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Witness Testimony of Mr. Carl Blake, Paralyzed Veterans of America, National Legislative Director

Mr. Chairman and members of the Subcommittee, on behalf of Paralyzed Veterans of America (PVA), I would like to thank you for the opportunity to testify today regarding the proposed legislation.  We appreciate the fact that you continue to address the broadest range of health care issues possible to best benefit veterans.  We particularly support any focus placed on meeting the complex needs of the newest generation of veterans, even as we continue to improve services for those who have served in the past. 

H.R. 1448, THE “VA HOSPITAL QUALITY REPORT CARD ACT”

Although PVA has no objection to the requirements for a Hospital Quality Report Card Initiative outlined in this legislation, we remain concerned that this wealth of information will go unused.  Collecting this information and assessing it without acting on any findings from that information would serve no real purpose.  We would hope that the congressional committees will use this information published in these reports each year to affect positive change within the VA.  However, we must emphasize that additional resources should be provided to allow the VA to properly compile this information as we believe that this could be a major undertaking.

H.R. 1853, THE “JOSE MEDINA VETERANS AFFAIRS POLICE TRAINING ACT”

PVA supports H.R. 1853, the “Jose Medina Veterans Affairs Police Training Act of 2007.”  H.R. 1853 will compliment the training that is currently in place for VA police officers.  Some of the current personnel in the VA police force nationwide may have little or no specific training to work with emotionally distressed veterans.  A majority of VA officers must deal with veterans with various degrees of emotional problems.  In conversations with some of the VA officers at the VA Headquarters here in Washington, D.C., they have informed us that they have been told to be ready to deal with the large number of new veterans returning from the Iraq and Afghanistan war who may have significant mental health problems. 

The current style of conduct as a VA officer is considered “situational enforcement”.  While regular law enforcement officers take action upon a violation of the law, VA police officers evaluate a given situation to determine if the situation presents a danger to veterans, medical staff, other individuals, or the officer.  If the situation is or could become harmful to individuals who are present, or to government property, the VA officer then takes action. 

All new officers receive initial training at the VA police officers training academy.  After that training any future training is at the discretion of the Chief of Police at each VA location.  The Chief will decide what training is required and how much training each officer receives.  One VA Chief we spoke with told us that his officers receive training primarily on how to handle veterans age 60 to 70, as that is the age group of most veterans that they see at the VA medical center. 

PVA believes that VA police officers across the system should have mandatory, standardized, training to help them address the new challenge of dealing with the newest generation of veterans, along with the older veteran population.  This bill would certainly support this idea ensuring that specific training to help VA police officers understand how to best handle the new Iraq and Afghanistan veterans and how to accommodate them as they come to the VA for services.

H.R. 1925 (New VISN in the Gulf Coast Region)

PVA opposes H.R. 1925, a bill that would establish a new Veterans Integrated Service Network (VISN) in the Gulf Coast region.  This would encompass counties in Florida, Alabama, and Mississippi.  PVA has serious concerns about the precedent that this legislation would set.  The VA currently uses the VISN structure as a management tool for the entire VA health care system.  It makes no sense for the Congress to legislate how the VA should manage its system.  Furthermore, this sets a dangerous precedent whereby any member could decide that a VISN, or some similar network structure, should be redrawn in such a way to support his or her own district. 

However, we certainly believe that the current network alignment could be reassessed and possibly realigned.  There is certainly nothing that suggests that 21 service networks is the optimal structure.  But where does the VA draw the line when establishing its health care system structure?  With the current 21 VISN’s, the VA seems to do a good job of managing a massive health care system. 

H.R. 2005, THE “RURAL VETERANS HEALTH CARE IMPROVEMENT ACT”

PVA generally supports H.R. 2005, the “Rural Veterans Health Care Improvement Act.”  This bill would enhance the implementation of the rural health requirements of P.L 109-461 enacted last year.  However, we still have some concerns about how best to address the needs of veterans who live in rural areas.  PVA recognizes that there is no easy solution to meeting the needs of veterans who live in rural areas.  These veterans were not originally the target population of men and women that the VA expected to treat.  However, the VA decision to expand to an outpatient network through community-based outpatient clinics reflected the growing demand on the VA system from veterans outside of typical urban or suburban settings. 

PVA fully supports the provisions of this legislation which would align the mileage reimbursement rate afforded to eligible veterans with the rate that all federal employees get when they are on travel.  It is wholly unacceptable that veterans have to live with the 11 cents per mile reimbursement rate that the VA currently provides when all federal employees receive 48 cents per mile.  In fact, PVA believes that some of the difficulty in providing care to veterans in limited access areas, specifically rural areas, might be eliminated with a sensible reimbursement rate.  We believe that veterans would be less likely to complain about access issues as a result of their geographic location if they know that they will not have to foot the majority of the travel expense out of their own pocket.  This is a change that has been long overdue, and we urge the Subcommittee and all of Congress to take immediate action to correct this inequity. 

We also support the creation of rural health research, education, and clinical care centers.  These centers would essentially serve as centers-of-excellence for rural health care.  This could allow the VA to address the needs of rural veterans through broad application of the “hub-and-spoke” principle.  This is the same structure utilized in the spinal cord injury service.  A veteran can get his or her basic care at a community-based outpatient clinic (spoke).  However, if the veteran requires more intensive care or a special procedure, he or she can then be referred to the larger rural research, education, and clinical care center (hub).  This would ensure that the veteran continues to get the best quality care provided directly by the VA, thereby maintaining the viability of the system.  It will also allow the VA to develop excellence within the actual VA health care system, instead of farming out these services to the private sector.   Likewise, PVA supports the provisions to allow for transportation grants to veterans service organizations to assist veterans access the VA health care system.  We are all familiar with the success of the Disabled American Veterans’ (DAV) van program that provides transportation to medical facilities for disabled veterans who have appointments.  This provision would further support similar programs and allow other organizations to play an equally useful role. 

PVA has concerns about the demonstration projects that will establish partnerships between the VA and the Centers for Medicare and Medicaid Services to seek care in critical access hospitals or at community health centers.  Principally, we believe that this legislation is “jumping the gun” by getting ahead of the Office of Rural Health, which is responsible for determining if solutions, such as this proposed demonstration project, are feasible.  We think that this new office in the VA should be given time to do its job before Congress begins legislating solutions to the problems with rural health care for veterans.  This is certainly not to say that Congress should not pressure the VA to get the office operating expeditiously. 

Although we do not necessarily have a problem with the reporting requirements contained in the legislation, they seem to be redundant.  PVA believes that similar requirements were placed on the VA with the creation of the Office of Rural Health in legislation enacted during the 109th Congress.  We do not see the need for this requirement if the new office at VA will be fulfilling this task once it gets up to speed anyway. 

H.R. 2172, THE “AMPUTEE VETERAN ASSISTANCE ACT”

PVA has serious concerns about the provisions of this proposed legislation.  PVA strongly opposes the provision of Section 2 of H.R. 2172 that would allow the VA to contract for service and repair of prosthetic devices.  We interpret this legislation to mean that the VA can contract with a single entity to provide these services and repairs.  This is absolutely a bad idea.  By using a single entity, the pool of devices and services available will be severely limited. 

A one-size-fits-all approach to prosthetics cannot be applied.  As an example, prosthetics departments that serve PVA members needing wheelchairs often, if not always, contract with several different vendors to provide those wheelchairs.  Because every PVA member, and every disabled veteran for that matter, is different, the equipment they need varies.  Although an Invacare power chair may be suitable for one spinal cord injured veteran, a different spinal cord injured veteran might be better served by a Jazzy chair.  Two uniquely different veterans cannot be expected to use the same equipment simply because it might streamline processes for the VA.  We believe that giving the VA the authority outlined in this provision would have a significant negative impact on the severely disabled veterans who are the highest users of VA prosthetics services. 

PVA has no objection to the provision of the legislation that would require certification of VA orthotic-prosthetic laboratories with the American Board for Certification in Orthotics and Prosthetics or the Board of Orthotics and Prosthetic Certification.  However, we believe that the VA already meets these requirements, but if this provision will reinforce this action, then we have no problem with it. 

H.R. 2173 (Mental Health Services)

PVA opposes H.R. 2173 which would authorize VA to contract with community mental health centers to meet the needs of veterans dealing with mental illnesses.  As we testified earlier this year, we oppose any effort to allow the VA to contract out care when it can do a better and more cost effective job in its own system.  Furthermore, by allowing the VA to send these veterans out of the system to receive their care, it effectively relieves itself of the obligation it has to these men and women.  The VA must be appropriated adequate funding (steps that are finally beginning to take place) and it must be provided in a timely manner if it is going to have any chance of meeting these veterans needs. 

Moreover, Congress must continue to conduct aggressive oversight to ensure that funding specifically allocated for mental health initiatives is properly spent.  As explained in the Government Accountability Office (GAO) report of November 2006, the VA did not allocate all of the funding it planned to commit in FY 2005 for new mental health initiatives, nor did it spend all of the funds planned for FY 2006.  VA must be held accountable to ensure that it lives up to the goals established in its National Mental Health Strategic Plan.  Until such time as the VA meets these goals, the burden for mental health care should not be shifted to the community.

H.R. 2192 (VA Ombudsman)

PVA supports H.R. 2192, a bill that would establish an Office of the Ombudsman in the VA.  We believe that this office could certainly improve the transition of service members and their families from the Department of Defense to the VA.  The office can be an important information tool for the VA.  We do find it unfortunate, however, that such an office would be necessary as the VA as whole should be responsible for fulfilling this role through outreach. 

H.R. 2219, THE “VETERANS SUICIDE PREVENTION HOTLINE ACT”

The incidence of suicide among veterans, particularly Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans, is a serious concern that needs to be addressed.  PVA principally supports this legislation.  Any measure that will reduce the incidence of suicide among veterans is certainly a good thing. 

However, we must emphasize a couple of important points.  First and foremost, there need to be absolute standards established that ensure that the individuals staffing this hotline are adequately trained to handle the complex issues associated with individuals contemplating suicide.  We certainly support the idea that this service should be staffed by veterans, but they must have the proper training to deal with these cases.  Simply having the shared experience of military service is not enough.  This legislation seems to address this concern, but the VA cannot be let off the hook for ensuring that this is handled properly.

Secondly, clear steps for referral into VA mental health clinics and other VA facilities with related services must be outlined.  The private entities responsible for the operation of the suicide prevention hotline must understand how to refer veterans dealing with these problems into programs that will provide the services they need.  These services are essential to helping the veteran overcome the suicidal feelings he or she may be dealing with. 

H.R. 2378, THE “SERVICES TO PREVENT VETERANS HOMELESSNESS ACT”

PVA has no objection to the provisions contained in the proposed legislation.  Clearly, the most important factor in combating the problem of homelessness among veterans is preventing homelessness in the first place.  This legislation would seem to accomplish that task by offering financial assistance to organizations or entities that provide permanent housing and support services to very low income veteran families.  In the mean time, we believe that additional resources should be invested in programs that actually target veterans and their families who are experiencing homelessness as well.  With more than 200,000 veterans on the street on any given night, it is time to make real, meaningful efforts to end this problem.

H.R. 2623

PVA fully supports H.R. 2623, a bill which would prohibit the VA from collecting co-payments from veterans receiving hospice care whether in an inpatient or outpatient setting.  As we recall, the VA actually supported similar legislation during the 109th Congress.  This legislation only makes sense as it will align with current statute that prevents VA from collecting co-payments from veterans receiving hospice care in a nursing home setting.

We look forward to working with the Subcommittee to develop workable solutions that will allow veterans to get the best quality care available.  I would like to thank you again for allowing us to testify on these important measures.  I would be happy to answer any questions that you might have.