CELEBRITY IN CHIEF BARRY O IS IN SO MUCH TROUBLE THAT THE WHITE HOUSE IS RESORTING TO CREATIVE WEB ACCOUNTS IN AN ATTEMPT TO GIVE THE FADED STARLET A LITTLE HEAT.
MEANWHILE HE PANDERS AND CAN'T STOP FOCUSING ON URGING WOMEN THAT WHAT THEY ARE IS HOW THEY LOOK -- HE IS DEEPLY SEXIST MAN.
FROM THE TCI WIRE:
"Our nation's commitment to restoring the capabilities
of disabled veterans struggling with devasting combat wounds resulting
in the loss of limb began with the Civil War," declared US House Rep Ann
Marie Buerkle this morning shortly after she brought the House Veterans
Affairs Subcommittee on Health to order. "Restoring these veterans to
wholeness was a core impetus behind the creation of the Department of
Veteran Affairs and then, now, it continues to play a vital role in the
Department's mission."
Buerkle is the Chair of
the Subcommittee and this morning's hearing was entitled "Optimizing
Care for Veterans With Prosthetics." Chair Burerkle also noted,
"Following WWII, 1945, veterans disatisfied with the quality of VA
prosthetic care stormed the Capitol in protest. " How is the care
today? To answer that question, the Subcommittee heard from
four panels. Gulf War Veteran John Register and Vietnam Veteran Jim
Mayer. Disabled American Veterans' Joy Ilem, American Orthotic & Prosthetic Association's Michael Oros, Paralyzed Veterans of America's Alethea Predeoux and Southeast Wounded Warrior Project's
Jonathan Pruden. The third panel was the VA's Office of Inspector
General's Linda Halliday accompanied by Nicholas Dahl, Kent Wrathall
and Dr. John D. Daigh Jr. and Dr. Robert Yang. The fourth panel was the
VHA's Dr. Lucille Beck accompanied by Dr. Joe Webster, Dr. Joe Miller
and Norbert Doyle. Some of the issues were outlined in the Ranking
Member's opening remarks.
Ranking
Member Mike Michaud: I've said it on this Committee before, but what
seems to be the case, there is little accountability in management and,
once again, procurement procedures and policies were not in place or not
followed in managing nearly $2 billion worth of prosthetics and sensor
aids. The VA, in the last year's budget submission, claims $355 million
in savings in the Fiscal Year 2012 and 2013 due to aquistions
improvements. But if the VA can't follow its own policies and
procedures, how much faith can we have in the claim of acquisition
savings? I hope the VA can help us understand today what accountability
we should expect and to make certain that the VA does not continue to
overpay for prosthetics in the future, that taxpayers and veterans
receive the best value for their devices, and for management to ensure
that the prosthetics and sensor aids services is fully meeting veterans
needs. Finally, it has come to my attention that VA has proposed
changes in the procurement of prosthetics and that there is a high
degree of concern among some of our witnesses today as to the
effectiveness of these changes. I look forward to hearing from the VA on
these changes as well.
A
proposed change that's bothering some veterans? What proposal is
Ranking Member Michaud speaking of? On the second panel, Jonathan
Pruden explained the proposal (and here we're using his opening written
remarks which differ some what from what he delivered):
Under
current practice, VA physicians and prosthetists are able to see a
veteran, make a determination regarding the most appropriate type of
prosthetic equipment for a veteran, and relay that information to a
Prosthetics Service purchasing officer to complete a purchase-order to
obtain the needed item. Those purchasing officers exclusively handle
prosthetics' purchases, and are specialists in ordering medical
equipment specified by health care providers. A major change that the
Veterans Health Administration intends to institute on July 30th, would
require that any prosthetic item whose cost exceeds $3000 -- to include
such essential items as limbs, wheelchairs and limb-repair components –
must be procured by a contracting officer. This is not simply a matter
of substituting a generalist for a specialist. Under the proposed
change, these contracting officers would use a labor-intensive system
(the Electronic Contract Management System (eCMS)) designed to achieve
cost savings. That system, designed for high-dollar bulk-procurement
purchases that benefit from using the Government's purchasing power,
requires over 300 individual steps to manually process a purchasing
order. While well-suited for buying widgets, the system was neither
designed for nor well-suited to procuring highly specific,
individualized medical equipment. Ill-suited to prosthetics, this new
process would also require increased coordination between clinicians and
off-site contracting officers who would be responsible for purchasing
everything from light bulbs to now highly specific prosthetic legs.
This
is not a small change. Moreover, it not only increases the margin for
error but also the potential for prolonged, delaying "back-and-forth,"
with the likelihood of clinicians having to justify why a more expensive
wheelchair is clinically necessary when a seemingly-similar less-
costly model exists. We see no prospect that this planned change in
prosthetics procurement holds any promise for improving service to the
warrior. Instead, it almost certainly threatens greater delay in VA's
ability to provide severely wounded warriors needed prosthetic devices.
This
would be "the wrong path" Iraq War veteran Jonathan Pruden stated. He
was injured in a July 1, 2003 Baghdad bombing resulting in multiple
surgeries including the amputation of his right leg. This next excerpt
is from his oral testimony.
Jonathan
Pruden: Under the change, only a contracting officer could procure a
prosthetic item costing more than $3,000. This policy would effect
essential items including most limbs like mine and wheel chairs. It
would require the use of a system designed for bulk procurement
purchases that involves manually processing over three hundred -- that's
300 -- individual steps to develop a purchase order. This system may
be great for buying cinder blocks and light bulbs but it is certainly
not appropriate for providing timely and appropriate medical care.
Equally troubling, this change offers no promise of improving service to
the warrior. Instead, it would mean greater delays. The change could
realize modest savings but at what cost? A warrior needing a new leg or
wheel chair should not have to wait longer than is absolutely
necessary. I know warriors who have stayed home from our events, stay
home from school, from work, can't play ball with their kids or live
in chronic pain while they wait for a new prosthesis. I know first
hand what it's like to not be able to put my son into the crib while I'm
waiting for a new prosthetic, to live in chronic pain and to have my
daughter ask my wife once again, "Why can't Daddy come and walk with
us?" With VA moving ahead on changing procurement practices, wounded
warriors need this Committee's help. A prosthetic limb is not a mass
produced widget. Prosthetics are specialized, medical equipment that
should be prescribed by a clinician and promptly delivered to the
veteran. We urge this Committee to direct VA to stop implementation of
this change in prosthetic procurement.
We'll note this exchange from the second panel.
Chair
Ann Marie Buerkle: Mr. Pruden, in you testimony, you talked about how
VA prosthetic research has lagged in recent years. Now Mr. Oros talked
about outcomes but I think you're talking more generally in terms of the
research. What impact -- and I shouldn't speak for you. I should let
you say what research you were referring to. And then, if you could,
after you tell us that piece, what impact has that had on veterans and
the service that they need?
Jonathan
Pruden: VA has-has stepped up in a number of capacties in the past few
years. But, as Mr. Mayer pointed out earlier, DoD has taken the lead
on the development of the DEKA Arm [a project DoD and the VA work on
together] and all of these advanced techonology things. In years past,
VA has been -- One of its key roles and one of the reasons it exists is
to provide specialized medical equipment for our combat wounded, for our
veterans. And VA really needs to have the capacity and the focus on
research for durable medical equipment when DoD and Global War on Terror
Dollars go away. And this also ties into the discusssions about the
centers of excellence at Walter Reed, Brooke Army Medical Center and so
forth. When these dollars go away, those DoD facilities will certainly
scale back their capacity both for rehabilitation and for research. And
what we're calling for is for VA through the amputee system of care
and enhancements and research to be prepared to meet the needs as DoD
scales back.
Chair
Ann Marie Buerkle: Thank you. Miss Predeoux, I'm extremely concerned
with regards to your comments about the filing system being outdated and
the backlog that it creates. Could you comment on that for us?
Alethea
Predeoux: Yes, in my written statement with the filing system, it
refers to medical records in one VA medical center. And if, for
instance, one veteran was to relocate -- For example, our director of
benefits relocated to this area from San Diego and it took quite a bit
of time for the medical records to be delivered from San Diego to DC
simply because there's not one central system in which all the medical
centers are able to locate and actually view the medical records of a
veteran. And as the panel before us testified, it's not just a wait
time, it's a matter of being able to be comfortable and actually to be
mobil.
Noting that
Wounded Warrior was favoring a freeze on VA's proposed change, Ranking
Member Michaud asked Oros, "Do you think we should ask the VA to freeze
the reorganization? Bringing everthing in house?" Oros responded,
"Absolutely. Absolutely." US House Rep Gus Bilirakis wanted to know
about the real life effects if VA went through with their change in
procurement?
Jonathan
Pruden: Under the current system, there are safeguards in place to
ensure that VA is being fiscally responsible. And it can take a month,
two months. Some of this is predicated on the clinical needs of the
patient and the availablility of the product in their area which is
appropriate. Our real concern is that -- is that with the new system,
it would be supposition but it may take months and months longer to get
purchase orders for needed equipment. And the veterans should not have
to wait and the clinician's hands should not be tied. If they feel that
a device is appropriate and going to provide the best care for a
warrior, they should be able to prescribe that device. I have had the
opportunity to speak with over a dozen VA clinicians and prosthetists
who are currently serving in several former chiefs of prosthetics. And
every single one of them said that they share our concerns about the
ability to remain timely and potential delays in veterans receiving
needed prosthetic devices under this new system. Dr. Bechel and she'll
say that, 'One of the things that we're going to consider is if a device
is generally available and interchangeable. Then it will fall under
the federal acquisition regulations.' Who is determining what is
generally available and interchangeable? It's going to be somebody in
acquisitions , not a physician, not a clinician who has the patient's
best interest at heart. And that -- that's our real concern.
That's
one of the main points from the hearing. Time permitting, we may cover
some other issues or go deeper into this one in another snapshot.
From
the House to the Senate, Senator Patty Murray is the Chair of the
Senate Veterans Affairs Committee and the Committee issued the following
today:
FOR IMMEDIATE RELEASE
Wednesday, May 16, 2012
Contact: Murray Press Office
(202) 224-2834
Senator Murray's Statement on Sweeping Army-Wide Review of Behavioral Health Evaluations and Diagnoses
Investigations Will Review Mental Health Diagnoses Since 2001
(Washington,
D.C.) -- Today, U.S. Senator Patty Murray, Chairman of the Senate
Veterans Affairs Committee, released the following statement after the
Army announced that they will begin a comprehensive, Army-wide review of
soldier behavioral health diagnoses and evaluations since 2001. This
major announcement comes after Senator Murray spurred an investigation
into inconsistencies in diagnoses at Joint Base Lewis-McChord in her
home state of Washington. The Army has since returned PTSD diagnoses to
over 100 servicemembers that sought treatment there. Murray has
repeatedly pushed Army leadership to investigate whether problems
similar to those at Madigan were being seen at Army bases across the
country.
For more information on the Army's announcement visit:
"The
Army clearly realizes they have a nationwide, systematic problem on
their hands. I credit them with taking action, but it will be essential
that this vast and truly historic review is done the right way. That
means continued engagement from Army leadership at the highest levels,
prompt attention to the problems of servicemembers identified during the
review, and not only the identification of problems but quick action to
implement and enforce solutions.
"This
comprehensive review is born out of a review I helped initiate in my
home state that has already returned PTSD diagnoses to over 100
servicemembers since the beginning of this year. That review has been
successful because the Army identified and reached out to affected
servicemembers and veterans, conducted reevaluations using the
appropriate tools and best practices, and was made a priority by top
military leaders. This nationwide review must be given the same
attention from leadership in order to succeed.
"But
the bottom line is that the Army needs to fix the inconsistencies we
have seen in diagnosing the invisible wounds of war. Out of this
review, the Army needs to provide a uniform mental health policy so that
service members are given the care they need.
"This
is an issue that affects every aspect of the lives of those returning
from Iraq and Afghanistan. Without proper mental health treatment we
will continue [to] see see servicemembers struggle to readust to family
life, contine to self-medicate, and in far too many cases, take their
own lives.
"Servicemembers, veterans, and
their families should never have to wade through an unending
bureaucratic process to get proper access to care. The Army has an
extrordinary opportunity to go back, correct the mistakes of the past,
and ensure that they are not repeated."
###
Matt McAlvanah
Communications Director
U.S. Senator Patty Murray
202-224-2834 - press office
202--224-0228 - direct
