Congressional delegation again opposes regional VA leader (The Washington Post)
Mississippi’s congressional delegation says it’s still opposing the appointment of an executive to oversee veterans’ hospitals and clinics in Mississippi, Louisiana, Arkansas, Oklahoma, Texas. The four congressmen and two senators said Friday that they met with Veterans Affairs Secretary Bob McDonald Tuesday. They oppose plans to name Skye McDougall to direct the South Central Veterans Health Care Network. That Jackson-based organization oversees 10 veterans’ hospitals and associated clinics. “We are more convinced than ever that her appointment is a bad decision, and that the secretary and his team’s handling of the issue has made a bad situation worse,” the delegation said Friday in a joint statement. “Although this decision belongs to the Secretary, we are dismayed that he would disregard the unanimous advice of the elected representatives of the people.” In a Dec. 15 letter, the delegation objected to McDougall’s appointment based on her 2015 testimony to a U.S. House committee. They say McDougall testified that wait times at VA facilities she oversaw in Southern California averaged four days, when they were at least 10 times longer. U.S. Sen. John McCain objected last year to McDougall leading an Arizona-based network for the same reasons. “It seems that the Department of Veterans Affairs has been ‘hopscotching’ Dr. McDougall around the country — from Southern California to New Mexico and from Arizona to Mississippi — searching for a soft landing for her,” the Mississippi delegation wrote in December. “We are determined to see that her soft landing is not in Mississippi.” The delegation noted that veterans’ health care in Mississippi has been troubled in recent years. The G.V. “Sonny” Montgomery VA Medical Center in Jackson has faced allegations of improper patient care over the past decade, including claims of understaffing, a radiologist who didn’t properly read some X-rays, and dirty medical instruments. Officials there said last year they’ve hired more primary care physicians to improve the speed of care.
Rising use of opioid painkillers and efforts to curb them may lead soldiers, vets to heroin (Military.com)
Twenty-four year-old Aaron Nowiski died alone, on his bed next to two bags of heroin. The Army veteran, who served two tours in Iraq, had secretly been using the powerfully addictive drug, even fooling his family into the understanding that he had quit, before it claimed his life in 2011. … Studies show that soldiers and veterans use opioid painkillers – essentially the chemical equivalent of heroin – far more frequently than civilians because their military training and combat lead to far more injuries. A report by the American Public Health Association in 2011 found that the fatal overdose rate among VA patients is nearly double the national average. Other studies show that people who are prescribed opioid painkillers are 40 times more likely to become addicted to heroin. … The concern is that the harder it becomes to legally obtain opioid painkillers, the more likely it is that veterans addicted to them will turn to heroin. That could be especially true in Fayetteville, where painkiller use is so common. Statistics from the U.S. Drug Enforcement Administration show that more oxycodone – the main ingredient in Percocet and other addictive painkillers – was sold at pharmacies in the Fayetteville area than anywhere else in North Carolina in 2011. The sale of hydrocodone, a slightly less powerful but still potentially dangerous painkiller, ranked third-highest in the state. A lot of those prescriptions were written by doctors at Womack and the Fayetteville VA. The Observer was able to obtain the amount of painkillers prescribed by both hospitals for a series it did in 2013 called “Bitter Pills.” Those statistics show that in 2001, the VA prescribed the opioid painkiller hydrocodone to 1,130 patients. By 2012, those prescriptions had soared to 47,586 patients, a 4,100 percent increase in 11 years. Prescriptions for painkillers also had increased for active-duty soldiers at Fort Bragg. In 2012, more than 18,000 soldiers – about a third of the installation’s active-duty population – received a total of 46,870 opiate painkiller prescriptions through Womack. The same trend was happening throughout the federal VA system. According to the Department of Veterans Affairs, VA patients getting opioid prescriptions increased by nearly 77 percent between 2004 and 2012. In 2012, one in three VA patients received opioids to manage their pain, the department reported. Realizing they had a problem, the Department of Defense and the Department of Veterans Affairs began to de-emphasize opioid painkiller use by turning to alternative methods of treatment. While some opioid-reduction initiatives have proved effective, others have been fraught with problems. Last year, the Drug Enforcement Administration began requiring veterans to refill painkiller prescriptions every 30 days rather than 90 to help ensure that the drugs are not being abused. But according to published reports, backlogs at the VA blocked many patients from being able to see a doctor before their medications ran out. That, in turn, could lead veterans addicted to painkillers to buy heroin – which is less expensive and easily found – on the streets. … In 2012, the VA established a detoxification protocol for veterans with an opioid disorder. Before that, veterans were referred to a residential treatment program at another VA medical center. In 2013, the substance abuse program established a subprogram specifically focused on painkillers – the Opioid Replacement Therapy Program. In that initiative, veterans are provided Suboxone, a medication-assisted treatment that is FDA-approved for opioid dependence. Veterans also are taught coping skills to achieve and maintain abstinence from opioids and other drugs, according to the VA.
Philly VA misconduct cases closed, but lawmakers left with few details (Stars and Stripes)
The Department of Veterans Affairs says it has closed the book on its investigation of misconduct at its Philadelphia regional benefits office, without revealing the names of most of the people involved, what they did wrong or their precise punishment. Though the agency says implicated managers have been removed from decision-making positions, no one associated with the scandals was fired, a VA spokesman confirmed. In April, the VA Inspector General’s Office issued a scathing report documenting systemic manipulation of data and mismanagement at the Philadelphia office, which handles benefits claims for 825,000 veterans in three states. The misconduct covered up a huge backlog of claims, with piles of unprocessed mail, documents and inquiries socked away or destroyed. VA investigators released a second report in May that exposed disturbing misuse of office. It named two managers — Assistant Director Lucy Filipov and Pension Center Manager Gary Hodge — in a bizarre incident in which they coerced subordinates to attend a séance at Filipov’s home and asked them to pay for the medium, who was Hodge’s wife. Both managers were suspended. This week, in the first indication that the VA had concluded its investigations, Hodge and Filipov returned to work in lower positions — Hodge as a claims examiner (pension analyst) and Filipov as an insurance specialist. Asked this week about the developments, the VA’s chief spokesman said simply that the cases were closed. “At the Philadelphia VARO, all investigations and disciplinary actions for senior managers related to the April and May 2015 VA OIG reports and related VA administrative reviews, have been completed,” said VA spokesman James Hutton. “The subject employees have been returned to duty and, where applicable, disciplinary actions have been imposed.” The VA declined to answer further questions. The agency sent a statement last week to lawmakers — obtained by Stars and Stripes — announcing that it had concluded its disciplinary actions in the cases, which were the subject of several hearings in front of the House Committee on Veterans’ Affairs. Lawmakers expressed surprise that the VA had conducted its disciplinary activity in secret. … In all, nine Philadelphia employees were disciplined — most suspended for a number of days, and some demoted, according to the statement. For some, according to VA information sent to congressional offices and shared with Stars and Stripes, 14-day suspensions were shortened to ease the financial burden on the managers who were punished.
VA taking back work of helping formerly homeless vets (newsworks)
Just before Christmas, former Philadelphia Mayor Michael Nutter made the startling declaration that veteran homelessness had been “effectively ended” in Philadelphia, during a speech at City Hall. Yet just days later, the Department of Veterans’ Affairs quietly ended a three year, $1.5 million partnership it had with a nonprofit called Pathways to Housing, a group that had assisted many of the city’s most troubled homeless vets find housing. Even more importantly, the group had helped hundreds of chronically-homeless veterans stay housed. Many homeless men struggle with the transition from life on the streets to life in an apartment, and feelings of loneliness or hopelessness as they rebuild their lives. A lack of support can land people back in a cycle of destructive behavior and back on the streets. That’s what Pathway’s client Gary Core said, in a tearful interview last week. Core was recently notified, along with 123 other clients, that he would be saying goodbye to the caseworkers he had known for the last three years. “This is very chaotic for me, because it’s like losing my family,” he said. “It’s devastating for that kind of happiness to just be snatched from you after being given to you for so long.” Core, a 62-year-old Vietnam vet, had been living on the streets of Southwest Philadelphia for years, battling drug addiction. He was seeing social workers at the VA who eventually referred him — and many of the agency’s most difficult cases — to Pathways in 2011 as part of a trial program in combating homelessness. Caseworkers at Pathways helped him find an apartment, get counseling and relearn basic life skills, like grocery shopping or managing personal finances. Although Core says there was a more important part of his relationship with his caseworkers at Pathways. “They taught me and showed me that you’re not alone,” he said. “And that was the most important thing, because I’d been alone for so long.” Core has been in his apartment and off drugs ever since. In the past four years, the group has placed more than 400 homeless veterans and has become a national model for homeless support, emulated by the VA itself. But a few days before Christmas, Pathways was abruptly notified that its remaining 124 clients would be transferred back to the city’s main VA medical center. A spokesperson for the VA said the agency had determined it could provide homeless support internally, at a lower cost. “The changes are within the scope of the current contract,” said VA spokesperson Jennifer Askey. “The [Philadelphia VA] is in the process of implementing a thoughtful and comprehensive transition to ensure veterans continue to receive the level of services needed. Many of the veterans currently served by Pathways to Housing will work with Medical Center staff members they already know.” But both Core and Samantha Leader, a caseworker at Pathways, expressed concern that the VA won’t provide the level of care that helped their clients succeed. “We have about three to four case managers on each team, we have a nurse, a certified peer specialist, a team leader, assistant team leader and a program assistant. We also have a doctor and psych on staff and all of us work together with the clients as a team model,” said Leader. “At the VA you’re assigned one caseworker.” A recent National Institutes of Health study found that the average VA social worker was assigned between 25 and 35 homeless clients. Leader said her nonprofit’s ratio is 10-to-1. The veterans enrolled at Pathways will be headed back to the VA by April — they won’t have a choice. Core will keep his apartment, but says it feels like he’s “starting over.”
Chicago hospital adds outpatient program for troubled veterans (Daily Herald)
Chicago Behavioral Hospital, which 15 months ago took over Maryville Behavioral Health Hospital in Des Plaines, has spent millions of dollars to modernize the new Extra Mile Veteran Care center on the campus. “We’re creating an environment that is welcoming and homelike,” said Susan Young, a spokeswoman for the hospital, adding that there are 3,600 groups that work with veterans and “we’re here to partner with anybody.” More than 25 percent of the 700,000 veterans in the state live in Cook County. The center, a specialized private outpatient program in a separate building, addresses the mental health and chemical dependency issues of veterans and their families. Cost of care is typically covered by insurance or by groups aiding veterans, said Randy Kaniecki, senior vice president of US HealthVest, the New York-based company that owns the hospital. “What makes The Extra Mile Program so unique is that the majority of its leadership and senior practitioners are veterans themselves who empathize with the struggles their patients are undergoing,” said retired U.S. Army Col. David Sutherland, a consultant to US HealthVest, who spoke to the veterans and politicians at the open house of his personal distress at the traumas he witnessed during his military career. He commanded U.S. forces in Iraq and served as a special assistant to the chairman of the Joint Chiefs of Staff during his 29-year military career. The National Council on Behavioral Health reports that 30 percent of service members deployed to the wars in Iraq and Afghanistan will have a mental health condition requiring treatment. The families are often affected by these difficulties. As such, treatment services and preventive strategies must be inclusive of the whole family, be it traditional or nontraditional, Kaniecki said.
Lawsuit puts spotlight on veterans’ care (Las Vegas Review-Journal)
If advocates for the late U.S. Navy man Charlie Demos Sr. hoped their lawsuit alleging mismanagement at the Boulder City Veterans Home was going to cause a stir among elected officials who love to make political hay of their support for the military, so far they’ve been mistaken. The veterans home has its defenders, but it also has generated scrutiny separate and apart from the Demos lawsuit, which was filed last month in District Court in the wake of the elderly veteran’s April 2015 death related to Legionnaire’s Disease. An inquiry by the Southern Nevada Health District found the presence of legionella bacteria in the facility — including in Demos’ room. The report went on to state that “based on these results, the presence of Legionella pneumophilia in the water system may pose a health threat to residents and staff. As such, this finding should be immediately addressed to ensure that the disease causing organism is appropriately removed from the water system.” A state director with supervision over the retirement home defended the facility and downplayed the issue. Through attorney Martin Little, the Demos family complaint and class action accuses Nevada Department of Veteran Services Administrator Mark McBride of failing to “implement a proper program for the prevention, detection, or control of legionella bacteria and the prevention of Legionnaires’ Disease. A check of a variety of sources, including inspection reports kept by the Department of Heath and Human Services and Centers for Medicare and Medicaid Services, show the Boulder City facility lacking in several areas in recent years. While by no means the worst nursing facility in the state, according to official reports substantive improvement is needed. From December 2012 through June 2015, according to statistics compiled by ProPublica, the nursing home racked up 38 deficiencies. It was fined $20,166 in 2013, in part for failing “to ensure the resident received adequate supervision to prevent accidents.” In recent years, a resident suffered heatstroke and sun-related blistering after being allowed to remain outside on a hot summer day. The resident, eventually identified as former Nevada legislator Bob Robinson, later died of sepsis and other medical issues related to heatstroke. The incident and other deficiencies and regulatory failures, including a 15.5 percent medication error rate, led to an investigation by the Nevada attorney general’s office. (Some patients were put in danger by being issued medication without family consent.) Other inspections have focused on the level and quality of nursing care available at the facility. A pattern emerges that points to a lack of staffing and highly qualified personnel. And the problem only figures to increase in the coming years as Nevada’s veteran population, estimated at nearly 350,000, continues to grow. Among several key challenges: increasing available bed space while improving living conditions for aging veterans. That takes more than money. It also demands that members of Nevada’s congressional delegation keep their eye on the ball and exercise their political will. Although the nursing home isn’t in her district, Rep. Dina Titus, D-Nev., is a member of the House Committee on Veterans Affairs. Her work in 2015 to secure millions in funding for homeless veterans was laudable. And Rep. Joe Heck, R-Nev., goes to great lengths on his official websites to show his affinity for veterans. A physician, Heck often mentions his status as a veteran whether he’s on the floor of Congress or on the stump back home. But it appears residents of Southern Nevada’s veterans nursing facility need more help than they’re receiving. It’s becoming increasingly clear that the Boulder City Veterans Home may require increased scrutiny to meet quality assurance goals, but the health and dignity of its residents demands that greater resources be invested in order to keep the promise our society has made to our military men and women. If the Demos lawsuit helps accomplish that much, it will have done its namesake proud.
PVA announces winner of Congressional Leadership Award (Healio)
Paralyzed Veterans of America recently announced Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans Affairs, as recipient of its 2016 Gordon H. Mansfield Congressional Leadership Award. According to a press release from Paralyzed Veterans of America, Miller has led efforts to reform the Department of Veterans Affairs (VA). He has worked to expand access to health care services for veterans and to update the Choice program to improve veterans’ health care options. He also has worked to improve accountability for many VA senior executives. “Chairman Miller has elevated reform of the VA, particularly the health care system, to a level never considered by Congress in the past,” Al Kovach Jr., national president of Paralyzed Veterans of America, said in the press release. “He has consistently worked to ensure that veterans can get timely access to high quality health care in the most appropriate setting. He has also advocated for strong accountability for those employees, particularly at the senior executive level, who have jeopardized the delivery of health care and benefits services to veterans.” The Gordon H. Mansfield Congressional Leadership Award is named for the late Gordon Mansfield, former acting secretary of the VA and former executive director of Paralyzed Veterans of America. Mansfield also served as assistant secretary for congressional and legislative affairs for the VA and the first executive director of government relations for Paralyzed Veterans of America. He also was a combat-injured Vietnam veteran who was awarded the Distinguished Service Cross. “I want to thank Paralyzed Veterans of America for this honor as well as its exceptional advocacy for America’s veterans,” Miller said in response to the announcement. “[Paralyzed Veterans of America] PVA’s advice and counsel to the House Committee on Veterans’ Affairs has been vitally important in our efforts to improve veteran experiences and increase accountability and efficiency at the Department of Veterans Affairs. I am looking forward to continuing our partnership with PVA in 2016 and beyond.” Paralyzed Veterans of America will present the award to Miller during a private event on March 3, 2016.
High school students take polar plunge to help homeless veterans (The Virginian-Pilot)
When some Grassfield High School students learned about the number of military veterans who are homeless – nearly 50,000 nationwide – they were stunned. …they plan to do something about the issue. By jumping into the frigid Atlantic Ocean. The polar plunge will raise money for Vetshouse Inc., a nonprofit that provides housing for homeless veterans. Each year, the U.S. Department of Housing and Urban Development takes a point-in-time survey of homelessness. In 2015, it estimated nearly 48,000 veterans are homeless on any given night. That’s 11 percent of the adult homeless population. More than 600 of those are in Virginia, and nearly 1,100 are in North Carolina. “They have given so much for our country,” said Jacob Robinson, a Grassfield junior who helped plan the icy swim. The fundraiser is a gesture to honor that service, he said. … By earlier this week, they already had raised more than $500. Vetshouse, based in Virginia Beach, provides housing each day for to up to 26 homeless veterans. It also gives veterans help on skills such as resume writing and money management. Veterans can stay in the homes for a year or longer, as long as they are working, seeking a job or attending school. They also must buy much of their own food, do their own cooking and cleaning and follow certain rules, such as a ban on smoking. Willard Smith, executive director of Vetshouse, said he cried tears of joy when he heard about the Grassfield fundraiser. Vetshouse relies on donations and, beyond money, needs nonperishable food and household items like laundry detergent and cleaning supplies, he said. The actual number of homeless veterans is likely larger than the federal estimate, Smith said. He said he continually gets new applicants, especially during the winter. “Those who served you now need you to serve them,” Smith said. Students did the legwork for the fundraiser, said Col. Gordon Strong, who served 20 years in the Air Force and now oversees Grassfield’s Junior ROTC. Five other Chesapeake high schools offer such programs and, ideally, they will lead similar fundraisers in the future, he said. During winter break, a few students did a polar plunge “test run,” trying out the water to see how cold it might feel at the event. “Numbing” was Robinson’s thought. Still, sophomore Michael Dorey is excited. He hopes to attend the Naval Academy in a few years, then enter the military. For now, he said he’s looking forward to helping veterans. “They have given up so much to protect us,” Dorey said.