PETER ORSZAG CONTINUES TO BE GLAD HANDED AND BUTT SLAPPED IN THE PRESS AS THOUGH WALKING OUT ON YOUR PREGNANT GIRLFRIEND YOU REFUSED TO MARRY IS A GOOD THING.
IT IS, IN FACT, THE SORT OF THING A YOUNG BOY OF 17 OR A YOUNG MAN AS OLD AS 21 MIGHT GET AWAY WITH -- BUT EVEN SO AT LEAST ONE RELATIVE WOULD PULL HIM ASIDE AND TELL HIM HE NEEDS TO GROW THE HELL UP AND MAN UP.
INSTEAD PETE DUMPS HER TO TAKE UP WITH AN ABC REPORTER -- CAUSE THEY'RE EXTRA SLUTTY AT ABC? -- AND, IN DOING SO, HE EXPLAINS YET AGAIN HOW THE WHITE HOUSE IS NOT FRIENDLY TO WOMEN AND IS NOTHING BUT A BOOZY FRAT PARTY FOR A LOT OF MEN WHO SEEM TO THINK THEY'RE STILL BOYS.
THIS IS THE WHITE HOUSE THAT HAD TO BE SHAMED BY THE PRESS TO FINALLY LET A WOMAN GO GOLFING WITH THE PRESIDENT.
ARE WE STILL PRETENDING GOLF IS A MASCULINE SPORT?
THIS IS BARRY O'S WHITE HOUSE. BARRY O WHO REFUSED TO PICK A WOMAN -- NOT JUST HILLARY, THEY REFUSED TO PICK ANY WOMAN -- TO BE ON THE TICKET WITH PRINCESS BARACK. THIS IS THE SAME BARRY O WHO CALLED WOMEN "SWEETIE" ON THE CAMPAIGN TRAIL. THIS IS THE SAME BARRY O WHO IS A SEXIST PIG AND HAS A BUNCH OF SEXIST PIGS WORKING FOR HIM.
PETER ORSZAG FIT RIGHT IN.
BUT IN YOUR OWN FAMILY? YOU'D PROBABLY KICK THE S**T OUT OF PETER, GRAB HIM BY THE EAR, AND SAY, "DUMP THE FLOOZY, YOU'RE MARRYING THE MOTHER OF YOUR CHILD. YOU'RE OVER 40, YOU'RE DAMN WELL OLD ENOUGH TO KNOW BETTER."
FROM THE TCI WIRE:
"The Committee meets today to recieve testimony on the status of our efforts to prevent military suicides and the challenge in detection, treatment and management of the so-called invisible wounds of war which we consider to include Traumatic Brain Injury, concussive events, Post Traumatic Stress and other combat-related psychological health concerns A hearing on military suicides was requested by Senator [James] Inhofe several weeks ago and we all appreciate that request," Senator Carl Levin declared today bring the Senate Armed Services Committee Hearing to order. Appearing before the Committee was Gen Peter Chiarelli (Army), Adm Jonathan Greenert (Navy), Gen James Amos (Marine Corps), Gen Carrol Chandler (Air Force), and the VA's Dr. Robert Jesse.
Chair Carl Levin: The increase in suicides by military personnel in the last few years is alarming. In 2007, 115 Army soldiers committed suicide; in 2008 the number increased to 140, and to 162 in 2009. Similarly, 33 Marines committed suicides in 2007; 42 in 2008, and 52 in 2009. I understand that there are a number of additional cases where the Armed Forces Medical Examiner has not yet concluded whether the deaths are by suicide, so the 2009 numbers will likely be even higher. These increases indicate that despite the services' efforts, there is still much work to be done. We must improve our suicide prevention efforts to reverse the number of services members taking their own lives. I am greatly concerned about the increasing numbers of troops returning from combat with post traumatic stress and traumatic brain injuries and the number of those troops who may have experienced concussive injuries that were never diagnosed. Studies indicate that mild traumatic brain injury -- or concussion -- is associated with PTSD, depression and anxiety. These conditions, in turn, may contribute to the increase in the number of suicides. Key to suicide prevention is to make greater efforts to end the stigma that too many perceive attaches when they receive mental health care. Another key, of course, is the proper and timely diagnosis and treatment of Traumatic Brain Injury and Post Traumatic Stress and increasing awareness of and access to mental health care resources as well as leadership support for those seeking such care. We hope to hear from our witnesses today the approach that each service and the Department of Veterans Affairs is taking to help detect, treat and manage psychological health problems to include Post Traumatic Stress and Traumatic Brain Injury. The numbers of suicides have increased in every service, but significantly more so in the Army and Marine Corps, the two services most heavily engaged in ground combat in Iraq and Afghanistan. Congress has recognized the strain on these ground forces and has over the past several years authorized significant increases in the active duty end strengths for the Army and the Marine Corps.
"The burdens of our missions in Iraq and Afghanistan are tremendous and so are the consequences for those who serve," Ranking Member John McCain stated. "Many of our service members have answered their country's call with multiple deployments to combat and little time for rest and recovery at home."
Chair Carl Levin: A couple of weeks ago, National Public Radio reported that the military is failing to diagnose brain injuries in troops who served in Iraq and Afghanistan, that the injuries were not documented on the battlefield, that soldiers with TBI don't always get the best medical treatment and interviews with soldiers at Fort Bliss revealed that some soldiers with TBI were crying out for help still had to wait more than a month to see a neurologist. Also they reported that many military doctors have failed to accurately diagnose TBI. Can you give us your response to those reports?
Gen Peter Chiarelli: Mr. Chairman, I prepared a complete response to National Public Radio in which I detailed my problem with the report. I've got three basic problems with the report. Number one, it criticizes the leadership for not caring or not doing anything about it. I think that's far from the truth. I took great exception with the report stating that our doctors seemed to [not] care and are not properly diagnosing these injuries without explaining the real issue here. And you cannot isolate Traumatic Brain Injury without talking about PTS. As I mentioned in my opening statement, the comorbidity of symptoms between these two make it very, very difficult for doctors to make that diagnosis. Of my Army wounded warrior population, this is the most severlyly wounded population I have, with a single disqualify injury of 30% or greater, 60% have either TBI or PTS. 43% PTS, 17% TBI. And I really believe that when you fail to talk about both PTS and TBI and this issue of comorbidity, you're doing a great disservice because to state it flatly: Our science for -- on -- the brain is just not as great as it is in other parts of the body. And researchers are struggling today to-to find the linkages and to learn everything they can about the brain. And because of this, we're going to see some misdiagnosis. I-I can tell you of the folks that the National Public Radio talked about, they had over 200 appointments a piece, uhm, and there's no doubt you could go to anyone of our posts and find soldiers who are struggling because of our inability to nail down and to diagnos exactly what treatment they need for these behavioral health issues but, I promise you, it is not for a lack of trying or real care on the part of our doctors and our leadership is totally committed to working these issues.
Chair Carl Levin: In terms of the wait that one of the soldiers, I guess, claimed of a month or more to see a neurologist?
Gen Peter Chiarelli: I will tell you that a neurologist is not the answer necessarily to these soldiers' issues. I have a total of 52 neurologists in the United States Army. 40 of them are currently practicing. 40. And that's when I include my child neurologist. The team that will work with somebody on any behavioral health issue is -- is a team of a neurologist, possibly a psychatrist, nearest case manager who will look at the entire file or medical record of care given to that-that soldier and work to provide them the best that they can. The -- One of the problems we have here, and I get this from talking to doctors, is even the medications for PTS and TBI are totally different. So if we misdiagnose at the beginning and provide diagnosis of PTS when in reality it's TBI, the medications we're going to put that soldier on are going to be different than what the real problem is and maybe different from another behavioral issue that a soldier may have. Because it's not all TBI and PTS. There's anxiety issues, depression issues, other issues that are the product of the-this-these wars that are causing us so much difficulty in this area. I've got 79% of the psychiatrists currently assigned to the United States based on my authorization prior to 2001. And I know that that authorization is lacking but I only have 79%. And it's not just an Army problem. This, I think you will all agree, is a national problem in a shortage of behavioral health specialists.
Chair Carl Levin: So there are some areas of professional need where we are short. Is this a matter of funding, is this a matter of finding people or what is it?
Gen Peter Chiarelli: No-no, I don't believe it's a matter of funding at all. I think it's a matter of finding folks. Of getting them to move to some of the places where the Army is stationed. When you have shortages, it's much -- You know, I think a psychiatrist might prefer to be in Nashville than in Clarksville, Tennessee. So we have to rely on that TriCare network many times to provide some of the behavioral specialists that we need.
Chair Carl Levin: And in terms of this delay issue, is the delay the result of the lack of resources in the cases that were talked about on NPR or is that a matter of the complexity which you just described.
Gen Peter Chiarelli: I-I-I'd argue it's a case of the complexity. I really would. And I'm not saying in every instance that we're getting soldiers in exactly when we want them to be but when soldiers are assigned to our WTU, they have a primary care manager of a rate of one to two hundred, a primary care manager -- where you or I would have a primary care manager at a ratio of 1 to 12,000 to 15,000. They have a nurse case manager at a ratio of one to twenty. They have a squad leader at a ratio of one to ten or less. So we've done everything we can to focus our resources, our limited resources, in this area but I will tell you, we are short behavioral specialists.
Chair Carl Levin: But again, that's not a funding issue?
Gen Peter Chiarelli: It is not a funding issue.
The general seemed sincere in his first reply to Levin (quoted above). He seemed sincere in his second. But there's a contradiction in the two. In the first, it's concern for the well being of the soldier. In the second, it's woah-ways-me. "A team" of two people? And one is a neurologist that the soldier can't get to see, all he or she is seeing is a case worker and that's supposed to be acceptable? In what world? There's also a shift from the notion that the soldiers deserve the best care (lip service, I know) to 'the best that these overworked doctors and caseworkers can give.' That's a world of difference.
In the second, 'It's woah-ways-me, I only have 40 neurologists.' I'm not seeing and I'm not hearing that supposed real committment to the issue. I'm hear justifications and insults. And that's especially clear when the general decides to speak of "other behavioral issues."
PTSD and TBI are not behavioral issues (I am aware some treat them as if they were, I'm also aware those treatments do not have longterm success rates) and that, after all this time and all this supposed education, a United States general doesn't know that, doesn't grasp that, it's rather telling. And it goes a long way towards explaining the manner in which the second response was delivered which was in a between-you-and-me kind of way and seemed to mock the illnesses. Not behavior issues, illnesses. And the Army would do well to get away from that term as well as to get away from calling medical providers "behavioral specialists." In addition, the 'squad leader' is not part of a medical team. Nor is the 'nurse case manager' that the general blurred all lines of reality on. Yes, he or she has a one to twenty ratio . . . for the designated time that they're responsible for a certain squad (such as an hour each day or a portion of a day). There's a world of difference between that reality and what the general was implying or impLYING. No, for every 20 soldiers on a base, you will not find that there is one nurse case manager. That's not how it works and he knows that. The reality is that a general physician of some sort (and that may be increasing the qualifications of the man or woman) is responsible for all care. And if there are misdiagnosis as the general wants to state, that's all the more reason the soldiers need to be seeing a specialist and not some general practitioner.
As for being 'caused so much difficulty in this area,' the general's 'suffering' is of no concern to most Americans and he needs to climb down from his cross and grasp he has a job to do, one he's paid handsomely for by US tax payers. He's not paid to whine. He's paid to ensure the safety and well being of all those serving under him. That's what he was there to talk about but instead he wanted to play Drama Queen. As his voice rose and rose, what it really came down is he refused to answer direct questions and if you tried to piece together the answer from his many words, what you got was: "I'm offended NPR and ProPublica reported what they did but, yes, it is accurate."
And it's probably a good time to remember Adrienne Kinne's testimony at Winter Soldier in 2008 (see March 25, 2008 snapshot for an overview of all her testimony), specifically her testimony on Friday March 14th at the panel on veterans healthcare. Kinne spoke of after leaving the military and pursuing her education further. She did some college internships at VA hospitals and then was an assistant on a research study. The study was on PTSD and TBI -- Post Traumatic Stress Disorder and Traumatic Brain Injury. The group devised a way to screen for TBI, hammered down the details and were ready to proceed.
Adrienne Kinne: And then they went to go to the next step, to actually make this happen. And I was actually on a conference call when someone said, "Wait a second. We can't start this screening process. Do you know that if we start screening for TBI there will be tens of thousands of soldiers who will screen positive and we do not have the resources available that would allow us to take care of these people so we cannot do the screening." And their rationale was that medically, medical ethics say if you know someone has a problem, you have to treat them. So since they didn't have the resources to treat them, they didn't want to know about the problem.
Has a lot really changed? Doesn't appear so from the general's testimony. Picking immediately back up with Levin's questions.
Chair Car Levin: Alright, now, Dr. Jesse, the VA, as I think you've testified, screens all of our Iraq and Afghanistan veterans who receive care from the VA for TBI. Does that screening for TBI indicate that there is a routine failure in the military to properly diagnose TBI before you see that veteran, while they're still on active duty?
Dr. Robert Jesse: No-no, sir, I don't -- I don't think we can say that. The problem with TBI is that there-there's no hard, fast diagnostic test. There's not a lab test that you can send off and get an answer back. And the other thing is that of temporal issues -- is that often it takes time to manifest some of the -- some of the effects that would have to show up. So I don't think think that it's a -- it's a failure on the Department of Defense to find these people. I think it's uh, uh, may just be, uh, the complexity of the disease.
Good to know it's no one fault, right? Who pays you, Dr. Jesse? Oh, yeah, perfectly clear now. Tomorrow we may note Senator Daniel Akaka's questioning. He focused on suicides and it's worth noting but, if you can't tell, the general and the doctor disgusted me. And I'm not really big on people attacking the press with bluster with non-specifics. When, for example, Senator Mark Udall spoke to the general (the only one focused on in this snapshot) about a doctor who didn't think it mattered -- put this in writing -- whether or not TBI was properly diagnosed, he did a song and dance and refused to answer. I don't have time to quote his multitude of lies. The NPR and ProPublica report stands. Click here to refer to those reports. Instead of the general's diversions, we'll note this from Senator Akaka's office:
AKAKA INTRODUCES LEGISLATION TO IMPROVE VETERANS' DISABILITY CLAIMS PROCESSING
WASHINGTON, D.C. – Senate Veterans' Affairs Committee Chairman Daniel K. Akaka (D-Hawaii) introduced legislation today to make much-needed improvements to VA's disability claims processing. VA provides disability compensation to approximately 3.1 million veterans across the nation.
"VA's system to provide veterans with disability compensation is well intended, but it is broken. This bill will move the Department closer to fulfilling its obligation to provide every eligible veteran with timely and accurate disability compensation," said Akaka.
As Chairman, Akaka has held a series of hearings on improving the veterans' disability compensation system (to view the Committee's hearings click here). The Committee will hold a hearing to review disability claims processing on July 1, at which time witnesses will testify about Akaka's legislation.
The Claims Processing Improvement Act of 2010 (S.3517) would make various changes to the way VA processes disability compensation claims, including provisions to:
- Set up a process to fast-track claims that have been fully developed;
- Help veterans with multiple disability claims by allowing VA to provide partial disability ratings; and
- Provide that the Department give equal deference to the medical opinions of a veteran's non-VA doctor.
The bill would also establish a test program at several Regional Offices replacing VA's method for identifying musculoskeletal disabilities. Compensation under the pilot would be based on a functional assessment of limitations due to the disability, such as standing, walking or lifting, and would take into account the severity, frequency and duration of symptoms of the disability. To identify disabilities, the pilot would use the common language of the International Classification of Diseases, rather than VA's current Rating Schedule.
To read Senator Akaka's statement in the Congressional Record introducing the bill, click here: LINK
-END-
Kawika Riley
Communications Director
U.S. Senate Committee on Veterans' Affairs
Senator Daniel K. Akaka (D-Hawaii), Chairman
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