Citizens for Responsibility and Ethics in Washington - PTSD

Senator Akaka on V.A.: "widespread indifference to the invisible wounds of war"

crew — Mon, 9 Jun 2008 07:43:40 -0500

Continued fallout from the release of an email by CREW and VoteVets.org obtained from a Veterans Affairs (VA) employee directing VA staff to refrain from diagnosing soldiers and veterans with Post Traumatic Stress Disorder (PTSD). The email can be seen here. Last week, the Senate Veterans Affairs Committee held hearings on the subject. The Chair of that Committee, Senator Daniel Akaka (D-HI), blasted the VA for its "widespread indifference":

The Veterans Affairs Department seems to have a widespread indifference toward veterans with mental illness, U.S. Sen. Daniel K. Akaka and other Senate Democrats said yesterday.

Their comments came after the Senate Veterans Affairs Committee, which Akaka chairs, heard a VA psychologist deny she was trying to save money when she suggested in an e-mail to her staff that they use other mental illness diagnoses for veterans who may have post-traumatic stress disorder.

"This incident was both disturbing and disappointing," Akaka said. "It reinforced fears among many veterans that the VA's mental health system is not meeting all their needs."

The e-mail, written by Norma Perez, a former PTSD program coordinator for the VA medical center in Temple, Texas, followed another problem where VA officials tried to suppress data on veteran suicides, Akaka said.

"Together, these incidents suggest a possible trend — widespread indifference to the invisible wounds of war," Akaka said. "We are concerned about systemwide problems within VA's mental health system."

Akaka has asked the VA to review and revise its PTSD treatment and compensation guidelines and provide complete data on veterans' suicides. He also has requested a VA inspector general's investigation of the Temple VA medical center.

Senator Tester on VA's PTSD email: "I just think that is criminal"

crew — Thu, 5 Jun 2008 08:25:30 -0500

More fallout from yesterday's hearing in the Senate Veterans Affairs Committee. The Committee called several staffers from the Department of Veterans Affairs. Witnesses included Norma Perez, the VA hospital's PTSD program coordinator. Last month, CREW and VoteVets exposed an email sent by Perez to to a number of VA employees, including psychologists, social workers, and a psychiatrist stating that due to an increased number of “compensation seeking veterans,” the staff should “refrain from giving a diagnosis of PTSD straight out” and they should “R/O [rule out] PTSD” and consider a diagnosis of “Adjustment Disorder.”

At the hearing, Perez tried to explain and defend her actions, but Senators weren't convinced. From the Honolulu Advertiser:

U.S. Sen. Jon Tester, D-Mont., a committee member, said he "didn't buy" Perez's explanation.

"She sent out an e-mail telling folks not to worry about real diagnoses but to diagnose people with this adjustment disorder," he said. "I just think that is criminal. If people are going to get the help they need in a timely manner, we need to do the best diagnosis we can."

After the hearing, Melanie Sloan, executive director of Citizens for Responsibility and Ethics in Washington, said there is widespread misdiagnosis of veterans with PTSD to cut costs.

"It is unconscionable that administrators like Norma Perez and those higher up the food chain are instituting a process by which our service members are lied to on a regular basis," she said.

Jon Soltz, an Iraq war veteran and chairman of VoteVets.org, said the problem is serious.

"Veterans clearly are having problems getting diagnoses with PTSD, and even when they are diagnosed, cannot get approved for disability claims," he said. "This is shameful treatment of the men and women who fought for our nation in war."

Senate Veterans Affairs Committee holding hearing this morning on PTSD

crew — Wed, 4 Jun 2008 08:25:57 -0500

Last month, CREW and Vote Vets "released an e-mail obtained from a Veterans Affairs (VA) employee directing VA staff to refrain from diagnosing soldiers and veterans with Post Traumatic Stress Disorder (PTSD):

On March 20, 2008 a VA hospital’s PTSD program coordinator sent the e-mail below to a number of VA employees, including psychologists, social workers, and a psychiatrist stating that due to an increased number of “compensation seeking veterans,” the staff should “refrain from giving a diagnosis of PTSD straight out” and they should “R/O [rule out] PTSD” and consider a diagnosis of “Adjustment Disorder” instead.

Congress is now getting involved.

From the Senate Veterans Affairs Committee:

Hearing: Systemic Indifference to Invisible Wounds

June,4,2008

Wednesday, June 4, 2008 9:30am SR-418

Oversight hearing - Systemic Indifference to Invisible Wounds

Click Here to View LIVE Hearing

1-Committee Leadership

Chairman Daniel K. Akaka

Panel I

DR. NORMA PEREZ, MENTAL HEALTH INTEGRATION PSYCHOLOGIST, CENTRAL TEXAS VETERANS HEALTH CARE SYSTEM

MICHAEL J. KUSSMAN, MD, UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS

REAR ADMIRAL PATRICK W. DUNNE, USN (RET), ACTING UNDER SECRETARY FOR BENEFITS, VETERANS BENEFITS ADMINISTRATION, DEPARTMENT OF VETERANS AFFAIRS

CREW and VoteVets to VA Inspector General: Investigate PTSD Misdiagnoses; "This practice is widespread and systemic."

crew — Wed, 28 May 2008 10:42:00 -0500

CREW and VoteVets.org requested that the Inspector General for the Department of Veterans Affairs (VA) open an investigation into the process and manner by which the VA makes a diagnosis of post traumatic stress disorder (PTSD) in veterans. The letter to the VA, which we sent today, can be found here.

In the wake of the disclosure by CREW and VoteVets.org of an internal VA e-mail advising VA mental health staff in Texas to consider a diagnosis of adjustment disorder in place of a PTSD diagnosis as a cost-cutting measure, both organizations have received new information from VA employees and veterans attesting to the fact that this practice is widespread and systemic. VA Secretary James Peake has repudiated the email as not reflecting VA policy.

The VA has adopted incentive programs that, by rewarding those employees and hospitals that distribute lower levels of compensation to veterans, encourage adjustment disorder diagnoses rather than the most appropriate but also more costly diagnosis of PTSD.

In addition, the VA's internal computer system permits medical files to be changed by health professionals who did not conduct the initial examinations, a practice that appears to have resulted in changed diagnoses from PTSD to adjustment disorder, even where there is no additional medical evidence to support the downgraded diagnoses.

CREW and VoteVets.org also heard from VA employees who suffered retaliation for their failure to support these practices.

Melanie Sloan, executive director of CREW, said:

It is unconscionable that the VA would actively encourage its staff, through monetary incentives, to misdiagnose our veterans’ mental health. Add to that the mind-boggling disclosure that medical files can be altered to downgrade service members’ conditions, and we have a VA that is betraying those it is supposed to serve. The VA Inspector General must spearhead an investigation into these abhorrent practices immediately.

Jon Soltz, Iraq War vet and Chair of VoteVets.org, added this statement:

Despite what Secretary Peake said, the misdiagnoses being encouraged at the Temple, TX VA Center were not an isolated incident. The only question now is: How widespread is this, and how high up does the problem go? Those of us who served this nation in war deserve to have full confidence in the programs set up to help transition us back to civilian life. These new revelations personally give me zero confidence in the mental health screening and care system the VA oversees.

On May 14th, CREW also sent a Freedom of Information Act request to the VA asking for all records pertaining to any guidance given regarding the diagnosis of PTSD.

More calls to investigate V.A.'s PTSD policy after CREW and VoteVets released email

crew — Fri, 23 May 2008 10:41:52 -0500

Last week, CREW and Vote Vets "released an e-mail obtained from a Veterans Affairs (VA) employee directing VA staff to refrain from diagnosing soldiers and veterans with Post Traumatic Stress Disorder (PTSD):

On March 20, 2008 a VA hospital’s PTSD program coordinator sent the e-mail below to a number of VA employees, including psychologists, social workers, and a psychiatrist stating that due to an increased number of “compensation seeking veterans,” the staff should “refrain from giving a diagnosis of PTSD straight out” and they should “R/O [rule out] PTSD” and consider a diagnosis of “Adjustment Disorder” instead.

The fallout continues. Today, NPR is reporting that more members of Congress are asking for an investigation into this matter:

In an e-mail, a psychologist at the Olin E. Teague Veterans' Center in Temple, Texas, advised her staff to stop diagnosing veterans with PTSD to save money. The e-mail became public last week.

The head of the Department of Veterans Affairs insists that's not VA policy.

Psychologist Norma Perez was hired last summer to help coordinate a PTSD program at the center, which draws a lot of veterans. Not long afterward, Perez announced she would disband a dozen or so PTSD therapy groups, in which about 140 veterans met monthly with a clinical counselor. Perez wanted to replace the long-term groups with short-term plans — lasting no longer than three months — that focus on coping skills and cognitive processing therapy. The VA uses a broad range of therapies for PTSD, including group therapy.

Some veterans in the program said Perez told them that long-term group therapy doesn't work. Some vets accused Perez of personally trying to destroy their groups.

But Kim Larsen, a former Army medic and Vietnam vet with PTSD, who attended two VA forums about the plan to disband the groups, had a different impression. He thought Perez was simply the messenger. Then he saw an e-mail from Perez to her staff, advising them to "refrain from giving a diagnosis of PTSD straight out...." It was dated March 20.

Incensed, Larsen shared the e-mail and it wound up with Citizens for Responsibility and Ethics, a watchdog group, and VoteVets.org, a veterans advocacy group. Last week, the groups posted the e-mail on the Internet, setting off a tempest.

Congressional leaders and Democratic presidential candidate Sen. Barack Obama called for an investigation, and the inspector general of the VA has begun one.

Rep. Bob Filner, a California Democrat who heads the House Veterans Affairs Committee, said of Perez: "I can't believe that someone at that level position is doing this on her own. Somewhere in the hierarchy people are saying, 'It's costing us too much with these PTSD diagnoses. Cool it.'"

Senator Obama demands investigation of VA email telling staff to "refrain from giving a diagnosis of PTSD straight out"

crew — Sat, 17 May 2008 10:14:00 -0500

Brandon Friedman from VoteVets reports in a diary at DailyKos:

Senator Barack Obama involved himself in the VA email situation today by sending a letter to VA Secretary James Peake demanding an investigation into whether or not the Department of Veterans Affairs is under-diagnosing combat-related PTSD as a cost-cutting measure. Obama then requested hearings on the matter and, within hours, those requests were granted by the chairmen of the House and Senate Veterans Affairs Committees.

This move by Obama comes after VoteVets.org and CREW produced an email on Thursday from a VA official--Norma Perez--in which she advised a number of VA employees, including psychologists, social workers, and a psychiatrist that, due to an increased number of "compensation seeking veterans," the staff should "refrain from giving a diagnosis of PTSD straight out" and they should "R/O [rule out] PTSD" and consider a diagnosis of "Adjustment Disorder" instead.

The story has now been picked up by the AP, the Washington Post, CBS News, the New York Daily News, MSNBC, CNN, the Politico, and the Military Times.

In his letter to Peake today, Obama called on the VA Secretary

to launch an investigation into the incident to evaluate whether Perez was advised to send this e-mail or give this instruction at the urging of her superiors; whether staff members at the Teague Center followed Perez's advice, and if so, how many veterans were affected by incorrect diagnoses; whether officials at other veterans centers have given some similar admonitions to staff members charged with diagnosing PTSD; whether affected veterans have been given immediate re-diagnoses and; whether this is an incident or a trend through the VA system.

You can read the full text here.