum of Agreement toward the treatment of soldiers with new spinal cord injury and disease (SCI/D) at VA SCI centers.
Ensuring that these men and women gain quick access to VA care in spinal cord injury centers is critically important because it begins what will become a lifelong treatment process.
SCI/D care in the VA is unique from private care for spinal cord injury rehabilitation because of the care coordination that the veteran receives for the remainder of his or her life.
We ask that the Subcommittee work with your colleagues of the House Committee on Armed Services to ensure that our SCI/D veterans are getting the complete, proper, and appropriate care they have earned and deserve.
PVA also remains concerned that the VA must maintain its capacity for the provision of SCI/D care as mandated by Public Law 104-262, the Veterans Health Care Eligibility Reform Act of 1996. This law required the VA to maintain its capacity to provide for the special treatment and rehabilitative needs of veterans with spinal cord injury, blindness, amputations, and mental illness.
The baseline of capacity for spinal cord injury was established based on the number of staffed beds and the number of full-time equivalent employees assigned to provide care on the date of enactment of the law.
Unfortunately, the single biggest accountability measure, an annual capacity reporting requirement, expired in April 2004. This allows the VA to make changes to its SCI/D capacity in a less than transparent manner.
In accordance with the recommendations of The Independent Budget for fiscal year 2011, PVA calls on this Subcommittee to approve legislation to reinstate this vitally important reporting requirement.
Lastly, Mr. Chairman, the SCI/D programs of the VA face a common challenge with the larger health care system, a shortage of qualified nurse staffing. In order to meet this challenge head on, some SCI centers in the VA have offered recruitment and retention bonuses to enhance their nurse staffs, unfortunately, this is not a uniform national policy and these actions are subject to the budget decisions of local VA medical center and Veterans Integrated Service Network directors.
In accordance with recommendations of The Independent Budget, we believe it is time for the Veterans Health Administration (VHA) to centralize policies and funding for systemwide recruitment and retention of SCI nurse staffing.
Additionally, we believe Congress should establish a specialty pay provision for nurses working in the SCI service, and should consider extending similar provisions to the other VA specialized services.
Once again, Mr. Chairman, Ranking Member Brown, I would like to thank you for the opportunity to testify. I would be happy to answer any questions that you or the Members of the Subcommittee might have.
Thank you.
[The prepared statement of Mr. Blake appears in the Appendix.]
Mr. MICHAUD. Thank you very much.
Ms. Ilem?
Ms. ILEM. Thank you. Mr. Chairman and Members of the Subcommittee, thank you for inviting DAV to testify at this important hearing about VA specialty rehabilitation services for severely injured Iraq and Afghanistan war veterans. My remarks are focused on VA's polytrauma and traumatic brain injury system of care.
According to VA, over the past 7 years, a total of 1,792 in-patients with severe injuries have been treated at VA's Polytrauma Rehabilitation Centers, also known as PRCs.
Early on in the wars, VA received little information about the treatment that wounded servicemembers had received before arriving at a VA facility; however, in late 2009, a team of VA polytrauma specialists visited the Landstuhl Army Medical Center in Germany to establish a regular information exchange on these transfer cases between the military and VA PRCs.
We are pleased with this relatively new development and believe it has begun to address the gaps in care that were clearly evident early on in the wars.
Recently, DAV's National Commander visited the Tampa VA PRC. He met with injured patients and families and received very positive feedback about the level and coordination of care provided, and the high regard these families held for the dedicated VA and DoD staff.
Also in preparing for this hearing, I had the opportunity to interview with a father of a severely brain injured servicemember now at the Tampa PRC. I was very pleased to learn that from the date of his son's injury to present, the communication and care coordination provided between DoD and VA in his opinion was seamless.
We acknowledge and commend the report of improved collaboration between the Departments, and we value the dedicated staffs that created and sustained this critical system to better coordinate and optimize care for the severely injured.
According to the Institute of Medicine (IOM), VA has established a comprehensive system for polytrauma and severe TBI care for acute and chronic needs that arise in the initial months and years post injury, but IOM also reported that protocols and programs to manage the lifetime effects of these conditions are not in place and have not been fully studied.
In this connection, DAV is aware of an extraordinary proposal called the Heroes Ranch. We understand that property is available for a proposed Tampa area facility to service a VA post-acute long-term residential brain injury model for the most severely injured.
According to the proposal, a three-tiered program would include post-acute long-term care for patients in a vegetative state or a state of emerging consciousness, subacute residential rehabilitation in a safe environment to treat patients with neurobehavioral deficits, and an outpatient day rehabilitation services program, a specialized form of adult day health care.
We understand this proposal is pending within VA, however, we are not clear if it has been approved or funded, therefore, we ask the Subcommittee to inquire about the status of this unique initiative.
For the severely impaired, in many cases, VA may need to provide permanent living arrangements in an age appropriate therapeutic environment, thus we are very pleased to see at least one PRC is planning for these unique facilities and we urge VA to move forward in establishing this type residential rehab model.
As highlighted in prior hearings, DAV also remains concerned about the problems that exist in the Federal Recovery Coordinator Program in social work case management system that are initial to coordinating complex components of care for polytrauma patients and their families. We believe these issues warrant continued oversight and evaluation by the Subcommittee.
Mr. Chairman, although not defined in the severely injured category, we would like to bring to the Subcommittee's attention our concerns about treatment and care for veterans with mild to moderate TBI residuals.
Multiple sources indicate that in the near future VA will likely be confronted with a significant OEF/OIF injured population with these problems. We believe VA level two PRC sites may struggle to provide the specialized or individualized interdisciplinary care and support this particular population will need.
We ask the Subcommittee to provide oversight to ensure sufficient resources and staff are available for VA to also accomplish this mission.
Additionally, VA TBI specialists with whom we have consulted believe a new specialized dual track program is necessary to meet the individualized needs of veterans with mild to moderate TBI residuals accompanied by post-traumatic stress disorder.
Mr. Chairman, for these reasons we hope VA will now turn its attention to the needs of thousands of veterans with less life threatening, but still troubling brain injuries, caused by war that are little understood but in need of significant attention.
Mr. Chairman, this concludes my statement and I will be able to take any questions you may have.
Thank you.
[The prepared statement of Ms. Ilem appears in the Appendix.]
Mr. MICHAUD. Thank you very much.
Mr. Tarantino?
Mr. TARANTINO. Thank you, Mr. Chairman, Ranking Member, and Members of the Subcommittee, on behalf of Iraq and Afghanistan Veterans of America's 190,000 members and supporters, I would like to thank you for allowing us to testify before the Subcommittee.
My name is Tom Tarantino and I am a Legislative Associate with IAVA. I proudly served in the Army for 10 years, and during these 10 years, my most significant and important duty was to take care of other soldiers. In the military, they teach us to have each other's backs. And although my uniform is now a suit and tie, I am proud to work with Congress to continue to have the backs now and in the future.
Over the past few years, the Committee has secured impressive improvements to the VA health care system. IAVA applauds the work this Committee has done and will continue to do in the months and years to come.
Now we have asked our members what they thought of treatment they are receiving at the VA and we received a wide range of opinions, both complimentary and critical. However, several common themes appeared. Long waits for appointments, frequent interaction with rude administrative staff, a growing distrust of VA health care, and long drives to VA facilities. Fortunately, we received very few complaints about the actual quality of care at VA medical centers. But in addition to the concerns listed above, our members have expressed concern with how the VA deals with traumatic brain injury.
To properly treat returning combat veterans with mild to severe TBI, the VA must completely rethink and adapt their medical rehabilitation practices. IAVA is concerned that the VA has limited or denied access to some veterans seeking recovery services for TBI, because current statute requires that the VA provide services to restore function to wounded veterans. And while full recovery should always be the desired outcome for rehabilitation, sustaining current function or just preventing future harm should also warrant access to VA services.
And I have no doubt that Members of this Committee agree that the VA's role isn't just to help those who might get better, but also to help and support those who might get worse.
IAVA recommends adjusting these statutes to embrace the realities of injuries like TBI. Veterans should be able to focus on maintenance and recovery not fighting with the VA.
Among our members seeking services at the VA, the single most common complaint is how long it takes just to schedule an appointment. Despite improvements of wait times for primary care and specialty car,e many veterans have experienced unacceptably long waits just to speak to someone who can get them an appointment that is 4 to 6 weeks away. Unfortunately, I have experienced this myself. After spending 45 minutes attempting to get my primary care team on the phone I gave up and vented by frustration on Twitter. Fortunately somebody at the VA follows my Twitter feed and I actually received a call from the Medical Director's Office at DC a day later. I was able to get an appointment because of the magic in new media, but the point is that no veteran should wait 45 minutes listening to a phone ring.
In addition to the long wait times, some veterans have to drive almost an entire day to get to their local VA facility, and IAVA is concerned that the VA has yet to develop a consistent and humane policy for answering that age old question of how far is too far to make a veteran drive to the VA?
Now we acknowledge that the VA can't always be a short drive for every veteran, these veterans however should be given a choice to continue using VA care or access more convenient local medical care.
We also believe the VA should assist veterans who need to drive to their appointments. They should provide a lodging stipend and mileage reimbursement for veterans forced to travel long distances for VA medical care, and it should be comparable to the stipend paid to VA employees when they travel.
Now those of us in this room know that the VA provides good care and services; however, the reality is that some of our members openly fear going to the VA. Recent media reports about HIV (human immunodeficiency virus) and hepatitis exposure only served to fuel that fire. A veteran who reads about his or her battle buddies being exposed to infectious diseases while being treated at a VA medical center will likely think twice before they try to seek the care and services they need.
Now whether or not those fears are actually warranted is a topic for another hearing, but the end result is the same, that if the VA and VA health has a massive public relations problem, and until the VA adequately addresses this issue, many combat veterans will be weary to seek treatment.
IAVA believes that in order for the VA to conduct effective outreach, it must centralize its efforts and aggressively re-brand itself to the American people as one Department of Veterans Affairs.
Now the VA provides great health care, it has sent generations of Americans to college, it is enabled millions of veterans to own their own home, and regularly contributes to the advancement of medical science. It is absolutely astounding to me that only a handful of Americans actually know that.
In addition to re-branding itself to America. the VA has to develop a relationship with servicemembers while they are still in service. Like many successful college alumni associations that greet students at orientation and put on student programs throughout their entire time in college, the VA must shed its passive persona and start recruiting veterans and their families more aggressively into VA programs.
Now overall, the VA continues to provide good care to our Nation's veterans; however, we must continue to strive for better. In the military they taught us to never stop improving our fights positions and always be forever vigilant. It is this proactive ethos that continues to lead to victory on the battle field. And if we are to honor the service and sacrifice of American's warriors, we must instill this spirit in all the services that we develop to care for them.
I want to thank you for your time and attention and I would happy to answer any questions.
[The prepared statement of Mr. Tarantino appears in the Appendix.]
Mr. MICHAUD. Thank you very much.
Ms. Williams?
STATEMENT OF DENISE A. WILLIAMS
Ms. WILLIAMS. Mr. Chairman and Members of the Subcommittee, thank you for this opportunity to present the American Legion's views on the Department of Veterans Affairs efforts to care for severely injured servicemembers from OIF and OEF.
The United States military operations in Iraq and Afghanistan has produced a significant number of servicemen and women with amputations. According to the DoD, as of April 3rd, 2010, there has been a total of 1,552 members that suffered amputations. This unique population of younger servicemembers requires extraordinary medical care and rehabilitation. Walter Reed Army Medical Center, among many DoD facilities dedicated to assisting wounded warriors, has highly advanced programs to care for warriors with amputations.
In response to the large number of veterans with prosthetics and rehabilitative needs, VA established the Polytrauma Rehabilitation Centers, however, the American Legion is concerned about VA's ability to consistently meet the long-term needs of these young veterans.
As stated by the Military Medicine Journal, rehabilitation is a crucial step in optimizing long-term function and quality of life after amputation.
Although returning veterans with combat-related amputations may be getting the best in rehabilitative care and technology available, their expected long-term health care outcomes are considerably less clear.
It is imperative that both DoD and VA clinicians seriously consider the issues associated with combat-related amputees and try to alleviate any foreseeable problems that OIF/OEF amputees may face in the future.
The VA has made great strides in addressing the increased influx of young veterans with amputations; however, it has been reported that VA does not have the state-of-art prostheses available in comparison to the DoD. That is why it is of utmost importance that VA receives the adequate funding to ensure that all VA medical facilities are fully equipped to address these veterans' prosthetic needs.
This is especially vital for the veterans that reside in rural and highly rural areas. It would be a grave disservice to these veterans if they have to bear the burden of traveling hundreds of miles in order to receive care in addition to enduring their debilitating condition.
The American Legion applauds VA on the establishment of the Prosthetics Women's Workgroup to enhance the care of female veterans in regard to their prosthetics requirement. Despite this implementation, there are still cases where the fitting of the prostheses for women veterans has presented problems due to their smaller physique.
The American Legion urges VA to increase their focus on amputation and prosthetics research programs in order to enhance and create innovative means to address this population of veterans' health care needs.
During our "System Worth Saving" site visits to the polytrauma centers, some facilities reported that there were staffing shortages in certain specialty areas such as physical medicine and rehabilitation, speech and language pathology, physical therapy, and certified rehabilitation nursing. This was attributed to the competitive salaries being offered for these positions in the private sector.
Considering the complex nature of these severely wounded veterans, the American Legion finds this unacceptable. The Department of Veterans Affairs needs to step up their recruiting efforts in these areas so that in the future these veterans are not faced with the dilemma of going outside of the VA for care.
There are currently 49,460 blind veterans enrolled in the VA health care system and that number is expected to increase because of the number of eye injuries in Iraq and Afghanistan. DoD reports that in the current conflict, eye injuries account for 13 percent of all injuries. The American Academy of Ophthalmology reports that eye injuries are a very common form of morbidity in a combat environment.
DoD does not provide rehabilitation for blindness. Unlike other injuries where after rehabilitation warriors may be retained and continue service, blinded warriors are medically discharged and relegated to utilize the VA for their rehabilitative needs.
Section 1623 of the National Defense Authorization Act of 2008 requires DoD to establish a Center of Excellence in the prevention, diagnosis, treatment, and rehabilitation of eye injuries, and for DoD to collaborate with VA on matters pertaining to the Center.
In addition, Section 1623 directs DoD and VA to implement a joint program on traumatic brain injury post-traumatic visual syndrome, including vision screening, diagnosis, rehabilitative management, and vision research. Unfortunately, the Center has yet to be fully established because of constant funding delays and bureaucratic hurdles.
The American Legion calls for immediate action from the Secretary of Defense and the Secretary of VA to rectify this important issue.
Mr. Chairman and Members of the Subcommittee, the American Legion sincerely appreciates the opportunity to submit testimony and looks forward to working with you and your colleagues on these important issues.
This concludes my written statement and I would welcome any questions you may have.
[The prepared statement of Ms. Williams appears in the Appendix.]
Mr. MICHAUD. Thank you very much, Ms. Williams. And once again, I would like to thank all the panelists for your testimony and also for the recommendations included within your testimony, which will be very helpful.
This question is for all the panelists. I have heard anecdotes from veterans who applaud the prosthetic services that they receive at the Department of Defense, but are very leery of the care that they might receive through the VA system. Do you believe that DoD provides better overall prosthetic services compared to the VA, or do you believe that these anecdotes that I am hearing represent just a few, isolated cases?
Ms. ILEM. I will go ahead and take a stab at that.
I think early on, you know, we heard reports, I mean, I remember from hearing even with Tammy Duckworth, you know, one of the situations is—that is very unique is DoD and Walter Reed obviously have had, you know, the focus has been on them for really doing much of the prosthetics and rehab there on site.
I know that VA, from attending their prosthetic meetings, you know, have integrated their people to go out there and see, you know, what is going on as these people start to transfer back to VA, but the complaints were, you know, when they return to the VA to have either their item serviced or to continue their rehabilitation, they ran into sort of a disconnect from, you know, anyone at the facility where they had been working with the prosthetist and had very much attention to and access to all the newest items and options, you know, at the DoD site. You know, it seemed very different within the VA.
I think that, you know, VA's prosthetic services tried to really improve that and make, you know, good strides in trying to make sure that they are ready to accept these veterans as they transition back into VA to prepare—to repair their equipment, to have—I know that they have access to all of the vendors that are working out there, and they have done this liaison work.
I am hoping that, you know, that that perception as Tom as mentioned, you know, it lingers when you hear so much about DoD and then people want to return there because it is a very sensitive issue in terms of the people that they are working with and the items that they are working with, and then to have to go to a new system where people that haven't seem the high-tech equipment, you know, you don't have a lot of confidence. I am sure, if they are saying that is the first time I have seen that. But the truth is they are getting access to some of the most high quality equipment that nobody has seen.
So I am hoping it is changing, but it still may be the case in some situations.
Mr. BLAKE. Mr. Chairman, I just sort of want to piggyback a little bit on what Joy had to say and also make another comment first.
Representing a membership that is probably one of the highest in users of prosthetic devices and equipment from the VA, I would say that our members generally never—I won't say never—generally do not have problems getting the most state-of-the-art wheelchairs and other types of equipment that they need. In the occasion where maybe there is some difficulty getting a piece of prosthetic equipment or whatever it may be, it is usually just a matter of working with the prosthetics department through our service officers or what have you to make sure that the right steps are taken. But our members are not experiencing a lot of problems getting what they need. And believe me when it comes to state-of-the-art wheelchairs, you would be surprised at what is out there.
I want to sort of tag along with what Joy had to say. I think you would find that DoD is not unlike VA in sort of the prosthetic structure, and some of the VA's prosthetic services, not unlike the rest of its health care, has become adaptable to changing needs of this generation. Prosthetics is no exception.
I think a lot of focus is put on the—we talk about these advanced prosthetics that the servicemembers are getting from DoD, but it really boils down to them getting them through Walter Reed, Bethesda, Brooke or some of the major military check points. But if they went back to a lot of home stations, I think you would find that a lot of these military treatment facilities, they don't exactly have the capacity to meet their needs when it comes to prosthetics or the maintenance required for that equipment either.
So DoD is not unlike VA in this respect. And I think VA is probably trying to address it more than DoD would in that respect. And we have heard time and again from Mr. Downs, who oversees the VA's prosthetics, that I think he recognizes the need for them to become more adaptable and get it to the field so that as these men and women ultimately are going to come to their local facilities the VA can meet their needs, particularly on the maintenance of this high-end equipment.
I mean, they are intimately involved in what is going on out at Walter Reed in particular, because that is sort of where everything begins when it comes to these advanced prosthetics.
So you can beat up on the VA for it, but in fairness to the VA, I mean they are seeing demands on their system that they never could have imagined before now also.
Mr. MICHAUD. Thank you very much.
My last question, for all the panelists is, in talking to your membership, do you believe that specialty care within the VA system is provided equally among all VA facilities?
Mr. BLAKE. I will speak to the SCI side of it. I think because of the model that has been established we feel pretty confident that it is sort of a uniform policy in the way all SCI care is provided across the system. That again is a function of the way the entire SCI service has been set up through the hub and spoke model.
We are encouraged to see that the VA is sort of moving that way in the polytrauma aspect, and yet there are a lot of challenges as it relates to TBI that Joy raised and going forward that the VA is going to have to figure out how to deal with along the way.
But I feel pretty confident that they do the right think across the board when it comes to SCI service in particular.
Ms. ILEM. I would add onto that.
Some of the complaints that we have heard from veterans contacting us about mild to moderate TBI is that, you know, their families sort of recognized they had an issue, they had been using the VA system for other things, went to the VA, weren't satisfied in areas of the country.
I mean, I had received calls sort of from different locations saying, you know, I ended up in the private sector with VA fee basing me into an outpatient program that really offered a range of things that I have learned so much in the last 6 months in terms of, you know, mild TBI, how to deal with it from my family center care addressing, you know, a range of issues and opportunities for them to have this wide range of outpatient care. And in those cases, you know, I have contacted the VA directly and tried to find out is it, you know, just this location that they are having this problem or is this a systemic problem? It is hard to say unless, you know, somewhere like PVA, you know, really has people on the ground that are doing site visits in the region. Within that specific area, you know, that is a concern of ours.
We are hoping that in certain areas they have the interdisciplinary teams that are needed to provide that care and that they have developed a wide range of services and a good type of program for that, but I am not convinced of that that it is everywhere yet.
I think at certain locations, you know, with the—obviously with the major polytrauma centers, but as you go further out and then obviously in the rural areas where those services are not available, you know, and they have to connect them with the nearest private-sector facilities, you know, we would like to see some continuity of care and make sure that care is available everywhere.
Mr. MICHAUD. All right.
Ms. WILLIAMS. I would like to add that during our site visit that was a main issue, staffing shortages as Joy just mentioned. In the areas where they have the polytrauma centers you will see where they have a lot of specialty care available, but as you go out to the other facilities there is definitely a shortage for specialty care, and we hear that from the veterans and we have also heard that from VA staff themselves at the facilities that there is a shortage.
Dr. ZAMPIERI. The same thing. The major centers, both the military polytrauma centers, Walter Reed, Bethesda, Brooke Army Medical Center, Balboa in San Diego, or you go to any of the four VA polytrauma centers, it is amazing. I think everybody gets seen by everybody. I mean it is not unusual to have a team of 30 different specialists seeing a patient.
And the hand off has improved dramatically from back in 2005 when I was sitting in this room I think with a couple things. One is we always are concerned that, you know, everybody focuses I think on, you know, the famous beat up in this town is Walter Reed when something goes wrong, and the universe focuses there, but the patients who are evacuated back through Landstuhl come back into the United States, I think there is a misperception that well everybody goes through Bethesda or Walter Reed, and in actuality, some people will admit that about 30 percent of all the wounded and walking wounded actually go back to the original home platform base of deployment.
So if you go to Fort Drum or Fort Carson, Colorado, or Fort Gordon, Georgia, or just name a base, Fort Hood, Texas, you will find individuals who were evacuated back through the system that didn't get seen in one of these highly specialized centers, and some of those are the ones that we find that have a vision problem that, you know, they didn't have a lot of other severe injuries so they were evacked back and then they sort of get lost. Somebody on one side doesn't notify the VA blind rehab services or the local Visual Impairment Services Team (VIST) coordinator that they have somebody that is experiencing vision problems, and that there is treatment available, that there is specialized devices from prosthetics that are available to help them in their recovery and treatment.
And so that is why the Vision Centers of Excellence is important, because it isn't just the major trauma severe cases that need to be tracked, it is all of the types of injuries, mild, moderate, severe, as far as vision goes, that need to be carefully tracked and followed, and the providers need to be able to exchange the information between them—between the VA providers, the ophthalmologist and the military, their colleagues in the military treatment facilities. Because again, a person at Fort Drum, New York, may suddenly have somebody come in that was evacuated back from Landstuhl with injuries and that is where one of the problems is.
Thank you.
Mr. MICHAUD. Thank you. Mr. Bilirakis?
Mr. BILIRAKIS. Thank you, Mr. Chairman, I appreciate it.
Mr. Zampieri, on that point again, I understand your frustration with the delays in the planned construction and operation of the Vision Center of Excellence. How confident are you that your timeline will be met?
Dr. ZAMPIERI. Thank you very much.
Wow. I have been chasing the ghost of timelines for quite a while, and I am not sure. You know, in fact someone said that what was originally—you know, the Vision Centers of Excellence by the way is not a clinical surgical center, it is an administrative headquarters to coordinate and facilitate information flow of connectivity between all of these patients and the providers, and so you are not building a surgical rehab center or whatever, it is like 4,000 square feet of office space, and here we are, the money was provided in the war supplemental last August and originally it was hoped that the construction would start this summer, then I was told it wouldn't start until this fall, and now I am being told that instead of January, February, or March, that it won't get done until next May or June.
I mean this is really phenomenally incompetent. I mean, I don't know how else to put it. You know, they open up a 72,000 square foot National Intrepid Center of Excellence for traumatic brain injuries and mental health, which cost $68 million, has all the state-of-the-art equipment in it, over 100 employees, those are clinicians and providers and counselors and therapists, and they do that and a grand opening, at the same time they can't renovate 3,800 square feet of just office cubicles so that we can get this thing up and running and people all collocated instead of temporary office spaces where they have been moved like three times in the last year and a half?
And so yeah, I am a little frustrated, and I don't believe any of the timelines.
And also I might as well, since you asked, there is never a budget anywhere in anybody's testimony, and I am frankly very frustrated about that.
Thank you.
Mr. BILIRAKIS. Thank you.
Mr. Blake, I appreciate your interest in reinstating what we call the capacity report; however, I am concerned that the requirements for that report need to be reevaluated and updated to ensure that the information contained in the report is relevant and functional. Would you be willing to work with us on that?
Mr. BLAKE. Absolutely, and we have already discussed this with the staff. There was some discussion about why the capacity report even expired in the first place, and I have already talked to our staff at PVA as well about the willingness to try to figure out what would be a more useful report, what kind of information should it include, and how could it be used once these reports were to be processed again?
So the short answer is, yes, sir, very much.
Mr. BILIRAKIS. Thanks so much, I appreciate it.
Ms. Ilem, I hope I didn't mispronounce your name. In your testimony you mentioned the proposed facility in Tampa called the Heroes Ranch, which is in my Congressional district. I think this is a wonderful concept. I have some background here and I have talked to the James A. Haley VA Medical Center about this and I believe it could be a viable solution to the problem of how to treat our catastrophically wounded warriors.
Can you tell me more? Give me your thoughts on this, and if you can elaborate a little bit I would really appreciate it because it is something that I would like to pursue.
Ms. ILEM. Sure. As I noted in my statement our National Commander was able to visit the facility and came back and told me about this proposal that he had seen.
One of the things we have been hearing from different people actually starting a couple a years ago is the concern about a number of patients, you know, probably not a significant number, but still those that may not be able to go home, they may not have someone to care for them at home, and it really wouldn't be a—you know, a really appropriate place to put them that was within a Federal system to make sure that they have continued rehabilitation throughout, and obviously these would be the most severely impaired.
So my understanding of the overview of the project was to really have this residential facility that would be for these very specific group of people.
And I asked some folks there, you know, why a place away from a clinical setting? And they mentioned to me that, you know, when they have taken people out, some of the severely wounded, when they get them out of the clinical setting they really start to see some progress and a responsiveness in some of these people, and so it is so important to be in an environment that is not perhaps just a clinical, you know, the clinical setting.
Also, you know, this would be a very highly specialized type of care setting and model, and so I am really hoping to hear from VA if they are able to comment on it.
DAV would certainly support, as we have talked about it in The Independent Budget, we have talked about it in the testimony, that there is probably going to be a need for maybe a couple of these centers in the country to make sure that these people aren't forgotten after, you know, time goes by and that we really provide them with the state-of-the-art care that they need, even those that perhaps aren't going to be able to be reintegrated with their families or into society in any real way, but they need a setting too that continues the care for them.
So we would love to collaborate with your staff and you on this project, and hopefully VA can shed some light on this and let us know what the status of the initiative may be.
Mr. BILIRAKIS. Thank you very much. Thank you for your willingness to work with me on that.
Mr. Chairman, I have one last question, is that o
Sign Up for Committee Updates
Stay connected with the Committee