[Congressional Record Volume 151, Number 104 (Wednesday, July 27, 2005)]
[Extensions of Remarks]
[Pages E1638-E1639]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    COMPELLING SERIES ABOUT VA FUNDING SHORTFALLS IN NORTHWEST PAPER

                                 ______
                                 

                         HON. PETER A. DeFAZIO

                               of oregon

                    in the house of representatives

                        Wednesday, July 27, 2005

  Mr. DeFAZIO. Mr. Speaker, I am placing an article from the July 25, 
2005, Seattle Times newspaper into the Congressional Record because I 
think it is important that all of my colleagues understand the real 
world impact underfunding the VA is having on veterans suffering from 
mental disabilities.
  To those who say that VA is adequately funded, I say read this 
article. Spending on VA mental health care services, adjusted for 
inflation, is $630 million below the level in 1996, despite an 11 
percent increase in veterans seeking services. During that same 1996-
2003 period, overall mental health staffing for the seriously mentally 
ill declined by 31 percent, and funding for drug and alcohol treatment 
dropped by 54 percent.
  VA mental health professionals have been asked to cut back on the 
number of sessions offered to veterans on a monthly basis, to cut back 
on the time allotted for each session, lengthen the time between 
visits, and drop some patients altogether.
  It is unacceptable to treat those who have served our country with 
such disdain. The President and Congress have found trillions of 
dollars to provide tax cuts to wealthy individuals and profitable 
corporations. And Congress and the President will send tens of billions 
of dollars to foreign governments this year. Clearly there is enough 
money to adequately provide for our veterans. The President and 
Congress have simply chosen not to make caring for veterans a priority. 
That has to change, immediately.

                [From the Seattle Times, July 25, 2005]

              VA Straining To Treat Post-Traumatic Stress

                            (By Hal Bernton)

       ABERDEEN--During counseling, Vietnam veteran Rod Chenoweth 
     always sits in the same place--a blue fabric couch carefully 
     positioned in a corner to give his body the protective cover 
     of a side and rear wall as he talks about his life.
       He recounts an argument that left him seething in anger. He 
     talks about an evening flashback to the grenade that wounded 
     him in the leg and killed his 19-year-old buddy.
       Chenoweth says the therapy, paid for by the Department of 
     Veterans Affairs VA), has helped pull him back from thoughts 
     of suicide and other self-destructive acts in a life scarred 
     by post-traumatic stress disorder (PTSD)--a war injury that 
     ranks among the most common and the most difficult to heal.
       Starting in July, Chenoweth's sessions with Aberdeen 
     therapist Jack Dutro have been reduced from twice to once a 
     month, a cut that comes as thousands of Iraq war veterans 
     join those of previous wars in seeking treatment from the 
     strained VA.
       ``I can understand that the new veterans need to be dealt 
     with,'' said Chenoweth, 56. ``But it's going to be tough. 
     Jack has been a lifesaver.''
       The agency is required by law to take care of the war 
     wounds of all combat veterans.
       But the agency's PTSD experts, in a report delivered last 
     fall to Congress, warned that the VA ``does not have 
     sufficient capacity to meet the needs of new combat veterans 
     while still providing for the veterans of past wars.''
       Internal reports show the VA's mental-health network has 
     been frayed by years of staffing cuts and budgets that failed 
     to keep pace with the growth in patients.
       According to an internal review of the agency's budget, 
     delivered to Congress in September, problems have been years 
     in the making:
       Between 1996 and 2003, annual spending for treatment of the 
     serious mentally ill increased from $2.16 billion to $2.4 
     billion. But when those budgets were adjusted for inflation 
     in medical costs--the increased costs of salaries and 
     services--spending in 2003 was actually $630 million below 
     the 1996 level. Meanwhile, the number of veterans seeking 
     those services climbed by 11 percent.
       During the same period, overall mental-health staffing for 
     the seriously ill declined by 31 percent.
       Drug and alcohol treatment for the seriously mentally ill, 
     often a critical part of the program for those seeking PTSD 
     therapy, has been the hardest hit. Annual funding, adjusted 
     for inflation, dropped by 54 percent nationwide between 1996 
     and 2003.
       ``It's been a perfect storm of rising needs and tight 
     resources,'' said Tom Schumacher, who directs a Washington 
     state effort to assist PTSD veterans.
       The Northwest VA network has fared better than most of the 
     nation, avoiding many of the staff cuts that hit other 
     regions.
       But the four-state region that includes Washington, Oregon, 
     Idaho and Alaska also is one of the busiest hubs of 
     treatment. The PTSD patient load alone has increased from 
     3,194 in 1996 to 4,671 in 2004.
       To help manage the crunch, the VA Puget Sound Health Care 
     System earlier this year imposed new restrictions on PTSD 
     therapy for veterans who already have undergone at least six 
     months of treatment.
       The VA guidelines now call for no more than once-a-month 
     individual therapy, or twice-a-month group therapy. Those 
     apply to Puget Sound-area clinics and a network of VA-funded 
     private therapists who work around the state.
       Dr. Miles McFall, director of PTSD programs at the VA Puget 
     Sound, said that more frequent therapy does not necessarily 
     help, and those in trouble are welcome to check into an 
     inpatient VA hospital clinic.
       ``Even if money was not an issue, this is what we should be 
     doing,'' he said. ``We care about our Vietnam vets. We're not 
     going to turn our backs on them.''
       Other therapists say while some veterans can handle less 
     treatment, the more unstable ones may suffer setbacks.
       ``Some of them are devastated and feel like they have been 
     abandoned one more time,'' said Jim Shoop, a Mount Vernon 
     counselor. He said his office is reducing service to more 
     than 50 vets with PTSD.


                         a lifetime of trouble

       Soldiers have always suffered from the mental wounds of 
     war.
       But the diagnosis of post-traumatic stress disorder only 
     emerged in 1979 in the aftermath of the Vietnam War as tens 
     of thousands of distraught veterans, suffering from 
     flashbacks, sleeplessness, anger and other symptoms, poured 
     into VA hospitals.
       By 1988, the VA estimated that 479,000 vets suffered PTSD 
     symptoms.

[[Page E1639]]

       For many of these vets, PTSD has meant a lifetime of 
     trouble.
       Chenoweth served with the Marines in Vietnam from 1968 to 
     1969, when the U.S. sustained some of its heaviest 
     casualties. He turned 18 just before boarding the plane to 
     Asia and soon found himself fighting in villages where 
     anybody could be the enemy.
       Chenoweth ended his tour of duty in a psychiatric hospital 
     in Oakland. But it wasn't until the late '80s--after more 
     than a dozen failed jobs, several more hospital stays and two 
     broken marriages--that he was diagnosed with PTSD.
       ``The killing doesn't stop,'' Chenoweth said. ``You taste 
     it. You smell it. And you feel it. It uses all your senses.''
       The numbers of older veterans seeking mental-health 
     treatment surged again in recent years, as new wars unfolding 
     on television in Iraq and Afghanistan added to their stress.
       That, coupled with the influx of soldiers returning from 
     Iraq, has ratcheted up pressure on the VA system.


                          more become eligible

       In the '90s, the VA went through a dramatic overhaul, 
     moving away from a centralized hospital system as hundreds of 
     new clinics opened up around the country. Congress also 
     loosened eligibility requirements, so that more vets 
     qualified for services, and increased the agency's overall 
     health-care budget from $17 billion to more than $28 billion.
       The transformation was lauded as a great success in an 
     Annals of Internal Medicine article last year.
       But mental-health services often lost out as regional 
     administrators juggled budgets to pay for soaring caseloads, 
     new services and pricey new drugs.
       Managers also sometimes balked at pouring money into 
     treatment for illnesses of the mind when compared with 
     physical illnesses that are often easier to measure and cure.
       ``I regret to report that there are stigmas in the VA about 
     the mentally ill,'' Thomas Horvath, a psychiatrist who serves 
     as chief of staff at the agency's Houston medical center, 
     told Congress in 2004.
       ``In this, we may be no worse than the rest of health care. 
     VA needs to do better.''
       Sen. Patty Murray, who worked as a college intern in the 
     Seattle VA psychiatric ward, has helped lead the 
     congressional effort to boost funding for VA programs, 
     including mental health.
       ``I have talked to soldiers who are returning, and a number 
     of them say `my marriage is much more difficult . . . I am 
     having trouble getting my head back in to work,' '' said 
     Murray, ``It's the beginning of trouble. And the fallout from 
     this 10, 15, 20 years from now is tremendous.''
       The issue of VA funding has been rife with partisan 
     politics recently.
       Murray, a Democrat, initially was rebuffed by the 
     Republican majority in an effort to gain emergency funding 
     for VA medical services.
       VA administrators in June acknowledged a roughly $1 billion 
     budget shortfall, prompting Senate Republicans to do an 
     about-face and work with Murray to boost funding.
       Congress is expected to approve an additional $975 million 
     to $1.5 billion to help dig the agency out of the hole for 
     this fiscal year.
       If this money is equally divided within the agency, mental 
     health would receive less than $300 million.
       This emergency cash would fall short of shoring up the 
     system.
       To fully meet the needs of the seriously mentally ill, the 
     VA would require an infusion of as much as $1.6 billion, 
     according to a draft of the agency's strategic plan.
       That estimate didn't assess the added costs of treating new 
     Iraq veterans.


                         just good-enough care

       There is no fixed formula for treating PTSD.
       Instead, the VA offers general guidelines for addressing 
     the illness. This treatment may involve drugs that aid sleep 
     and reduce anxiety or help fight depression. It may include 
     classes in anger management and other coping skills.
       Finally, there is therapy, which often enables the vet to 
     recount and come to terms with combat experiences.
       Some patients may benefit from just a few classes and 
     counseling sessions. Others with chronic PTSD attend sessions 
     for months or years. Some patients do fine in group; others 
     do much better with individual therapy. But as budgets have 
     shrunk, some VA mental-health workers say, they have been 
     pressured to treat more people in less time.
       In Portland, the VA mental-health clinic staff by January 
     had shrunk by 25 percent due to budget freezes, according to 
     an internal staff newsletter. The newsletter described the 
     Portland program as ``unquestionably underfunded.''
       Therapists in Portland earlier this year were asked to 
     consider cutting individual sessions from 50 minutes to 30 
     minutes, and lengthen the time between visits, according to 
     an internal VA memorandum.
       They say they were also asked to consider dropping some 
     patients altogether, after refilling their prescriptions and 
     referring them back to primary-care physicians.
       Megan Streight, a VA spokeswoman, said the Portland VA does 
     not expect staff to cut back services for patients who need 
     therapy. She also said that some jobs have been filled. ``We 
     are confident that veterans continue to receive high-quality 
     mental-health care,'' Streight said.
       But several Portland VA therapists expressed worries that 
     expanding caseloads combined with a smaller staff threaten 
     the quality of some care. All requested anonymity, concerned 
     that speaking publicly could cost them their jobs.
       These therapists say they have been asked to try to 
     complete treatment of new patients in 10 or fewer counseling 
     sessions, even those recently returned from Iraq. Some of 
     these vets arrive at the VA with marriages already in turmoil 
     or broken. Others have isolated themselves at home, and 
     balked at returning to work. One, who came in after beating 
     his wife, had penned a suicide note.
       One therapist said she has been reluctant to stick several 
     troubled Iraq vets in first-step classes of 20 or more that 
     teach coping skills. But her own caseload already runs to 
     several hundred patients, so she has no openings for more 
     one-on-one counseling. To make room for the Iraq veterans, 
     she asks some of her older veterans to come less often.
       ``But what kind of message is that--that you're not as 
     important as the new guys coming in,'' she said.
       The therapist says she needed to get used to the short-
     staffed conditions.
       ``I was told that there needed to be some changes made at 
     the hospital due to the lack of resources, and I was going to 
     have to adjust my thinking,'' said the therapist. ``You need 
     to give Just good-enough care.' ''
       The Puget Sound VA's mental-health programs also have been 
     caught in the regionwide budget crunch, which included a 
     partial hiring freeze that replaces only one worker for every 
     five who leave their jobs.
       ``We have to make the best use of resources that we can,'' 
     said John Park, Puget Sound VA's director of health-care 
     planning, at an April 30 community meeting on mental health 
     sponsored by U.S. Rep. Jim McDermott, D-Seattle. ``You can 
     only cut so much of the budget before things get dicey.''


                        sharing hopes and fears

       Most PTSD patients in Puget Sound are seen in a specialized 
     program that includes clinics and in-patient care. The 
     program has a national reputation for research and treatment.
       McFall, who heads that program, says he was able to snag a 
     special grant that allows him to add several more positions 
     to the 21-person clinic staff in the months ahead.
       ``I want to say that the sky isn't falling. We can get 
     every Iraq veteran an appointment within a week,'' he said.
       But the local VA policy to limit treatment for patients who 
     have had six months of therapy has caused a backlash. The 
     loudest protests have come from the state network of private-
     practice therapists who are paid by the VA to treat vets with 
     chronic PTSD.
       ``I believe that in order to do long-term recovery, I have 
     to do a lot of work,'' said Steve Akers, a Vietnam vet who is 
     an Everett therapist. Akers offers weekly group sessions, as 
     well as individual counseling.
       At the group sessions, the vets spend 90 minutes sharing 
     hopes, fears and a few laughs before ending with a healing 
     circle where they all grasp hands on a wooden staff known as 
     a ``talking stick.''
       One veteran of both the Vietnam and Gulf wars still lives 
     on a razor's edge. At his house, he has installed a perimeter 
     trip wire that sounds an alarm to warn of intruders, and 
     outside lights that can turn midnight into day along a 400-
     foot driveway. The house is full of loaded guns, weapons his 
     wife fears might be inadvertently used in a combat flashback.
       ``She doesn't want the one under the bed, and in every 
     room,'' the vet said during the session. ``But I've got to 
     live with myself. I don't feel secure.''
       Akers opted to take things one step at a time, focusing on 
     a pistol in a bedroom drawer.
       ``So, at one point, would you be willing to put the pistol 
     in one drawer, and the ammo in another? You'll still have 
     your safety factor but have to think to react.''
       ``I could do that,'' the vet responded. ``But it will be 
     really hard for me. When they break in that door, they're 
     only going to do it once. ``
       Under the new VA policy, the group's weekly meetings will 
     be reduced from twice a month to once a month.
       Among the vets, that's the subject of much bitter debate.
       ``I try not to take it personally,'' said the veteran with 
     the loaded gun. ``There is an intimacy here that is 
     incredible. I want to save it. And the fear, you know, is 
     that it's not going to last.''

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