Mr. Chairman and Members of the Subcommittee:

Thank you for this opportunity to present The American Legion’s views on these two important pieces of legislation. 

H.R. 3051, Heroes at Home Act of 2007

This bill seeks to improve the diagnosis and treatment of traumatic brain injury in members and former members of the Armed Forces; to review and expand telehealth and telemental health programs of the Department of Defense (DOD) and the Department of Veterans Affairs (VA), and for other purposes. 

Section 2 of HR 3051 requests the Secretary of VA establish a program on training and certification of family caregivers of veterans and members of the active duty Armed Forces with Traumatic Brain Injury (TBI), as personal care attendant.  Pursuant to section 744(a) (2) of Public Law 109-364, a Veterans’ Traumatic Brain Injury Family Caregiver Panel was established in 2007. 

The 15 member Panel was created by the DOD to operate under the Department of Health as a Subcommittee to advise and specifically provide DOD and VA with independent advice and recommendations on the development of training curricula to be utilized by the abovementioned family members on techniques, strategies, and skills for care and assistance for such individuals with TBI.  The panel has convened on occasions, to include a recent town hall meeting, to discuss matters related to the development of a this curriculum and to hear from the public about the issue.

The American Legion asserts that the advice of this Subcommittee into the provisions of this piece of legislation is vital, and that its absence may deprive such a bill of an effective stance and approach to treatment and care of TBI.  The American Legion, in its continued efforts to increase access and quality of care to all eligible and potentially eligible veterans, supports this proposal, as it would help to accomplish this ongoing challenge.

H.R. 6153, Veterans’ Medical Personnel Recruitment and Retention Act of 2008

This bill seeks to amend Title 38 of the United States Code to enhance the capacity of VA to recruit and retain nurses and other critical health-care professionals, in addition to addressing other issues.  The American Legion applauds this proposal to amend the methods of hiring and retaining additional medical personnel of various disciplines to adequately equip VA Medical facilities to ensure the adequacy and quality of treatment and care.

 The American Legion supports the proposal request in Section 2 (j), which seeks to amend 7451 (c) (2), to allow critical fields such as nurse anesthesiologists, to exceed rate limitations on authorized competitive pay.  Although VA has various antidotal programs in place, to include recruitment, relocation, and retention incentives for these hard-to-fill positions, there remains a shortage of such nurses and specialty medical physicians. 

The overall response to the question of shortage indicated that salaries and delays in appointments were key causative factors.  The American Legion, during its VA Medical Center site visits to 49 facilities in 2008 encountered various recruitment issues, including such delays in the appointment of nursing assistants.  Management attributed these delays to a three to four month hiring process.  By the time management completed the hiring process, applicants have accepted a position in the private sector.

In their site visits the American Legion representatives ascertained other areas with difficulty recruiting; these included mental health positions, specifically psychologists and psychiatrists; Dermatology; Gastroenterology; Orthopedics; and, Anesthesia.  A study published in the New England Journal of Medicine ascertained there were shorter inpatient stays and lower complication rates in hospitals with higher staffing levels, while there were longer inpatient stays and increased urinary infections, gastrointestinal bleeding, pneumonia and shock or cardiac arrest in hospitals with lower staffing levels.  Thus planning and adequate staffing up front can help curtail long term care costs and unnecessary complications to the veteran patients down the road.

We hereby urge Congress to act on this piece of legislation by incorporating it into the VA system to prevent the Healthcare system from being included in the casualties of the projected shortage of medical professionals through the year 2020. 

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 the abovementioned matters and issues of similarity. Thank you.