Friday, January 20, 2012

Military suicides and other issues

Yesterday morning, we noted: "Most veterans, whether they suffer from PTSD or not, are not going to harm themselves or others violently. (They may be far more likely to harm themselves via self-medication over the long run if the VA fails to provide the help needed.) And not to dismiss or minimize the concerns or crimes that have taken place recently, but someone harming, at this point, physically harming, is still more likely to turn that inward and self-harm." We noted that because it's true. But we also noted a violent incident because it was true as well. Veteran Ron Capps (Time magazine) attacks the media (specifically the Christian Science Monitor and CNN -- though both are building on regional coverage) for reporting on it. Fine. Hold the media accountable and do it in whatever 'tone' you're comfortable with. But here's a little tip you'd be smart to file away: Time magazine is not a personal journal.

Meaning if the perception of your writing is that you write only to defend yourself, no one's going to give a damn and it's going to turn into, "Oh, there goes Ron Capps, talking about himself again." In other words, if you're going to post at Time, there are plenty of veterans issues to cover and you might try stepping beyond what appears to be your own self-interest about the way you're treated, you might try being about something larger. A far more solid use of the space today (at an outlet that is not known for offering any media criticism) would have been for you to cover Secretary of Defense Leon Panetta's announcement this week regarding sexual assault in the military or the burn pits symposium next month at Stony Brook (details later in this entry). Covering topics like that and reducing the critique of CNN and the Christian Science Monitor to a two sentence put-down would be more effective for a piece running at Time magazine. By pursuing the presentation Capps goes with risks readers walking away with, "What a self-involved hot-head." Which really doesn't refute the image he's decrying. (The style is fine for Veterans Today -- it would have to be angrier or more sarcastic for this space -- but for Time it's all wrong. Time's not Newsweek, it still makes some effort at journalistic detachment and objectivity. And that may be one of the reasons that Time, unlike Newsweek, still has a significant number of readers.)

The suicide rate is a big deal in the morning e-mails. First, any article telling you that suicides are down among veterans was written by someone either stupid or lying. The numbers are not there to make any comparison on veterans. The Senate Veterans Affairs Committee has had to spend years advocating for the VA to track that and those numbers will only start emerging. There's no number set from the past they can compare them to.

Second, it's not "down." The rate among service members is not down. In the total pool (which would include reserves), it has leveled off. Leveled off is not "down" in any significant sense of the term. Elisabeth Bumiller (New York Times) handles the data best, "Suicides among active-duty soldiers hit another record high in 2011, Army officials said on Thursday, although there was a slight decrease if nonmobilized Reserve and National Guard troops were included in the calculation." If active duty suicides have actually increased, why are so many headlines ignoring that and instead going with leveled off or (worse and wrong) "drops"?

Look no further than Larry Shaughnessy (CNN) which runs with Gen Peter Chiarelli's claims. Another bad 'report' would be Julian E. Barnes' for the Wall St. Journal which opens with, "The Army believes it has halted the rise of suicide in its ranks, saying that improved treatment of brain injuries and post-traumatic stress has helped stem years of increases." But active duty did increase, Barnes. And you can bury that in the body of the report ("Active duty suicides rose slightly last year, but the increase was offset by declines in the reserves") but that doesn't change the fact that it rose. Nor does it change the fact that the rate of suicide is higher in the military than in civilian life. Point being, it is unacceptable. It has been unacceptable. 'Leveling off' -- even if that's your emphasis -- is no 'good news.' The rate is too high and it's obviously not being dealt with appropriately since it continues to be high.

Bumiller reports, "Asked if he was frustrated by the jump last year in suicide by active-duty soldiers, General Chiarelli said no." I'm frustrated by Chiarelli's lack of frustration. And I can't believe he said "no" to that. I believe it, I'm not accusing Bumiller of making that up. I just am shocked at how stupid he was to have made that remark, you're in James Watt land when you make that remark, something no official should want or seek. (Watt was Secretary of the Interior under Reagan -- first term -- and prone to stupid remarks such as his attack on the Beach Boys as promoters of drug usage.) The CNN report contains a quote of Chiarelli's in full but the quote doesn't really alter anything. If you're tasked with reducing suicide, you're always bothered and concerned by the rate. That's a given for the job.

In other veterans news, Senator Patty Murray is the Chair of the Senate Veterans Affairs Committee and her office notes:

For Immediate Release
January 19, 2012
Murray: 202-224-2834
Filner: 202-225-9756

Murray, Filner Request GAO Review of VA's Sterilization of Reusable Medical Equipment Policies and Procedures

(Washington, D.C.) -- Today, U.S. Senator Patty Murray, Chairman of the Senate Committee on Veterans' Affairs, and Congressman Bob Filner (D-CA) sent a letter to Government Accountability Office (GAO) Comptroller Gene Dodaro expressing concern over reports of shortcomings in the sterilization of reusable medical equipment. In the letter, they urge the GAO to investigate whether VA's leadership is taking appropriate actions to address these problems across the system.

"On numerous occasions, VA has reported to Congress about the various investigations it has conducted and the problems these investigations have identified, which they claim have led to the development of new processes and procedures to reduce the risk of these problems reoccurring," Senator Murray and Congressman Filner said in the letter. "However, we continue to hear about the same types of quality of care incidents at VA medical facilities and we are concerned that this is an indication that VA is not effectively learning from these incidents and subsequently translating those lessons into system-wide improvements."
The full text of the letter follows:

January 19, 2012

The Honorable Gene L. Dodaro

Comptroller General of the United States

Government Accountability Office
441 G Street, NW
Washington, D.C. 20548

Dear Mr. Dodaro:

We know of repeated quality of care problems throughout the Department of Veterans Affairs (VA) health care system. Some of these problems, such as shortcomings in the sterilization of reusable medical equipment, reoccur with unacceptable frequency. This raises concerns as to whether VA's leadership is taking appropriate actions, including the appropriate disciplinary actions, to effectively address the problems across the system. On numerous occasions, VA has reported to Congress about the various investigations it has conducted and the problems these investigations have identified, which they claim have led to the development of new processes and procedures to reduce the risk of these problems from reoccurring. However, we continue to hear about the same types of quality of care incidents at VA medical facilities and we are concerned that this is an indication that VA is not effectively learning from these incidents and subsequently translating those lessons into system-wide improvements.

Therefore, we request that the Government Accountability Office (GAO) conduct a review of VA's processes and procedures for responding to quality of care incidents that occur within its health care system. Specifically, we request that GAO review the following:

1. What processes and procedures does VA use to respond to quality of care incidents that occur at its medical facilities, including quality assurance reviews and disciplinary actions? To what extent do these processes and procedures compliment and inform each other? What, if any, gaps or inconsistencies exist?

2. How does VA determine which processes and procedures to use to respond to quality of care incidents? What factors contribute to why certain processes and procedures are chosen by VA over others?

3. What challenges, if any, do VA staff face when using these processes and procedures?

4. To what extent are the processes and procedures carried out consistently across VA's health care system?

5. What data, if any, does VA systematically collect with regard to its employees' involvement in quality of care incidents, including clinicians and others? How, if at all, are these data trended and analyzed? To what extent are these data used to determine what actions to take in response to these incidents?

6. To what extent does VA use the data to identify opportunities for system-wide quality improvement?

As a follow-on to the above work, we also request that GAO perform an in-depth assessment of the extent to which VA medical facilities follow the processes and procedures used to respond to quality of care incidents.

Thank you for your work to improve the care and services our veterans receive. We look forward to reviewing your findings.


Chairman Ranking Democratic Member
Senate Committee on Veterans' Affairs

Ranking Democratic Member
House Committee on Veterans Affairs

The following community sites -- plus Susan's On The Edge, the Guardian and -- updated last night and this morning:

Next month is the first ever scientific symposium on Burn Pits:

1st Annual Scientific Symposium on
Lung Health after Deplyoment to Iraq & Afghanistan
February 13, 2012

sponsored by
Office of Continuing Medical Education
School of Medicine
Stony Brook University

Health Sciences Center, Level 3, Lecture Hall 5
Anthony M. Szema, M.D., Program Chair
Stony Brook
Medical Center

This program is made possible by support from the
Sergeant Thomas Joseph Sullivan Center, Washington, D.C.


* Register with your credit card online at:

* Download the registration form from:
fax form to (631) 638-1211

For Information Email:

1st Annual Scientific Symposium on
Lung Health after Deployment to Iraq & Afghanistan
Monday, February 13, 2012
Health Sciences Center
Level 3, Lecture Hall 5

Program Objective: Upon completion, participants should be able to recognize new-onset of lung disease after deployment to Iraq and Afghanistan.

8:00 - 9:00 a.m. Registration & Continental Breakfast (Honored Guest, Congressman
Tim Bishop

9:00 - 9:30 Peter Sullivan, J.D., Father of Marine from The Sergeant Thomas Joseph
Sullivan Center, Washington, D.C.

9:40 - 10:10 Overview of Exposures in Iraq, Anthony Szema, M.D., (Assistant
Professor of Medicine and Surgery, Stony Brook University)

10:10 - 10:40 Constrictive Bronchiolitis among Soldiers after Deployment, Matt
King, M.D. (Assistant Professor of Medicine, Meharry Medical College,
Nashville, TN)

10:40 - 11:10 BREAK

11:10 - 11:40 Denver Working Group Recommendations and Spirometry Study in
Iraq/Afghanistan, Richard Meehan, M.D., (Chief of Rheumatology and
Professor of Medicine, National Jewish Health, Denver, CO)

11:40 a.m. - Microbiological Analyses of Dust from Iraq and Afghanistan, Captain Mark

12:10 p.m. Lyles, D.M.D., Ph. D., (Vice Admiral Joel T. Boone Endowed Chair of
Health and Security Studies, U.S. Naval War College, Newport, RI)

12:10 - 12:20 Health Care Resource Utilization among Deployed Veterans at the White
River Junction VA, James Geiling, M.D., (Professor and Chief of Medicine,
Dartmouth Medical School, VA White River Junction, VT)

Graduate students Millicent Schmidt and Andrea Harrington (Stony Brook
University) present Posters from Lung Studies Analyzed for Spatial
Resolution of Metals at Brookhaven National Laboratory's National
Synchrotron Light Source

1:20 - 1:40 Epidemiologic Survey Instrument on Exposures in Iraq and Afghanistan,
Joseph Abraham, Sc.D., Ph.D., (U.S. Army Public Health Command,
Aberdeen Proving Ground, MD)

1:40 - 2:10 Overview of the Issue Raised during Roundtable on Pulmonary Issues
and Deployment, Coleen Baird, M.D., M.P.H., (Program Manager
Environmental Medicine, U.S. Army Public Health Command)

2:10 - 2: 40 Reactive Oxygen Species from Iraqi Dust, Martin Schoonen, Ph.D.
(Director Sustainability Studies and Professor of Geochemistry, Stony
Brook University)

2:40 - 2:50 BREAK

2:50 - 3:15 Dust Wind Tunnel Studies, Terrence Sobecki, Ph.D. (Chief Environmental
Studies Branch, U.S. Army Corps of Engineers Cold Regions Research
and Engineering Laboratory, Manchester, NH)

3:15 - 3:45 Toxicologically Relevant Characteristics of Desert Dust and Other
Atmospheric Particulate Matter, Geoffrey S. Plumlee, Ph.D. (Research
Geochemist, U.S. Geological Survey, Denver, CO)

3:44 - 4:15 In-situ Mineralogy of the Lung and Lymph Nodes, Gregory Meeker, M.S.
(Research Geochemist, U.S. Geological Survey, Denver, CO)

Continuing Medical Education Credits

The school of Medicine, State University of New York at Stony Brook, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The School of Medicine, State University of New York at Stony Brooke designates this live activity for a maximum of 6 AMA PRA Category 1 Credit(s)TM. Physicians should only claim the credit commensurate with the extent of their participation in the activity.

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