Tag: veterans

Pentagon Reviewing Care for Veterans Exposed to Chemical Weapons

An October investigation by the New York Times (NYT) has led the Pentagon to review and adjust how it cares for veterans returning from tours in Iraq who believe they were exposed to chemical weapons.  The NYT investigation notes that between 2004 and 2011, American and American-trained Iraqi troops “repeatedly” found chemical weapons and were even wounded by them on “at least” six occasions.  All told, the report states that 5,000 chemical warheads, shells or aviation bombs were found in that time.  It also noted that secrecy was needed regarding the discoveries.  Secrecy surrounding the missions, however, may have put a number of military service personnel at risk as they were not aware of the threat these old munitions were to their health. Also, they were not allowed to discuss with military doctors the nature of their injuries and thus could not receive the proper treatment.

In 2004, the Army sent out instructions for the treatment of exposed soldiers which included collection and analysis of blood and urine samples for all potentially exposed soldiers followed by annual, long-term follow-up appointments – coordinated by the Deployment Health Clinical Center at Walter Reed Army Medical Center – for those who had indeed been exposed.  In addition, incidents of exposure were to be recorded and reported by Command Surgeons and a database maintained by the US Army Center for Health Promotion and Preventative Medicine.  However, the original NY Times investigation uncovered veterans who were never given blood and urine tests, told their symptoms were from something else, and returned to duty before their symptoms were over.  Furthermore, the long-term care they were promised was never followed up on.

Defense Secretary Chuck Hagel moved quickly to correct these issues.  Shortly after the investigation, which only mentioned 17 American service members that were exposed, he ordered an internal review of Pentagon records, specifically the collection of “post deployment health assessments” held by the Army’s Public Health Command.  In a statement following that review, the Pentagon now says that more than 600 American service members reported exposure to chemical weapons in Iraq according to the surveys filled out by troops returning from combat tours.   In the survey, they specifically ask the question “Do you think you were exposed to any chemical, biological and radiological warfare agents during this deployment?”  The Army surgeon general’s office said that 629 of these surveys were affirmative for this question.

The Army and Navy have both made statements that the examinations promised to long-term veterans will start to be available in early 2015.  Furthermore, because the previous policy of secrecy created a lack of records of exposure, the military will be reaching out to units that were possibly exposed to try and find all of the affected veterans.  Finally, there will be a hotline for veterans to call who believe they were exposed to chemical weapons.  Hopefully as the secrecy fades away and outreach continues – these veterans can get the help they need.

Subcommittee Hearing Sheds Light on Opioid Overdose Deaths among VA Patients

On October 10, 2013, the House Committee on Veterans’ Affairs’ Subcommittee on Health held a hearing on the topic of the “VA’s [Veteran Affairs] Skyrocketing Use of Prescription Painkillers to Treat Veterans.”  The committee called on doctors, military personnel, family, and government officials to learn more about the alarming increase of prescriptions to veterans by VA hospitals and its effect on patients.

The problem has been dramatically increasing since September 11, 2001, as a wave of new veterans returned home from the multiple theaters of the War on Terror.  The Center for Investigative Reporting has found that prescriptions of four drugs – hydrocodone, oxycodone, methadone, and morphine – have been prescribed 270% more over the past 12 years and contributed to a fatal overdose rate of double the national average among VA patients.  In addition, a study by the San Francisco VA Medical Center found that patients with PTSD and depression were more likely to receive higher-dose opioid prescriptions, 2 or more opioids concurrently, sedative hypnotics concurrently with other opioids, or obtain early opioid refills.  This is despite the fact that opioids can hinder recovery from PTSD and other mental health conditions.

One contributing factor is the sheer number of patients, therefore limiting the amount of doctor-patient time that would otherwise be afforded in VA hospitals.  Josh Renschler, Sergeant US Army (Ret.), spoke at the hearing about how his primary care VA appointments would sometimes be 3 months apart despite the pain from a mortar attack in 2008 being “wildly out of control.”  Between appointments, the only care he could receive was increased prescriptions, causing him to take up to 12 pills a day, some of which were prescribed simply to counteract the effects of others.  Another contributing factor to the increase in opiate prescriptions is veterans’ limited access to help outside the VA.  A submission to the hearing by the Iraq and Afghanistan Veterans of America (IAVA) noted that some barriers to treating chronic pain included “formulary barriers, inability to access state prescription monitoring programs (which would allow [medical personnel] to see if patients have previously been prescribed controlled medications like opioids), and barrier[s] to consulting with experts outside of the VA.”

In some cases, doctors do not want to prescribe opioids, but are forced to by the hospital administration.  One doctor at the subcommittee hearing, Dr. Pamela J. Gray, recounted that she was forced to prescribe opioids against her better judgment.  She was hired by the VA Medical Center in Hampton, Virginia where she was forced into a “pain specialist” role even though she had no prior specialized training.  She explained that she dealt with difficult pain patients with “large doses of Schedule II narcotics.” (Schedule II narcotics are those with medical benefits that otherwise have a high risk of abuse and dependency.)  When she attempted to move away from opioid prescriptions, she received pressure from service chiefs, nurses, the Chief of Medicine at the hospital, and even non-medical personnel such as patient care advocates and administrative assistants to keep her prescription rates steady.  Her continued efforts to reduce prescriptions and even to help patients seek mental health consultations eventually cost Dr. Gray her job.

The VA is aware of the problem and working towards a solution.  In 2009 it implemented VHA [Veteran’s Health Administration] Directive 2009-053 which, among other things, provided a plan to treat pain in VA patients. The plan included behavioral and mental health monitoring, physical rehabilitation, use of advanced diagnostic services, seeking of specialty consultations, and monitoring effectiveness of prescribed drugs to determine if they should continue to be used.  However, despite recognizing the severity of the problem and that more complex treatments are needed, prescriptions continued to rise.