In March 2011, former Marine Clay Hunt faced a life full of promise. Having survived a gunshot wound and combat tours in Iraq and Afghanistan, he traveled to Haiti to do humanitarian work, had a new job and was shopping for a truck.
Hunt was considered by many a poster-boy for suicide prevention, a veterans advocate who worked with Team Rubicon and Iraq and Afghanistan Veterans of America to raise awareness of post-traumatic stress disorder and the need for expanded care for post-9/11 veterans.
But below his upbeat, gregarious manner, Hunt struggled. When he moved to Houston in early 2011, he sought care at the Veterans Affairs Department hospital to make medical appointments for his PTSD and ensure his medications arrived uninterrupted.
Yet despite Hunt’s advanced understanding of the VA health care system, he wrestled with the massive bureaucracy. At Houston, he wouldn’t be able to see a psychiatrist for two months. His much-needed medication was unavailable at the VA pharmacy because the hospital didn’t stock brand-name drugs.
He confided to his mother that the loud, crowded, impersonal medical center was “too stressful” and he wouldn’t return.
Two weeks later, he shot himself at age 28.
‘Something went wrong’
“In that two-week window, something went wrong,” Hunt’s mother, Susan Selke, told members of the House Veterans’ Affairs Committee. “He just got a job, he bought a truck on Friday. By the next week, he was dead.”
Since news erupted in April of delays in patient appointments and scheduling that contributed to delays in care and, possibly, deaths, the VA has been under fire for covering up the scope of its problems, punishing whistleblowers who tried to alert supervisors and ignoring patients who begged for help.
On Thursday, the House Veterans’ Affairs Committee sought to put a “face” on the issue in an oversight hearing focused on continued problems with access to mental health treatment at VA.
“None of the [hearings held so far] have presented the all-too-human face of VA’s failures so much as today’s, a hearing I believe will show the horrible human cost of VA’s dysfunction and, dare I say, corruption,” said Rep. Jeff Miller, R.-Fla., chairman of the committee.
VA data show that suicide rates among veterans who use VA health care have increased by nearly 40 percent among male veterans under 30 and by more than 70 percent among male veterans ages 18 to 24.
The statistics are shocking, but families whose children have died since serving in combat say they aren’t surprising, given the system’s inability to track patients and privacy laws that prevent family members from speaking with physicians or learning anything about their loved ones’ health.
Dr. Howard and Jean Somers’ son Daniel died last year after a long battle with PTSD and guilt related to his combat service. As a National Guardsman, Somers’ status as a veteran was questioned, dragging out his efforts to get help.
When he finally was deemed eligible, he fell victim to an antiquated appointment system, missing notifications and appointments. He also was uncomfortable with the type of care he was offered.
Frustrated and feeling alone, Daniel wrote a heartbreaking suicide note before shooting himself: “Too trapped in a war to be at peace, too damaged to be at war … not only am I better off dead, but the world is better without me in it.”
The Somerses say they want to work through VA to fix the system, envisioning an organization that is a “center of excellence” for war-related injuries.
They would like to see much of the routine care now provided by VA, including primary care appointments and treatment for illnesses and injuries not related to deployment, outsourced to private providers.
“Our son was told they had no psych beds and no ER beds. He lay down in the corner of the VA and cried. No effort was made to see if he could be admitted to another facility. He was in crisis and was told, ‘You can stay here, and when you feel better, you can drive yourself home,’ ” Jean Somers said.
Witnesses who testified at the hearing noted that the Health Insurance Portability and Accountability Act, or HIPAA, designed in part to protect patient information, serves as a major roadblock for families trying to help those with mental illness.
Frequently, mental health patients feel so stigmatized by their illnesses that they are reluctant to sign release forms allowing a loved one or family member to participate in their health care. And sometimes their mental health conditions affect their ability to make sound decisions.
While there are exceptions in HIPAA that allow providers to speak with family or caregivers if a patient is a danger to themselves or others, this exception is not widely used and also is debatable: What one doctor considers “dangerous” may differ from another‘s.
“I never knew of Brian’s PTSD, traumatic brain injury or high suicide risk,” said Peg Portwine, mother of Brian Portwine, who died by suicide in 2011 after having been redeployed to combat with a traumatic brain injury and PTSD.
“I think that life-threatening situations like his should be shared with an emergency contact person who may be able to help,” she said. “VA needs to work with the service organizations and include the families in the plan of care.”
Families seek input role
Dr. Maureen McCarthy, the Veterans Health Administration’s deputy chief patient care services officer, said VA continues to take steps to improve its mental health treatment capability. But she acknowledged “there have been veterans with complaints about access.”
More than 1.4 million veterans sought VA mental health treatment in fiscal 2013, up from 927,000 in fiscal 2006. VHA now employs 21,128 full-time mental health employees.
McCarthy said VA continues to fight to expand its mental health treatment capability. “VA is committed to providing timely, high-quality care that our veterans have earned and deserve and we continue to take every available action and create new opportunities to improve suicide prevention services,” she said.
The families who testified at the hearing said they would welcome an opportunity to contribute to the restructuring of VA mental health treatment.
The Somers family brought a 22-page report with recommendations, while retired Army Sgt. Joshua Renschler, said the system needs a substantial overhaul, suggesting a team-based approach of interdisciplinary care, with all doctors responsible for treating a veteran working as a team, providing the patient care tailored for their case.
It seems that should be standard practice, but it’s not what he experienced at VA, said Renschler, who has TBI and is volunteering with Branches of Valor, a nonprofit that helps troops and veterans with deployment-related trauma.
“We need a system that serves the veteran, not one that requires the veteran to accommodate the system,” Renschler said.