Simmering tensions between members of the House Veterans Affairs Committee and officials at the Department of Veterans Affairs boiled over this week following an IBTimes report that the veterans department had substantiated three ethical lapses -- one of which involved veteran suicides -- cited last March by an agency whistleblower.
U.S. Rep. Jeff Miller, R-Fla., chair of the House Veterans Affairs Committee (HVAC), told IBTimes this week that at a January briefing, a VA official told a member of his HVAC staff that the agency did not follow up on some veterans who admitted to having suicidal ideas during a health study on veterans -- and who later committed suicide.
“My staff contends that during a Jan. 3, 2014, verbal briefing, VA officials confirmed that VA personnel did not follow up on some veterans who admitted to suicidal ideation -- and who later committed suicide -- during a study of Gulf War veterans,” Miller said. “If VA contends there was a miscommunication, it was only brought on by VA’s lack of transparency and reluctance to provide the committee with written details of its investigation into Dr. Coughlin’s allegations."
VA has confirmed some of the lapses cited by whistleblower and former VA epidemiologist Dr. Steven Coughlin in testimony before the HVAC's Subcommittee on Oversight and Investigations, but insists the agency does not know if any of the veterans from the study later committed suicide.
Coughlin claimed that the VA failed to follow up with nearly 2,000 veterans who reported in what was known as the “New Generation” study of veterans by the agency’s Office of Public Health (OPH) that they had suicidal thoughts.
“Some of those veterans are now homeless or deceased,” Coughlin said at the hearing. “I was unsuccessful in getting senior OPH officials to address this problem in the study.”
Curt Cashour, a senior HVAC staff member, told IBTimes that at that January briefing, Dr. Robert Jesse, VA’s principal deputy undersecretary for health, told Eric Hannel, the oversight and investigations subcommittee’s staff director, that some veterans who were not followed up on later took their own lives.
Hannel declined a request for an interview for this story. But Rep. Miller stands by Hannel's contention.
Asked about VA’s reported admission at the briefing that some veterans had killed themselves, the agency declined to comment on the record. Instead, its press office provided IBTimes with the results of an unrelated OPH study in which there were no proven suicides.
When asked again this week, a VA spokesperson said that the agency rejected the HVAC's contention. "In these briefings, no VA official nor staff present at the meetings stated that veterans had committed suicide when [study participants] were contacted for follow-up," said the spokesperson.
There are three VA health studies at issue:
- - The National Health Survey of Gulf War Era Veterans and Their Families (“National Health Survey”) (1995-2001) included 15,000 deployed and 15,000 non-deployed veterans and their families in a study of adverse health outcomes associated with the Persian Gulf War (follow-up study in 2004-2005).
- - The Health Surveillance for a New Generation of U.S. Veterans (“New Generations”) (data collected 2009-2011) included 30,000 deployed and 30,000 non-deployed Operation Enduring Freedom/Operation Iraqi Freedom veterans in a study of chronic medical conditions, post-traumatic stress disorder (PTSD), other psychological conditions, general health status, reproductive health, pregnancy outcomes, behavioral risk factors, etc. On this study, Coughlin was a co-investigator.
- The Follow-Up Study of a National Cohort of Gulf War and Gulf Era Veterans (“Gulf War Follow-Up Study”) (data collected 2012-2013) included 15,000 deployed and 15,000 non-deployed veterans in a follow-up of a 1995 National Health Survey to study chronic medical conditions, PTSD, other psychological conditions, general health status, Chronic Fatigue Syndrome (CFS), Chronic Multisymptom Illness (CMI), etc., 20 years post-deployment. On this study, Coughlin was principal investigator (PI).
During the Gulf War Follow-Up Study’s initial pilot study of 167 veterans, six veterans said they had suicidal thoughts; that was on Aug. 1, 2012. But the VA does not know if any of those six have committted suicide since that date, according to a spokesperson.
Dr. Tom Puglisi, executive director of VA’s Office of Research Oversight, which looked into Coughlin’s charges, acknowledged this week that he and Jesse conducted the review of Coughlin’s allegations and briefed HVAC staff about that review in January. But Puglisi would not say whether any veterans in any of the studies on which Coughlin worked who identified themselves as suicidal and were not followed up on immediately by VA later committed suicide.
When asked that question, Puglisi responded by saying that the veterans in these studies “were not in VA facilities when they participated. These studies were paper-and-pencil surveys mailed to veterans who returned the surveys by mail or responded through a computer website. A small percentage were interviewed by telephone.”
But several veterans sources told IBTimes that VA had those veterans’ names and contact information and could have quickly and easily connected them with a mental health professional as soon as they learned from the mailed-in surveys that the veterans had suicidal thoughts.
In the official review of Coughlin’s allegations, VA writes that the “lack of active follow-up for suicidal ideation in the online and paper-and-pencil surveys from the New Generation Study was not considered problematic” by VA’s Institutional Review Board (IRB) at the time the study was conducted, and that the approximately 2,000 veterans who expressed suicidal ideation “were not at that time considered to be at undue risk.”
Coughlin’s Charge Stands
The VA confirmed that it demonstrated a lack of immediate concern for some veterans who said they had suicidal thoughts. The agency said in its response to Coughlin's charges that “there was a delay in follow-up of suicidal ideation for 167 veterans who completed surveys in the pilot phase of the Gulf War Follow-Up Study.”
The VA says Coughlin’s claim about the nearly 2,000 veterans has not been substantiated and contends there have been no suicides. But the agency’s decision not to comment on the specifics of the New Generation study raises questions: Has VA followed up with all of the nearly 2,000 veterans referenced by Coughlin in the study? And if so, how many are deceased and what were their causes of death?
Miller said VA routinely refuses to engage in constructive and honest conversations when challenged, and routinely ignores media inquiries and congressional requests for information, of which there are more than 100, some dating back more than a year. He noted that while VA completed its investigation of Coughlin’s charges report on July 5, 2013, the department didn’t brief HVAC staff until nearly six months later.
“And even then, department officials only provided a verbal rundown of the report’s findings, would not provide a copy of the actual report, and did not provide any written documentation that would have eliminated confusion as to the contents of the report,” Miller said. “We’re committed to providing the public with timely and accurate information regarding the conduct and performance of the department, but we can only do so if we have VA’s full cooperation. In this case, we didn’t get that.”
Glenn Bergmann, a former VA litigator who is now a partner at Bergmann & Moore, which represents veterans in VA disability claim appeals, said, “I am shocked that VA apparently does not have a process to follow up when our vulnerable veterans are identified as part of a study, especially suicidal veterans or veterans with severe posttraumatic stress disorder.”
VA did say this week that Coughlin’s charges have led to changes in protocol for dealing with suicidal tendencies among veterans in its studies. Puglisi said that among other things, OPH leaders participated in “targeted human resources training in dispute resolution, reasonable accommodations, dealing with employee medical information, and supervisory practices and standards.”
Veterans’ Mental Health is VA’s 'Highest Priority'
Anthony Hardie, a Gulf War veteran and longtime veterans advocate who has provided testimony before Congress on veterans’ health, said that as soon as VA learned that veterans were suicidal in these studies, by mail or phone, “they had an absolute obligation to do something about it. And they didn’t.”
Hardie said that when he served in the Gulf War, he did not lose a single person he served with. “Since then, I have lost a number to suicide, and a lot of this has to do with Gulf War illness,” he said, referring to the mysterious and debilitating illness that afflicts 250,000 veterans, according to the Institute of Medicine. “When your health is so bad and quality of life is so poor, you’re so sick and weak and you’re in chronic pain, and you know there is no treatment, contemplating suicide for many veterans is unfortunately a natural next step. I know, because like countless Gulf War veterans, I’ve been there myself. VA has failed in its research on Gulf War illness. There is still no treatment two decades later, and suicide is sadly one of the tragic results of this failure.”
Puglisi insisted that the mental health and wellbeing of veterans is VA’s “highest priority,” and that “even one suicide is one too many. That’s why VA has put into place an intensive, multi-pronged effort to expand its suicide prevention programs and data systems to increase understanding and prevention of suicide among veterans.”
Yet it seems that this "expansion" happened only because of a 2007 lawsuit brought by Veterans for Common Sense (VCS), a veteran advocacy organization. Michael Zacchea, a VCS board member who is a retired Marine lieutenant colonel, said the suit “addressed VA’s failures to recognize the burgeoning mental health crisis that manifests itself in suicides. I don’t believe VA would have had anything like this if not for the ongoing political and legal pressure put on the department.”
The suit was filed July 23, and one week later the VA linked up with the civilian Suicide Prevention Lifeline -- 1-800-273-TALK (8255) -- and added a feature for veterans seeking help in which they can press 1 and be directed to a VA hospital.
In 2008, VA put suicide prevention counselors in every facility. That, too, was the result of the VCS lawsuit, said Zacchea, who noted that the suit was very effective in forcing VA to make changes despite the fact that the case ultimately was not heard last year by the Supreme Court.
Zacchea said the lawsuit was filed because VA had failed to implement a mental health strategic plan, and one of requirements in the lawsuit was that there be a mental health suicide expert in each VA facility. "One reason why VA was turning away suicidal veterans was because no one was able handle veterans who came into hospital in a suicidal state," Zacchea said.
While VCS continues to apply pressure, so does Miller. Last July, the lawmaker, whose committee is one of the few effective bipartisan committees in Congress, launched a Trials in Transparency Web page with HVAC ranking member Mike Michaud, the Democratic congressman from Maine. The site highlights the instances in which VA has not provided Congress with requested information.
“VA’s widespread and systemic lack of accountability is exacerbating all of its most pressing problems, including the department’s stubborn disability benefits backlog and a mounting toll of preventable veteran deaths at VA medical centers across the country,” Miller said. He suggested that what VA leadership fails to understand is that to overcome VA’s challenges, it must acknowledge them to Congress and the public -- two groups that Miller said are actively pulling for VA to succeed.
“But rather than working with its supporters to solve its problems and better serve America’s veterans, VA continues to downplay or ignore some of its toughest challenges, treating each one like an impending public relations crisis -- one in which to admit mistakes would be to admit defeat,” he said. “But this isn’t about PR. It’s about problem solving. Until VA leaders realize this, the department’s most serious problems will persist. In the meantime, America’s more than 20 million veterans continue to wait for solutions.”