Will Health Care Look Like the V.A.?

The hidden cost of healthcare at the VA: loss of privacy and possible loss of Constitutional rights. In the area of mental care, the VA uses the conroversial and unreliable DSM IV.

For the purpose of determining the extent of damage to a veteran, the VA uses a "scale" to rate the vet. It is known as the GAF and it is included in the DSM lV, called "the bible" by VA psychologists; there have been four versions and a fifth's debut is anticipated for 2012:

"Perhaps more significantly, they said, DSM-V is likely to include dimensional assessments in addition to the familiar symptom checklists from past versions of the "psychiatrist's bible."

Since it was first published in 1952, the DSM has provided the definitive word on what is and is not mental illness, with enormous influence within medicine and on the world beyond.

The elimination of homosexuality as a mental illness in the third DSM edition issued in the 1970s, for example, is now widely viewed as a watershed development in changing society's view from outright hostility to varying degrees of acceptance.

DSM-V is on track to be published in 2012, capping 13 years of literature reviews, commissioned research, and intensive discussions among more than 160 mental health professionals."

http://www.medpagetoday.com/MeetingCoverage/APA/14270

In the example cited above, it should be clear that cultural,social, and philosphical variations between the psychiatrist and the veteran could be crucial when the conclusions of the psychiatrist, based on the DSM, are assumed to be the qualifying factors for compensation and the terms of the compensation denied or granted by the bureaucrats at the Veterans Benefits Administration, all of whom at the most senior levels, are political appointees. The result of this process was the deliberate misdiagnosis of veterans with PTSD:

" The chairman of the House Veterans Affairs Committee plans a summer attack on the military's disability review system, hoping that congressional hearings focusing on what he called the 'terrible scandal of deliberate misdiagnosis' of mental health problems could lead to an overhaul of government policies.

Rep. Bob Filner, D-Calif., said he expects to have veterans testify they were improperly diagnosed as having pre-existing personality disorders rather than post-traumatic stress disorder, a move that denies service members military disability benefits and could, under some circumstances, even leave them with no post-service veterans' benefits if their mental health problems have led to misconduct, such as abuse of alcohol or drugs.

'This is a real scandal, in my opinion, to save a few dollars ... that wrecks lives,' Filner said Thursday in a meeting with reporters to talk about committee plans."

http://www.armytimes.com/news/2007/06/military_misdiagnosedvets_070628w/

The vague and sometimes strange categories in the DSM have been widely critized for decades and one of its pricipal authors admitted the short-comings of the DSM as a diagnostic tool:

"DSM chief author Robert Spitzer recently admitted on BBC TV: 'What happened is that we made estimates of the prevalence of mental disorders totally descriptively, without considering that many of these conditions might be normal reactions which are not really disorders. That's, that's the problem, because we were not looking at the context in which those conditions developed.'

In every case of psychiatric abuse that CCHR International has ever dealt with, if there was no life upset, then there was an underlying, neglected physical condition at the root of symptoms and behavior which was then wrongly labeled as a 'mental disorder.' For instance, undetected brain tumors or food or environmental allergies which manifested as sleep disturbance or inexplicable sensations are often given a DSM diagnosis and then "treated" with one or more powerful, mind-altering, life-threatening psychiatric drugs.

DSM's authors state that they do not know the cause of any mental disorder. So, it is not surprising that there are no objective tests for mental illness (if they don't know the cause, then what would they test?). It is foreseeable that the psychiatric establishment will eventually have to concede that their diagnostic system is completely subjective and that no one ever labeled with a DSM disorder had any mental illness.

But psychiatrists and psychiatric expert witnesses are counting on plaintiffs and their attorneys to not be aware of the grave shortcomings of their diagnostic system. Recently, CCHR International provided a personal injury attorney with information on the DSM's lack of scientific credibility. She had this to say: 'I did the deposition of the defendant's psychiatric expert. I did some major damage! Defense counsel just about jumped out of their skin when I brought up the fact that the DSM says that there is the potential for misuse or misunderstanding in forensic psychiatry because of the imperfect fit between the ultimate concerns of the law and psychiatry!'

It may be the American Psychiatric Association's Fifth Amendment right to publish a book that catalogs behaviors and calls them mental disorders but when that theory is applied to the lives of individuals, with often catastrophic results, it becomes another issue entirely."

http://www.psychcrime.org/articles/Editors_of_Psychiatrys_Diagnostic_Manual_Admit_Its_Unreliability.html

The DSM is flawed and the flaws are made worse by the personal/poiltical/social beliefs of the medical person using the DSM and its GAF scale at the VA even as recently as last year:

"Recently released documents from the Department of Veterans Affairs (VA) are further proof the VA has failed to adequately address the crisis in veterans' mental health care, according to a former VA employee turned veterans' advocate.

In March, Norma J. Perez, the post-traumatic stress disorder (PTSD) coordinator at a VA facility in Temple, Texas, wrote an email (PDF) to her subordinates stating: 'Given that we have more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out. Consider a diagnosis of adjustment disorder, R/O [ruling out] PTSD ... we really don't ... have time to do the extensive testing that should be done to determine PTSD...

New VA documents obtained exclusively by VCS using the Freedom of Information Act indicate the VA is only paying disability benefits for PTSD to 33,247 Iraq and Afghanistan Veterans, although 67,717 have been diagnosed with PTSD. According to Sullivan, VCS is calling for an investigation into this apparent discrepancy.

A Government Accountability Office (GAO) report in September 2007 stated that the VA's 'lack of early identification techniques' led to "inconsistent diagnosis and treatment" of PTSD and Traumatic Brain Injury. According to the GAO, early diagnosis is essential in preventing PTSD's consequences - which could be deadly. "

http://www.truthout.org/article/veterans-attest-ptsd-neglect-va

In their landmark book, "The Selling of the DSM," authors Stuart A. Kirk and Herb Kutchins continued the theme of their earlier works in presenting convincing arguments and case histories that that the DSM lll was seriosly flawed and left vets to dismal fates, notably suicide. As we have seen, the flaws of the DSM IV are similar in nature--and consequences. Early in the book, they write:

"Redefined as a technical problem, diagnostic reliability lost its simpe, intuitive meaning to its practitioners and became, in the hands of a few teams of research psychiatrists, complex and mysified"

http://books.google.com/books?id=_crqUmHz7mEC&dq=selling+dsm&printsec=frontcover&source=bn&hl=en&ei=tUZPSs2PBomEtweikZCiBA&sa=X&oi=book_result&ct=result&resnum=7

The continued use of a mystical "bible" for diagnoses ( though this use is unconvincingly denied ) will always suffer from the quirks of societal beliefs, ideological beliefs, the politics of bureacracies, and the strong urge of psychiatrists to sound absolute and scientic in their use of catagories of jargon. The vet meanwhile wioll continue to be denied the services and benefits that common sense could provide.

"'The committee strongly concludes that the best way to determine whether a person is suffering from PTSD is with a thorough, face-to-face interview by a health professional trained in diagnosing psychiatric disorders,' Mayeux said.

In asking the IOM to evaluate and confirm the DSM-IV criteria, the VA was not seeking to challenge the criteria but to provide validation of those criteria to those who did challenge them,' said Ira Katz, M.D., Ph.D., deputy chief patient care services officer for mental health at the VA. 'The goals were very well met.'

Acceptance of the DSM-IV criteria meant that new, idiosyncratic standards need not be created and verified, a major concern for Darrel Regier, M.D., M.P.H., executive director of the American Psychiatric Institute for Research and Education and director of APA's Division of Research.

'Frankly, I'm surprised that things went so smoothly,' Regier told Psychiatric News. 'A panel of experts agreed that the present criteria were evidence based and that there were plenty of assessment instruments to use.'

Separating diagnosis from treatment and disability was a good choice because the latter two issues probably lay more at the heart of the VA's concerns, said Regier."

http://pn.psychiatryonline.org/cgi/content/full/41/14/1

You may remember that Dr. Katz also said that suicde among vets, like cancer, would always be with us. What he did not say was that denial of those benefits could result in suicide, which clearly is the case. Dr. Regier also did not say that evidence is not proof and therein lies the danger presented by bias among psychiatrists.

http://davidemeadows.newsvine.com/_news/2009/07/05/2994849-the-va-uses-faulty-testing-to-deny-benefits-to-veterans

Also, the care by the VA is so bad that it has led to suicides:

The situation with veterans being denied benefits is one reason the suicide rate is so high. As heatless as this sounds, the reality is that veterans may have money in VA accounts and they are denied the use of that maney and money from their monthly compensation checks. This creates a financial strain on the veteran and reduces the veteran's sense of self to the point that the thought of iiving as a ward of the State without power over his own life becomes intolerable and suicide results. Convincing a VA bureaucrat that he/she is the cause of suicide is impossible, because the VA bureacracy beleives that it knows best when it coms to the distribution of benefits for vets. The vets also may self-medicate the drugs and/or alcohol to reduce the feeling of irrelevance in his life and the VA uses this fact as a reason to continue the denial of benefits to the vet. The spiral toward suicide BECAUSE OF THE VA ITSELF therefore is SYSTEMIC and self-perpetuating.

How bad is the problem? From a case late last year:

"SAN FRANCISCO — The U.S. Department of Veterans Affairs may paint a rosy picture of improving healthcare for veterans, but the agency has systematically denied benefits to sick veterans and delayed claims so long that many of them commit suicide, a lawyer for two advocacy groups argued in federal court Monday.

'The court faces an agency that is in denial and a healthcare system and an adjudication system that are broken down and in crisis,' said Gordon P. Erspamer, one of the plaintiffs' attorneys, in an opening statement in the class-action suit against the VA.

The lawsuit was filed in U.S. District Court on behalf of Veterans for Common Sense, based in Washington, D.C., and Veterans United for Truth, based in Santa Barbara. It does not seek damages, but wants the court to compel the department to improve the care of hundreds of thousands of veterans suffering from post-traumatic stress disorder.

The veterans' lawyers displayed new documents on the court's computer monitors. Included were two e-mails among VA officials conferring about the suicide rate of veterans. The officials said four to five suicides a day and 1,000 attempted suicides a month were occurring among people receiving care from the VA.

One of those e-mails, by Dr. Ira R. Katz, VA deputy chief of the Patient Care Services Office for Mental Health, began with the word, "Shh!"

The e-mails 'show how bad the situation is,' Erspamer said. 'They're keeping it a secret because they're embarrassed by it.'"

http://articles.latimes.com/2008/apr/22/local/me-veterans22

As late as last year the VA was engaged in a cover-up of how many vets are commiting suicied and the fact that they were denied benefits:

"Earlier in the day, Senator Murray delivered a speech on the Senate floor to urge passage of the bill. In the speech, she also condemned the Department of Veterans Affairs (VA) for purposely withholding critical information on the rising number of veteran suicides.

Internal e-mails, which became public in a court hearing, show that the VA has vastly downplayed the number of suicides and suicide attempts by veterans in the last several years. The e-mails from the VA's head of Mental Health, Dr. Ira Katz, show that 6,570 veterans committed suicide in 2005, a number significantly higher than the VA had publicly stated.

Senator Murray called for Dr. Katz's resignation earlier this week. "

http://murray.senate.gov/news.cfm?id=296782

The VA adopted a laughable suicide prevention hotline and failed to implement programs that woulkd benefit veterans:

"The problems persist because "VA has not implemented critical provisions, involving suicide prevention, required by its own plans, the veterans advocacy groups alleged in court papers. "As such, services to which VA acknowledges veterans are entitled are being unreasonably delayed, in some instances denied entirely because the delay leads to the death by suicide of individual veterans."

"An injunction compelling VA to implement its own directives is both appropriate and required," the advocacy groups said in an appeal brief. "At a minimum, a remand is necessary to remedy the district court's erroneous discovery rulings and 'systemic' evidentiary standard."

Two years ago, Veterans for Common Sense and Veterans United for Truth sued the VA, alleging some war veterans were turned away from VA hospitals after they sought care for PTSD and later committed suicide."

http://www.opednews.com/articles/Crisis-at-the-VA-as-Benefi-by-Jason-Leopold-090605-678.html

The leadership at the VA has shown a callous attitude toward the suicides, calling them ae inevitable as cance:

But according to a November 2006 report by the Government Accountability Office (GAO), spending for the program was substantially less than what the VA had proposed - leaving untreated tens of thousands of veterans who were at risk of suicide.

" In June 2007, in response to a VA inspector general's report that also criticized the VA's failure to implement the MHSP, William Feeley, the VA's undersecretary for health, operations and management, issued a memo requiring VA hospitals and outpatient treatment centers to provide urgent mental health care within 24 hours and nonurgent care to veterans within 14 days.

But Feeley, who was one of a handful of VA officials who received lucrative bonuses in 2006, admitted in a deposition last year that he never conducted any oversight to ensure his directives were being adhered to. In that deposition, Feeley said an uptick in veterans suicides and suicide attempts did not mean VA failed to provide proper care to veterans.

'A suicide does not mean negligence on the part of a medical center director or a network director,' Feeley said. 'Suicide occurs just like cancer occurs.'

http://www.truthout.org/060509A

A recent study showed a relationship between vets who were given money, and not denied it, and an improvement in the vets' attitude about life. Also, the study showed that giving the vets cash, instaed of holding and spending it for the vet, did not lead to an increase in drug or alcohol problems.

"RESULTS: Beneficiaries (N=50) did not differ from those were denied benefits (N=123) on any baseline sociodemographic or clinical characteristics. However, beneficiaries were more willing to delay gratification, as reflected in scores on a time preference measure. Three months after the initial decision, beneficiaries had significantly higher total incomes and reported a higher quality of life. They spent more on housing, food, clothing, transportation, and tobacco products but not on alcohol or illegal drugs. No differences were found between groups on standardized measures of psychiatric status or substance abuse. CONCLUSIONS: Receipt of disability payments is associated with improved subjective quality of life and is not associated with increased alcohol or drug use. "

http://psychservices.psychiatryonline.org/cgi/content/full/51/12/1549

http://davidemeadows.newsvine.com/_news/2009/06/27/2975386-veterans-denied-benefits-commit-suicide

I woulsd also add that the VA's computer system, which Obbama likes. is not secured. I have an investigation going now about a clerk at the VBA who accessed my (I thought) private medical records. Anyone with access to a puter terminal can invade your privacy.

I've always heard wildly different stories of the VA. Being that visiting a doctor or having surgery requires some of the deepest trust you can place, it typically brings up strong opinions from people. It's highly intimate, and even the slightest of mistakes can effect a person permanently. The stories from veterans going to the Milwaukee-area VA have all been of the horror variety. Had that VA not been so slow, my grandfather would likely be alive today. I can't place 75 years of a bad diet on them but still, they dragged their feet on him and many others.

So the only rational conclusion I can come up with on healthcare in general is: needs improvement. And I will always come with that conclusion no matter how well the field of medicine improves.