Thursday, July 14, 2011

The Senate Veterans Affairs Committee hearing

Today I attended the Senate Veterans Affairs Committee hearing on mental health.

This is a jump around post with observations on different topics.

First, the carpet. Do they not clean the carpet? I don't mean the senators. I don't expect that John Kerry's like, "Got to make a vote -- oops! It's my day to run the carpet cleaner!" But I was just really surprised by how stained parts of the carpet was. Now it's blue with patterns on it and maybe from certain angles the stains look like part of the patterns? I checked to make sue that I was seeing stains and I was.

Second, why Elaine bailed on me? I had an e-mail asking that, saying, "Man, your gal went back to California, she bailed on you!" It's our vacation. We're doing three weeks and we can be apart a night without falling apart. Elaine is a psychologist. Her practice is strictly vets now and all pro bono. She deals with PTSD all the time in solo sessions and in group sessions. (I'm saying that from what vets tell me about when I hang out in the office. All Elaine ever gives me is "rough day" when it's been a tough one. Otherwise she says nothing and is a stickler for patient confidentiality.) So the point is, Elaine is wiped out by this issue many times a month. I am interested in this issue. She's already up to her neck in it and has been for years. It would not have been relaxing for her to attend the hearing nor would it have been easy. So that's why she flew back yesterday.

Third, I couldn't do it. I couldn't attend these hearings day after day. They make me angry.

For example, today an IG [Inspector General] was on the first panel of the Senate Veterans Affairs Committee hearing, Dr. John Davigh. Check out the snapshot for C.I.'s excerpt of the first panel. It's all in there.

Andrea Sawyer is a caregiver to her husband who is an Iraq War veteran, medically retired with a rating of 100% disability. Committee Chair Murray asks a question of him. And as they're talking, Andrea Sawyer's example comes up and he starts pontificating-- when the question was meant for Andrea, it was about her life -- about how she used fee-based care because blah blah blah.

But, as she corrects him, she didn't. She used TRICARE and was able to do that because of her husband's disability rating. Due to that medical retirement, they can't use the fee-based system (as she explains). She knows that. She'd talked about her husband's 100% disability rating prior to the doctor babbling away.


He should have her or he's not listening. If he did hear her, apparently this so-called IG, this expert doesn't know the first thing he's talking about or he'd know that Loyd Sawyer didn't qualify for fee-based care.

They really love to lie, don't they? And to stall. And to try to run out the time clock before the senator can ask another question.

On the second panel?

Committee Chair Patty Murray: Mr. Shoenhard, we heard from the IG [Inspector General] that Atlanta was not prepared to handle the influx of new veterans who needed mental help and this isn't the beginning of this war. It's been going on for a very long time. We've been talking on this Committee for a very long time about PTSD and TBi and the invisible wounds of war and the high number of soldiers who come back and need access. How can it be that the VA was not prepared for this?

William Schoenhard: Uh, Madame Chairman, that's a tremendously important question. In Atlanta and that's true of VISIN 7, we're Atlanta's -- this is one of our fastest growing areas for veterans enrollment. We had there about 7 or 8% increase. I-I, we concur with the IG and I have talked with Mr. Clark who is the director there. We were not as quick as we should have been. And we're going to learn from this. And we're taking this report not just for Atlanta but for other facilities particularly in high growth areas.

And on and on he blabbed. How did he answer her question -- the one he called "tremendously important" -- of "How can it be that VA was not prepared for this?"

Apparently the answer is because there was a small, less than 10% increase.

There were no real answers.

And Committee Chair Patty Murray had to make the point that when they are not seeing a veteran in need in a timely manner, it effects the veteran and it effects the family of the veteran.

The witness palmed it off on another witness. It was a woman with VA. I don't know her name. I grabbed the handouts at the hearing and her name isn't on any. I've got C.I.'s notes but, for shorthand, she draws a face for whomever is speaking. It's quicker than doing their name, just a quick sketch of the face.

Okay, C.I. said it's Dr. Zeiss. Antonette Zeis. That should be correct because C.I. spelled it out for me. She's filling in for Kat at Kat's site and may already be working on her "I Hate The War" over at The Common Ills. (She types much faster than I do. I really do hunt and peck.)

how well the suicide prevention hotline works.

but i want to suggest to you that the ultimate prevention of suicide is to supply the treatment in a timely fashion that our veterans need

So Schoehorn is listing things and Committee Chair Patty Murray asks him< "Are you doing that or are you just identifying that as a problem?"

That's when he passed off to Zeis who talked about a new program being developed and Chair Murray wanted to know, "When will you see that how long does it take to collect all those data?" And that was the question on everyone's mind but Zeis had talked and talked without ever providing that.

Once asked, Zeis said she hoped to have it active by the end of the year. Chair Murray wanted to know if then it would be analyzed causing further delays, "My question is does everybody have to wait another year?" Zeis said no and also said that they could make adjustments as they go along this year.

I like Patty Murray, I'm glad she's the Chair. She's a basics, no frills kind of chair. What's going on, what do you need, how can we fix it, why isn't it fixed.

I've been to hearings where people used their time to do a little infomercial for themselves, for instance. She's not that way at all.

Nor is Richard Burr. Like most of the community, I see him as the grouchy uncle saying what needed to be said but everyone else was too scared to. That comes from Kat's reporting because she's really captured that aspect of him in her coverage over the years of him.

But this was my first time seeing him in action and I did wonder, "Will I miss what Kat sees? Will I not get the no pussy footing around, here's the question we need answered, type thing?"

On the second panel, this is how Burr opened his questioning.

Ranking Member Richard Burr: Mr. Schoenhard, how do you define timely for a veteran with a gun in his mouth?

William Schoenhard: Instantaneous, sir.

Ranking Member Richard Burr: So is that the directive that comes out of the central office to all individuals at all locations that would come in contact for the first time with a veteran with mental health needs?

Yeah, he was saying what needed to be said.

And the answers were not forthcoming and he did not hide his displeasure. At one point, he wanted to know if anyone at the VA had "been fired because of some of the issues that have risen from veterans like two that we heard from today?" Answer? The witness sidestepped it.

Burr finally told him, "If you only take one thing away from this, please understand it does not work. There are gaps, there are holes. There are veterans that are falling through the cracks with mental health problems that I don't think went undetected." Instead, he thought the veterans were facing VA employees who "really didn't give a damn if they got the care in a timely fashion or not."

Senator Scott Brown, on the second panel, agreed with Committee Chair Patty Murray that there also needed to be more cooperation with the Defense Department so that when service members became veterans and moved into VA, they weren't lost and knew what to expect and how to navigate the system.

Brown also noted that "these are the most consistent stories I've heard," these veterans stories where someone's contemplating taking their own life or has tried to because he or she isn't getting the care they need despite fighting the VA to get that care. He told Schoehorn that "when you're dealing with people's lives, your response rate needs to be perfect" because every mistake could cost someone's life.

"Everything's great, great, great," he said of the way the VA witnesses portrayed the events in their testimony, "but outside it's not, people are hurting."

Ava has reported on Scott Brown repeatedly because she usually writes it up for my mom's site and Brown is our senator on the Committee. And I've enjoyed her coverage -- much better than anything in the Globe or Herald. And I also enjoyed her piece for Third entitled "Ava spills Scott Brown's dirty secret" but was that a writing exercise (it's a great read) or did it capture Scott Brown? Or did it do both?

I think it did both. I saw the gestures she talked about, saw the mumbles, saw him zero in on key points others missed. I was really impressed.

I voted for Scott Brown in the election. My whole family did. We are Democrats and Socialists. My grandfather (Socialist) led the move (I was co-leader) because we saw it as our chance to say no to ObamaCare. We've already got RomneyCare and we knew ObamaCare wasn't what people thought they would be getting. We were tired of it. We were tired of the attitude that the Kennedy's owned the seat. That did more than anything to harm Democrats in that election.

Martha Coakley (?) was a strong opponent until she won the Dem primary and then began walking back every promise she made. For example, she was going to stand for universal health care and not ObamaCare. Until she won the primary.

So it was take another Democrat who wouldn't show a spine or send a message.

And the attacks on Scott Brown really ticked me off. Especially that stupid rant Keith Olbermann did.

So my family turned out for Brown and we're a big family. BIG. My mom's one of eight children and so am I. "Small" in our family has meant the person only had four kids. (My brother broke that with his one daughter.) We're all over the state and we're union workers and police and fire and nurses and just everyday people. And sitting in the hearing today, I was really proud that we had voted for Scott Brown. He did a pretty solid job.

Here's C.I.'s "Iraq snapshot:"

Thursday, July 14, 2011. Chaos and violence continue, Tim Arango reveals that Nouri's made clear he wants the US military to remain in Iraq, the US Congress hears about a veteran with a gun in his mouth having to wait and struggle for mental care (after that incident as well as before it), a caregiver explains she gave up her teaching career when her principal told her she could work on getting her husband better or she could teach but she couldn't do both, and more.

Yesterday on Flashpoints (KPFA, Pacifica), guest host Kevin Pina spoke with Mahdi Darius Nazemroaya who has left Canada to report from Libya on the illegal war. Excerpt.

Kevin Pina: Well there is a lot going on in the news. We hear of abuses by the so-called rebels against the population which is finally reaching the press. Italy today unfortunately we hear has also come out again in support of the NATO war although officially they've withdrawn from it and Secretary of State Hillary Clinton says that Muammar Gaddafi's days are numbered. Give us an update. What's going on on the ground, Mahdi?

Mahdi Nazemroaya: Well Italy's statement is disheartening personally for me but people here don't see it as -- I don't think they see it as important compared to Italy's withdrawal. In regards to Hillary Clinton's statements, I was aware of that and people here are aware of that too and they just believe that's the USA trying to muscle in and trying to pull this coalition together and to keep the momentum of the war going. In regards to her statement and the Human Rights [Watch] statement, they've been on Libyan TV and I've been watching Libyan TV and they've been talking about the Human Rights Watch report about the rebels and the abuses towards civilians and the infrastructure and that has been on TV all day.

Kevin Pina: Now, of course, Human Rights Watch qualified that report by saying that although you had to remember that the Gaddafi regime was responsible for far more human rights violations.

Mahdi Nazemroaya: There has been fighting on both sides and there have been people caught in the middle of the fighting but what the news here is saying, their TV, it's being broadcast over and over is the angle of Human Rights Watch that talks about the rebels. Now we've got to remember and focus on that almost the entire world and corporate media has been focused on the atrocities that they say that the Libyan government has been committing and most of them are not accurate or true but nobody's really been focusing on what the rebels have been doing such as the reports about child soldiers -- which I was just reading about -- or about Italy and France's involvement in taking children out of Misrata, there been reports -- actually the Social Affairs Minister of Libya, Ibrahim al-Sherif came up, he launched an investigation actually into the disappearance of 52 boys and 53 girls -- a total of 105 orphans from Misrata. And they caught somebody from the rebel side -- a doctor, a medic who said that they were taken to Italy or France. And that reminds me of of what happened in Chad in about 2007 when they tried to take kids out of Chad illegally.

Kevin Pina: And you're listening to Flashpoints on
Pacifica Radio and that is the voice of Mahdi Nazemroaya coming to us directly from Tripoli, on the ground in Libya. We're discussing the situation there as NATO bombs continue to drop and as the international community through NATO rally to try to take down the regime of Muammar Gaddafi. So tell me what would these kids be used for? What are we talking about here? Are we talking about kids that would be taken into slavery, that are kidnapped basically, taken away from their families? What are we talking about here?

Mahdi Nazemroaya: The investigation is ongoing. The individual that they caught from the rebel side? Originally they weren't sure. The witnesses said they were taken on either a Turkish or an Italian or a French ship. But they caught someone from the rebel side who was either a doctor or a medic who says that they were taken to Italy or France for adoption. And these children, they don't know -- they cannot be taken out of here. The Libyan government has demanded that if they're gone, they be returned and there's an investigation. And this is making the news here. This is something that is on the news as well as the Human Rights Watch report.

That's an excerpt. The broadcast covered other wars as well. And it broadcasts live from 5:00 to 6:00 pm, Monday through Friday on KPFA and other stations. There was an Iraqi media report, there was a discussion with Raed Jarrar about the US possibly staying in Iraq and Gareth Porter addressed the Afghanistan War. In an ideal world, we'd have the space to note all of that but we don't have that space.

Daniel Williams: I was deployed to Iraq in '03, was deployed with the 4th infantry division out of Fort Hood, Texas. During that combat deployment, I suffered mental and physical injuries that will forever be part of my life. I was exposed to an improvised explosive device. I injured my body, my brain and my mind. I received a Traumatic Brain Injury, TBI, but I believe that almost as severe as my injury is the Post Traumatic Stress Disorder, PTSD, an invisible injury that no one else can see but it haunts my every move. From the moment I got injured until the time that I was honorably discharged, I received very little help from the Army or even acknowledgement of my state. I went to the base clinic at Fort Hood, Texas where I was told that I was having anxiety disorder and readjustment issues but I would need to wait six months before I could get an appointment with a psychiatrist, just an initial appointment to be looked at. In the winter of 2004, after receiving no help or any hope of help, I attempted -- I attempted suicide by putting a 45 caliber pistol in my mouth while I was locked in a bathroom. My wife begged me to let her in but I wouldn't agree. She called the police and when the police arrived, I argued with them. Then they kicked down the drawer and at that time I pulled the trigger. By the grace of God the weapon did not go off. The officer handcuffed me and put me in the seat in the back of his police car. One of the officers attempted to clear the weapon but at that moment the weapon went off. The same round that refused to kill me went off perfectly for him. Thankfully no one was injured. I was admitted to the psychiatric ward of the base hospital and remained at in patient for two weeks. At this time I was diagnosed with readjustment issues and anxiety disorder but the physicians also acknowledged that I had PTSD. I was told by the doctors that the treatment record would be kept confidential and it was not. It took me over a year to be able to be put out of the military service because of my mental illness.

Daniel Williams went on to outline problems within the VA which included that health care givers -- doctors -- tasked with helping treat his PTSD were unaware that noises and crowds were, at best, off-putting and, at worst, harmful to his treatment. Another VA doctor thought shock treatment was the way to go with PTSD. When not dealing with those extremes, he had to deal with just the hassles of getting an appointment. He had one appointment, for example, scheduled today. Clearly, he did not make that appointment. When he explained he couldn't make it because he was going to be appearing before the US Congress, he was told, no problem, they can reschedule him for four months from now. That was the earliest they could fit him in, they said.

"Good morning and welcome to today's hearing on how we can close the gaps in mental health care for our nation's veterans," declared Senator Patty Murray today as she brought the Senate Veterans Affairs Committee hearing to order. "We all know that going to war has a profound impact on those who serve. And after more than eight years of war, in which many of our troops have been called up for deployments again and again, it is very clear that the fighting overseas has taken a tremendous toll that will be with us for years to come. More than one-third of veterans returning from Iraq and Afghanistan who have enrolled in VA care have post-traumatic stress disorder. An average of 18 veterans kill themselves every day. In fact the difficult truth is that somewhere in this country, while we hold this hearing, it is likely that a veteran will take his or her own life."

The Senate Veterans Affairs Committee heard from two panels this morning. The first was composed of Iraq War veteran Daniel Williams (who is now with NAMI), caregiver Andrea Sawyer, Dave Underriner (Chief Executive of Providence Health & Services, Oregon Region) and the Assistant Inspector General for Healthcare Inspections for the Office of the Inspector General covering the VA Dr. John Daigh. The second panel was the VA's William Schoenhard.

Andrea Sawyer is married to Iraq War veteran Sgt Loyd Sawyer. He was part of the Army Mortuary Affairs team. While serving with them in Iraq, "he began exhibiting signs of mental distress."

Andrea Sawyer: Upon his return, I tried for eleven months to get him help. Ultimately, I sat in a room with an Army psychiatrist and my husband and watched Loyd pull a knife out of his pocket and describe his plan of slitting his throat. Multiple episodes of hospitalization and intensive treatment followed before he was permanently medically retired from the Army due to severe PTSD and major -- major depression. Loyd immediately enrolled in care at the Richmond polytrauma center. In October 2008, he received a 100% permanent and total disability rating from the VA. Given his urgent need for extensive help, we tried to get him into the PTSD clinic in Richmond. But the first available appointment required a two month wait. When he was finally seen, we were told that the only thing available in the clinic would be a quarterly medication management session and a once-every-six-weeks therapy appointment. Knowing that his depression was spiraling and his PTSD symptoms were worsening, we elected to use his TRICARE. He began treatment with a civilian counselor. He was able to see him once or twice a week. But over the next six months, I became increasingly concerned about the imminent possibility of suicide. Despite getting little help from our local VA, but thanks very much to our Federal Recovery Coordinator, Loyd was able to enroll in an inpatient PTSD program at the VA Medical Center in Martinsburg, West Virginia. We had high hopes for this hospitalization but it turned out to be a nightmare. The program delivered on none of its promises. His counselors and doctors there never coordinated with his local VA mental health clinician, his civilian counselor or his Federal Recovery Coordinator. He was placed on medication that made him physically and verbally aggressive despite having been taken off that same medication for the same reason while on active duty. Over the course of this 90 day program, Loyd had fewer than five individual therapy sessions and on returning home promptly discontinued all of his medication which was a step bacward as he had been completely meds compliant for eighteen months leading up to hospitalization. In calling the Richmond PTSD clinic for help, I was told it would be four weeks before they could see him. I tried to have his primary care manager intervene but was told that I and his FRC were wasting the time of his primary care manager. Eventually, again with help from our Federal Recovery Coordinator, I was able to get Loyd an appointment within a week with a VA psychiatrist outside of the PTSD clinic. She suggested that he attend the weekly thearpy group that met with the clinician inside the Richmond PTSD clinic. Feeling rather hopeless, he decided to try the therapy group and actually found great solace in being able to relate with others you were experiencing the same symptoms he was. Unfortunately, four months later, and without consultation of the patients, the medical center staff announced that the VAMC was changing its treatment model and would be disbanding the group by year's end. For those wishing to continue in a group setting, the VA would be turning them over to an untested VA program without a clinician. Despite the veterans petitioning to remain in a VA clinical program, their year long effort has been unsuccessful except to temporarily the clinician. The 40 member group has withered to an average of five to seven because now, as a support group located off the VA campus, veterans cannot take sick leave to attend their meeting. My husband is a veteran with well documented, severe, chronic PTSD who gets treatment at one of VA's major VA polytrauma centers. We have all the advantages that should guarantee him good treatment -- an excellent, caring Federal Recovery Coordinator, the priority associated with a 100% service-connected disability rating, a fabulous OIF case manager and the assistance of a super VSO. If a veteran with all these advantages cannot access timely, consistent, appropriate veteran-centered care in this system dedicated to the care of veterans, what confidence can this Committee have that a newly enrolled veteran who has recently returned from the war zone will have a greater success?

She noted, rightly, that VA "is failing." I have no idea why the White House is coasting. I have no idea how they get away with it. Andrea Sawyer had a set of statistics that you hear over and over, year after year, if you sit through these hearings. One statistic that was new to me was that approximately 20% of veterans who are diagnosed by the VA with PTSD do not get a follow up visit within 12 months of their initial diagnosis. Sawyer called it a veterans mental health care crisis and it's pretty hard to dispute that if you're paying attention to what's actually going on. Excerpt from first panel questioning.

Chair Patty Murray: Thank you very much for your testimony. And, Dr. Daigh, let me start with you. You heard the testimony. The stories that we've heard before the Committee today are not unique. I hear them everywhere I go and Congress has been listening to this. We have responded with the resources, with legislation, new programs. The IG [Inspector General] has provided the oversight. Yet here we are and these stories are still here and they're relevant again today. You mentioned a little bit in your testimony some things you thought, coordination of care, those kinds of things. I heard you talk about Altanta. They needed the clinicians but it's not that they didn't try, you said, it's just that they weren't there. Is that lack of people available to hire, is it lack of resources, is it lack of -- Tell us what we need to be doing in order to make sure that the VA has what it needs or to be telling the VA what it needs to do.

Dr. John Daigh: I think that there -- from my understanding of the situation in Atlanta and looking at the data, there was a tremendous growth in the demand for mental health services over a relatively short period of time. I'm not -- And-and-and some of the assumptions that they made about how they would provide care, their inpatient ward for example, they thought it would be functional and it wasn't. So they had to adjust. And I think they could have made better decisions about how they adjusted. And our report says that we think they could have made better decisions about how they adjusted. But part of the problem is that if you have pre-arranged relationships with universities or private practices or clinics of specialists that you know you need and can easily call on them as opposed to fee basis where you say, "I can't meet your demand, here's a chit, go get care," if you have an organized way, the records are shared, they expect to see patients --

Chair Patty Murray: Which goes to the closed system that I think Mrs. Sawyer was referring to, is that correct?

Dr. John Daigh: I think it was -- I think it was along the lines of what she was saying where she was able to go outside the system and get some help that was [turned head from microphone as he continued talking and was inaudbile]. Okay, sorry.

Chair Patty Murray: Mrs. Sawyer, tell me what your experience was.

Andrea Sawyer: We actually were not able to use the fee-based system in the VA because my husband is medically retired. We have TRICARE and so we just simply chose to exercise the TRICARE benefit. It was not in conjunction with the VA. Even requesting fee based at Richmond, even for physical or mental care is a labor intensive process. It takes months, it's not easy to get done, it's really kind of a broken system. So it's -- Even though there has been a directive that people should be able to use fee-basis care in times of wait, you still have to get it approved and it almost takes, pardon the pun, an act of Congress to get it done.

Chair Patty Murray: Well Mrs. Sawyer, in your testimony, let's talk about that. You just told us time and time again you were fighting everything to get appointments, to get attention. Dr. Daigh mentioned needing a "captain of the team." Did you ever feel like there was a captain of the team?

Andrea Sawyer: Quite honestly, I feel like I'm the captain of the team. I feel that I monitor symptoms, I see the increase in symptoms, the decrease in his quality of life and at that time I activate the chain as it is. I call the FRC, I call the clinic, I call the OIF case manager. I do everything I can. The problem is, with the VA, we have found is time and time again I have gone in and said, "We are seeing this civilian counselor." I've said it to the neuro-psychiatrist, I've said it to the person he was seeing in the PTSD clinic, I've said it to his OIF case manager. It's in his records. And yet again and again, I get comments from the PTSD clinic, "We didn't know he was seeing anyone else." I'm sorry. You can Google it and find that he was seeing someone else. We haven't stayed quiet about it. And we just can't get them -- I hand the number over, I ask them to call his counselor, I am his health care power of attorney. Also there's a flag on his chart, I'm supposed to coordinate his medical information because of the cognitive processing disorder. I constantly say, "Please call his counselor." And they don't.

Chair Patty Murray: This is a full time, 24-7 job for you.

Andrea Sawyer: Yes, ma'am.
I gave up my job. In order to keep him alive, that's what I had to do.

Chair Patty Murray: I hear that all the time and it has to have a huge impact on you. Tremendous amount of courage and I think about all the men and women out there who don't have Mrs. Sawyer as the captain of their teams. So I appreciate what you've been doing.

Andrea Sawyer: Thank you.

Chair Patty Murray: Mr. Williams, again, thank you for your service and all of what you're talking about is echoed in many other stories as well. You mentioned getting a hard time to get an appointment. I was curious from you whether any of the mental health care you receive is after hours or on weekends? That's another thing I hear from a lot of people who are trying to have a job, do other things and can't get the care because of lack of after hours or weekend services. Is that something that you've been able to access or see a need for?

Daniel Williams: There needs to be a larger amount of this care, yes. The access -- The only access I have to this is the vet center which is not communicating with the VA actual facility. This is a center where they do after hours counseling, they do marriage counseling. They're really not communicating, to be honest with you. They have no idea what's going on. There needs to be more of it, needs to be more advertised that there is this after hours care that can be used when you have -- You get off at six o'clock? Well have sessions at seven, eight o'clock at night. Uhm, you know, the family members need this care too because the family members have the same or gain the same PTSD or whatever the diagnosis may be as the veteran does. I know as Ms. Sawyer said, she gave up her -- pretty much her life to help her husband. And this is what happens not only to her but I think just about every family. Either the spouse leaves or the spouse stands behind them. And I know if it wasn't for the woman behind me, I would not have any care that I have today because she has given up her job too to take care of me. And there does need to be some more after hours. I know NAMI is partnering with the VA to do Family-Family. Family-Family is a program that helps the service member's family understand why they're doing the things that they're doing, why they're trying to get an adrenaline rush, why they're doing these little quirks that may not make sense to the family.

Chair Patty Murray: This may be a rhetorical question but it seems to me like people like both of you know this system really well, you're families have really borne the burden of this silent disorder of Post Traumatic Stess Disorder and Traumatic Brain Injury. We have a country that says "We're there for our soldiers" but you alone have borne this. Does the country understand PTSD? Do your neighbors and employers and people in the community know what you're going through or do you feel pretty alone? Either one?

Daniel Williams: To be honest with you, I feel very alone. The only other people that understand is my family. And when I say "my family," I mean my wife and other soldiers or other veterans. They're the only ones that understand the actual pain, the invisible pain I live with every day. And it's very, very hard to try to express to the nation. We get condolences, "thank you for your service" -- we hear that very often. But when was the last time someone actually said, "Alright, we need to make a change in the VA center. You need more services." That's the type thanks that I believe -- I take more to heart action than I do words. Because like I said, it's not only my suffering. I suffer from my Traumatic Brain Injury, my wife has to go through it, my kids have to go through it. So this is a never-ending cycle. My kids will have PTSD because of my actions. And if we could put peers together, family members like Ms. Sawyer and my wife together, more times the support for one another, not only for themselves but for us, it would be a stronger VA system. They've got to start looking at family oriented stuff. It's just the veteran [currently] and half the time the veteran can't even get stuff done. I mean it literally takes my wife getting to the point of getting arrested by the VA police to be able to see my psychiatric doctor because people are sitting on their phones, talking on their cell phones during business hours, telling me to hold on a minute, and I'm having a crisis where I'm fixing to honestly have a breakdown. And it takes people, like these two women, to have that. And not every veteran has that. Not everyone is fortunate enough. And I think that needs to somehow be a mentorship to veterans that don't have the support system.

Chair Patty Murray: Mrs. Sawyer, want to add anything?

Andrea Sawyer: Truly, I don't feel that the community understands. We spend a lot of time at the VA going to the VA is never just "go for an hour for an appointment." It's you go, you sit, you have a nine o'clock appointment and you might get seen by eleven. And then the doctor says, "Oh, we're only running two hours late today. That means we're on time." Then we sit for an hour. Sometimes it's not a good appointment then it takes hours for him to wind down. And get home and the neighbors say, "What do you do all day?" I talk to a lot of other caregivers who are in my situation and I've attempted to mentor some of the other caregivers because I do have a lot of time to deal with caregivers that I've met through
Wounded Warrior Project who are at different stages in their recovery. And I've been privileged that they trust me to call and ask: "Okay, we're stuck. What do we do?" We've built our own strong network outside of the VA and that's really what I use to survive. We have a community kind of all to ourselves. We've kind of been ostracized from the community. I left my job teaching. I had great scores, you know for the be-all-to-end-all test at the end of the year that all teachers are judged by whether we say they are or not, great scores. But I had missed a lot of work. It was my fourth year, my tenure year, and it was Loyd's first year after he was retired. We were spending a lot of time at the VA which meant I was spending a lot of time out of the classroom and the principal came to me and told me I had to choose between getting my husband better and teaching. So I left. So, no, the community does not understand.

Chair Patty Murray: Well thank you very much for sharing that with us and, Mr. Williams, I know your wife is sitting directly behind you, we want to thank her for being here as well and all she does for you.

We're going back to Daniel Williams because in his remarks before questioning, he was summarizing his prepared remarks. Like Senator John Kerry, I'm not big on people (mainly government officials) coming in and reading word for word their statements. Beside it being dull, they end up with a false end because the time runs out and they just have to stop or quickly come up with a conclusion in the middle of their statement. Both Daniel Williams and Andrea Sawyer summed up their remarks and did not read their prepared statements. In his oral opening statement (noted above), he noted that his medical conditions and treatment were disclosed to others without his permission. In his written statement, he went into detail on that. I think that's an important issue and understand he had to condense but wanted to include his details on that from the written testimony (prepared remarks):

I was admitted to the psychiatric ward of the base hospital and remained at in patient for two weeks. At this time I was diagnosed with readjustment issues and anxiety disorder but the physicians also acknowledged that I had PTSD. I was told by the doctors that my treatment records would be kept confidential. However, my platoon sergeant was notified and she then proceeded to tell my fellow soldiers which in turn caused much heartache and turmoil for these guys with whom I had gone through war and had shed blood, sweat and tears. They began to look down on me, because in their eyes, I was weak and they thought that I would not be able to do my job, nor could they trust me to go back to war with them if we were called to do so. I think that there needs to be more punishment for non-commissioned officers or any other soldier who has access to soldier's private mental health records and does not keep that information confidential. As in the past and still today, if a soldier has a mental health issue and fellow soldiers learn about it, then confidence is borken and military careers unquestionably are harmed. It took over a year for me to receive my medical evaluation board decision, and during the entire period I felt the effects of almost daily ridicule from members of my unit, a great pressure that affected my PTSD. I felt I let my soldiers down -- that I was of no use to them anymore. I had lost my brotherhood.

No one should have their medical confidientiality violated and it's an important issue so I wanted to include that. At his site, Mike will be covering another aspect of the hearing and Ava will be at Trina's site later tonight ("much later" she says -- we just finished the round-table for the gina & krista round-robin before I started dictating the snapshot) to report on Senator Scott Brown as she usually does. I've got a call in to Kat to see if she wants me to write at her site since she usually covers Ranking Member Richard Burr (Kat's in Hawaii). Tuesday's snapshot covered the first two panels of Monday's House VA Subcommittee on Health hearing and Mike covered the third panel that night with "House Veterans Affairs Subcommittee on Health hearing."

Today Tim Arango (New York Times) reports, "The government of Prime Minister Nuri Kamal al-Maliki is privately telling American officials that it wants their army to stay here after this year." In an analysis piece, Arango reviews some possibilities should the US military stay on the ground in Iraq beyond 2011. Arango notes the increase in attacks on US soldiers (which have resulted in at least 17 deaths in six weeks, possibly 18 and which include wounded and attacks in which no one is injured or killed) and sees it as a possible portent, he notes the belief that Shi'ite militias are being armed by "Iran" (an element in Iran or the Iranian government) and that Nouri al-Maliki seems unable/unwilling to take on the militias ("Recently, the Iraqi Army conducted an operation against the militias in the southern part of the country, the Shiite heartland. But the campaign fizzled with no major arrests, and no significant impact on the militant networks."). Arango notes the disparity in the treatment of Sunni insurgents versus Shi'ite insurgents which includes their treatment in the Iraqi 'justice' system. Arango cites 3 members of Moqtada al-Sadr's Promised Day Brigades being caught by the US military attempting to set a roadside bomb. When the three men appeared before the judge, the judge barred testimony from any of the Americans and found the three not guilty. Arango explains that the White House wants an agreement passed by Parliament -- insisting that's the only way US soldiers would have legal protections. This isn't in Aragno's article, this is me speaking, that's incorrect. The UN mandate, for example, previously governed the US military presence in Iraq and it was not passed by Parliament. There are a variety of options that can be legally pursued. I'm not going to list them because it's not my job to assist the White House in VIOLATING THE CONSTITUTION. What the White House is in the process of doing is negotiating a treaty. They know that. And Joe Biden and Barack Obama called it that when the Bush administration negotiated and pushed through the SOFA. Prior to the 2008 November election, Barack and Joe both called the SOFA a violation, both objected to it and both insisted it would have to go to the Senate for a vote. Within days of winning the 2008 election, they stopped objecting and removed their objections from their offiicial campaign site. Arango doesn't deal with the US Congress. That's not a liability or error. He's based in Baghdad. I wouldn't expect his article to address the Congressional issue. But the White House is attempting to push through a new treaty and the plan is to circumvent the Senate -- ignoring the Advice and Consent clause in the Constitution (Article II, Section 2, Clause 2) -- just as the previous administration did. But, to be clear, the assertion by the US government that the Parliament must sign off on the treaty is incorrect as evidenced by the UN mandate. (Nouri renewed it twice after becoming prime minister, both times without the Parliament's approval, both times the Parliaments moaned and griped -- but it didn't make the UN mandate illegal.) Back to Arango who concludes his article on a new treaty extending the US military stay with this paragraph:

To make this palatable to the citizens of Iraq and the United States, the public relations game is to draft language that is politically acceptable yet obscures the reality that American soldiers will continue to face an enemy, will need to defend themselves and will almost certainly continue to die.

On the topic of withdrawal, Al Mada reports today that a component of the Sadr bloc in Parliament is insisting that although Moqtada al-Sadr said he was freezing the Mahdi Army (due to corruption and an inability to trust them, he said), he's not doing that. He's only, they insist, freezing the activities in relation to US troops and that this is not intended to suggest that they support an extended US presence in Iraq. They are collecting signatures, in Parliament, to oppose the extension of the US military presence in Iraq. Al Mada also reports that that Sami al-Sakari al-Mahdi has stated that the Mahdi militia is in disarray and that State of Law agrees with the decision to dissolve the Mahdi militia because "any military action outside the framework of the Iraqi forces is act outside the law." Dar Addustour reports that a "joint security committee" has been created to determine whether or not the US military should stay beyond 2011 and that the committee is led by Nouri al-Maliki and . . . US Gen Lloyd Austin. They state this joint security committee was formed after the meet-up of political blocs at Iraqi President Jalal Talabani's home on Saturday. The Post-Journal editorial board explains plan-B (shoving the military under the State Dept umbrella to keep it in Iraq) and asks some key questions:

Why is this force - one strong enough to defeat the armies of some small countries - needed? To guard U.S. diplomats, [Under Secretary of State Patrick] Kennedy told members of Congress. To get an idea of how much protection the State Department personnel will need in Iraq, consider that the agency requires only about 1,800 security employees for all the rest of its posts throughout the world.
Kennedy admitted to lawmakers the security force will be used for military-type operations under State Department orders.
That doesn't sound much like the U.S. combat role in Iraq ended last fall. Clearly, President Obama has found a way to claim he has kept his pledge to pull troops out of Iraq while not really keeping it.

Today was an important day for Iraq historically and we'll note it via Tweets. The Washington Post's Ed O'Keefe notes:

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Al Jazeera's Rawya Rageh adds that the revolution led to the establishment of the Iraqi republic.
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Rawya Rageh
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The new US Secretary of Defense Leon Panetta made a number of gaffes -- unless he's trying to come off as the crazed loose cannon -- on his visit to Iraq. That would include his claim that the Iraq War has a connection to 9-11 other than the lies the Bush White House told to sell it and the way they (falsely) linked the two. (Leon Panetta, who knows better, made the same false link while speaking to US soldiers serving in Iraq.) One thing wasn't a gaffe and NPR's Kelly McEvers Tweeted on it today.
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She is correct that, as Panetta spoke, "unilateral" response to attacks would be "force protection." Turning to violence today, Reuters notes 1 man was shot dead in Kirkuk while 2 women were shot dead in Mosul (with "a shop owner standing nearby" left injured). Fang Yang (Xinhua) reports a Sadiyah roadside bombing left six people injured and an al-Abbarh roadside bombing left an "orchard owner and his son" injured.

VA wasn't able to handle the influx this isn't a new war, this has been going on for a very long time. We've been talking about PTSD and TBI and the invisible wounds of war and the high number of soldiers who come back and need access. How can it be that