[Congressional Record Volume 165, Number 176 (Tuesday, November 5, 2019)]
[Senate]
[Pages S6384-S6385]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mrs. BLACKBURN. Thank you, Madam President.
  This weekend, thousands of Tennesseans and, of course, millions 
across this Nation are going to pause and give thanks for our veterans. 
Quite frankly, this is something we should be doing every single day.

[[Page S6385]]

  I am just amazed and so grateful that there are men and women, like 
the Presiding Officer, who have worn the uniform and who have served--
brave men and women who wake up every day in some of the most dangerous 
places on the face of the Earth and do a job that would bring many of 
us to our knees. We look at this and say it is basically impossible.
  When our veterans have done their part and come home, they find 
themselves facing another set of struggles. The challenges the veterans 
face are well documented, and we hear about them: long waits and long 
lines at VA hospitals and clinics, long recoveries from battle wounds 
that they have suffered, and severe emotional and mental health 
struggles that, if left untreated, could end in tragedy. There are 
systems in place to help our returning heroes. We just need to be using 
these correctly.
  Earlier this year, the VA OIG--Office of Inspector General--released 
a report showing that the agency's system for keeping track of 
controlled prescriptions had almost entirely broken down. Think about 
that. We are in the middle of an opioid crisis in this country. There 
is a system in place, but the VA's system for keeping track of all of 
these prescriptions had almost entirely broken down. This is truly 
unacceptable.
  Pretty much what is happening is this: The State-operated 
prescription drug monitoring program--or PDMP--contains valuable 
information about what drugs veterans are being prescribed outside of 
the VA healthcare system. VA clinicians are supposed to check this 
database before prescribing opioid-based and other controlled 
medications to make sure their patients--that patient in front of them, 
that veteran in front of them--are not receiving too many pills from 
multiple sources.
  Get this. That Office of Inspector General report--the OIG report--
showed that 73 percent of our VA patients who were prescribed opioids 
walked out of the pharmacy, medication in hand, without a VA clinician 
ever having performed the minimum required checks. So the system is 
there. It could be utilized, but what happens? The clinician gives the 
prescription but never checks the database in 73 percent of the cases.
  This failure to follow through puts 19 percent of those patients at 
risk for problems with their care coordination, and almost half of 
those VA patients were under long-term care for chronic pain and were 
at a higher risk for opioid-use disorder and overdose.
  We hear about these reports time and again, and we say: How in the 
world could this possibly happen? How could this be acceptable? It is 
not.
  We look at how it has happened, and here is what we found out. It 
happened because the VA didn't make the rules clear enough.
  Get this. Officials highly recommended that clinicians submit a PDMP 
query, but they didn't explicitly state that it was required under 
existing VHA directives, and there were no national oversight controls 
to act as a backstop. So the rule is there, but a bureaucrat, a 
clinician, says: Well, they recommend it, but it is not required, so I 
will skirt that.
  Along with their report, the OIG handed the VA a laundry list of 
recommendations, including directives to develop national oversight 
programs, better train their clinicians--that one should be an 
imperative--and embed accountability checks into the technology used to 
track patient care. VA officials have submitted now-approved corrective 
action plans, and we thank the VA Secretary for this. It is our job to 
make sure that they do follow through with this.
  The lack of organization that turned VA clinics into unwitting pill 
pushers has made it almost impossible for veterans to seek help during 
times of mental and emotional distress.
  In September, the VA published a report that confirmed our worst 
fears. As of 2017, there has been no significant change in veteran 
suicide rates. In 2017, the suicide rate for veterans in Tennessee hit 
32.6 percent, which is significantly higher than the overall national 
suicide rate. It will take more than 1 day of recognition to fix this. 
It is going to take commitment and an all-hands-on-deck approach.
  I am an original cosponsor of the Improve Well-Being for Veterans 
Act, which will help vets connect to the over 50,000 existing suicide 
prevention programs that are ready and waiting to be helpful. The bill 
will also give regulators a tool to measure how effective these 
programs are. It is a good start, but it is not enough.
  Earlier this year, President Trump launched the PREVENTS Initiative, 
and we thank him for this attention to the needs of our veterans. 
PREVENTS establishes a cabinet-level task force responsible for finding 
the root causes of disconnect between veterans and helpful services 
from the VA and private organizations. Their job is to develop a 
strategy for Federal, State, and community leaders to engage with 
veterans, improve research and access to resources, and work from the 
ground up to prevent suicide.
  Here is the caveat: This will work only if we remain in constant 
contact with veterans back home and use those interactions to find the 
cracks that veterans continue to fall through.
  For years, we have listened to frustrated complaints from agency 
officials insisting that untangling the VA's procedural knots is an 
exercise in futility. Sometimes you hear: Well, it just can't be done. 
We do things this way because we have always done things this way. That 
is not necessarily true. We do them because oversight has not been 
exercised.
  It is time for all of us--not just lawmakers and rulemakers--to 
finally accept that ``honoring their service''--honoring the service of 
these heroes--means helping these heroes heal when they need it and not 
leaving them at the mercy of a broken and bloated bureaucracy.
  I yield the floor.
  The PRESIDING OFFICER. The majority leader.