Transcripts For CSPAN2 Veterans Administration Mental Health Care 20140829

To receive Mental Health care at a Outpatient Clinic in pennsylvania. He was told he would be unable to get an appointment for six months. When that employee left another va employee lean in to tell the veteran that if he told her he was thinking of killing himself she would be able to get him appointment much sooner in three months instead of six. Luckily that veteran wasnt considering suicide. But what about those veterans who are . How many of the tens of thousands veterans that va admitted have been left on waiting list for weeks, months and even year for care were seeking Mental Health care appointments . House education and Workforce Committee are suicidal or edgeing toward suicide as a result of not getting the care they earned . Despite the increase in budget, program and staff the suicide rate among veterans has remained more or less stable since 1999 with approximately 22 veterans committing suicide every day. The most recent data has shown over the last three years rates of suicide has the increased for veter veterans under 30 and 70 for male veterans between the age of 1824 who use va coverage. Today we will hear testimony from three families and they will tell us about their sons daniel, clay and brian. Three operation iraq freedom veterans who sought Va Health Care following combat. Each young man faced barrier after barrier in the struggle to get help. Each of these men ended up turning to suicide. Daniel sommers wrote in a letter behind he felt his government abandoned him and faced a system of dehumanization, neglect and indifference. The va owed daniel, clay and brian so much more than that. I yield to the Ranking Member with that for his opening statement. Thank you very much, mr. Chairman, for holding this very important hearing. We have had many discussions and debates on how to deliver the best service to the military and how to establish creditability within the department of affairs. Over the course of hearing and discussions we have touched on a number of important issues but one we have not zeroed in on much is access to health care and Suicide Prevention. That is why the hearing today is so important. I would like to thank all of the panelist for joining us and particularly i want to thank the family members joining us who have lost a loved one. They are speaking about a loss of a love one and particularly with a child can be difficult and exhausting experience. But we have to listen to your stories and identify what went wrong and we can take action to ensure those failures are not repeated again. We have taken steps to help put in Place Program and initiatives aimed at early dedesk ditext. The department of Veterans Affairs spending on Emergency Health has doubled sented 2007 but it nose working as well as we hoped, and we have to figure out why. A 2012og report found that vha data on whether it was providing timely access to Mental Health service is is unreliable, and the gao report from that year not only confirmed that disturbing finding but also said that inconsistent implementation of vha scheduling policy made it difficult, if not impossible to get patients the help they need when they need it. That is why we have to look at this situation. That is a problem that we have seen repeatedly as we dig into the vas dysfunction and enough is enough. Our veterans and their families die serve a va that delivers timely Mental Health services that cover a spectrum of needs, from ptsd, counseling, for family members, for veterans, to urgent, roundtheclock response to a veteran in need, a recent va oig report found that in one facility patients waited up to 432 days. Well over a year. For care. So once again, we are find that our veterans deserve much better than what they care they are receiving. In all of the area wes must address. We have to look at a comprehensively, and fixing mental halve service Health Service is is an important year. We look forward to trying to solve some of the problems with the difference funkal department were seeing over the last several months. Thank you, mr. Chairman, for having this very important hearing and for the panelists for coming today. Ieel i yield black my back my time. Her honored to be joined by our first panel of witnesses this morning. Family members of the three veterans veterans who sadly and track tragically lost their lives to suicide, and im sure i speak for each of my colleagues when i say that each of you have our deepest sympathies to you for your loss. I am both grateful and at the same time angry that you have to be here to share your stories of your sons weapon each of us. So, if you could approach the witness table, please. Joining us is dr. Howard and jean sommers. Susan and richard silky. And peggy portwine. Were also joined on our first panel by josh renchlr a veteran of the army who will share his personal story. For your service and being here today. Please proceed with your testimony, dr. And mrs. Somers. Were grateful for this opportunity to testify today. Were especially pleased to see arizona representative an kirkpatrick and daniels representative s and our own california representative, scott peters, who have been great allies to us in our efforts to advance reforms of the va based on experiences of our son. As many of you know our jr. Y started june 10, 2013, when damage tack his own life following his return from his second deployment in iraq. He suffered from post Traumatic Stress disorder, brain injury. He spent six futile and tragic years trying to access the va health and benefits systems before finally collapsing under the weight of his own despair. We have attached the story of daniel to our testimony which provides the details of his effort squeeze hope youll read it. Today it is our objective to begin the process which will ultimately provide hope and care to the 22 veterans a day who are presently ending their lives. Just over a year ago and four days are daniels death, feeling fortunate we at least had a letter from him, we spent 30 years in the business of health care, sat down with daniels wife, and his mother, together we feet qualified to prepare a 19page report entitled systemic issues at the va it is attached to our testimony. The purpose of the report remains the same to improve access to firstrate health care at the va. To make the va accountable too veterans it was created to serve. It and to make every va employee an advocate for each veteran. At the start, daniel was turned away from the virginia due to his National Guard Inactive Ready reserve status. Upon initially accessing the va system he was denied therapy. He had innumerable problems with va staff being uncaring, insensitive, and adversarial. Literally no one at the facility advocated for him. Administrators frequently cited hipaa as the reason for not involving family members and for not being able to use modern technology. The vas appointment system, known as vista, is at best inadequate. It impedes access and lacks basic documentation. The Va Information Technology infrastructure is antiquated, and prevented related agencies from sharing critical information. Theres a desperate need for come pattability twin Computer Systems in the vha, the vba and the dod. Continuity was not a. A fierce refusal to outsource anyone or anything. At the time daniel was at the phoenix va, there was no Pain Management clinic to help him with his chronic and acute pain. Few coordinated enter agency goals, policies and procedures. The fact that the form larry must rejustify their needs when they transfer to the va. There were inadequate facilities and inefficient charting process. There was no way for daniel to ascertain the status of his benefits claim. There was no vla, vba appointment system interfacing, nor prioritized proactive procedures. There was no communication between disability determination and vocational rehabilitation. This report is offered in a spirit of a call to action and reflects the experience of daniel with services in 2007 until his death last june. At seen through our eyes. How concern then was the impediments which daniel encounters were systemic of deeper and broader issue friday the issues in the va. Affecting a much broader population of Service Members and veterans. Unfortunately, this has been proven true as dramatically evidenced by recent revelations. Many of the reforms in the report will require additional funding for the va, but with that new funding, should come greatunder scrutiny and a demand for better, measurable results. There is, however, an alternative to attempting to repair the existing system. We believe congress should seriously consider fundamentally revamping the mission of the va health system. And the new model we envision the va would transition into a center of excellence, specifically for warrelated injuries. While the more routine care provide by the rest of she va Healthcare System would be open to private Sector Service providers, much like tricare. That approach would compel the current model to selfimprove and compete for a veterans business. This would ultimately allow all veterans to seek the best care available, while allowing the va to focus its resources and expertise on the treatment of complex injured suffered in modern warfare. We thank you for your time and would be happy to further discuss our recommendations and suggestions. We hope that the systemic issues raised here will provide a platform to bring the new Va Administration together with lawmakeres, vs os, veterans, and private sector administer user tore a comprehensive review and reform of the entire va process. And if the va, committee, or congress as a whole, make the decision to involve other stakeholders in a more formal reform process, would be honored to be among those chosen to represent the views of affected families. Thank you. Thank you both for your testimony. Thank you, chairman miller, Ranking Member, and distinguished members of the committee. Thank you for the opportunity to speak with you today about this critically important topic of Mental Health care access at the va. Suicide among veterans, and especially about the story and experience of our son, clay. My name is susan and i am here with my husband. I am the mother of clay who died by suicide in march 2011 at the age of 28. Clay enlist the mariner corps in 2005 and served in the infan tray in jab of 2007 he deployed to iraq. Shortly after rifing in iraq he was shot through the wrist by a bullet that barely missed his head. After he returned to Twenty Nine Palms to recuperate he was diagnosed with ptsd. Then clay attended and graduated from the ma katrina corps Scout Sniper School in march of 2008. Then deployed to southern afghanistan. Much like his experience in his deployment to iraq clay witnessed and experience the loss of several fellow marines. Clay received a 30 disability rating from the va for his pts. After discovering his condition prevented him from maintaining a steady job, clay appealed the 30 rating only to be met with significant bureaucratic barriers, including the va losing his files18 months later and five weeks after his death, clays appeal finally went through, and the va rated clays pts100 . Clay exclusively used the va for his medical carry after the marine corps, he lived in the Los Angeles Area and received care at the Va Medical Center there in l. A. Clay constantly voiced concerns about the care he was receiving in terms of the challenges he faced will skewed skewedling and treatment. He received counseling only as far as a brief discussion whether the medication was working or not. If not, he would be given a new medication. Clay used to say aim a gibb begin tester for drugs. He moved to colorado where he also used the va there and then finally home to houston to be closer to family. The houston va would not refill the prescriptions they received from the Grand Junction va because they said that prescriptions were not transferable and a new assessment would have to be done before his medications could be represcribed. Clay had only two appointments in january and february of 2011, and neither was with a psychiatrist. It wasnt until march 15th the was able to see a psychiatrist at the houston Va Medical Center. But after that appointment clay called me on his way home. And said, mom, i cant go back there. The va is way too stressful and not a place i can go. Ill have to find a vet center or something. Just two weeks after his appointment with the psychiatrist at the houston Va Medical Center clay took his life. After clays death i personally went to the houston Va Medical Center to retrieve his medical records and i encountered an environment that was highly stressful. Large crowds no one at the information desk, and i had to flag down a nurse to ask directions to the medical records area. I cannot imagine how anyone dealing with Mental Healthiers could successfully access care in a stressful setting. Clay was consistently open about having pts and survivors guilt and tried to help others coping with similar issues. He worked hard to move forward and found healing by helping people. Including participating in humanitarian work in haiti and chile after the earthquakes. He also standard in a Public Service advertising campaign, aimed at easing the transition for veterans and helped Wounded Warriors in Long Distance rode biking events. Clay fought for veterans in the halls of congress and participated in iraq and afghanistan veterans of americas annual storm the hill. Clays story details the urgency needed in addressing this issue. Despite his proactive and open approach to seeking care to address his injuries, the va system did not adequately address his needs. Today we continue to hear about individual and systemic failures by the va to provided a quilt care and address adequate care. Not one more veteran should have to go through what clay went through with the va after returning home from war. Not one more parent should have to of the before Congressional Committee to compel the va to philadelphia its fulfill its responsibilities to those who served and sacrificed. Mr. Chairman, understand that today youre introducing this Suicide Prevention for American Veterans act, the reforms, evaluations and programs directed by the legislation will be critical to helping the va better serve and treat veterans suffering from mental injuries from war. Had the va been doing these things all along, it vary well may have saved clays life. Mr. Chairman, richard and i again appreciate the opportunity to share clays story and our recommendations how we can help ensure the va will uphold its responsibility to properly care for americas veterans. Thank you. Thank you both four for your testimony this morning. Mr. Portwine, youre recognized. Thank you, mr. Chairman, distinguish committee members. My son, brian, gave 100 to every task he performed. And his military service was no exception. By the time he was 19 years old, brian was rewarded the purple heart and the Army Commendation medal. Im before you today to share brians story. At 17 he enlisted in the army. After training in infantry he was deployed to baghdad where the patrolled on the streets. It was an extremely daunting service. This occurred before the surge of troops. Brian lost 11 brothers. While serving in iraq in 2006, brians tank was struck by an rpg, the flames engulfed the tank, the driver was knocked uncon shouse and the men fought for their lives as the driver was unable to lower the ramp. Five shoulders scrambled through the flames, manually lowered the ramp and exited with injuries. Brian suffered a blast concussion, and injuries to his face and legs due to shrapnel. Later he was in a humvee when his sergeant signaled for bryan to suite seats for him. The switched seats to brian was in the passenger seat. 20 minutes later the ied hit the humvee, killing he sergeant and throwing brian from the vehicle. Six other ied explosions during his 15 month deployment. Id like to pause here and ask, isnt this enough to warrant a thorough evaluation and further testing . The powers that be apparently thought of sending brian to Walter Reed Hospital but didnt. Experiences with the physical and medical injures fluff to possibly exempt him for another deployment . Apparently the va felt his care was iffy enough to stamp a no go on his clearance form, and then crossed out and written, go. How and why this decision was made is beyond me. After his first deployment, brian was ecstatic to be home again elm he enrolled in daytona state college. He worked in the admissions counseling office. He created videos to share resources with students, hosted events and linked students with parttime employment around their school schedules. But brian suffered with shortterm memory loss. He would have to write everything on his computer, his iphone or calendar. Husband friends told me when he was out, he would say, where are we going again . I have scrambled brains from iraq. To help cope he posted events on hi computer, his calendar and his phone. In 2010, military recalled brian. He said, mom, theres no point, you have to get your mind in a completely different place. You have no idea what is coming. During this second deployment, brian didnt email or call home to any family. Or friends. Little did we know how he was struggling with anxiety attacks, panic attacks, traveling the same roads as the first tour. He knew the stigma of admitting ptsd as all soldiers do, so you just man up and move on. Upon returning from the second deployment, brian was evaluated. He was diagnosed with pssd, tbi, depression and anxiety. At this time id like you to refer to the documents you received, brians medical documents. A document that brian could not remember the questions asked from the therapist during the interview. He had extensive back pain. He couldnt sleep. He felt profound guilt. He suffered from low selfesteem and as a result, he was a risk for suicide. Nonetheless, he was immediately discharged and told to follow up. How in the world you can ask someone who cant remember the questions asked to follow up with the va is beyond me. Brian deteriorated quickly from december 2010 to may 27th 2011 when he took his life. He couldnt stand how he would be angry, depressed, anxious, but he didnt know how to cope. It took a toll on his relationships. If the dod and va assessed brian for suicide risk, it was their duty to treat him. But he received nothing. He applied for disability, but was unable to wait. Brians unit has lost three others besides himself to suicide since the 20062008 tour. Suicide surpassed come pat fatalities for the first anytime history. Its a very slippery slope from ptsd and tbi to death. Something our va should realize. Our soldiers never hesitated in their mission to protect, serve, and sacrifice for our country. Now its time for the va to prove their commitment to our soldiers. I never knew in of brians pssd or suicide risk. He felt if he could survive two tours of iraq he can survive anything. I think its a lifethreatening situation like this and it should be shared with the family so we are able to help. The va needs to work with the service organizations, including the families, and the plan for care. Im requesting, im begging, this committee to pass act 2182, the save act, this has been a most devastating war in history in terms of suicide, our whole nation continues to suffer and every day we continue to lose 22 brians a day. I promised my son at his funeral i would stop this injustice. These are quality young many who had so much to offer society. Please pass this act and support any legislation that gives our soldiers the timely and loving care they deserve. Thank you. Thank you. Sergeant . Youre recognize for your statement. Chairman miller, Ranking Member, members of the committee, i appreciate the opportunity to discuss va Mental Health care and want to acknowledge the loss and courage of these family members ensuring they werent in vain, and i struggle with similarities of the stories. As an infantryman who lost so many in the iraq war, and injured and struggled with the thoughts of suicide, from overwhelming chronic pain and other injuries, i just thank yall for being here. My experience with the Va Health Care system began in 2008. Sorry. Thats okay. You have plenty of time. After i was medically retired from the army due to severe injuries from a mortar blast in iraq, excuse me. Ive been a patient but im also an advocate for other warriors who are struggling with deploymentrelated traumas. For a period of 12 months i did receive excellent Mental Health care at a va facility. Easy one stop access through a farmly and social work providers, unfortunately, though, hospital administrators decided this care was too costly. Now veterans at the facility go through an impersonal intake assessment process and then have to find their way around a sprawling facility to access the care they need. For many warriors just navigating around the facility is anxietyprovoking in itself. And for others its so frustrating they drop out of care altogether. Theres lessons to be learned here. First, veterans with Mental Health issues will seldom open up and discuss painful private issues with a club issue in shaken never met. More likely to describe surface issues like difficulty sleeping. It takes time to build a trust to talk about the deeper issues. No every clinicians is skilled at winning the trust or insightful enough to sense when theres deeper problems. Working with a team increase¢ likelihood of someone to see something that others may have missed. This is implications suicide preprevention prevention as well. There arent necessarily obvious signs a veteran is a suicide risk. One thing is for sure, we wont prevent suicides by doctors, mechanically going down a mandatory list asking questions like, have you contemplated suicidal thoughts lately or harming others . Sometimes theres red flags that an astute clinicians can spot, like the breakup of a relationship or other major life events. But in a treatment system where i get sent to building 3 for a neurology gist for chronic back pain, building 61 to see a psychiatrist for sleep problems and building 81 to see a social worker for relationship issues no one is getting the full picture so its likely no one is going to see if my life is spinning out of control. As an integrated Health Care System the team members shared observations and can see potential problems before they became explosive. I think the most important step the va can take to prevent suicide is to improve the Mental Health care delivery. Access is an issue but we have to ask yourselves, access to what . Access to Mental Health care isnt enough unless the care is effective. For example, providers who work with combat veterans need to under the warrior mentality and work hard to win the veterans trust. If the clinicians lacks the awareness or cant give patients time, veterans drop out of treatment. Also, veterans who are not ready for extensive therapy will drop out of programs even though theyre hailed as evidencebased therapy. The bottom line is the va care must be veteran centered. That has to mean understand each veterans system and building a system to meet the veterans needs and preference, novelty the other way around. The warriors im screaming dont come in for ptsd or anxiety when the tex bcs say they should most dont come into treatment until they reached crisis point in their lives. A veteran needs to get into treatment immediately but we wont solve that problem by establishing a requirement like a 14day rule. Doesnt happen a warrior who is at the end of his rope to get assessed within 14 days but no actually begin treatment within three months. This is how the va implements such policies. Add additional steps to get into treatment. So they you can see someone within 14 days they added a second intake pro process so now you intake to intake to get the treatment you need. I know that some believe the way to solve the veteran problem is to expand veterans access to nonva care. I really personally doubt thats any kind of Silver Bullet solution. The two big concerns is, first, detailed in my mull statement, many reports and studies point to a National Shortage of Mental Health provides and theyre reality quality of care issues here. The va could certainly benefit from a greater use of purchased care, where and when its available but wouldnt happen veterans just to be seen bay provider who arent equipped to provide effective care. Whether because of lack of training and treating combat related its not just a matter of access but access to what it . Has to be effective treatment. Die believe there are va facilities that are providing veterans with timely access to effective patient centered care, but it is not systemwide. For my perspective, the starting point for va leadership is to adopt the principle that provide ing timely Mental Health care must be a top priority. The va achieved that with the efforts to combat veteran homelessness. Tells me the va can have an impact. When artificial performance requirements decent create distortions when clinicians have latitude to provide good care. Improving one part of the approach should be to institute the Interdisciplinary Team is based model i described but the core has to center on the veteran and that patients needs and preferences. They had a pharmacist, a social worker, a psychiatrist thomas psychologist and primary care on one team and weekly meet to discuss the case load. The wait times were short, the quality of care was up, and management of medications were the best we have stayed within the v. A. After 12 months of whether the team began to dissipate and when i was told that have been told since the by others within the v. A. It was a temporarily funded program it was too costly to give this to post an 11 v. A. Veterans when a facility director house to provide care for all veterans to set aside the amount of funding in requires to provide this level of care for one portion of the population was not practical. I would like for you to elaborate on the fact talk about daniel having innumerable problems with the virginia staff literally saying no one at the facility advocated for him. Could you give any examples of . If i dont make it through this howard will finish. The most egregious event was when did hill presented to the emergency room. It took daniel a lot to go through the of the eighth facility and some of the things mentioned were part and parcel even there were speed traps of the highway and when the lights flash that would give flashbacks even if he was just going by so was very difficult to drive down to the of the day. With is busy but he presented in a crisis to one of the eleMental Health departments he said he needed to be admitted to hospital. This is something we have been told by his wife who has the bsn nursing and his motherinlaw who is a psychiatrist and talk to her multiplications. He was told they had no beds and was told by the same department there is no beds in the emergency department. But he went to the corner he laid down on the floor and was crying there is no effort made to see if he could be it committed to another facility the rich to major Medical Centers within a mile and a half with in phoenix v. A. That is another issue we need to discuss at some point. But he was told you cant stay here and when you feel better you can drive yourself home. That is just an example for the lack of advocacy and lack of compassion that we know he had encountered through the system we know others specifically in Oklahoma City that had similar circumstances and different v. A. Facilities. Did he ever speak to any v. A. Official how he was treated . We do not. The appointment system is so antiquated that things are not even documented you cannot even go back to the system to document a contact in the system. As far as we are aware he did not speak anybody at v. A. About this. It is something he just would not do. It was a field a feeling of i tried. And the pressures that are brought to bear. These are things that all together became overwhelming my belief is he still had that military mentality this is what somebody has told you i have to excepted i cannot go above and beyond. I need to except what theyre telling me. Thank you. Once again a want to thank the panel for coming today to talk about your stories and i appreciate it if it cannot be easy. So my question is can you go into further detail why you think it is important to encourage every veteran suffering with combat Health Mental issues to have points of contact to get the hipaa waiver . Interesting you should say hipaa because it usually stops the conversation. We have been trying to do with this issue because it takes a village zero large village, to not only treats but recognize and approach our veterans who might be in a crisis. We feel it is critically important to expand this support network and actually at this point hipaa changes would be wonderful. We ran a medical practice and what we have come to learn what hipaa says is not how it is practiced. People are afraid of hipaa so they take the regulation that is their and then really you do have some options under hipaa especially if you feel somebody is a threat to himself for the family or the community that you can reach out to family members or a caregiver in a situation like that but it is critical to identify prior to deployment surgery appointment what we call the support network so these people can be educated as to what experiences of their loved one or even a High School Football coach or your best friend from second grade so they can be educated as to what the experiences might have been with the signs and symptoms of a crisis might be and that you dont take no for an answer. If you see somebody is in trouble you can direct them to the proper treatment and proper facility. Says one way we think hipaa does not even come into the equation it comes when you are in treatment. With you are in treatment and there is an issue said the therapist should certainly take the opportunity to contact the closest people to the patient. My second question i heard a case even though the department of Veterans Administration that v. A. Employees cannot talk to others in use the excuse of hipaa. Have to have that problem . We have not heard that was hipaa issues but a total communication breakdown issue the fact the Computer Systems were incompatible its selfie and the fact as far as we know of the knicks still uses a post card system and nobody could document the fact that those cars are even cent and we know after dignified and the Suicide Prevention coordinator contacted his widow. They were talking and were going to send her information to what type of counseling facilities are available to her, she asked where are you going to send it . In their system they had an address that was four years old. And he had been involved with the v. A. Over that entire period of time. My time is quickly running out. How long had he been taking medication for his pts . Was he denied medication . Gimmicky began taking medication in 2007 when he was at 29 palms recuperating from his gun shot wounds and iraq. When the standing is he received medication that he received active duty they care seemed to be good. When he transition to he was never denied medication andrews told they could not refill his prescription the followed him from the of lawsuits angeles v. A. And from Grand Junction he had to start over as a new patient we had this yesterday in the meeting but that was one of his major frustrations that when they go to another facility they have to go back through everything. Just to reach count everything. That is ridiculous to have that redundant system. When he was told in houston they could never refill the prescription you need to call that v. A. Never prescribe it to earlier and see if they will refill it for you. He was leaving the country for a couple of weeks and needed the nef while he was gone. Klay was proactive and able to do that and was determined and took care of its and got it from the Grand Junction v. A. When he came back from haiti to the appointment in february added is the clinical psychologist and he was not given a new prescription until he saw the psychiatrist on march 15. His first appointment was january 6 that february 10 then finally march 15 he sees a psychiatrist. Part of that when he was active duty they found a drug that worked best for him. Namebrand no generic but he had been on others as a variety of drugs but lexipro seemed to work to the best with the least side effects. When he came out of active duty in to the v. A. System a pair of a generic drugs are the drugs of choice and was given the generic which is close but it is not the same thing. At that time there was not said generic for lexipro. When he arrived at houston v. A. And asked for a refill end somewhere in the first couple of appointments said he would like to go back on lexipro as that worked better for him with less sideeffects, the state cap a psychiatrist said i understand that does work you in did give it to him so he leaves the march 15 the Psychiatrist Office goes to the pharmacy at the v. A. He spent two hours in the pharmacy. He was called to pick up the prescription and given the ambien for sleep then told they could not give him lexipro they dont stop it because it is not generic it would have to be mailed to him. It was. Sometime within the next week. But if you know, about antidepressant medications you cannot stop them cold. You cannot wait for it to come in the mail than expected will work quickly it takes a while. They have to stay built up in your system. He was extremely frustrated and called me on the way home and said i cannot go back to the doctor at the houston and v. A. I have spoken with him several times since clays debt that has been very fourth coming and i appreciate the information he has given me put something in our last conversation a couple of weeks ago i had not heard before i was concerned about ambien there is a lot of conversations among parents and spouses and family members that had died of suicide and ron ambien for sleep problems. So it was the problem was postTraumatic Stress. The doctor talking specifically about ambien said actually ambien would not be the best drug for the type of sleep problems that come from pts. The nightmares, there is another drug and that was a drug that works best for thats the difficulty. So why did you prescribe that drug for him then as opposed to ambien . The haunted us because within that two week window something went wrong. He moved back home and just return from haiti doing volunteer work great hope that was great therapy and started a job he had bought a truck the friday before he called and asked me to meet him. And by thursday the next week he was dead. We were with him over the weekend on that saturday a whole family saw him at various points. He had lunch with his dad. We went to a movie with him that evening. I just cannot believe within five days he was dead. We know he suffered pts we know he was treated he was very open about it, sought help, and that two week window is just a mystery that haunts us. And we have done everything we can to find answers. I want to thank you for being here. You have given so much and i knew the committee and our country thinks you. I would like to ask about the role of families in treatment and therapy. A constituent came to me and her husband was stationed with the special forces have for carr said colorado and he took his life is she is an advocate for program passe holistic approach involving families whether parents or spouses. In should there be more of a role for families that are offered through the v. A. Or is there a lack . We sir they show there is of black. Is has a lot to do with the year of repercussions under hipaa and a total misunderstanding. Finishes in just the family to cb did not have dysfunctional families so restarted to use the term support network. Of lot of young men and women joined the service it doesnt mean they dont have a support network. So we like to you get away from gold you point i recently read a report by the National Association of Mental Illness no question that Family Involvement is beneficial. No question. It becomes more of an issue. That is why howard and i have been working to identify a support network. Daniel was of the combat is celsius mentally and physically if they could have identified right then give us a support network. Who would you write down . His motherinlaw would have bet on it. It would have been so helpful because when he got back home he was not capable of that anymore. Not from a legal standpoint but not making correct decision. Anyone else . Our experience like most families we did not know what pts was. We had no idea. Told us he was diagnosed and on medication. But we didnt know the ramifications and like most warriors their strong. Had we known the extent of what he talked to his counselors about regardless of hipaa legalities somebody outside of that counselor and the patient needs to know that the patient could identify somebody who would be able to be aware to say this person needs help. Looking back there was all kinds of things going on in his life. We didnt know. There is a lot of literature out there and a lot of information. I believe any family and has an individual involved in the military. The we should probably assume that there is some sorts of pts involved. With suicide klay had conversations with susan. I thought about that but i would never do that he would address the issue then lied about it. So the family plays a huge part to be advocates for the individual to just watch them to do something about it. The condition v. A. Needs to have best practices with programs available to include families everywhere. It also going back through his medical records for whatever reason i wanted his medical records to read he had apparently as early as november or december of 2009 spoken to someone in the v. A. In los angeles about suicidal thoughts. And he is separated from the marines and i knew nothing of that. When they say they have struggled with the thoughts that i could not do that to you. In his mind he believed as far as we know there were two times he had enough insert the suicidal thoughts he did reach out to talk with me and other times spoke with a close friend then after that he shared with me with all of us. We knew he it struggled with suicidal thoughts in he was on medication and we are assuming with pts and suicidal thoughts. Please go to private care. Mae no great psychiatrist or counselors and lets do that. For my medical care is to come through the v. A. Bill that to me i want to talk to someone who has ben in war or knows about war and pts with the things i have seen and done. I believe a lot of veterans have that same feeling and therefore i do the least that we have to it is incumbent upon us to make sure that we get it right in every visibly because veterans are expecting that. They dont want this to be a burden to their families financially. I am very much open to making it easy for the care to be available. And with that i wanted to ask doctor summers youre also a medical dr. . Ima urologist. I practice in phoenix and live in san diego. I am from riverside. I went to visit my va. They are able to get veterans to see a family practitioner in 24 hours if need be. Im not so sure about Mental Health care psychiatrists. They indicated to me there was a shortage of psychiatrists and i recently visited a new facility and the director of the facility told me i asked him if there was with shortages he was experiencing and he identified Behavioral Health and psychiatry can you tell me if there are general shortages in your area . There is a shortage of Mental Health professionals nationwide and there are many issues that go into it. Certainly reimbursement is one. We know one of the people daniel had been seeing and this is another area of care he was forced to go outside of the system just because he couldnt be seen in phoenix. There was no availability and Mental Health of a little and i think you have to divide psychiatry and psychology and i think with these people who are suffering from ptsd if the psychologists have the psychiatric social workers who are providing most of the care as opposed to the psychiatrists themselves. But psychiatry and psychology are incredibly important and what happens is if we try to recruit into the va, and the community is losing that Mental Health component and it is a huge issue that has to be addressed by the medical schools and by society in general but its not just you hear. The representative and i and overwork offered a bill that would increase the number of residencies as the va hospital and i expect a number of them to approve it and they would stay but also something would that go into the community as well. My thing is even if we do approve the va to make it more easy, easier to use the areas like mine youre still going to have trouble finding the care. People have trouble finding people in the community and aware of the military culture and who are aware of the issues that veteran status. I could get your information to the staff but im trying to understand. If we are going to be trying to with the pc free program and the other issues that are being promulgated now, there has to be communication between the va and the providers who are seeing the veterans who are being referred out. I think i understand your point of view as well about your doubts about radical destruction that we have to try to get it right because of the expectation that her son had. That was her comfort zone. So we have to do both things at once. Make sure every va center has excellent Mental Health care as well. The concern with the bill that increases the number of practitioners. The effectiveness of care really has to be a systematic approach to solve the efficacy of what care is being provided as well as the numbers to accommodate the sheer overwhelming amount of veterans that are trying to access that already broken system so i just wanted to add that. As a father of three and a veteran i appreciate your courage to come here today and speak. Its heartwarming and i know this is very difficult for you to do and its been difficult to sit and listen to the testimony. There are a good number of veterans sitting up here. Im a veteran of the vietnam era it was a reunion of a bunch of young boys growing up in the 60s for all eagle scouts and all but one was was mayor of care of our friends and he didnt make it out of the vietnam. So i can tell you the loss is very helpful and as it does for my friend about the safety years so thank you for your courage. I think youd bring up you bring up a great point all of you have today. The coordinated effort that you put forward, the Team Approach was very good and i certainly do understand what the va was saying. The veterans that are my age i think that this needs to be expanded if that method you put forth like it worked extremely well should be looked at and doctor summers brought up an incredible point. I know you probably dont as i did with some primary care in your practice. You dont just get to be a urologist. Your patients get to know you and share a lot of things with you and dealing with this is very complicated. As you all have pointed out in this so eloquently pointed out is that this approach of caring for people to find and sometimes are difficult to spot because you saw your son. Thats been one of the things that troubled me all of my career was trying to figure out. You and your wife brought up something thats extremely important that its probably as important as a good person to lead on and i think you have to hook up have to talk about for the have to hook up with insurgents was talking about to have this Sophisticated Team together. Putting that together is a big challenge. Its important for the transition program. In california where they have the base where they teach them and make it like an iraqi town so they learn how to take the crowds and the buildings and all that but when they come back its just you are there for a week and then in the community is the transition. I cant use the centers to send them where they could have psychiatrists and psychologists and look at them and give them assignments and see if anybody has poor concentration and memory. You cant just take them like cattle where they have their brothers to confide in. When they come back they put their life on the line to trust these other brothers. Did nobody is going to understand, so they dont open up. Most people they open up to is their brothers. If they put together one veteran thats been home with the veteran they will open up to the person much more than they are a therapist or have Group Therapy. Maybe they can confide each other because it is going to take a while to build up trust for the therapist. Thank you very much for your courage being here today. I yield back. You are recognized. I apologize. Thank you mr. Chairman and end all of you for your career james being here today. I appreciate what you said about once a diagnosis is made and medication as prescribed, staying on that medication i am i really want to know how often the veterans have to refill those prescriptions and i would like to hear from each of you what youve learned about that and are they given a 30 day supply and have to constantly back. At our facility in Washington State cant medication for given him a 30 day supply there is an option for the refills its pretty confusing and i normally messed it up pretty well so my wife has to manage that you have to put in a donation three weeks before you needed and i usually forget until im about to run off and then im off my mad a long period of time. As long as the other issues that have been discussed from one facility to the next im item in the southern part of Washington State and people are coming up from Portland Oregon which is about an hour away on medications that are not transferable to the va facility where where im at and so they have to start all over as the guinea pig earlier trying medications that may try to get to the point youre able to approve the non formulary medication that he had another facilities. As well as the transition from the dod to the va care it took about four years for the dod to balance about nine medications for myself and when we transition to the va care many of those traditions were not on the formulary. And we had to go back to that guinea pig phase again and we ended up on 14 in order to utilize the medications available to the va. So there are many issues talking about that. That is just unbelievable. Any other families clicks i would never put any medication they diagnosed he had traumatic brain injury, pts, but he was never put on any medication. Medication for his back when he was thrown from the humvee and muscle relaxer and it was temporary but they never prescribed screaming out three times a week with nightmares and having your brothers wake you up and then telling them how embarrassing that was i think they need to be on some medication. These medications are so subtle and so particular to the individual. Its just mindboggling that there is not an easy way to identify and work with the individual veteran to determine exactly what that cocktail if you will looks like and then be able to without, to just seamlessly transferred back to wherever that data is. These people are young and on the move and they are all over the place. So those very years need to be taken down. Thank you representative kirkpatrick for being such a support and help for us. Theres multiple issues that have to do with the medications. Just the fact that the formularies are not the same as a huge issue and it doesnt just affect veterans at the va system. There are veterans who are retired from the military who see physicians but at the va and the dod so they are at Medical Centers and they cannot be on some of the medications from one to the other because the formularies are not the same. The problem is that not only does the va used 99. 9 generics but they use the cheapest generics. So, daniel who has not only ptsd and tbi but included irritable bowel have only certain medications he could tolerate. So maybe the tackle is the same but the bonding agent is different. But hes on a medication he has to take once or twice a day that gets a better price so now they have to take it three or four times a day. And the change in the medication changes everything. Its not only that the other thing that we heard from the unimpeachable sources is that the va as we heard with their policies there are some va where you can get a brandname medication with no problem. Others essentially it is impossible to get a brandname medication. So that brings up this huge issue that we have why there is so much variation in the entire system why we cant have more uniformity in the va system. You are recognized for five minutes. Thank you for sharing your story is being americans and patriots because your stories are going to help people in the future. Thank you for all of that. A couple of points and i think doctor summers was just talking about this and we talked about it in the hearing of her night. Its so fragmented that there is no overwhelming mission from the top with flexibility below. There is a structural breakdown on how you were actually going to conduct business and that is where we are asked whether you are talking to the vha. Next week we are digging into some of the vba issues also. One other point and then i will ask another question. Doctor rowe also validated when you talk about community and support networks these men and women are spending more time away from the Healthcare Facilities than they are in the healthcare facility. So friends and family members, classmates, buddies all have to be part of the healing process. I know the term holistic has come up a few times. Its part of the healing process. There is no Silver Bullet. You have to be able to help them in many different ways. That being said, in the va testimony, they mentioned to coordinators that are supposedly placed at all Va Medical Centers and by large clinics. They are supposed to follow up with the veterans that are at high risk. Were any of your sons ever contacted in the first month after they were designated highrisk by the Suicide Prevention coordinator . We are not aware of that. We didnt even know where he lived. Thats one of the issues we are dealing with and that goes into the whole support Network Issue is that we have spoken to so many families in the same situation and that basically shut us out of the equally asian and thats where if we had the opportunity if we could do some changes in this misinterpreted or deletion where we could have been more in touch with the staircase and they would have felt free to talk with us where we feel like we could have been more help but since he was married, it was as if we didnt exist. I think thats an important point is when brian was injured in the tank explosion i was notified of their were three in the morning and they called me from fort hood saying they were injured where they had taken him come hes back with his unit but yet you diagnose somebody with ptsd which can be lifethreatening injuries and nobody notifies you. That just doesnt make sense to me. Anyone else . Your question of being flagged as a highrisk is something that came out of that baffled us i guess when he was transitioning or moving to go to the va and houston his records appear and we run what i was told they were not seamlessly electronic for sand and they didnt have his records from la once hed gotten out of the marines. As i look back through those medical records because i said there were at least two or three times in there that its talked about and he talks and that it having had suicidal thoughts, so i would assume that he was flagged as a highrisk. It says on the medical record high risk highlighted when he comes to the houston va nobody knows he is at high risk. The psychiatrist didnt have anything other than saying this is what my past history has been and this is the medication that ive been on. So thats a great point when are they flagged as a highrisk and do any family members know that . Only way that i ever knew anybody called him high risk is when he got the medical records of him after he had died. I yield out. You are recognized for five. Thank you mr. Tremaine and i want to join my colleagues in thanking all of you for being here. And for sharing your stories and certainly through your stories about your son certainly to me i feel that patriotism through the stories and overall sincere commitment and service to the country. So thank you for being here. I wanted to ask the sergeant requesting. In your service when you were in theater is there any support system in place for you to go to get any kind of Mental Health support while you were there . It was very gutwrenching to hear and to wonder if he had a place to go to why he was in theater and how helpful that might have been in terms of his time there and transition coming home i deployed in 2003 after the initial surge it was a completely different war. We didnt have anything set and established at that time. So, to answer the question, no there wasnt anything however, again, i work with many, many veterans. Ive been told and recent deployments in afghanistan that after major events take place, there is sometimes availability to have a type of crisis debriefed. It is somewhat available. It is not streamlined across the board, but it has been implemented on some level. If i made the problem is that we know that there is an effort in the dod to destigmatize dental Health Issues, but if you are in theater i would venture to guess its good to be rare for somebody to take advantage of that because all of a sudden they are going to be taken off duty. And the whole idea to destigmatize is to say you come in for treatment but then once you are better then you will be able to join your unit or be able to regain your security clearance. But while you are under treatment you are not with your unit and youve lost your security clearance. So the issue was a huge issue and we know from people that weve spoken to that the people at the top are aware of it and trying to deal with it, but there is just so much you can do with a booth on the boot on the ground level. If i may, theres two separate levels. There is a Crisis Response which like the citizen team that can go out and basically say this is what happened, these are the normal reaction to the situation. If you experience this find somebody to talk to. So more in education and Immediate Response and effort has been available as you stated most military servicemembers and veterans as i stated earlier in my testimony are not going to go and say that was a horrible experience. I think i should talk to someone before i have issues. They are going to wait until it becomes a crisis point in life and a debilitating nature before they seek treatment. I just feel like if it was a part of the culture and theater that there is a constant by a law that is going on that that would have to be helpful to the men and women who were there. When they were on the 15 month tour there was at one time they lost four people in one mission and when he was out there the morale was very low because these were people that were high up surgeons so they sent someone and when the soldiers would go in and talk with then he asked the same question was it sort of like a movie and that just insulted them then just insulted them almost like why did you ask us a silly question survey all shut down and i think by not processing those thoughts come and youre going to internalize them so they are never dealt with. I think that even before in theater i think in a basic training they should be taught ptsd and while they are deployed and to report on each other for their own good and in transitioning home i dont think we can say it enough. Thats my opinion. We prepare our men and women to go to serve to the war we dont prepare them very well to transition back. Doctor somers, you talked about the barriers and we talked about Family Involvement piece. I yield back i apologize. Thank you very much. You are recognized for five minutes. Thank you mr. Chairman. I just want to say thanks to the moms and dads insurgents for your testimony i look forward to asking those questions and yield back you are recognized for five minutes. Thank you to all of the families for being with us today. For many of us sitting here today, the pain is to recognize your commitment to give meaning to your sons life 22 and 25. I cannot fathom what youre going through but i do want you to know that we will do our part to give meaning to their lives and it makes me feel im becoming more and more antiwar protester in. And i think our country has had those priorities misplaced getting us into conflict with not being focused on the cost, the societal cost to our country and the population of these extraordinary young man and the promise that they held going to tv and making a difference right here. So, i want to focus in because i think that from your experience you can really help the va and you can understand what makes the difference and i want to commend you all with your specificity of your recommendations. But in particular, ive been trying to understand the best practices and whether there is any effort in the va where there are practices that are known into Group Therapy for example or the types of medications that are helpful. Have any of you in any of your discussions whether within the va was instead the experience that you have had a meeting with meeting with people, have any of you come across any effort to share best practices with transition particularly around the ptsd and dutch, of how we can help people coming back on this level of term and i dont know if you can start with the surgeon if you are aware of any types of programs that are affected. There are great things that are defective but the problem is even though we can group of veterans together in a large sum and combat veterans in another category, its hard to label one program as effective for all so many find Group Therapy programming very successful. Many find combat veteran support groups very helpful. Some find oneonone mentoring very effective and helpful. This is why when we are talking about evidencebased therapy the best practices in the va pushing the ctv these things can be deemed as best practices but many veterans are not ready to go through such intensive therapy. They would rather pace themselves. So while it can be detected, it is washing the problem and i cannot really say that there is one thing that is straight across the board going to work for everybody. And that is why i stressed the importance of the team that works together to bring together what is best for each individual you are looking at more of an individualized approach but a Team Approach, and i think that you mentioned others on the team may see something in the care. I also want to visit this issue because im. In your review of the records at the center if any of you experienced the va asking the patient at any point in their service from the waiver to identify people that they would be willing to have their medical records shared. Daniel ended up going outside because his psychiatrist retired and they said we dont have anybody for you to see. And at the time he was having his motherinlaw was a private sector that referred her to somebody she knew in the community. As he was seeing that person, we actually asked him can we be a part of what is happening and he said that he would ask her but my guess is that he never asked her and we never got the feedback. It was the closest that we could come to have to share that information. I can speak to that a little bit as well. Going through the medical records from houston there was a form in that assessment and a question that says do you want us to or will you allow us to think it said do you want your family to be contacted regarding your care and he has checked no. As difficult as that was to read i know him and i cant even imagine i just really cant even imagine these people are so strong in the first place to raise their hand and say i will go and they go to the war and they have these injuries and especially with the mental injuries its so difficult to feel that you are a burden on other people, and i know that he felt that even though he knew how much he was loved unconditionally. Any of us would do anything to help him but he was 28yearsold and hed been a marine scout sniper. You just want to be able to take care of yourself and get the medical care you need. You are recognized for five minutes. Thank you for the service of your sons and sergeant. My heart goes out to you for your loss as a veteran myself. A question that i have is i mean do you think certainly sergeant in your case and then for the parents in the cases was the va overmedicated them in blue of giving chemotherapy . Why dont you start with you and then i will work this way. Thank you for that question. This is a culture that begins with the dod and extends into the va. It is an issue that we battle with on a daily basis as we provide support and service to veterans and activeduty members where im at in my local area. Part of what i do through the administrator that i am in is providing support groups through the channels. So i deal with this very closely on both sides. Medication is dont longer being used in the symptoms that we see on the deeper issues. What does the va do . Back they specifically utilize medication. To control it and keep them to suppress the symptoms without working on the deeper issues. He was only put on medication for his back. The term as terms he felt like a guinea pig constantly being something different. Is that you think that they chose the medications in lieu of therapy oneonone . Yes. The only oneonone therapy that he spoke of that seemed to be detected at a certain point in la he went to the vet center and had a counselor there that he really liked and felt he finally found somebody that he could talk with. From Daniels Point of view i think part of his problem is that he had the syndrome that manifested with so many physical symptoms. Succumbing yes he had a 24inch door full of pill bottles and was having so many interactions between the different drugs that he was taking in the gulf war syndrome. E. Wasnt being seen by the va psychiatrist after six months after he was home because he never got the postcard to get to a sign and another provider. How much of the stress of the factors leading to the suicide . Do you think it might have been related to the fact that i can tell you having been to iraq the first and then the second is that when you come home there is a huge i guess maybe separation anxiety that you were with and you develop these these interdependent bonds and this team around you all of a sudden it is just gone. People fall into dark and deep depression sometimes. Its easy for them to come back and then they have a long period of active duty with the same people that they serve with and i wonder if you might comment and we will start. This is a problem certainly with the National Guard. Daniel was a member of california National Guard with the military intelligence. They are routinely separated from their main unit and assigned to other units. Daniel went to iraq with the unit out of texas said he was already not with the unit he trained with. He went to iraq and when he came back his wife had moved to arizona to be with her parents, so california National Guard deployed to texas and then ended up in arizona. So, he had no support group whatsoever closeparen. It would have been phone calls and email. It is a known issue. Reserve and National Guard is a huge issue and not to take away the importance from regular Service Members in all branches of the service, but its a much bigger issue for those that do not have the opportunity to come back to a defined facility and spend time like you said with the people that they were deployed with. Good question. The bonds that these men and women were in combat are just incredible. So its very difficult for them to leave service and come back to their communities. He struggled about going home to texas or staying in california. I think one of the reasons he stayed there for a while is because his Close Friends were staying there and continuing. One of the tragedies is that he moved back to texas and wanted to consider going into that sort of thing and was having some struggles with that. After he died, he found out that i think three of his group were in the greater houston area and one of them in particular have actually gone through all the steps traded like a year ahead of him going into the Fire Department and it really could help him adjust to the knowledge that those people are there would have helped. So leaving the service and going back into the community. He was with the first calvary and that was the deployment that was supposed to be 12 months and then they extended it to 15. Of course very tight with all his brothers and they still are very connected online and text and everything. In college for the year when he was called out the second time, his unit was already home for the year so he was put with the louisiana National Guard. And he had no idea. Those were completely new people. So you can imagine when you are already damaged and you wake up screaming three times a night of anxiety and panic attacks that its very difficult. I think that he did bond with people. He was very social, but it wasnt the same type of fund he had with the first group. I think its been stated while and just to highlight on that that Battle System is ingrained in the community and you really become a family unit with those around you that you serve with and separating from that especially the wounded is until the warrior transition battalion and separated from that family unit even though they are with other Service Members it is different. And then they transition out and lose connection altogether for the most part and begin to isolate themselves out for that loss. And that is a very difficult thing and i think that is why the programs such as the va is a Navigator Program or so essential as we should look at that and look at the way that it can be implemented and improve upon it because the servicemembers and veterans connect best with other veterans especially those who have shared experiences and they can help each other navigate through the difficulties difficulty is that they experience within the system. Thank you mr. Chairman. I would like to join my colleagues in thanking you telling you what youve shared with us today is so powerful. Your story of brian and clay and daniel i hope will force us into the administration of the country to treat this issue with the respect and attention that it deserves and to get the results our veterans deserve and beyond the power of the stories which are just hard to put into words the effect they are having on me and i think my colleagues on the committee youve also comes with a table with solutions and proposals to improve the system. I love the idea that we think about the va restricting its responsibilities to becoming a center of excellence for the war related injuries. I havent thought about that before and i dont know what the effects would be. I would like to hear from other Veterans Service organizations but i love that you youre thinking about a big idea to transform a system that is obviously not working today but hasnt worked for a very long time for everything ive learned so far. This idea of an interdisciplinary approach to taking care of the veterans when they returned, id like to hear more about that. I think it makes a lot of sense given your earlier testimony. The beach about the system that you brought up identifying that support network when they are still enlisted are excellent ideas. What i would like to ask you is ive received so much more value from this testimony today than i ever have from a representative of the va including the reasons we should be focused on the scum of the ideas and suggestions to fix it so i would like to ask each of you if there was a formal process to involve you in fixing the va, would you like to participate . And if you have any ideas and exhibits that have come through so far that we havent raised today id like to give you an opportunity to share that and maybe we can start with doctor summers and move down. You know we want to be part of it if we can whatever efforts and they will be submitted as part of our testimony of 15 pages of problems and potentials of oceans. So, there are a lot of really good people who can be very beneficial to try to help the system. We just dont have the time to get into specifics right now but to answer your question for sure we would like to be involved if at all possible. Absolutely we would be happy to do whatever we can to help. I want to kind of shift the focus of little but of those of us that have lost children. Words cant describe it, but i sit here and look at the surgeon and listen to his story and we are surrounded by the veterans behind us. A lot of them from the group if there is any less lesson or Silver Lining that we have become friends with so many of these young veterans that have enriched our lives, i dont know where i would be without them. I mean that sincerely. They just have enriched our lives so much. Whatever we can do we cant do anything to bring back brian or daniel dot what we can do is whatever it is to make life better for all these veterans behind us and all of them all across the country all veterans not just iraq and afghanistan but all of them. We shouldnt have to be reminded of that and yet we seem to have to be reminded that we need to do better jobs so we are happy to do whatever we can to help. Anytime, anyplace, we are available. Part of the process for everybody at this table is to have the opportunity to go beyond the personal losses and to address the veteran community as a whole and to do whatever we can to take care of his family. So the opportunity to be in the communities to talk and to be able to be heard by people who hopefully have the heart and the ability to make some things happen. The va is very complicated. It is a huge animal and i know theres a lot of things that need to be dealt with. There are a lot of really good stuff there is done and some big problems. I think if we can just focus on the individuals as people and patients and care what do they need today modify the system based on that and i think that will take us a long way. The focus needs to be the veterans. Thank you. My time is expired. Would you like to indicate whether you would like to continue to be involved in a more formal way to include your ideas and experiences . It would be an honor for me to help make a change for the veterans to be paying it forward. I would echo anytime anyplace. I not only bring my own battlefield perspective but that of all of the veterans i work with and i can only offer that much. Thank you. Thank you mr. Chairman. District with ur recognized for five minutes are. Thank you mr. Chair i want to thank the group for being here. For your input this is tough to listen to and it even tougher for you guys. The comment about the parents not knowing im not surprised. After my second purple heart i didnt want my parents to know what was going on and this is going to be the problem that i think all of the viewers sharing that common denominator. Everybody that goes through these experiences is going to have huge psychological problems but who is it going to share with . Are they going to share with a psychiatrist or psychologist. The veteran culture and they are not going to open up i think you made a great point and comments about the Wounded Warrior program or to have the actual battalion where when somebody has a problem, they go into the system and i just want to get your feelings. Maybe im going down this wrong but i think they need somebody that had a problem they need an ombudsman, somebody that is going to look out for their interests that if they were a particular hospital they can go to the administrator and anybody and say wait a minute. This is an immediate situation we have to have a meeting right now or somebodys going to die on your watch. Can you comment more on that . Its pretty much what you were talking about in the same thing over and over and over again. But to cut through the red tape rightparen and their with individuals that understand the severity of the problem this is a core usual element to have somebody come alongside of these severely injured, cut through the red tape. This is something weve experienced firsthand and ive shared it with some of the folks recently. I had a veteran but we did a crisis intervention on and the suicide we had to remove from their primary residence. We have the position stability and i found out that he never accessed the care to the facility so i told him the next that he went down if he was actually denied treatment and told that he would be able to be seen in three months after telling somebody he attempted suicide a night before and i went down there and met with that veteran and we walked in and i said this is an unacceptable answer and we got the department had to come out and say we have a program we can start with next week and that saved that veterans like that david there are thousands more that are getting them though and not getting that extra answer because they dont have somebody to advocate for them and im not saying that is. Im saying if we had more people out there advocating for these veterans, we would be able to see the butterflies and get better care. I just got back from campus where i spent a lot of time down there and i saw some of the folks including my platoon sergeant 47 years ago and we talked about the infantry unit and you never forget the marines that you lost. 1967, horrible day. You never forget their names or the occasion just like you are never going to forget. But what you have to do is try to make the system better. Right now i think its broken in terms of capturing those individuals and their morale. Its down to the point they are going to do something that if we dont correct it is our fault. Is a systems issue in the va and our feeling is that everybody who works in the va should have only one purpose in mind and that is to advocate for the veteran. And its the person that sits in the Corporate Office to the person who takes the wastebaskets at night. That is the only thought that they should ever have. That concept of the on button in order for the lack of a better term somebody that is ultimately responsible or somebody that is that advocate for the person. We agree there needs to be and on the mend ombudsman program. They are doing a better job of that out in san diego but its not only the on button ombudsmen. It should be a Standard Operating Procedure for every hospital. I yield back. Is browned for five minutes. First let me thank each and every one of you. Let me just tell you i did some work with them and they would be very proud of you. Thank you very much for your service. I have to say that we are talking about the va that this isnt just the va. Its the dod. Its the dod that send people over and over again to combat and the scene is not transitional when they come back so its a big problem and to sit here and say its the va thats not true, its just not true and we need to deal with the problem. The fact is weve been fighting with the reservists and we send them over and over again and they didnt have the support that they need. Ive gone out when they deployed and they just dont have the others but all of the military branches have. We are not doing the war that we need to and in the sense that it is fragmented and we develop a competence of system, lets get everybody in the room. Lets deal with the system the way that we need to deal with it. Now, you mentioned the formulary. Now, the va and the dod be insist they negotiate the prices of the drugs to keep the cost down. What is wrong with the way that we are doing that . Because in the regular market, it is illegal for the secretary to negotiate the price which i think is dumb. Its no problem negotiating the price of the drug. The problem is the drugs arent the same for example lexapro you would want the formulary as opposed to the va formulary, no doubt about it. And i know firsthand that you can basically get anything that you need with relatively little hassle. So thats the big issue. We need to make it a single formula. Bottom line. Okay. Excuse me. Just in addition to that, its like, if the person is doing really, really well on a drug, there should be able to stay on the drug. And a daughter can override a you can get for 10 cents cheaper and they can have major effects on their body. Absolutely, but the doctor can override that. What she is saying is different. Its still a generic but as i said before, its a different formulation of a generic. And especially as was said, i mean, thats what so important to have these groups of the multispecialty groups, the interdisciplinary committees or whatever they are that are going to communicate amongst themselves. I think thats something we can work on. Ms. Port wine, i think you made a very important point. Your son come you realize was having Serious Problems and yet he was redeployed. Yes spent he wasnt getting the medication. It should event a timeout at that point. Even on the form you can say it no go to that was crossed through and then somebody stamped, coordinator to since the people, i forget what the column, put go. So that tells me there was hesitation to begin with. That wasnt dod. Dod. Take you very much. What im saying is its a lot of work that needs to go on. It is not just be a. Thank you again for your service. Thank you very much. This will mostly for five minutes. Thank you, mrminutes. Thank you, mr. Chairman. Thank you to the panel for being here. I can assure you that this is how things change in this country. Is when brave men and women step forward and say to the concerned body like this, republicans and democrats, sitting here listening to story, i cant even imagine, i cant pretend to imagine how tough it is to sit here and really does. And i think i can safely say that we are committed to bringing right to all of this wrong. And everyone of you have hit the nail on the head by saying, everyone of you have said the story is about the individual veteran. Ive only been on this committee for 18 months but the last three months, the chairmen and Ranking Member member have led an intense investigation into what the heck happened to the p. A. From the day that it started to the nation today, and every layer of this onion that we peel back comes down to the same core issue. Nobody is advocating for the veteran. And the culture itself, and when we talk about systemic problem and the culture itself, and as secretary to remove any bunch of people removed and were sitting or trying to be able to help america reset a button. Because americans believe in our veterans. They send us your to fight for our veterans. I want to just applaud your efforts. You have made such a huge difference here today. This is how laws change. This is a policy becomes correct and this is how we move forward in this country. We do it together. Unfortunately, sometimes it takes a disaster that weve had in a bureaucratic system of the va. But the frustrating thing for me is i have 54,000 veterans in the district have done i describe my veterans i talk about i have 54,000 veterans and their families in my district. I want to applaud your effort on to shoot issues i think we can address in this congress and we do not move forward. One is the support network. I cant even tell you, and i know you know how many constituents have called her office in indiana. The wife or the husband is in tears and theyre begging and advocating for the spouse that the va says it the mac pray with me from being involved in the. Ive gotten a personally involved in some of these Mental Health cases calling and trying to advocate for my constituent on behalf of the spouse. The answer is still no. Hipaa overrides but i did ask do you have a current law of hipaa . Do you described a different mission an than we do . The edge was no. Hipaa overrides. Is having a support network to be able to come in and be that bridge between someone whos dying and the system, and i applaud the effort. Im going to make sure that we do everything we can to get that part of the law changed because we can bring advocates into the lives of the struggling men and women. For the spouse is the title the families together, we can do that. I want to just thank you for your commitment as well on the issue of keeping this focus where it belongs. I think someday, i dont think this is a quick turnaround, but i think you have brought light, transparency and accountability another layer of what America Needs to do. While you are sitting here talking to us and while were trying to relate and share your grief, and trying to find solutions, youve had an opportunity to talk to the American People today. I guarantee you that every Single Person that you are an influence to, im going here for my constituents today and say, i relate to that mom and i relate to the father and i relate to my fellow servicemen. I think its a tribute today. This is how Government Works and we have a commitment to make sure we restore, not your sons, but certainly to america that they been fighting for. Certainly our trust and their trust in us as a government who asks them to go, fight for freedom and fight for liberty. Our finest euros in this nation. To be able to read and were instituted in by continue to read out the bad actors and the bad policy and to be an together set a reset button. I want to applaud your efforts and thank you very much for helping us reset an organization that started out as a great noble effort and money to a bureaucracy that is just run amok that you have argument today, my commitment that none of which youv have experiencedl be in vain. Thank you so much for be the i yield back. Mr. Waldrop five minutes. I would like to yield the first minute to my colleague mr. Peters represents mr. And ms. Summers. One minute. I want to thank the chairman and the committee for allowing me to be a gastric were not members of this committee but i dont think theres any place would rather be this morning. It takes a lot of courage to do what youre doing to i just want to say thank you for that. Also to let you know beyond the power of the story, its the education you provided only you can provide the user insights that only you have and so is very valuable to us. While we are new here, i can tell you that from time to time you see testimony thats going to make a difference and that is certainly whats happened today. You can feel very confident that those brothers you talked about and sisters will be heavily affected and helped by the time you put in and effort you put in today. I also just want to thank in particular howard and jean somers for your leadership for the time you put in on behalf of daniel and for the education youve given me. I look forward to continuing to work with you to make these issues, to resolve these issues and make things right with the veterans that the va sees. Thank you. Thank you, mr. Chairman. And again, thank you all for being here. Im sort another got the chance to know daniel or brian. I did have the privilege and honor to know clay, not only to work with him on veterans issues. The profound loss is felt by everyone who came in contact with them. It should be to the core because of someone so strong, and your point on we dont, youre not going to notice it, you will not see it and these are very special individuals. And josh curran unita, france over the years. Years. We were in st. Paul a few weeks ago working with the Wounded Warrior project. I applaud you. You hear it from the colleagues and this is a committee of heartfelt folks who want to get this right. I would just mention editing all of you get this, at this point i think the frustration we all feel, solutions and results are all that matter. Im done with it as you all are. Im done with the talk, done with the Pilot Programs. I understand we need to do some of that but there are suggestions that a concrete that could be put into this. I came here on the third of january of 07, the honor of being collected to congress but on the ninth of january i started working on ago. One of our colleagues, a vietnam veteran pilot leonard boswell, heres a couple things it said. Secretary of Veterans Affairs should develop a comprehensive program to reduce the incidence of suicide among veterans. Is shown corporate equivalent shown. Staff education for compassion, recognize and respect, proper protocol, best practices, screening of veterans receiving medical care, tracking of veterans in a timely manner, designation of Suicide Prevention counselors throughout and on and on and on. They did not do it. It was in law. We passed a. We gave the speeches. We have a signing ceremony and we were back home and said gee, we made a difference. Is the very same thing. And he said just like the parents from iowa, so i guess the thing i would ask from all of you is this is the second, that he is the second largest Governmental Agency behind dod. We have one of the smallest committees. We have committees i dont even know what to do that have 80 step on them. We can give lipservice or we can get serious about how were going to do. We can have this or we can allow if this crisis passes and American Publics attention focuses elsewhere, our veterans will be coming back to that our veterans city guide you from vietnam and others. They have seen this before. Heres what i think is different. There is no doubt in my mind the American Public wants to get this right. They are entrusting us as the representatives to get this right. The commitment ive seen from this chairman and Ranking Member, members of this committee, its different than the seven years ive been here. Its different than how we are focusing. Different among the advocacy and we cant let this pass. What i would tell you is, you mentioned and thank you for this, chairman miller and representative duckworth and myself along with vfw, a bunch of folks will be out there, we are going to introduce 2182. Heres what i which is different. This is a wellintentioned bout and wellwritten to look for your bike, these are the folks who helped write the bill. This is a wellintentioned bill. We are going out because we have, this is i guess the Silver Lining, you get tired of hearing that. Theres no Silver Lining when you suspect him go. What youve done is asked for a solution to i would ask each of you as 2182 starts to move, and senator walsh doesnt in the senate, lets together make sure it doesnt end up as a joshua omnibus act. At the secretary had all these authorities, the American People to do this and they did not do it. So i would only just state to each of you as my college mr. Orourke said, this is how democracy can work best. This is how we can incorporate people in it. This idea bringing our hands of who could have anticipated this, really, this bill started in 2007. He we sit in 2014. So keep the faith. We have to. But again i would say this, the cameras, the tv, the stuff thats there, whatever, none of it means the campaign. If we dont get results this time, then shame on us because heres the thing. Im not going to get to meet daniel or brian. I will not see clay aiken by gangster want to see josh. I want to see them for. I want to see the rest. That is our calling. Youve got the right guys of your together by commitments from the public together right folks sitting behind you writing that legislation. Now its going to be can we do to with that i yield back. Thank you. Dr. Benishek, five minutes. Thank you, mr. Chairman. Well i, too, would like to thank you for courage to be here today, and please know that your efforts today will make a difference at the va. I just really want to thank you. Mr. And mrs. Somers, i want to thank you for the 15 page primer there. A lot of good ideas, and i really appreciate you all taking the effort to put together a document like that. Mr. Selke and ms. Selke, i was disturbed by the comments that you found that the environment of the houston va was stressful. Could you elaborate on that . What specifically lead to that conclusion. Have you been there since . Hasnt changed . Tell me more about that. I went by myself that day, and i have not been back there since. For whatever reason i just felt compelled to go and quickly get his medical records. And i wanted to see them. It was just, again, for 10 weeks worth of care there so there were not a lot of. You drive up to the facility. Its huge, as they all are huge. They were so many people willing around out front, big crowds, lots of people that i dont know if they were there waiting for appointments or if they just dont have anywhere else to go, and hang out there. You go inside, and its like, i likened it to an airport terminal in a way. You go in and its just a hub. Gary busey. Lots of people milling around, lines. The cashier lines looked like in an airport where you would line up to get your tickets or something. It was very stressful for me and, of course, i was in a greased mode, but not a postTraumatic Stress mode. I just couldnt imagine. I could visualize clay going in and i could understand why when i left that day he called and said i can go back there. No one was at the information desk. You walk in the front door and they were on a break or something but no one was there. I looked around and finally found somebody who could direct me to where the medical records are and went and retrieved of those. Before i left, i remember standing there for a few minutes and just imagining if i were a veteran, if this were clay, how how do you negotiate this. You mentioned another thing, and that was your son had voiced concerns about the care he was receiving. Was their specific concerns that he raised . Im not sure i remember what youre referring to. Are right. Let me ask sergeant renschler a question. You wrote that come that veterans in particular often approach Mental Health care as hesitantly or distrust fully. How would you suggest that would change the dynamic to ensure that veterans who need Mental Health care feel more comfortable accessing care . Yes, sir. Thank you. A kind of starts with what she was just sharing. Even at our facility we have seattle and also american league. Seattle is a large hospital building, not laid a very userfriendly. Myself, i have a traumatic brain injury at it over, fairly well. But i get lost and confused in a place real bad and theres not a lot of friendly people there to direct me. I get Better Customer Service at best buy, quite frankly. A little bit of care training would go a long way within the Va Medical Centers. My other Medical Center closest to me is i campus with many, many buildings. And the building numbers dont even make sense but i will be in 81 and im told to go to Building Three which is right next door and building 61 is across the campus. The numbers make no sense. The facility is confusing, overwhelmingly back in and not a lot of people to help guide and navigate, a very confusing situation. So for one, just recognizing who the audience of a veteran is and making an environment conducive to healing would be a start. Another went through another one would be, as i discussed earlier and they keep bringing back to the Interdisciplinary Team, it takes report. It takes developing a relationship and report with a veteran to get them to go beyond surface level issues with a position. Im going to buy triage myself on active duty especially in infantry culture, sick call was very discouraged. And if you went to sick call, you were a wuss and you pretty much got crap for the rest of the day. So we dont go to sick call and let something as debilitating in nature. That kerry sticks with you for the rest of your life. So as im muscling through ridiculous thing, my wife will eventually say when he going to go see a chiropractor and gets a no . Its just that mentality of suck it up and drive on. Thats what these guys are doing better Health Issues and thats why when they get there, it is a crisis and needs to be treated as such. And so theres a twofold answer. Number one, the va needs to recognize that is going to be a lot of crises and come back in three months is not acceptable. Or come back in 14 days or intake seek an intake in another 14 days to get treated in three months. Still not acceptable. But instead to have a team to say hey, welcome here, this is your place, this is your team, these are the people caring for you, this is what were going to do for you and provide Better Customer Service, for one, but develop a relationship of trust and rapport so i can know that i can confide in these people to provide the quality care that a know that they should. Thank you spent i hope that answers. Thank you very much. Im out of time. Ms. Titus for five minutes. Thank you, mr. Chairman. Thank you all for being here. Your stories are tragic and heart wrenching but i hope you can take some comfort in knowing what powerful advocate you are. You have told your stories so eloquently, so orderly, so thoroughly that it really will help us to move forward. Ive just been noting down some things that we need to address. I think were at a point where we really can make a difference. So in addition to the things that youve suggested i want this committee and the people in the room, and the ascii for your help on this, for us to address some of the things i think are also related to the problem. First come you are obviously very loving families. You were there for your children. But many of our veterans dont have families like that. There arent many homeless veterans. They are sleeping on the streets, they dont know where to go to they dont have somebody that can turn to. And so we need to figure out a way how we can address the problem for those veterans as well as for those like your children. So i want is to not overlook that. A second thing is the vsos are there to provide services to veterans. When they dont have that ability to bond like they do while theyre in the military, the vso is there. They can be there 24 7 like your band of brothers and sisters can but they are there. Maybe we need to look at some ways that we can help them to do more outreach and better fill that gap for when people come out. Also weve heard some Horror Stories about the medicine and all the different drugs. I think we begin to hear that medical marijuana is a possible way to address ptsd. Lets dont leave that off the table as we move forward. Even something as simple as the notion of companion dogs. Thats something that you here that many veterans, if they have a pet, that helps them get through some of these troubled times. Lets keep that on the agenda. You mentioned about being a firefighter. Lets also remember that when veterans come back, they dont just need health care, both mental and physical, but they need to be able to transition into civilian life with easy access to education. So some of their training counts towards College Credits or employment, to retrain and have jobs so they have something to look forward to that takes a little of that burden off. So those are all things we need to look at the big picture day and i just thank you very much for committee to continue to go down this path with us. I would ask you, dont leave anything off the table. Anything you can think of the matter what it might be, now is the time for us to address it. So i dont know if you want to comment. I dont want to put you through more questions. I have one more comment. I know that the va has the emergency crisis line, one 800273talk, but i work for an insurance company. We have what we call nurse line, and any time a member can call 24 7, 365. Why dont have to wait until its a crisis for anyone to talk when youre starting to feel depressed would be a great time for a nurse to be able to assess and triage what care this person needs come to the need to go immediately now . Can it wait until tomorrow . Cant wait reaching three days . What do they need . I think by waiting until its a crisis line, you are more down that slippery slope. And if i might add, we are fairly new at this whole political thing, but i came across something called the independent budget, which if im interpreting correctly the vso put together for congress. And i would ask that next time that comes to you, that you really look at that really, really closely. Because these are your veterans talking to you. Id like to just add quickly. One of the things that clay said over the years that sticks with me, and its just wrong, he would say over and over, i have to grovel for my benefits. And i just think we need to wake up as a country. Our veterans should not have to grovel for anything. And it just should not be so difficult to get the care they need at all. Thank you very much. Doctor winthrop for five minutes. And to mr. Chairman. I cant thank you enough for being here today, the sacrifices you have made. And i pray that the sacrifices that your entire family have made will make us a better nation at the end of the day. I think most who sign up to serve have that intention. That theyll make this a better nation at the end of the day. I am a physician and also a reservist and i served in iraq for a year. That has let me to want to be here today. One of the things that are know as a doctor, im sure dr. Somers you can relate, that we have patients, regardless of their problems, theres a level of anxiety because they have something wrong, whether its musculoskeletal or mental, it doesnt limit. Something is wrong and theres anxiety. It makes it even more difficult and it heightens the anxiety we have all these administrative problems. I know you started to deal with that in private practice. More so maybe then when you first started. The prescription you think is best, they are not allowed to have those types of things just increase the patient problem, actually trying to take care of the patient. We really are here, i will say on this committee, not to complain but to come up with solutions. So you input today is extremely valuable. One of the things i see if it doctors credentialed with one viacom he should be credentialed at every va. It allows them to go from one nba to another if theres a deficit. If your prescription is good at one va issued be good at another the. You can do that if your patient is out of town, you can call another state and get the prescription filled. When you cant think of anxiety that comes with it. These are things we can fix. These are things weve got to fix. I will also contain is a big difference being in uniform and out of uniform as far as care as a reservist. I can just remember being with the family for 15 months and then also on the last one left at the airport. When i get on the save 90 days to go back to work. I said that aint going to work. Im going back in two weeks. Im getting my house in order and go back to work because you have something to go to. And so when youre just wallowing, and i think we need to engage. This is the do decide, engage in what youre doing when you go home. And have the va be part of that as well. Weve got to blend these two systems together to we have to engage in the postdeployment activity. When ive been in uniform ive had the opportunity to serve in Preventive Medicine, in particular Suicide Prevention. We learned a lot and we get a lot of training i think in uniform i want to look for and how the battle buddy and the types of symptoms are looking for. Sometimes when the decision is made that youre going to take your life, that theres a columnist and to look for somebody giving away their stamp collection or coin collection because theyve made up their mind. They spend more time with them because they have made this decision that the problems are going away. We give those in uniform but we dont give them afterwards. For guard and reserve in particular, you just go home. I did see pashtun ive seen at fort lewis families in engage with programs but that doesnt happen the same way with guard and reserve. Its a different animal. But i guess more than anything else what i want to do when you talk about solutions, we can all be trained to look for symptoms and look for signs, but how do we go about preventing the very ideation that taking ones life . What are we doing that creates a situation where someone comes up with that ideation that this is the best way to go . Thats the type of input we need and that to me is really Preventive Medicine more than anything else. And i hope that through this we find a way because our suicide rates are going up interests of the population as well. So we have a National Problem youre not just a military problem. Again i applaud all your input. Its extremely helpful to us and as youve seen, this is a determined group that wants to make a difference in history of our nation as we move forward. And we are glad to have you as a part of it. So your input is always welcome, ma and thank you for commitment. I yield back. Miss them for five minutes. [inaudible] scheckter mic. Thank you, mr. Miller and Ranking Member michaud for alumni to purchase the introducing the especial sex to my colleague from arizona, ms. Kirkpatrick or represent our states veterans so well in this committee. I want to thank all of todays panels for joining us. In particular thank you to daniels parents. For being here. We worked together quite closely and learned of daniel suicide and it is an honor an and a privilege to be here with you again today. Unfortunately, daniels story and the story of the of the young men who committed suicide is all too familiar in our country. 22 veterans a day are still in committing suicide. Even after weve heard the tragedies of the young men who lost their lives here. And their brothers all across this country. As we heard from mr. Walsh, congress has addressed this issue before, has passed legislation before, have said they were going to fix it before and yet the problem has not only not gotten better, its gotten worse. Ive heard a lot of testimony today about ideas to actually reform the system to make a better. They hit the issue is i think when the committee would agree needs to be addressed. Im particularly interest in the either the Pilot Program that sergeant renschler participate in. My question to dr. Summers would be about daniel. Daniels experience with the phoenix va, like many, many veterans experience at the phoenix va was one of lack of concern, lack of care, lack of followthrough and a discombobulated system that didnt allow veterans to get the care they needed. In particular one of the struggles of daniel face was as an individual certain classified service. He was unable to participate in Group Therapy. I guess he was not able to share the expenses he experienced while in service. And yet at the phoenix va he was unceremoniously put into Group Therapy. And when requested, private therapy wasnt 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. The medical home model, i believe, and the private committee has provided an opportunity to create patience and care and allow civilians to get the care they need in one home easily, that Senate Record on their needs. While the private program in washington was ended because of, well, i dont understand why. They said they didnt have enough money for it, which i think is outrageous and a horrible, horrible reason to stop providing care that we know is effective and appropriate. My question for doctor and mrs. Somers, we believe a medical home model would work for could be helpful to veterans like daniel. We know that many of our veterans face pts, tbi, physical maladies. Would a medical model have been a model that may have worked better for daniel and what he faced . Absolutely. As daniels beautiful bowel syndrome worse and come he didnt Irritable Bowel Syndrome worse and committed until he could leave the house. I can imagine that embarrassment. I cant imagine that investment. As howard mentioned, at the time phoenix had the speed trap set up on the major highway to get from his home to the phoenix va so we actually had to find a way to get off of the highway so that the flashing lights would not affect him. So absolutely. I can see that it would have been very helpful to him just to have the privacy, capability. I completely agree. I think not only the medical home model, but what we talked about, the ability within the facility for the different people, because of his ideas and his tbi and his ptsd, youre being treated as we learned here, the term being in silos. And what you have to do is you have to get out of the silos and you have to combine resources, combined knowledge. We have heard of programs such as was mentioned that have very successful where people can have problems and for that reason you have an optometrist or alcohol malik is in there and they say, well, we know it sounds and ophthalmologist in there and they say its this or this and something might not have thought it. The ability to create these panels of Care Companies like that would be overwhelmingly positive. Thank you. Mr. Chair, i do want to take a moment just to thank mr. Benishek for cosponsored legislation that we drafted with the summer specifically to address the issue of Service Members during class was sitting at in the appropriate care when they return to the va. I want to thank the subcommittee and the committee for supporting just a part of the solution to this issue. Thank you. I yield back my time. Thank you very much. Mr. Bilirakis, you are recognized for five minutes. I appreciate the panel testifying and appreciate your courage. I want to ask about alternatives communication. I want to ask of the entire panel, which alternatives do you believe the va kids can the va could consider in addressing the Mental Health issue . I realize you have to have some medication in most cases prescribed, but unfamiliar with the Recreational Therapy that the chairman and myself participated in a field there not too long ago on Recreational Therapy, the equine therapy in my district, we have quantum leap farms. Theyre all over. They travel from all over the country to go to quantum leap. The service dogs do wonders i understand from talking to veterans. Just to name a few. But can you maybe elaborate a little bit with regard to the alternatives to the medication for Mental Health therapy, ptsd, tbi, what have you . Yes, bryant had a brother who came back and he had ptsd and he had a friend that was doing some gardening so i started just working and gardening within. Ready soon they realized they really liked it and the garden was pretty good so they decided to make it bigger. Than they thought, well, lets take these festivals and take it to market and see if we can sell them. So now they have this huge area and they do this. Ive also heard of veterans going on farms because theres not a lot of loud noises and flashing lights and, yeah, the sound issues that they have with ptsd. So those are two others. Thank you. Anyone else, please . We could just put together an extensive list of what veterans use to cope with these things outside of medications. Motorcycle riding, bike riding, equine therapy, service animals. I mean, it just, the list could go on and on, and i would rather stressed the importance of the fact that there is no one solution, and until the va can get to implementing best practices systemwide and tailor fitting to each individual veterans and needs, and using these known best practices that exist out there, until they can do that were not going to be able to fix anything. We can put policy in place saying you have to provide access to these individual treatments that exist, but the implementation of that policy thats the major issue here. And yeah, i mean, the list is extensive. Thank you very much. Definitely one size does not fit all. Anyone else . Id like to weigh in on that. We hear a lot of the excuses that we heard at phoenix was, it has to be evidencebased treatment. How do you get an innovative therapy if everything has to be evidencebased before they would use it . I think they need to open up their minds a little bit and think outside the box, as youve heard, not every Therapy Works are every person. Everything does have to be individualized, and ive heard other gardening before. As being very therapeutic for people. I think they need to get out of the mentality that this is all we can do. We have these blinders on. Thank you very much. Autumn light is when you to listen to the veterans, just like you said. Anyone else, please . I think its again to use the word holistic. Its a community, a lifestyle sort of approach. I mean, the va needs to do what the va needs to do the best way the va can do it. But the va cant do everything. Clay qaeda put together some kind of therapy program. He got involved in service. That was helping them. He got involved with ipa, storm of hail and their community. He got involved with team rubicon doing Disaster Relief programs. He got involved with riding bikes, and that was great for him to be able to heal, but its also great for him to be there to help his brothers and sisters heal. The problem, you know, for whatever reason, when a person besides to take their life, they have given up hope. So what do you do about that . And clay could do everything. He could go on these, you know, on these missions and he could give one week bike rides, but what got him was being alone. In his apartment on himself, hopeless. And theres questions of matters of faith there. But it is a community approach. People need to come to government and volunteer organizations, partner, no one organization, not even the government can do it all. And Everybody Needs to realize that, come together and take care of these folks. Thank you so very much. I yield back, mr. Chairman. Mr. Jolly is recognized for five minutes. Thank you, mr. Chairman. I want to associate myself with the comments of mr. Bilirakis, ms. Titus about alternative therapies. Ms. Somers, appreciate your comment about evidencebased. Im not a doctor but i have seen evidence that nondrug therapies were. To me thats good enough and as good enough for the veteran comedy should be good enough for the va. I want to talk about the va acknowledgment of nondrug therapies and your experience with that, understand every case is going to be different. I hosted a va intake they recently. We had about 300 people come through my Congressional Office in the district. One man brought a backpack he dumped a surplus of medications. Dozens and dozens and dozens of bottles of them. Sergeant, you referred your of going from 11 trucks to 14. I think youve expressed some concerns about ambien. The use of generics and otherwise. Just on its face do you lack confidence in the way the va administers pharmaceuticals, not on the merits of pharmaceuticals, but in the experience of the pharmaceutical use administered and directed by the va . I mean, ill speak at. I spoke earlier about the difficulty of clay getting a prescription refilled. But what has been said before in the private world, if i go to a doctor and they determine i need synthroid for my low thyroid issue, i go and they get synthroid and i sent synthroid as long as i am we tested and shown to be effective. I dont understand why the dod and the va have two different pharmaceutical programs, and the veteran has to suffer the consequences when you separate from the service and move to va, especially on Mental Health drugs. You just, you cant swap them out and stop cold and all of that. Or even on anything physical. It makes no sense to me. I dont understand why one system wouldnt work for both. Why not whatever works for dod, as far as pharmaceutical medications or anything, why does the va have to be different . It sounds me like its a cost factor. They have to shift to the cheaper route. Well, we have people dying everyday because weve switched to the cheaper road. I realized very much this is just a matter of personal impression, not clinical, but my concern having heard each of your stories is that simple because of the volume of patients, million plus volume of Mental Health patients, 21,000 toys, youve raise concern about personalized care. And it would seem to me thats clearly lacking. I dont 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 discuss perhaps, or sergey come in your counseling, the ability to get alternative therapy. I say that is on a personal expense as well, a va intake day i had a man in my office who said equal and Therapy Works. Well, that was good enough for me. But it wasnt good enough for the va. So can you speak to any discussions about alternative therapies, availability of, your opinions to that . Yesterday. So again within the va yes, sir. They had at one point in Time Available for polytrauma patients from those who have suffered from comorbid conditions but we were able to access Recreational Therapy. I was put on a sixmonth waiting list, and when the six months came up that lost the recreational therapist so that was my only experience there. I never had a chance engage in it because i was downgraded from polytrauma care when the va determined that my traumatic brain injury had reached a plateau of recovery and that probably would not get better. Thats a completely separate hearing day. But as far as the efficacy of alternative therapies, i mean, we could, again, it really helps. The va currently the availability. The availability is not there through the a channel to its private communities we have to go. Doctor and ms. Somers . I would agree. And himself was a musician so he was, it was easy for him to take out a piano and guitar and that was his therapy. But i would totally agree with it. At the san diego bai know they have pottery classes. Which we were thrilled to hear about and a Guitar Program spent we talk about evidencebased its were not just medication. That are the psychological treatments that are out there but theyre only using two of them at this time when our summit of the potentials out there and the other thing that weve mentioned was the ecstasy and lsd for pain. Because of our national phobias against these particular chemicals, were making it very difficult to do trials with these for 10 show, potential benefits. Thank you very much. Mr. Chairman, i yield back. Thank you witnesses for participating. Was not you know what youve been at the table for three hours. And we are very thankful that you been willing to share your stories with us. So with that, thank you very much and you may be excused. [applause] [inaudible conversations] [inaudible] second and third panel. Heres whats ahead. We will have a conversation about companies that we incorporate overseas for tax purposes. In will bring a hearing on patient safety. Later into discussion on income inequality. A look at some of our prime time programming coming up tonight across the cspan networks. Join us tomorrow for more washington journal. This week and will be live from the National Book festival in washington, d. C. In addition of regular coverage on cspan2s booktv, cspan will show you the events science pavilion with authors discussing the Space Program and a number of other related topics. Coverage is attending an eastern on our companion network cspan. This weekend on the cspan networks. Tonight on cspan cspan to provide live coverage of the u. S. Senate floor proceedings and key Public Policy events. Ended we get booktv now for 15 years the only Television Network devoted to nonfiction books and authors. Cspan2 created by the cable tv industry and brought to you as a Public Service by local cable or satellite provider. Watch us in hd, like us on facebook and follow us on twitter. Just this week burger king announced it was buying Canadian Company to importance that would move there Corporate Headquarters to canada for tax purposes. We look into companies that use this tactic to avoid certain taxes. This washington note segment is about 40 minutes. Host on wednesday our last hour here, we take a look at recent magazine articles as part of our spotlight on magazine. Today the focus of the cover of