Senate Democrats

The Iraq Accountability Project: A Wrap-Up of This Week’s Senate Oversight on Iraq

This week Senate Democrats continued to pursue aggressive oversight of the President’s conduct of the war. Senate Democrats are united in their determination to hold the President accountable for his failed strategy in Iraq.

Thursday, May 17th

Senate Select Committee on Intelligence

Closed Mark-Up: Fiscal Year 2008 Intelligence Authorization Bill

Wednesday, May 16th

Senate Committee on Veterans Affairs

“Hearing on the nomination of Dr. Michael J. Kussman to be the Under Secretary of Veterans Affairs for Health.”

Senator Murray expressed concern that the Veterans Administration has tried to minimize the costs of the war in both money and lives.

SEN. MURRAY: [I have] serious doubts about the level of frankness we can expect from a VA that has tried to minimize the cost, both in money and in lives, of this war. Over the past several years, I have witnessed the VA transform itself into an agency that guards information like a mother bear guarding its young….

We are all pretty cautious about information we receive from the VA, and I’m really looking to find somebody in this position that we can trust, that will bring about a culture of change.

A representative of the Veterans of Foreign Wars testified that Dr. Kussman is well suited to address the challenges in veterans’ health care that our nation faces.

ROBERT E. WALLACE, EXECUTIVE DIRECTOR, WASHINGTON OFFICE, VETERANS OF FOREIGN WARS OF THE UNITED STATES: Certainly the system is not perfect. Access, especially for specialty care, continues to be a challenge; although we would argue that this is a function of a lack of dedicated and on-time resources, not one of administration. Once in the system, veterans are very pleased and typically receive the best of care. There have been some high profile examples recently where this has not been the case, and I do not want to make light of them, but we are confident that Dr. Kussman’s leadership, and his strong desire and dedication to improving VA health care will do much to fix these situations. Dr. Kussman has demonstrated a deep concern about the health issues facing all veterans, especially those with specialized needs, and those serving today. He wants to have VA learn more about traumatic brain injuries as well as improve on the delivery of mental health care.

One of the challenges he will face is finding qualified clinicians who fully understand the new challenges brought on by the war, and to help the thousands of returning service members who need first-rate mental health care and specialized services. We are confident that he is up to the challenge.

Many of the issues and challenges VHA faces today will be helped by Dr. Kussman’s military experience. All of us in Washington have been talking about a true system where DOD and VA create a seamless transition for military personnel to veterans’ status. We believe that if anyone can make that happen, it is Dr. Kussman, because he understands both systems and knows the necessity of creating such a system for the care and treatment of our wounded warriors, ensuring that they receive the benefits they have rightly earned by their honorable service to our nation.

The President of the Association of VA Social Workers testifies that Dr. Kussman is committed to seamless transition for our nation’s veterans.

DOUGLAS H. MITCHELL, JR., PRESIDENT, ASSOCIATION OF VA SOCIAL WORKERS: I believe Dr. Kussman is committed to making the transition from active duty military to veteran status and community life as seamless as possible. In August 2003, Dr. Kussman started the seamless transition program. He placed a VA social worker at the Walter Reed Army Medical Center to help transfer active duty patients to VA medical centers. Within a few months, a second social worker was added. Today, we have 14 social worker liaisons at 10 military hospitals. Dr. Kussman supports the liaisons and knows them by name. In Phoenix, our case managers interact often with these individuals. Dr. Kussman is committed to the best quality care possible for all veterans. But he is particularly concerned with the severely-injured OEF/OIF veterans. The second phase of seamless transition included a case management program to ensure that no veteran falls through the cracks. Every VA medical center has nurse or social worker case managers who follow their patients wherever they go — inpatient to outpatient to the community.

Dr. Fred Frese, a representative from the National Alliance on Mental Illness calls on Dr. Kussman to ensure that sufficient funds are provided for VA mental health programs, advocates effective Congressional oversight to ensure adequate investment and care.

FRED FRESE, PH.D., NATIONAL ALLIANCE ON MENTAL ILLNESS: As consumers and monitors, we know the VA programs that treat mentally ill veterans certainly need more funding–for professional and support staff, administrative help, program development, technology, equipment, furnishings, infrastructure, family caregiver respite and other supports. Our veterans in need of care for serious mental health conditions, whether new veterans from current wars or veterans from previous military service periods, depend on the good will of such promises. We ask your Committee to monitor VA’s investments and programs in mental health care to guarantee funding will remain available and will be used for the purpose for which it is intended.

On the ground every day we see the effects of what the national veterans’ service organizations have reported through the Independent Budget for years: chronic under-funding of veterans’ health care. Funding shortages and emergency supplemental appropriations, combined with the regular employment of Continuing Resolutions as stopgap measures to provide financial resources for VA health care, have caused deterioration in many VA programs, including those about which we are concerned. We are particularly concerned that VA’s “National Mental Health Strategic Plan” to reform its mental health programs, has been stalled by VA’s over-arching financial problems. … We hope Congress will closely monitor VA’s implementation of the new strategic plan to ensure it meets that promise.

Dr. Frese calls Dr. Kussman and Congress to ensure that the needs of returning Afghanistan and Iraq veterans are met, warning that their mental health needs are growing and will not be fully recognized for many years to come.

DR. FRESE: While we very much want to agree with the sentiments of Dr. Kussman, that the vast majority of our soldiers, sailors, marines, airmen and Coast Guardsmen are repatriating whole and healthy, with temporary adjustment problems, some reports are not encouraging. About two of every ten serving members are experiencing problems of a magnitude about which we all should be concerned. About 70,000 individuals have so far touched VA with some kind of mental or emotional challenge in post-service life. …Another outcome of these wars is the unknown degree to which “mild” and “moderate” traumatic brain injury (TBI) is going to manifest into behavioral, medical and psychosocial problems later. Thousands of our troops have been exposed to massive explosions in Iraq and Afghanistan but have come away apparently “unharmed” according to our current technology to measure harm. We believe the complete story of those exposures is yet to be told. Mr. Chairman, while many say that TBI is the “signature injury” of these wars, we believe the picture is more mixed, with a large burden of the war legacy expressing itself in mental and emotional damage from both TBI, post-traumatic stress disorder (PTSD), depression, substance abuse and other problems. We hope the Committee as well as the VA will remain vigilant and sensitive to the needs of this new generation as time goes by, because their needs are going to exist long after cessation of deployment of our forces into Southwest Asia. In this instance both Congress and NAMI need to depend on Dr. Kussman’s judgment to ensure these needs are addressed with sensitivity and care.

Dr. Kussman declared his commitment to fixing the mistakes that have been made in the health care of our veterans.

Dr. Michael J. Kussman, Acting Under Secretary for Health, Department of Veterans Affairs: Our care for OIF/OEF veterans has not been perfect by any means. We continue to learn what world-class care means to this new generation of service members and veterans–and to their families. Their expectations have raised the bar for our success, and we must continue to improve in order to meet those expectations.

When things have not gone well for individual veterans, I have listened intently–and then done whatever I could to insure that whatever mistakes we made will never happen again. It’s true we’ve made some errors, but we have accepted responsibility for those errors, and we will fix them properly, whatever the cost may be. We have learned–and we will continue to learn–from what we have done wrong. If you confirm me as Under Secretary, that is how we will do business throughout my tenure.

We are now focusing on some basic questions: are our waiting times, and our wait time measures, appropriate; are customers satisfied with their service; and are employees satisfied with their work. I believe, and I know members of Congress believe, we can do better in these areas….

I do not believe that the quality of our business processes matches the quality of the health care we provide. Among other things, we must be able to properly handle the sensitive personal information our veterans entrust to us.

Every VA employee, especially our managers and supervisors, has a duty and responsibility to protect sensitive and confidential information. I have worked with Secretary Nicholson and others to ensure that VHA is in the first rank of those who are helping to make our Department the gold standard in information security.

Dr. Kussman set forth the principal challenges in meeting the needs of our nation’s veterans.

DR. KUSSMAN: Make no mistake, however–I believe VHA has done an exceptional job of meeting the needs of our newest generation of veterans, and we have received remarkable support from the President and from Congress. But we still face many challenges. Among them are:

  • To improve our level of collaboration with our partners at the Department of Defense;
  • To enhance our ability to treat veterans with severe traumatic brain injuries, and to detect mild to moderate TBI where brain injuries are not immediately apparent;
  • To continue our search for the most effective therapies for Post-Traumatic Stress Disorder, and ensure those therapies are quickly distributed throughout our system and elsewhere;
  • To improve access for all enrolled veterans to our world-class care, from our newest veterans to our oldest; and
  • To meet the goal of the President’s New Freedom Commission on Mental Health to emphasize recovery, not stabilization, for every mentally ill veteran.
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