Friday, July 11, 2014





US House Rep Krysten Sinema:  Thank you, Mr. Miller and Mr. Michaud for allowing me to participate in today's hearing.  And special thanks to my colleague from Arizona Ms. [US House Rep Ann] Kirkpatrick who represents our state's veterans so well on this Committee.  I want to thank all of today's panelists for joining us.  In particular, thank you to Daniel's parents Howard and Jean for being here.  We've worked together quite closely since learning of Daniel's suicide.  And it is an honor and a privilege to be with you here today.  Unfortunately, Daniel's story and the story of the other young man who committed suicide is just all too familiar in our country.  And 22 veterans a day are still committing suicide even after we have heard the tragedies of the young men who lost their lives here and their brothers all across the country.  And, as we heard from Mr.[US House Rep Tim] Walz, Congress has addressed this issue before, has passed legislation before, has said they were going to fix it before and yet the problem has not only not gotten better, it's gotten worse.  I have heard a lot of testimony today about ideas to actually reform the system and make it better.  The Hippa  issue is one I think the Committee would agree needs to be addressed.  I am particularly interested in the pilot program that Sgt [Josh] Renschler participated in.  And my question, to Dr. and Jean Somers, would be about Daniel.  Daniel's experience at the Phoenix VA -- like many, many veterans' experience at the Phoenix VA -- was one of lack of concern, lack of care, lack of follow through and a discombobulated system that didn't allow veterans to receive the care they needed.  In particular, one of the struggles Daniel faced was as an individual who had served in classified service.  He was unable to participate in group therapy because he was not able to share the experiences he experienced while in service.  And yet, at the Phoenix VA, he was unceremoniously put in group therapy and when [he] requested private therapy was not able to get that care.  And of course as we know he took his own life as a result of being unable to get that care.  One medical home model, I believe, in the private  community, has provided an opportunity to create patient-centered care and allow civilians to get the care they need in one home easily that's centered directly on their needs.  While the pilot program in Washington was ended because of -- Well I don't understand why.  They say they really didn't have enough money for it which I think is outrageous -- horrible, horrible reason to stop providing care that we knew was effective.  My question for Dr. and Jean Somers is do you believe a medical home model would work or could be helpful to veterans like Daniel?  We know that many of our post-9/11 veterans face co-occurring disorders --  PTS, TBI, anxiety, depression, physical maladies.  Would a medical home model have been a model that may have worked better for Daniel than what he faced?  

Jean Somers: Absolutely.  As Daniel's irritable bowel syndrome worsened, he didn't feel he could physically leave the house.  I can't imagine that embarrassment.  [Long pause.]  And then, as Howard mentioned, at the time, Phoenix had the speed traps set up on the major highway to get from his home to the Phoenix VA.  So he had to actually find a way to get off the highway so that the flashing lights would not effect him.  So absolutely, I can see that it would have been very helpful to him just to have the privacy capability. 

Dr. Howard Somers:  I-I completely agree.  I think that not only the medical home model but what we talked about -- the ability within the facility for the different people because of his IBS and his TBI and his PTSD.  You're being treated, as we learned here, the term is in "silos."  And what you have to do is get out of the silos and you have to combine resources, combine knowledge.  And we have heard of programs such as was mentioned that are very successful and  that people can have problems and, for whatever reasons, you have an optometrist or an ophthalmologist in there and they say, 'Well, it sounds like it's not this but this.'  And it's something you might not have thought of.  So the medical home model, the ability to create these panels of care, I think anything like that would be overwhelmingly positive.  

US House Rep Krysten Sinema:  Thank you. And, Mr. Chair, while Mr. [US House Rep Dan] Benishek has already left, I do want to take a moment to thank him for co-sponsoring legislation [H.R. 3387: Classified Veterans Access to Care Act] that we drafter with the Somers to address the issue specifically of service members who have served in classified settings and who need appropriate care when they return to the VA.  And I want to thank the Committee and the Subcomittee for supporting just a part of the solution to this issue.

That was from today's House Veterans Affairs Committee.  US House Rep Jeff Miller is the Committee Chair and US House Rep Mike Michaud is the Ranking Member.  The Phoenix VA is, of course, only one part of the national scandal in the VA's failure to provide timely and needed to care to veterans who have been left to suffer.

Chair Jeff Miller:  Following a Committee investigation which uncovered widespread data manipulation and accompanying patient harm at the Dept of Veterans Affairs' medical facilities all across this nation, this Committee has held a series of full Committee oversight hearings  over the last several weeks to evaluate the systemic access and integrity failures that have consumed the VA health care system.  Perhaps none of these hearings have presented the all too human face of VA's failures so much as today's hearing will in fact do.

Jean and Dr. Howard Somer are the parents of the late Daniel Somers, an Iraq War veteran who took his own life following his facing multiple obstacles while he attempted to receive care.  His parents, in their opening statement, cataloged some of these obstacles:

A1.    At the start, Daniel was turned away from the VA due to his National Guard Inactive Ready Reserve status.
A2.    Upon initially accessing the VA system, he was, essentially, denied therapy. 
A3.    He had innumerable problems with VA staff being uncaring, insensitive and adversarial.  Literally no one at the facility advocated for him. 
A4.    Administrators frequently cited HIPAA as the reason for not involving family members and for not being able to use modern technology.
B1.    The VA’s appointment system known as VISTA is at best inadequate. It impedes access and lacks basic documentation.
B2.    The VA information technology infrastructure is antiquated and prevents related agencies from sharing critical information.  There is a desperate need for compatibility between computer systems within the Veterans Health Administration, the Veterans Benefits Administration, and the DOD. 
B3.    Continuity of care was not a priority.  There was no succession planning, no procedures in place for “warm handoffs”; no contracts in place for locum tenems; and a fierce refusal to outsource anyone or anything.
B4.    At the time Daniel was at the Phoenix VA, there was no pain management clinic to help him with his chronic and acute fibromyalgia pain.
B5.    There were few coordinated inter-Agency goals, policies and procedures.  The fact that the formularies of the DOD and VA are separate and different makes no sense since many DOD patients who are stabilized on a particular medication regimen must re-justify their needs when they transfer to the VA.

B6.    There were inadequate facilities and an inefficient charting process.

His parents were on the first panel along with the parents of Clay Hunt -- Susan and Richard Selke -- and the mother of Brian Portwine -- Peggy Portwine -- and retired Sgt Josh Renschler. 

Clay Hunt was an Iraq War veteran and an Afghanistan War veteran, a member of Iraq and Afghanistan Veterans of America.  He took his own life following a move to Houston where he was unable to get the prescription for his Post-Traumatic Stress and was told he'd have to wait two months to see a psychiatrist.  Committee Chair Jeff Miller's suicide bill is named in the memory of Clay Hunt.

Brian Portwine was an Iraq War veteran.  His mother Peggy Portwine explained that Brian's first deployment to Iraq found his unit patrolling Haifa Street in Baghdad and that 8 of his fellow service members would die during this deployment.  He survived a 2006 RPG attack.

Peggy Portwine: Brian suffered a blast concussion and had lacerations to his face and legs from shrapnel. This was Brian’s first episode of Traumatic Brain Injury. During another mission Brian and his 1st Sgt were on patrol in a Humvee and had switched seats so Brian was now in the passenger seat. Twenty minutes later an IED hit the Humvee and his 1st Sgt was killed and Brian was thrown from the Humvee and injured his back. Besides these two  incidents Brian was involved in five other IEDs during his 15 month deployment.  After coming home after his 1st deployment Brian had trouble with short term memory. When his friends were going somewhere he would often say "Where are we going again?  You know I have scrambled brains." To help cope with this he would post everything he had to do on his calendar or computer. In 2010 Brian was recalled to the Army and deploying from Fort Shelby, Miss. During this deployment Brian did not email or call home or to his friends. Little did we know how he was struggling with PTSD and TBI. He had panic attacks being on the same roads he had traveled on the 1st tour where IEDs went off often. He had nightmares 3 x a week and would wake up his unit and someone would have to wake him up. He suffered with anxiety, depression, insomnia, poor concentration, and hypervigilance. But he was never sent home.

Peggy Portwine noted Rose Kennedy [mother of President John F. Kenney, Attorney General Robert F. Kennedy and Senator Ted Kennedy -- among others] once stated that "time heals all wounds."  Peggy Portwine declared, "I disagree.  The wounds remain.  In time, the mind -- to protect its sanity -- covers them with scar tissue and the pain lessens.  But it is never gone."

She would like to see S. 2182: Suicide Prevention for American Veterans Act (introduced by Senator John Walsh) passed.

Sgt Josh Renschler is an Iraq War veteran.  He served in the military for almost six years. He was medically retired from injuries he sustained in Iraq   He did not receive treatment, he received drugs from the VA to mask the pain, not to help make him healthier.  His doses of Percocet were repeatedly increased until his tolerance for the drug was so strong that they had to switch him to methadone. He was placed on a cocktail of over 13 drugs ingested daily.  Among his many pains, there were pains resulting from nerve damage -- something his VA physical therapist (or 'therapist') had not considered or raised but would be discovered in an MRI.  Renschler has suffered a liver scare and remains in intense pain.  Acupuncture was thought to be a possibly viable treatment for relief from some of the pain, however, it would require him to travel one hour to treatment and one hour back which would defeat any relief he might experience as a result of the treatment.

On the topic of alternative treatments, let's note this exchange from the hearing.

US House Rep David Jolly:  You've raised concern about personalized care and it would seem to me that's clearly lacking.  I don't know what your impressions would be -- if you could speak to that.  And also, simply whether or not alternative therapies have ever -- your sons had that discussed perhaps, or Sgt, in your counseling, the ability to get alternative therapy?  And I say that based on a personal experience as well.  At VA Intake Day, I had a man in my office who said, "Equine therapy works." Well that was good enough for me. But it wasn't good enough for the VA.  So can you speak to any discussions about alternative therapies?  Availability of?  Your opinions to that?  

Sgt Josh Renschler:  Yes, sir.  So again, within the VA medical center, they-they had at one time available to poly-trauma, those who suffered from comorbid conditions, we were able to access recreational therapy and I was put on a six month waiting list.  And when the six months came up, they lost the recreational therapist. That was my only experience there.  Never had a chance to engage in that because I was downgraded from poly-trauma care when the VA determined that my Traumatic Brain Injury had reached a plateau of recovery and it probably would not get better.  That's a completely separate hearing day but as far as the efficacy of alternative therapies, we could -- Again, it really helps and the VA --

US House Rep David Jolly:  The availability? 

Sgt Josh Renschler:  The availability is not there through VA channels.  It's private community is where you have to go. 

US House Rep David Jolly: Doctor and Ms. Somers, do you?

Jean Somers: Yeah, yeah.  I would agree with that.  Daniel himself was a musician so it was easy for him.  He got a piano and a guitar and that was his therapy.  But I would totally agree with that.  At the San Diego VA, I know that they have pottery classes which we were thrilled to hear about and a guitar program.

Dr. Howard Somers: And-and when you talk about evidence-based, it's certainly not just medications.  I mean there are in the psychological treatments that are out there but they are only using two of them when  there are so many potentials out there.  And the other thing that we had mentioned was the MDMA Ecstacy and LSD for pain -- the MDMA for PTSD and the LSD for pain.  Because of our national phobias against these particular chemicals, we're making it very difficult to do trials with these, uh, potential-potential benefits. 

RECOMMENDED: "Iraq snapshot"