TIME White House

Adviser: Obama ‘Madder Than Hell’ About VA Scandal

President Obama is urging Veterans Affairs Secretary Eric Shinseki to fix issues in the VA's hospital system after his testimony last week before the Senate Veterans Affairs Committee about reports that at least 40 veterans died while waiting for care at a Phoenix hospital

President Barack Obama is “madder than hell” about reports of long wait times that led to preventable deaths at veterans’ hospitals, according to a top adviser.

White House Chief of Staff Denis McDonough said on Sunday on CBS’s Face the Nation that Obama is urging Veterans Affairs Secretary Eric Shinseki to “continue to fix these things until they’re functioning the way that our veterans believe they should.”

Shinseki himself used similar language last week when he testified in front of the Senate Veterans Affairs Committee about reports that at least 40 veterans died while waiting for care at a Phoenix VA hospital.

“Any allegation about any adverse incident like this makes me mad as hell. I could use stronger language here, Mr. Chairman, but in deference to the committee, I won’t,” Shinseki said on Thursday.

Dr. Robert Petzel, the VA’s top health official, resigned on Friday. House Republicans have also scheduled for Wednesday a vote on legislation that would expand Shinseki’s firing power.

TIME Veterans

Top Veterans Affairs Official Resigns

VA Secretary Shinseki Testifies Before Senate On State Of VA Health Care
U.S. Veterans Affairs Secretary Eric Shinseki and Veterans Affairs Undersecretary for Health Robert Petzel testify before the Senate Veterans' Affairs Committee about wait times veterans face to get medical care May 15, 2014 in Washington, DC. Chip Somodevilla—Getty Images

The Department's Undersecretary for Health Robert Petzel steps down amid scandal involving an alleged cover up of long wait times for patients

Amid a scandal over delays in care for veterans and forged records at veterans’ hospitals, the top official for veterans’ health care resigned on Friday.

Veterans Affairs Secretary Eric Shinseki accepted the resignation of Robert Petzel, the department’s undersecretary for health care. Shinseki asked for the resignation, the Associated Press reports, quoting an anonymous source. Petzel was already set to retire this year. The resignation comes one day after Shinseki and Petzel came under fire during a four-hour hearing of the Senate Committee on Veterans’ Affairs, in which senators said they were enraged by the problems plaguing the department, including long waits for appointments, a backlog of benefit applications and reports of unnecessary deaths.

“As the President has said, America has a sacred trust with the men and women who have served our country in uniform, and he is committed to doing all we can to ensure our veterans have access to timely, quality health care,” the White House said in a statement provided to TIME. “He has asked Secretary Shinseki to conduct a review of Veterans Health Administration practices and procedures at its facilities nationwide to ensure better access to care, and that review is ongoing.”

“If these allegations are true people should be going to jail, not just resigning their positions,” Senator John McCain said on Fox News Thursday Night. He added that the Justice Department will likely conduct a criminal investigation.

[AP]

TIME Veterans

Top Veterans Affairs Health Care Official Resigns

Veterans Affairs Secretary Eric Shinseki Testifies Before Senate Robert Petzal
Eric Shinseki, U.S. secretary of Veterans Affairs (VA), left, and Robert Petzel, U.S. VA undersecretary for health, swear in to a Senate Veterans' Affairs Committee hearing in Washington, May 15, 2014. Andrew Harrer—Bloomberg/Getty Images

Undersecretary for Health Dr. Robert Petzel has stepped down a day after being grilled in Congress amid uproar over alleged malfeasance and cover-ups at the Department of Veterans Affairs. Petzel said in September that he planned to retire this year

Updated 7:18 p.m. ET

Secretary for Veterans Affairs Eric Shinseki announced Friday he accepted the resignation of the official in charge of the VA’s healthcare services.

Undersecretary for Health Dr. Robert Petzel offered his resignation a day after sitting aside Shinseki while both men were grilled on Capitol Hill. Shinseki and Petzel faced questions Thursday about long-standing inefficiencies in the VA’s healthcare system, as well as allegations that VA officials covered up evidence of delays at a Phoenix, Arizona, clinic that may have led to the deaths of 40 veterans.

“As we know from the Veteran community, most Veterans are satisfied with the quality of their VA health care, but we must do more to improve timely access to that care,” Shinseki said in a Friday statement. “I thank Dr. Petzel for his four decades of service to Veterans.”

Petzel said in September that he planned to retire this year, according to the Associated Press.

“As the President has said, America has a sacred trust with the men and women who have served our country in uniform, and he is committed to doing all we can to ensure our veterans have access to timely, quality health care,” the White House said in a statement. “He has asked Secretary Shinseki to conduct a review of Veterans Health Administration practices and procedures at its facilities nationwide to ensure better access to care, and that review is ongoing.”

This post was updated with a statement from the White House.

TIME Veterans

VA Day of Reckoning: Head Could Roll Over ‘Secret Lists’

Obama Welcomes Wounded Warrior Project's Soldier Ride To White House
VA Secretary Eric Shinseki and President Obama at a veterans' event last year. Win McNamee / Getty Images

Secretary Eric Shinseki faces Congress, and trouble, if woes are widespread

There’s a sword of Damocles hanging by a hair over Veterans Administration chief Eric Shinseki as he heads to Capitol Hill on Thursday to testify on the VA’s expanding secret wait-list mess. It’s an apt place for the retired four-star Army general, himself a veteran wounded in Vietnam. He finds himself in the tightest spot in his five years as secretary of the Department of Veterans Affairs, dealing with the downstream costs of two of the nation’s longest wars.

Charges—and confirmations—about VA double bookkeeping when measuring how long veterans have to wait for appointments are nothing new. But what has given the latest stories more impact are the deaths allegedly linked to the delays, the secret lists designed to hide them, and charges that the secret lists were a way for VA executives to mask shortcomings and thereby maximize their cash bonuses.

Those bonuses come from an annual $150 billion VA budget, triple 2001’s spending.

Congressional Research Service

Whether the sword falls won’t depend so much on what Shinseki tells the Senate Veterans Affairs Committee. He has already said he won’t resign. What’s critical is how Congress and veterans react to what he says, and what a VA-wide inspector general’s probe into the problem turns up. Shinseki will survive if he convinces them he was ignorant of such wrongdoing—he has denounced it as “absolutely unacceptable”—and shouldn’t have been expected to detect it on his own.

But anyone who has paid attention to VA data is aware that there have been persistent efforts inside the agency to make vets’ wait times seem shorter than they actually are. One 14-day limit for getting an appointment was ripe for abuse, and critics say such abuse should have been anticipated and eliminated. Shinseki’s defense becomes weaker with every corroborated story of his subordinates gaming the system. If there’s evidence that the problems are systemic, Shinseki’s days are numbered.

“This is an accountability moment for the VA,” says Phil Carter, who served as an Army officer in Iraq and now champions veterans issues at the nonprofit Center for a New American Security. “The key question is where within the organization to fix accountability: at the secretarial level, the regional level, the hospital level, or some other place.” Only after the IG’s inquiry, Carter says, can the government “decide who should be held accountable for these issues.”

“This is not a new problem,” Paul Rieckhoff, head of the Iraq and Afghanistan Veterans of America, conceded last week. “Veterans have been dying in line for care for decades.” IAVA, like most veterans’ groups, has not called for Shinseki’s ouster.

But others have already made up their minds. “General Eric Shinseki has served his country well,” Daniel Dellinger, the commander of the American Legion, said May 5, when he and his 2.4-million-member organization called on Shinseki to step down. “However, his record as the head of the Department of Veterans Affairs tells a different story. The existing leadership has exhibited a pattern of bureaucratic incompetence and failed leadership that has been amplified in recent weeks.”

There is a baby-bathwater issue, too. “Surveys suggest that patient satisfaction is high among the 6.5 million veterans who get care each year from the VA,” Senator Bernie Sanders, I-Vt., who chairs the veterans committee, said Wednesday. “And while the American Customer Satisfaction Index said VA patients rank their care among the best in the nation, it is clear to me that there are problems within the VA and that the VA has got to do better.”

The VA is the country’s single largest health-care system, with its 300,000 employees spread among 151 medical centers, 820 clinics, and other sites tending to the needs of 230,000 vets a day. “While of course Shinseki is responsible for everything that happens at VA, he’s been fixing serious problems and overall the system is improving,” says Ron Capps, an Army veteran who has sought help from the VA. “So we should give him some more time and space to continue with his plan.”

Whether or not the fudged wait lists are widespread, warning lights highlighting them have been flashing for years:

  • The VA’s “method of calculating the waiting times of new patients understates the actual waiting times,” the agency’s inspector general said in a 2007 report on outpatient visits. “Because of past problems associated with schedulers not entering the correct desired date when creating appointments, [the VA] uses the appointment creation date as the starting point for measuring the waiting times for new appointments.”
  • In 2012, the IG said that when it came to getting a mental-health appointment within the VA goal of 14 days, the agency claimed it met that target 95% of the time. But after drilling deeper into VA data, the IG concluded only 49% got their appointments within two weeks.
  • That same year, the IG reported that patients at a VA facility in Temple, Texas, had “prolonged wait times for GI [gastroenterology] care [that] lead to delays in diagnosis of colorectal and other cancers…staff indicated that appointments were routinely made incorrectly by using the next available appointment date instead of the patient’s desired date.”
  • Not surprisingly, the longer the wait for care, the worse the result. “Long-term outcomes, such as death and preventable hospitalizations, are more common for veterans who seek care at facilities that have longer wait times than for veterans at facilities that have shorter wait times,” the federal Institute of Medicine said last year.

 

 

TIME U.K.

British Charity Sees Rise in Afghanistan Vets Seeking Mental Health Help

A U.K. veterans mental health charity reported a 57% increase over one year in Afghanistan veterans seeking support

The number of British veterans of the war in Afghanistan seeking help for mental health issues increased sharply from 2012 to 2013, a charity group said Monday, warning that need would continue to rise as the country ends its involvement in the war.

Combat Stress, a U.K. veterans mental health charity, said the number of veterans seeking its help went up 57% in the course of a year. The group received referrals for 358 veterans last year, compared to 228 in 2012. Its caseload now includes more than 660 veterans. The increase is linked to the withdrawal of British troops in Afghanistan from all but two bases in Helmand province.

The charity said it found that veterans wait an average of 13 years after serving before seeking help, but the average time has now fallen to 18 months for Afghanistan veterans. Combat Stress also reported that their total caseload of 5,400 veterans across the country was the highest number in its 95-year history.

“We have had great support from the Government and the public over recent years and we simply could not operate without the generosity we have experienced, ” said Commodore Andrew Cameron, chief executive of Combat Stress. “We cannot allow the ex-Service men and women who suffer from the invisible injuries of war to go unnoticed and untreated.”

TIME Veterans

This Woman Is the Last Civil War Pensioner Alive

The last living child of a Civil War veteran, Irene Triplett still receives a monthly pension from the federal government

Irene Triplett, 84, receives a $73.13 monthly pension payment from the Department of Veteran Affairs every month. It’s for her father’s military service—in the American Civil War.

Triplett is the last child of any Civil War veteran to still receive benefits for the conflict that ended a century-and-a-half ago, the Wall Street Journal reports. Triplett’s father, Mose Triplett, was born in 1846 and joined the Confederate forces in 1862 before deserting and signing up with the Union. In the 1920s, he married a women 50 years his junior, who later gave birth to Irene.

16 widows and children of veterans from the 1898 Spanish-American War still receive benefits from the VA. While the last World War I veteran died in 2011, 4,038 widows and children still get monthly payments for their family members’ service in that conflict.

[WSJ]

 

TIME politics

Veteran Affairs Secretary: I Won’t Resign

Secretary of Veterans Affairs, Eric K. Shinseki Tours VA Medical Center-Hampton, in Hampton, Virginia
Secretary of Veterans Affairs, Eric K. Shinseki exits a shuttle while being given a tour of the VA Medical Center-Hampton, in Hampton, Virginia. The Washington Post/Getty Images

Secretary Eric Shinseki rejected calls from veterans advocacy groups for his resignation Tuesday, after allegations of systematic neglect at veteran care facilities

Embattled Veterans Affairs Secretary Eric Shinseki rejected calls for his resignation Tuesday, amid allegations that veteran care facilities had neglected to treat patients in need of urgent care.

Shinseki told the Wall Street Journal that he would work toward improving communications with the American Legion, the nation’s largest veterans advocacy group, which called for Shinseki’s resignation on Monday.

The Legion accused Shinseki of “poor oversight” after whistleblowers came forward with reports of a care facility in Phoenix shunting patients onto a secret waitlist, obscuring prolonged wait times that may have contributed to patient deaths.

“I’m very sensitive to the allegations,” Shinseki told the Journal, promising that he would react to the conclusions of an independent investigation.

[WSJ]

TIME Military

TBIs MIA: An Estimated 30,000 Undocumented Bruised Brains

Army Explosives Team Destroys Roadside Bombs In Iraq
Captured explosives used in roadside bombs are detonated by an Army bomb-disposal unit in Baghdad in 2005. John Moore / Getty Images

The Pentagon recorded only half of the wars' traumatic brain injuries, a new study estimates

Despite its vaunted intelligence-gathering capability, the U.S. military was surprised when enemies in Iraq and Afghanistan began building and deploying roadside bombs to kill and maim U.S. troops.

It got so bad that a soldier asked Defense Secretary Donald Rumsfeld nearly two years into the Iraq war why U.S. troops were forced to defend themselves against such improvised explosive devices with homemade “hillbilly armor.”

“You go to war with the Army you have,” Rumsfeld told the soldier, “not the Army you might want or wish to have at a later time.” It took the Pentagon three more years before Mine-Resistant Ambush Protected vehicles finally began trickling into Iraq.

While the troops were waiting for that armor, the Pentagon was also neglecting to track the traumatic brain injuries caused by such blasts, a new medical study says. TBIs—the “signature wound” of the post-9/11 wars—are tough to diagnose and treat. Without a good accounting of those who experienced a TBI, those challenges multiply.

The report’s authors, using amputations as a proxy for TBIs, conclude that the military documented only one in five TBIs estimated to have affected U.S. troops between 2003 and 2006. Responding to legislation, the Pentagon began tracking TBIs more closely beginning in 2007.

Overall, during the eight years spanning 2003 to 2010, the study estimates that 32,822 active-duty troops suffered undocumented TBI wounds. That’s more than the 32,176 documented by the Pentagon over the same period of time. “This analysis provides the first estimate of undocumented incident TBIs among US military personnel serving in Iraq and Afghanistan” before Congress demanded the improved counting, the report says.

Such missing diagnoses are important, says the study, conducted by a pair of Johns Hopkins University health experts. Undocumented TBIs could lead to troops being booted from the military as malingerers or for personality disorders—discharges that could restrict their access to care from the Department of Veterans Affairs.

For those remaining in uniform, it could lead to additional combat tours, boosting their chances of a second TBI and the “visual and auditory deficits, posttraumatic epilepsy, headaches, major depression, and suicide risk” that accompany multiple TBIs, according to the study. Even a so-called “mild” TBI can rattle the (helmeted) brain inside the skull, leading to a host of maladies including memory loss, cognitive deficits, mood volatility, substance-abuse disorders, personality changes, sleep difficulties and possibly post-traumatic stress disorder.

“In recent years, the U.S. military has generally been reactive, rather than proactive, in responding to public health crises, including suicide, psychotropic drug misuse, and gaps in wounded warrior care,” says Remington Nevin, a co-author of the study. “Public-health leaders within the Department of Defense have a troubling history of having epidemics and programmatic deficiencies identified only by outsiders long after the time to act has passed, rather than having these identified internally in time to mount an optimally effective response.”

A top Army psychiatrist at the time says troops minimized the issue, and their leaders weren’t seeking it out. “Soldiers did not want to come forward, for fear that would be taken out of the fight, or thought to be malingerers,” says retired Army colonel Elspeth Ritchie. “And we — the medics and the line [officers] — were not looking for it.”

The authors used an interesting yardstick to estimate the number of undocumented TBIs: they calculated them by developing a mathematic formula that established a relationship between amputations and TBIs, based on the wars’ later years when the Pentagon was more rigorously tracking TBIs. Unlike TBIs—the so-called “invisible wounds” of the nation’s post 9/11 wars—amputations are visible and easily counted.

IED blasts cause most TBIs and amputations, making missing limbs a good tool to estimate the missing TBIs, says the paper, by Rachel Chase and Nevin of Hopkins’ Bloomberg School of Public Health. “Including amputation counts in the model as a proxy for injury causing events is appropriate, given strong clinical and ecological evidence of common mechanisms of injury” for amputations and TBIs, they write in an article in the Journal of Head Trauma Rehabilitation slated to be posted next week.

Too often, wars’ impacts aren’t gleaned until years later. Mustard gas experiments poisoned thousands during World War II. Cold War nuclear-weapons tests are suspected of causing cancer. Agent Orange was the ticking time bomb in Vietnam—the Department of Veterans Affairs is still adding to its list of medical consequences. Gulf War Syndrome stemming from the first war with Iraq, in 1991, remains a mystery. Traumatic brain injury is simply the latest in the list of war’s unintended repercussions.

The authors put together two Pentagon charts and circled the missing TBIs. Nevin
TIME health

Almost Half of Homeless Men Had a Previous Brain Injury

Homeless people and TBI
Past traumatic brain injuries were correlated with homelessness Getty Images

A new study of homeless men found that 45% of the subjects surveyed had experienced traumatic brain injuries in the past. Brain injuries can cause both cognitive and personality problems that researchers don't yet fully understand

Traumatic brain injuries (TBIs) happen in a moment: a jarring collision while playing sports, an accidental fall, a sudden bomb blast. But their effects can last for a lifetime. Cognition and decisionmaking abilities can be damaged. Mood and behavior can shift suddenly, sometimes resulting in increased aggression or reduced motivation. While most people who suffer a TBI will be able to continue on with their lives unchanged, a subset of victims are never the same. The trajectory of their life is altered permanently.

Just how altered isn’t clear, but a new study published in the journal CMAJ Open offers some sobering data about a possible connection between TBI and homelessness. Jane Topolovec-Vranic, a researcher in trauma and neurosurgery at St. Michael’s Hospital in Toronto, surveyed 111 homeless men recruited from a city shelter to see whether they had suffered a TBI sometime in their past. She found that 45% of them had experienced a traumatic brain injury at some point in their life. (Sadly, most of her subjects’ TBIs resulted from assault.)

“You could see how it would happen,” she says. “You have a concussion, and you can’t concentrate or focus. Their thinking abilities and personalities change. They can’t manage at work, and they may lose their job, and eventually lose their families. And then it’s a negative spiral” — a spiral that, for the men in Topolovec-Vranic’s study, ends up in a homeless shelter. There’s no clear data on how prevalent TBI is in the general population, which makes it difficult to say for sure whether the homeless men in Topolovec-Vranic’s study were injured at an unusually high rate. Hers was also a small study, which limits any larger conclusions about the connection between TBI and homelessness.

But the more we learn about the long-term effects of TBI, the more worrying such injuries become. Another study recently published in the Journal of Adolescent Health found that nearly half of all newly admitted adolescents to the New York penal system had a history of TBI. Studies have also shown that military veterans who suffered a TBI are more likely to commit suicide than those who didn’t.

Our brains are extraordinary machines, and we now know that they continue to change throughout our lives — for the better and, sometimes in the case of TBI, for the worse. Homelessness is sad enough in its own right, but the thought that a single traumatic brain injury could make that fate more likely is truly tragic.

TIME

This Doctor Volunteers to Help Suffering Soldiers

The trauma war brings can become part of veterans, their families and communities

+ READ ARTICLE

Though her practice specializes in treating children, clinical psychologist Barbara Van Dahlen’s greatest influence may be getting fellow doctors to give their time and expertise to help soldiers returning from war.

Concerned about the mental health consequences of the wars in Afghanistan and Iraq, she founded in 2005 Give an Hour, a national network of mental-health professionals like herself who provide free services for American veterans, their loved ones and their communities.

TIME honored Dr. Van Dahlen as one of the 100 Most Influential People in the World in 2012. Former Chairman of the Joint Chiefs of Staff Admiral Mike Mullen said of Dahlen: “Barbara has tenaciously attacked the epidemic of post-traumatic stress disorder, helping break through the stigma that prevents many from seeking help. She has also created an opportunity for many who have not served in uniform to make a difference.”

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