requesting this committee to pass 2182. this is the most devastating war in history with suicide in the nation continues to suffer and we continue to lose 22 bright and a day per promised that his funeral i would stop this injustice. . . 2182 and support any legislation that gives our soldiers the timely and loving care that they deserve. thank you. >> thank you, ms. portwine. sergeant wrenchler, you're recognized for your statement. >> chairman miller, ranking member michaud, members of the

committee, i appreciate the opportunity to discuss va mental health care, and i certainly want to acknowledge the loss and the courage of these family membe members, ensuring that this wasn't in vain, and i struggle with the severity of the stories. as an infantryman who lost so many in the iraq war and injured and struggled with the loss of suicide from chronic pain and other injuries, i just thank you all for being here. my experience with the va health care system began in 2008. sorry. >> it's okay, you've got plenty of time. >> after i was medically retired from the army due to severe injuries from a mortar blast in iraq -- excuse me.

i've been a patient but i'm also an advocate for other warriors who are struggling with deployment-related traumas. for a period of about 12 months, i did receive excellent mental health care at a va facility. it provided easy one-stop access through deployment health models staffed by mental health, pharmacy and social work providers. unfortunately, though, hospital administrators decided this well-staffed interdisciplinary care was too costly. now veterans at the facility go through a personal intake assessment process and have to find their way around a stra sprawling facility pto access te care that they need.wandering ty

is enough stress in itself. they will seldom open up and discuss private issues with a clinician they've never met. they're more likely to describe surface level issues, like difficulty sleeping. it takes time to build a trust to talk about the deeper issues. and not every clinician is skilled at winning the trust or insightful enough to sense when there is deeper problems. working with a team increases the likelihood of someone to see something that others may have missed. this is implications for suicide prevention as well. veterans will rarely volunteer to clinicians that they're contemplating suicide. and there aren't necessarily obvious signs that a veteran is a suicide risk. one thing is for sure, we won't prevent suicides by doctors mechanically going down a mandatory list asking questions like, have you contemplated suicidal thoughts lately or harming others?

sometimes there is red flags an astute clinician can spot, like the breakup of a relationship or other major life events that can lead a person to take a desperate act. in a treatment system where i get sent to building 3 for neurologist for chronic back pain, building 61, to see a psychiatrist for sleep problems and building 81 to see a social worker for relationship issues, no one is getting the full picture. so it is likely that no one is going to see if my life is spinning recklessly out of control. as an integrated health care system, the va can provide the kind of care i once received from an interdisciplinary health team. there the team members shared observations and can see potential problems before they became explosive. so i think that the most important step that the va can take to prevent suicide is to dramatically improve its mental health care delivery. access is certainly an issue, but we have to ask ourselves,

access to what? access to mental health care isn't enough unless that care is effective. for example, providers who work with combat veterans need to understand the warrior mentality, and they may have to work hard to win that veteran's trust. if a clinician lacks that wareness or has too many patients to give each enough time, veterans will get frustrated and drop out of treatment. veterans that aren't ready for therapy will drop out of the multiweek treatment programs even though they're hailed as evidence-based therapy. the bottom line is that the va care must be veteran centered. that has to mean recognizing each veteran's unique situation, and individual treatment preferences and building a flexible system to meet the veterans needs and preferences. not the other way around. the warriors that i'm describing don't come at a treatment for

pt ptsd or anxiety because the text books say they should. most don't come in until they have reached a crisis point in their lives. certainly a veteran in distress who finally asks for help for combat incurred mental health condition needs to get into treatment immediately. but we won't solve that problem by establishing an arbitrary requirement like a 14-day rule. it doesn't help a warrior at the end of his rope to get assessed within 14 days but not begin treatment within three months. this is the way that the va is currently implemented such policies. they have added additional steps to get into treatment, so that you can see someone within 14 days, they added a second intake process, so now you intake to intake to finally get the treatment you need. i know that some believe the way to solve the veteran problem is to expand veterans access to nonva care. i really personally doubt that's any kind of silver bullet solution. the two big concerns with that

is, first detailed in my full statement, many reports and studies point to a national shortage of mental health providers within the community. secondly, there is real quality of care issues here. va could certainly benefit from a greater use of purchase care, where and when it is available, and when it can be effective. but it wouldn't help veterans just to be seen by providers who aren't equipped to provide effective care. whether because of lack of training and treating combat-related ptsd or cultural competence or any other reason. again, it is not just a matter of access, but access to what. it has to be effective treatment. i do believe that there are va facilities that are providing veterans with timely access to effective patient centered care, but it is not system wide. for my perspective, the starting point for va leadership at all levels is to adopt the principle that providing timely, effective mental health care for those with service-incurred mental health conditions must be a top

priority. the va achieve that with its efforts to combat veteran homelessness recently. that tells me the va can have a real impact when the direction and priorities are clear. when artificial performance requirements don't create distortions, and when clinicians have latitude to provide good care. improving mental health care definitely requires the comprehensive approach. one part of that approach in my view should be to institute the kind of interdisciplinary team-based model i described earlier, but the core of any approach has to center on the veteran and that patient's need'needs and preferences. we need a system that serves the veteran, not one that requires the veteran to accommodate the system. i hope that this hearing brings us a step closer to that kind of va care system. and i thank you for the time and i would be happy to answer any further questions that you may have.

>> thank you very much, sergeant. thank you, again, to all the witnesses. sergeant, if i could go back to you since you were the most recent person to testify, you talked about the interdisciplinary care team that you had for 12 months. and then after that, you alluded to the fact that the hospital director or somebody said that it cost too much to do it that way. i think we would all benefit from you elaborating a little bit about how that occurred and what did you transfer to what type of a care? >> yes, sir. in 2008 until 2009, the va rolled out, i believe, four different deployment health care models nationwide. the deployment health care model that i speak of was one that was rolled out washington state for the american lake va medical center. and it was put together by dr. steve hunt with the va.

and this model provided one wing of a hospital floor in which an interdisciplinary care team for deployment health post 9/11 veterans exclusively that had a pharmacist, social workers, psychiatrist, psychologist, and primary care on one team and weekly they would meet to discuss the case load of that team. and the wait times were short for care. the quality of care was up. the management of our medications were the best that we had seen within the va. however, after 12 months, the team began to dissipate and what i was told and have been told since by dr. steve hunt and others within the va is that this was a temporarily funded program and it was too costly to provide this level of care to exclusively post 9/11 va -- or veterans within the va center when a facility director has to

provide care for all veterans to set aside the amount of funding that it required to provide this level of care for only one portion of that population was not practical. >> mr. and mrs. somers, i would like for you to elaborate, if you would, a little bit on the fact that you talked about daniel having enumerable problems with va staff being uncaring, insensitive and adversarial. saying literally no one at the facility advocated for him. could you give us any specific examples or are they generic examples? >> absolutely. probably the most -- i don't make it through this, howard will finish. probably the most egregious event was when daniel presented to their er --

>> it took daniel a lot to go to the va facility and some of the things that had been mentioned here were part and parcel of the fact. even along the highway in phoenix, there were speed traps on the highway, and when the lights flashed, that would give him flashbacks, even if he wasn't the one speeding. if he was going by on the highway at the time. so it was very difficult for him to drive down to the va. it is busy. but he presented there in crisis. he presented to one of the departments, to the mental health department. he said he needed to be admitted to the hospital. this is something that we have been told by his wife, who as jean mentioned, has a bs in nursing and his mother-in-law who is a psychiatrist. and he told them this on multiple occasions. so he was told that the mental health department they had no

beds, and he was told by the same department that there were no beds in the emergency department. so this brings up another few issues, but the fact is that he went into the corner, he was -- he laid down on the floor, he was crying. there was no effort made to see if he could be admitted to another facility, there are two major medical centers within a mile and a half of the phoenix va. the vision issue is another issue that we need to discuss at some point. but he was told that you can stay here and when you feel better, you can drive yourself home. that is just an example of the lack of advocacy, the lack of

compassion, that we know that not only daniel has encountered through the va system, we have met other veterans, specifically in oklahoma city, who had very, very similar circumstances at different vas. >> do you know if he ever spoke to any va official about how he was treated? >> we do not. the other problem, of course, is that these visits are never -- the appointment system is so antiquated that things are not even documented. there is no way to go back into the system and to document a contact in the system. so no -- as far as we're aware daniel did not speak to anybody at the va about this. it is just something he wouldn't do. he just wouldn't do. there was a feeling of, i tried and this is just another example

of what the pressures that are brought to bear. we brought not only the vha, but the vba issues into account and these are just things that altogether just became overwhelming. >> my belief is that he still had that military mentality, you know, this is what an authority told you, i have to accept it. i cannot go above and beyond. i just need to accept what they're telling me. >> thank you. mr. michaud. >> thank you very much, mr. chairman. i want to thank the panel for coming today to talk about your stories and your family and really appreciate it, i know it can't be easy. so dr. somers, my question is, can you go into further detail on about why you think it is important to encourage every veteran suffering with pts and other combat-related mental health issues to supply a list

of points of contact and get a hipaa waiver? >> interesting that you should say hipaa because once somebody says hipaa, that sort of stops the conversation. we have been trying to deal with this issue because it takes a village, a large village, to not only treat but to recognize and to approach our veterans who might be in crisis. we feel it is critically important to expand what we call the support network, and actually at this point a hipaa change would be wonderful. we really -- we ran a medical practice and jean can tell you that what we have come to learn that what hipaa really says isn't what -- isn't how -- isn't

how it is practiced. people are afraid of hipaa, so they take the regulation, that is actually there, and they take it to the nth degree and really you do have some options under hipaa, especially if you feel that somebody is a threat to himself or to his family or to the community where you can reach out to family members, or a caregiver in a situation like that. but we feel it is absolutely critical to identify prior to deployment, certainly during deployment, and after deployment what we call the support network, so that these people can be educated as to what experiences their loved one or maybe not even a loved one, maybe it is a high school football coach or maybe it is your, you know, math teacher or maybe it is your best friend from the second grade, but so these people can be educated as to what the experiences might have been, what the signs and

symptoms of crisis might be, and educate it to the fact that you don't take no for an answer. and if you see that somebody is in trouble, that you can direct them to the proper treatment, to the proper authority, to the proper medical facility. and that's not actually something that you have to worry about with hipaa. so that's one way that we feel that hipaa doesn't even come into the equation, hipaa would come into the equation when you're in treatment. and we really feel that if you're in treatment, and there is an issue, then the therapist should certainly take the opportunity to contact the closest people to the patient. >> thank you. my second question relates to hipaa. i heard a case where even though it is the department of veterans administration, where vha

employees could not talk of vba employees and they used the excuse of hipaa. have you heard that -- have you had that problem? with your son? >> we haven't heard that was a hipaa issue. we felt it was a total communication breakdown issue, the fact there was -- the computer systems weren't compatible within the va system itself, and the fact that as far as we know phoenix still uses a postcard system for appointments, and nobody could document the fact that postcards were even sent. and we know for a fact that after daniel died, and the suicide prevention coordinator contacted his widow, and they were talking and they were going to send her some information as to what kind of counseling facilities were available for her, and she asked where are you going to send it, they, in their system, had an address that was four years old.

and he had been involved with the vba and with the vha over that entire period of time. >> my time is quickly running out. mr. and mrs. selke, how long had clay been taking medication for his pts and how long has he -- was he denied medication through the va? >> he began taking medication in 2007, when he was back at twenty nine palms recuperating from the gunshot wound in iraq. my understanding is that he, again, received medication that he needed when he was active duty. his care seemed to be good and he felt comfortable with it. when he transitioned to va care, he was never denied medication. what happened when he moved to houston, he was told that they

could not refill his prescription, that had been -- that followed him from the l.a. va and in grand junction, colorado, for a short time, he was having to start over as a new patient and i was -- had this reinforced yesterday in a meeting, but it was -- that was one of his major frustrations. and that i've heard from fellow veterans of his that when they go some -- to another facility, they have to go back through everything, all the recounting everything. and it -- that seems ridiculous to have to have that type of redundant system. when he was told in houston that he -- that they could not refill his prescription, he was told, you need to call the va that prescribed it, wrote the prescription earlier and see if they will refill it for you.

he was leaving the country. he was going to haiti for a couple of weeks and he needed to have enough medication while he was gone. and clay was proactive enough and was able to do that. he just was determined and he said, okay, and he took care of it and he did get it from the grand junction va. when he came back from haiti, and went to his appointment in february, that was with a psychologist, a clinical psychologist, and my understanding was he was never -- he was not given a new prescription until he saw the psychiatrist on march 15th. so his first appointment was january 6th, second appointment february 10th or 11th, and finally march 15th, sees a psychiatrist. also part of that issue was when he was active duty, lexapro was found to be the drug that worked

best for him. name brand drug, no generic, but they -- he had been on paxsill, on zoloft, a variety of drugs. lexapro seemed to work the best with the least side effects. when he came out of active duty and into the va system, apparently generic drugs are the drugs of choice and he was given, i believe it is the generic for salexa, which is close, but not the same thing. at that time there was not a generic for lexapro. when he arrived at the houston va, and asked for a refill, and then he also somewhere in those first couple of appointments said that he would like to go back on lexapro, as that worked better for him, with less side effects, when he met with the psychiatrist, he said, okay, i understand from your background that that's worked before, and he did give him a prescription for lexapro.

so clay leaves on march 15th, the psychiatrist office, goes downstairs to the pharmacy at the va, to fill his prescriptions. and he spent two hours in the pharmacy, he was called up to the pharmacy desk to pick up his prescriptions, and given the ambien for sleep, and given -- told they could not give him lexapro, they don't stock it because it is not a generic, that it will have to be mailed to him. so it was mailed to him, sometime within the next week, i think they told him a week to ten days that he would get this. a couple of issues there, if you know about antidepressant, anti-anxieties medications, you can't -- you can't stop them cold. you can't wait for it to come in the mail, and then expect that it is going to work quickly, it

takes a while for these to work. they have to stay built up in your system. he was extremely frustrated. he called me as i said in my testimony on the way home and said i just can't go back there. the doctor at the houston va, i have spoken with him several times since clay's death, he's been very forth coming. i appreciate very much the information that he's given me. something in our last conversation which was just a couple of weeks ago that i had not heard before, i have been concerned about ambien, there have been just a lot of conversations among parents and spouses and family members of veterans who are dhave died of suicide and they have been on m ambien for sleep problems. whether there is a connection or not, i don't know. but it was a high number that are given that when they have

sleep problems and sleep problems are common, huge problem with post traumatic stress. the doctor, the other day, in talking about specifically ambien and sleep medications, he said, well, actually, ambien would not be the best drug for the type of sleep problems, and i believe the term is hyperarousal, but i'm not 100% sure on that, for the type of sleep problems that come from post traumatic stress. the nightmares and flashbacks and that sort of thing. there is another drug that starts with a p, i don't have it with me, like prazasin and he said that is the drug that actually works best for that type of sleep difficulty. and i was so stunned that i couldn't ask the question, well, why didn't you prescribe that drug for him as opposed to

ambien that he was given over and over different times before. so that haunts -- that's something that haunted us for three years, because in that two-week window, something went wrong. clay had moved back home, he had just returned from haiti, doing volunteer work, which gave him great -- just great hope, that was great therapy for him. he had started a job. he had bought a truck the friday before. he called me and asked me to meet him and he bought a truck for work. and by thursday the next week he was dead. we were with him over the weekend on that saturday. the whole family at various points during the day, saw him. he had lunch with his dad. he had -- we went to a movie. richard and i went to a movie with him that evening. i could -- i just -- i just

couldn't believe it, that within five days he was dead. so we know he suffered post traumatic stress, we know he was treated for it, he was very open about it, sought help, and that two-week window is just a mystery that haunts us. and we have done everything we can to try to find out answers. >> mr. lamborn for five minutes. >> i want to thank you all for being here. you've given so much. i thank you i know the committee thanks you. and the country thanks you. i want to ask about the role of families in treatment and therapy. i have a constituent who came to me and her husband was stationed with the tenth special forces at fort carson, colorado, where i represent. and he took his life. andan advocate for a

program that has a holistic approach that involves families, whether parents or spouses. and i would like to ask any one of you who has insight as to whether there should be more of a role for families in the treatment programs that are offered through the va. or is there a lack there? >> we certainly, during the time that daniel was with the va, certainly feel that there is a -- there was a lack. and, again, we feel it has a lot to do with fear of repercussions under the hipaa law. and also a total misunderstanding of what the law currently is. and i would like to take your point further and say that it shouldn't just be family, i think we would all like to say we did not have dysfunctional families, but there are dysfunctional families out there and so we started using the term support network. a lot of young men and women

undoubt ledly join the service get away from families. that doesn't mean they don't have a support network. we would like to get away from the whole blood kinship and say it is a support network. i think it goes without saying, i recently read a report by national association mental illness that there is no question that family involvement is beneficial. there is just no question. it becomes more of an issue, i believe, and it is why howard an i have been trying to work with the dod to get them to identify a support network, because certainly in daniel's case, daniel was a geek. but he was at his absolute healthiest, mentally and physically after he joined the army. and he went through basic training. he was in great shape. if they have could have identified right then and said, daniel, give us a support network for you, who would you

write down, you know? he had really, really good friends, we hope we would have been on it, his wife would have been on it, his mother-in-law probably would have been on it, his brother-in-law. it would have been so helpful to have that list then. because when he got back home, he wasn't capable of that anymore. i like to say, you know, not from a legal standpoint, but he had diminished capacity. he was not making correct decisions. >> okay, okay. anyone else? mr. selke? >> thank you. our experience, like most -- probably a lot of families is we didn't know what pts was. we had no idea. clay was, again, very open about it. told us he was destinationed with it. told us he was on medication, seeking counseling. but we didn't know the ramifications of that.

and like most of our warriors, they're strong. and so he was, you know, put on a real good act. had we known the extent of even what he talked to his counselors about, the idea that the somers have approached about regardless of the hipaa, you know, legalities of that, for -- if in fact somebody has that conversation with their -- that counselor, somebody outside of that counselor and the patient needs to know that the patient could identify somebody who would then be able to be aware of what is going on, and to say, you know, this person needs help. clay, looking back, there was all kinds of things going on in his life. there were just red flags. and we didn't know. and there is a lot of literature out there, there is a lot of

information. i believe that any family who has an individual involved in the military, after they had come back, or really anytime, they should probably just assume that there may be some sort of pts involved there. the suicide deal, clay actually had a conversation with susan and said, hey, mom, i thought about it, but i would never do that to you all. he actually addressed the issue and lied about it to us. and so the family plays a huge part in really being advocates for the individual and being able to just watch and watch for signs and then maybe be able to do something about it. >> in conclusion, i would have to say, the va needs to learn best practices and have programs available that include families. everywhere. >> if i could add something to

that, going back through clay's medical records, for whatever reason, when he died, i immediately wanted his medical records. i wanted to read everything i could and try to grasp what was going on. he had apparently as early as november or december of 2009 spoken to someone in the va in the l.a. va about suicidal thoughts, that's on one of his reports, at the end of 2009. he had separated from the marines at the end of april of 2009. i knew nothing of that. we didn't learn until the fall of 2010 when he told us, he said, i have struggled with this thought, but i could never do that to you all. i just can't. and i don't think -- i think in

his mind he believed i'm thinking these thoughts, but i could never do that. as far as we know there were two times during the fall of 2010 that he did have enough serious suicidal thoughts that he did reach out, one time he called and talked with me, and another time he spoke with a close friend, and then after that second time he shared with me, you know, that -- or with all of us. so we knew in 2010 at the end of the year, we knew he had struggled with suicidal thoughts. and we also knew that he was on medication and we're assuming that with post traumatic stress and suicidal thoughts and that that the va knew best how to take care of him. i begged him, please, let's go

to private care. we will pay for it. we know great psychiatrists, counselors in houston, let's do that. he would not do that. he was adamant. he said, i have served in the marine corps for four years, my medical care is to come from the va, they owe that to me, i don't want to go to private care. i want to talk to someone who has either been in war or knows about war and post traumatic stress and the things that i have seen and done in are war. i don't want to go to private care. and that was just his personal feeling. we have heard that from other veterans as well. that's as difficult as the system is, that's their comfort zone. and they need to be feel they can be taken care of. >> my hearts go out to you.

>> mr. takano, you're recognized for five minutes. >> thank you, mr. chairman. it is very difficult to listen to your story. i'm very touched by them. so i definitely want to thank all of the families for being here today. so, let me ask this question of miss selke, i believe a lot of veterans have that same feeling and therefore i do believe that we have to, it is incumbent upon us to make sure that we get it right at every facility, because veterans are expecting that. they don't want to see this be be a burden to their families financially. i am very much open to making it easier for nonva care to be available. and with that i want to ask dr. somers, you are also a medical doctor, dr. sommer esom? >> i'm a urologist.

>> you're from the phoenix area. >> i practice in phoenix. we currently live in san diego. >> in san diego. i'm from riverside, north of san diego, as you know. i went to visit my own va, in loma linda. they're able to -- they get -- they're able to get veterans to see a family practitioner in 24 hours if need be. i'm not so sure about mental health care or psychiatrists. they indicated to me there is a shortage of psychiatrists. and i recently visited a new kaiser facility and i asked him if there was a -- what shortages he was experiencing. can you tell me if there are general shortages in your area of these kind of practitioners? >> there is a shortage of mental

health professionals nationwide. and there are many issues that go into it. certainly reimbursement is one. we know one of the people that daniel had been seeing because -- and this is another issue of continuity of care, he was forced to go outside the va system, just because he couldn't be seen in phoenix. there was just no availability, no mental health available. and i think you have to divide psychiatry and psychology. for these people suffering from ptsd, it is the psychologist and the psychiatric social workers who are providing most of the care as opposed to the psychiatrist themselves. but psychiatry and psychology are incredibly important and what happens is if we try to

recruit into the va, the community is losing that mental health component. and it is a huge issue. it is an issue that has to be addressed by our medical schools, by society in general. but it is not just an issue here and there. >> here is the thing. dina titus and i represent a bill that would increase the number of residencies at va hospitals. i expect a number of those -- if we approve it, a number of those residents would stay, but also something would go into the community as well. >> right. >> my thing is even if we do approve -- make it more easy, easier for vets to use, that areas like mine, they're still going to have trouble finding that care, you know, in the community. >> they will.

and they'll have trouble even if you have people in the community, you'll have trouble finding people in the community aware of military culture and who are aware of the issues that veterans face, and, again, that's just brings up a whole other issue, whole other series of issues. >> i wish i had more time. maybe i could get your information through my staff, because i'm trying to understand also your criticism of the vista medical records. there is also an issue of the -- >> be trying to with the pc-3 program and with the other issues that are being promulgated now, there has to be communication between the va and the providers who are seen the veterans being referred out. so huge, huge issues that have to be addressed. >> i think i understand your point of view as well about your doubts about radically

restructuring, that we got to try to get it right in the va facilities because of that expectation that miss selke -- and the selke's son had, that they -- that was their comfort zone. so we got to do both things at once, make sure that every va center has excellent mental health care and try to provide some options. >> yes, sir. my concern with the bill that just increases the number of practitioners at a hospital, we're not solving the issue with effectiveness of care. so it really has to be a systematic approach to solve the efficacy of what care is being provided as well as the numbers to accommodate the sheer overwhelming amount of veterans that are trying to access that already broken system. i just wanted to add that, sir. >> thank you. mr. chairman? >> dr. roe, you're recognized for five minutes. >> thank you, mr. chairman.

and i thank, as a father of three, and a veteran, i appreciate your courage to come here today and speak. it is a really heart warming and i know this is very difficult for you to do. and it has been difficult to sit and listen to the testimony. there are a good number of veterans sitting up here. i'm a veteran of vietnam era. and just want to thank you for that. and in being here. i can tell you this past weekend, i returned to something very joyous for me. it was a reunion of a bunch of young boys growing up in the '60s, who were all eagle scouts. and all but one was there, of our friends, he didn't make it out of vietnam. so i can tell you that this loss that you have, that you're sharing with us, is very, very helpful, that loss will go with you as it does for my friend of almost 50 years. so thank you for your courage to

be here. i know it is very difficult. and sergeant renschler, you bring up a great point, all of you have today, and the coordinated effort you brought forward, that team approach i think was very good. and i certainly do understand what the va was saying, if this works for the oif, oef veterans, it should work for all veterans. the majority that they're serving are veterans of my age. i think this needs to be expanded if that method that you put forward, it looks like it worked extremely well, should be looked at. and dr. and mrs. somers brings up an incredible point. dr. somers, you probably dealt with, as i did, some primary care in your practice when you were in urology. you don't just get to be a urologist, your patients get to know you and share a lot of things with you. and dealing with this is very

complicated. as you all have pointed out, and miss selke so eloquently pointed out, is that it -- this approach of caring for people with pts or chronic mental illness is extremely difficult. dr. somers and i could go in operating room and remove a tumor. that's easy. this is much more difficult to do. and those signs and symptoms are very difficult to spot because miss selke, you saw your son, when he was actually, you thought, doing very well, that week before he passed, and i think as a doctor, that's been one of the things that troubled me all of my career, is trying to figure out when you have a patient that would take their life, it is why did this happen, and many times that week or two before, things seem to be going well. you think things are going better. i think dr. somers, you and your wife brought up something that is extremely important, that a good friend is probably as important as a good doctor, good person to lean on.

and i think you have to do what sergeant renschler was talking about to have this very sophisticated team together for people in need, but you also just need someone, it may not be a family member, like you pointed, it could be a coach or pastor or whom ever it might be in your life, it could be a family member, i think putting all that together is a real challenge. i will hear later from the va about what they plan to do. but any further thoughts along that line would be helpful, if anybody would like to share some of the -- your thoughts about what we could do. >> i think it is important for the transition program. i know before that brian went to iraq the first tour, he went to california where they have a base where they teach them all, like, they make it like an iraqi town. so they learn how to control crowds, take buildings and all that. but had th but when they come back, it is

boom, you're there for a week and then out in the community. there is no transition. why can't they use those centers they use to send them where they could have psychiatrists, psychologists, and look at them, give them assignments, see if anybody has poor concentration, poor memory, you know, and use these resources that we have, you know, say, okay, now you need to go do laundry, give them a list of things to do see if they're able to do that, and, you know, observe them, we can't just take them like cattle and put them up through a bunch of questions and then let them go in the community where they don't have their brothers to confide in. when they come back, they have put their life on the line to trust these other brothers, they would die for them. they come home, they don't have anybody they're going to trust that much. and nobody that has been in war is going to understand so they don't open up. the most people that open up to is their brothers. michigan has a program called buddy to buddy. that they put together one

veteran, you know, that has been home with the veteran. so that if they have any problems, that are going to open up to that person much more than they are a therapist. or have group therapy, let the veterans talk among themselves. they could, you know, have a group of ten veterans and then have group therapy and maybe they could confide in each other. because it is going to take a while to build up trust with a therapist, if you do. >> totally agree, thank you very much for your courage of being here today, mr. chairman. i yield back. >> mr. brownly, you're recognized. apologize, mrs. kirkpatrick, you're recognized. >> i appreciate what you said about once a diagnosis is made, and medication is prescribed, staying on that, on that medication. and i'm really want to know how

often our veterans have to refill the prescriptions, and i would like to hear from each of you what you've learned about that experience, are you given a 30-day supply, they have to go back constantly back, or on sergeant, we can start with you and then work our way down the panel. >> yes, ma'am. so at our facility in washington state, medications are given on a 30-day supply. there is an option for mail refills. the system is pretty confusing and i normally mess it up pretty well, so my wife has to manage that for me for most part. you have to be able to put in a request three weeks before you need it, and i usually forget until i'm about to run out and so then i'm off my meds for a long period of time, which is never good. as far as the other medication issues that have been discussed, continuity of medications from one facility to the next. i'm in southern part of washington state, and people who are coming up from portland,

oregon, which is about an hour away, are on medications that are not transferrable to the va facility where i'm at. so they have to start all over as a guinea pig is what was discussed earlier, try medications they may have already tried in the past to get to the point where they're able to approve a nonformulary medication. it took four years for the dod to balance nine medications for myself, and when we transitioned to va care, many of those medications were not on the f m formulary and we had to go back through the guinea pig phase again and we ended up with 14. there are many issues as we talk about that. >> that is just unbelievable. any other families want to -- >> brian was never put on medication. they diagnosed he had depression, pts, but never put on any medication, he was put on

medication for his back when he was thrown from the humvee, naparcin and muscle relaxer and that was temporary, but they never even prescribed, screaming out three times a week with nightmares and having your brothers wake you up and then telling the therapist how embarrassing that was, i think you need to be on some medication. >> agreed. >> these medications are so subtle, and they're so particular to the individual. it is just mind boggling that there is not an easy way to identify and work with the individual vet, determine exactly what that cocktail, if you will, looks like. and then be be able to without -- to just seamlessly transfer that to wherever that bed is. these people are young and they're on the move. and, you know, they're all over the place. and so that -- those barriers need to be taken down.

>> dr. and mrs. somers. >> yes. thank you. and thank you, representative kirkpatrick, for being such a support and a help for us. there is multiple issues that have to do with the medications. just the fact that the formularies are not the same is a huge issue. and it doesn't just affect veterans at the va system. there are veterans who are retired from the military who see both -- who see physicians both at the va and the dod. so they are seeing people at both different medical centers and they cannot be on similar medications from one to the other because the formularies are not the same. the problem is that not only does the va use 99% generics, but they use the cheapest generics. so daniel, who had not only ptsd

and tbi, but full blown gulf war syndrome, which included irritable bowel, had only certain medications he could tolerate. maybe the chemical in the medication is the same, but the bonding agent is different. maybe he's on a medication he only has to take once or twice a day, but the va gets a better price, so now he has to take it three or four times a day. and the change in the medication changes everything. so i mean the issues, the issues are just huge. it is not only that -- and the other thing that we have heard, and from unimpeachable sources, is that vas vary as we heard with their pharmacy policies. there are some vas where you can go and get a brand name medication with no problem, other vas that essentially it is impossible to get a brand name

medication. so, i mean, that brings up this huge issue that we have is why there is so much variation in the entire system. why we can't have more uniformity within the va system as a whole. >> thank you. thank you, dr. somers. my time is up, thank you. >> sorry. >> let me just conclude by saying your testimony is heart breaking. and i can barely hold back my tears and i thank you for being here. i yield back. >> thank you, mr. runyan, you're recognized for five minutes. >> thank you, mr. chairman. and i thank all of you for sharing your stories and truly being great americans and great patriots because your stories are going to help people in the future and thank you for all that. a couple of points and i think dr. somers was talking about it, and i think we see it all day. we talked about this in the hearing the other night. it almost seems like the va is

so fragmented, that there is no overwhelming mission from the top with flexibility below. that's -- and i think there is a structural breakdown on how you're actually going to conduct business. and that's really where we're at, whether you're talking vha or vba. it is the same issue. and we have yet to -- i think next week we're digging into some of the vba issues also. it's a culture. and one other point, and then i'll ask one question, and it -- and miss somers was talking about it and dr. roe also validated it, when you talk about community and talk about support networks, these men and women are spending more time away from the health care facility than they are in the health care facility. so friends, family members, you

know, classmates, buddies, all have to be part of the healing process. not doing that. and i know the term wholistic has come up a few times. i think the sergeant mentioned it a couple of times. it is part of the healing process. there is no silver bullet to cure somebody. you got to be able to help them in many different ways. that being said, in the va's testimony, they mentioned suicide prevention coordinators are supposedly placed at all va medical centers and the large clinics. they're supposed to follow up with veterans at high risk. were any of your sons ever contacted in that first month after they were designated high risk by a va suicide prevention coordinator? >> we're not aware of that. the fact they didn't even know where he lived would bear proof

of that. >> that's one of the issues that we're dealing with also and that goes into the whole support network issue, is that -- and we have spoken to so many, so many families in the same situation is that daniel was married. and that basically shut us out of the equation. and that's where if we had the opportunity, if we could do some changes in this misinterpreted hipaa regulation where we could have been more in touch with his therapist and they would have felt free to talk to us, where we feel that we could have been more help. but since he was married, it was as if we didn't exist. >> i think that's important point is, like, when brian was injured in the tank explosion, i was notified, 3:00 in the morning an they called me from fort hood saying he was injured, where they had taken him, he's

back with his unit, but yet you diagnose somebody with ptsd and tbi which can be life threatening injuries and nobody notifies you. that just doesn't make sense to me. >> anyone else? >> your point, or question of being flagged as a high risk, this is something that came up that really baffled us, i guess. when clay was transitioning or moving to houston and started to go to the va in houston, his records apparently from what i was told, those records were not seamlessly, electronically sent. they did not have his records from l.a. and that's where the bulk of his time was once he had gotten out of the marines. so as i look back through those medical records, as i said, there were at least two or three

times in there that it talked about and he talks and admits to having had suicidal thoughts, so i assume that he was flagged, would have been flagged as a high risk. i mean, it says on the medical record, high risk, highlighted. when he comes to houston va, nobody knows he's a high risk. the psychiatrist didn't have anything other than clay saying, this is what my past history has been, and this is the medication i've been on. so that's a great point is to when are they flagged as a high risk? do any family members know that? the only way i ever knew that anybody called him a high risk was when i got his medical records and poured over them after he had died. >> thank you. chairman, i yield back. >> miss brownley, you're

recognized for five minutes. >> thank you, mr. chairman. i want to join my colleagues in thanking all of you for being here, and sharing your stories and certainly through your stories about your sons, it certainly, to me, i feel their patriotism through your stories and their overall most sincere risk commitment and service to our country. so thank you for being here. i wanted to ask sergeant renschler a question. and so in your service, when you were in theater, was there any support system in place for you to go to get any kind of, you know, mental health support while you were there.

hearing brian's story, it was re gut wrenching to hear it, and, you know, just to wonder if brian had a place to go to, why he was in theater, how helpful that might have been in terms of his time there, and his transition coming home. >> ma'am, thank you. when i deployed was 2003, it was right after the initial surge, it was a completely different war theater. we really didn't have anything set and established at that time. so to answer the question, no, there wasn't anything. however, again, i work with many, many veterans, currently, in active duty members and i have been told in recent deployments in afghanistan that after major events take place, there is sometimes availability

to have a type of crisis debrief. it is somewhat available. it is not -- it is not streamlined, not across the board, but it has been implemented on some level. >> if i may, the problem is that we know that there is an effort in the dod to destigmatize mental health issues. but if you're in theater, i would venture to guess that it is going to be incredibly rare for somebody to take advantage of that because all of a sudden they're going to be taken off duty. and the whole idea to destigmatize it is to say, okay, you come in for treatment, but then once you're better, then you'll be able to rejoin your unit or you'll be able to regain your security clearance. but while you're under

treatment, you're not with your unit, and you lost your security clearance. so i mean the issue is a huge issue. and we know from people that we have spoken to that the people at the top are aware of this, and they're trying to deal with it, but there is just so much you can do on a boots on the ground level. >> well, if i may, so there is two separate levels here. there is a crisis response, muc type of a situation. if you experience this, find somebody to talk to. more of an education and immediate response. that has been available as stated, most military service members and veterans as i stated earlier in my testimony are not going to say, gee, that was a

horrible experience, i should talk to somebody before i have issues. they are going to wait for it become a crisis point before they seek treatment. >> i just feel like if it was part of the culture being in theater that there is kind of constant dialogue that is going on, that that would have to be helpful to the men and women who are are there. >> brian did tell me one time when they were on the 15-month tour there was at one time they lost four people in one mission. when he was out there, the morale was very low after that because these were people high up, sergeants and lt and that. so they sent someone in, and when the soldiers would go in and talk with them, he asked the same question, was it sort of like a movie? that just insulted them almost. it was like, why would you ask such a silly question, so they

all shut down. i think by not processing those thoughts you are going to internalize them so they are never dealt with. i think even before they are in theater, i think in basic training they should be taught ptsd and while they are deployed and report on each other for their own good and in transitioning home. i don't think we can say it enough. that's my opinion on it. >> thank you. thank you. i think it just confirms we prepare our men and women to go to serve and to go to war. we don't prepare them very well to transition back. dr. somers, you talked about hipa and the barriers to hipa. you mentioned also modern technology? am i? i yield back. i apologize. >> thank you very much.

>> thanks to the moms and dads and sergeants for your testimony. i will look forward to asking the va question. i yield back. >> thank you very much. >> thank you, mr. chairman and thank you to all the families being with us today. for many of us sitting here today, the pain is to recognize your commitment to give meaning to your sons' lives. i'm the mother of two sons 22 and 25. i can't fathom what you are going through. i want you to know we will do our part to give meaning to their lives. it makes me feel, personally, i'm becoming more and more anti-war/pro-veteran. i think our country had those

priorities misplaced getting us into conflict, but not being focused on the cost, societal cost to our country and to the population. these extraordinary young men and the promise that they held going to haiti and making a difference right here. i want to focus in because i think from your experience you can really help the va and the dod to understand what could make a difference. i want to commend you all with the specificity of your recommendations. in particular, i've been trying to understand best practices, and whether there is any effort or known groups or the types of medications that are helpful, have any of you in any of your

discussions, whether within the va or since then, the experience you had meeting with people, have any of you come across any effort to share best practices with the transition, particularly around pts and tbi and just the trauma, how we can help people coming back from this level of trauma? maybe we can start with the sergeant, if you're aware of any types of programs that are effective. >> thank you, ma'am. there are great things that are effective, but the problem is is even though we can group veterans together in a large sum and combat veterans in another category, it's hard to label one program as effective for all. so many find group therapy programming very successful. many find combat veteran support

groups very helpful. some find one-on-one peer mentoring very effective and helpful. this is why when we are talking about evidence-based therapies, best practice of the va pushing pct, these things can be deemed as best practices, but many veterans aren't ready to go through such intensive therapy. they would rather pace themselves. though they can be very effective squashing the problem, i can't say there is one thing that is straight across the board going to work for everybody. that's why i stress the importance of a team that works together to bring together what's best for each individual veteran in a veteran-centered care rather than a systemic care

a veteran has to adhere to. >> you are looking for an individualized approach, but a team approach. you mentioned others on the team may see something in the care. >> yes, ma'am. >> i also want to visit this issue of hipa. i'm an attorney. i worked 25 years in health care. there's definitely a waiver process. this happens in private sector medicine. are any of you aware, and through your review of the records after the fact, have any of you experienced the va asking the patient at any point in their service for a waiver to identify people that they would be willing to have their medical record shared with? >> i know we had specific -- daniel ended up going outside the va because his psychiatrist

retired and they said we don't have anybody for you to see. at the time he was having suicidal thoughts. his mother-in-law who is a private sector psychiatrist referred him to somebody she knew in the community. as she was seeing that person, we asked him, can we be a part of what is happening and he said he would ask her, but my guess is that he never asked her and we never got the feedback. it was embarrassing is probably the closest word we could come to with him to share that information. >> i can speak to that a little bit, as well. going through clay's medical records from houston from the va, there was a form in that assessment and there is a question that says, do you want us to or will you allow us to, or it said do you want your family to be contacted regarding

your care? and he had checked no. as difficult as that was to read, i know him and i can't even imagine, and i really -- i just can't even imagine. these people are so strong in the first place to raise their hands and say i'll go. and they go to war and they have these injuries, and especially with the mental injuries. it's so difficult to feel that you are a burden on other people. i know clay felt that, even though he knew how much he was loved, unconditionally. any of us would do anything to help him, but he was 28 years old. he had been a marine scout sniper. you just want to be able to take care of yourself and get the medical care you need. so it didn't surprise me to see

that, that there was a question of would you allow your family. >> thank you. my time is up. thank you, mr. chair. i yield back. >> thank you. mr. kaufman, you are recognized for five minutes. >> thank you, mr. chairman. first of all, thank you so much for the service of your sons and sergeant, in your case your own service. my heart goes out to you for your losses as a veteran myself. the question i have is, i mean, do you think, certainly sergeant in your case and then for the parents in the cases of your sons, was va overmedicating them in lieu of giving them therapy?

>> thank you for that question. this is an issue we battle with on a daily basis as we provide support and service to veterans and active duty members. part of what i do through the ministry i'm in is providing support groups through the chaplain's channels. so ideal with this very closely on both sides. medication is no longer being used as a tool to subdue the symptoms while we work on the deeper issues. >> no. what does the va do? >> the va specifically utilizes medication to control it and keep them, suppress the symptoms without working on the deeper issues. >> thank you. please. >> brian was never put on any medication. only for his back when he had that problem. >> okay.

>> yes. clay was on quite a bit of medication. as i said, he felt like a guinea pig, constantly being begin something different. >> do you think they chose medications in lieu of therapy? >> sure. >> one-on-one therapy? >> yes. the only one-on-one therapy that he spoke of that seemed to be effective at a certain point in l.a. he went to a vet center and had a counselor there that he really liked and felt he finally found somebody he to talk with. >> okay. >> from daniel's point of view, i think part of his problem was that he also had gulf war syndrome which manifested with so many physical symptoms. so, yes, he had a 24 inch by 24 inch drawer full of pill bottles, but i think it was because he was having such incredible interactions between the different drugs he was taking for pts and the gulf war

syndrome. >> and daniel was not being seen by a va psychiatrist six months after he was home, just because he never got the post card that he was supposed to get to assign him another provider. >> how much of the stress of the factors leading to suicide do you think might have been related to the fact that -- i can tell you having been to iraq, first iraq war then the second, that when you come home there is a huge, i guess maybe separation anxiety that you develop these interdependent bonds in this team around you and all of a sudden it is gone.

it is just gone. people fall into very dark and deep depressions sometimes. i think it's easier for those that come back and they have a long period of active duty with the same people that they served with. i wonder if you might comment. we'll start with this side of the table. >> this is a problem certainly with national guard. daniel was a member of california national guard with the military intelligence. they are routinely separated from their main unit and assigned to other units. daniel went to iraq with an mp unit out of texas. so he was already not with the unit he trained with. he went to iraq. when he came back, his wife had moved to arizona to be with her parents. he's california national guard deployed through texas and ended up in arizona. so he had no support group

whatsoever close by. it would have been phone call and e-mail. >> this is a news magazine issue. reserves and national guard, it's a huge issue. not to take away, of course, from regular service members and all branches of the service, but it's a much bigger issue for those who do not have the opportunity to come back to a defined facility and spend time, like you said, with the people they were deployed with. >> great question. the bonds that these men and women form in combat are just incredible. so it's very difficult for them to leave service and come back to their communities. lay probably stayed in, he struggled about going home to texas or staying in california. i think one of the reasons he stayed there for a while was because his close friends, marines were staying there and continuing in his life. one of the tragedies with clay was he moved back to texas and

he really wanted to consider going into working for the fire department, paramedic, that sort of thing, and was having some struggles with that. after he died, he found out that, i think, three of his group were actually in the greater houston area. one of them in particular had gone through all the steps. he was like a year ahead of him going through the fire department. it would have helped just the knowledge those people are there would have helped. there is a big break leaving service and going back to the community. >> when brian went first he was with first caf. that was deployment that was supposed to be 12 months and they extended it to 15. he was very, very tight with all those brothers and they are still very, very connected online and text and everything.

when he was in college then for the year, then when he was called back the second time, his unit was already home for the year. so he was put with louisiana national guard. he had no idea those were completely new people. so you can imagine then when you are already damaged and you wake up screaming three times a night and have anxiety and panic attacks, you know, it's very difficult. i think he did bond with the people. he was very social, but it wasn't the same type of bond he had with the first group. >> i think it's been stated well. to highlight on that, the battle buddy system is so culturally engrained in the military community. you really become a family unit with those around you that you serve with. separating from that, and especially our wounded as they are shuffled from their units to

a warrior transition battalion, they are separated from that unit. they transition out and lose connection and begin to isolate themselves after that loss. that's a very difficult thing. i think that's why a program such as the va's peer mentor and navigator program are so essential. we should look at that and look at the way it's being implemented and improve upon that. service members and veterans connect best with other veterans. especially those who have shared experiences and can help navigate through the experience es they experience through this system. >> thank you. >> mr. o'rourke for five minutes. >> thank you, mr. chairman. i would like to join my colleagues thanking you and telling you what you have shared with us today is so powerful. sergeant, your story, the story of brian and clay and daniel, i

hope will force us and the administration and this country to treat this issue with the respect that it deserves, with the attention it deserves, and to get the results that our veterans deserve. and beyond the power of the stories, which are just -- it's hard to put into words the effect they are having on me and i think my colleagues on this committee. you've also come to the table with solutions and proposals to improve the system. i love the idea that we think about the va restricting its responsibilities to becoming a center of excellence for war-related injuries. i haven't thought about that before. i don't know what the effect would be. i would love to hear from other veterans and veteran service organizations. i love that you are thinking about a big idea to transform a system that is obviously not working today, but hasn't worked for a very long time from

everything that i've learned so far. this idea of an interdisciplinary approach to taking care of veterans when they return, i'd like to know more about that. i think it makes a lot of sense begin your earlier testimony. the buddy-to-buddy system you brought up. identifying a support network when these service members are still enlisted are all excellent ideas. i'd like to ask you is, i've received so much value from this testimony today than i ever have from a representative of the va, including the reasons why we should be focused on this, the ideas and suggestions on how to fix it. i'd like to ask you if there was some formal process to involve you in fixing the va, would you like to participate? secondly, if you have any other ideas because there have been so many good ones that have come through so far that we haven't

raised today, i would love to give you an opportunity to share that. maybe we can start with dr. somers and work down. >> we want to be part of whatever efforts. we submitted as part of our testimony 15 pages of problems and potential solutions. there are a lot of really good people who can be very beneficial to try to help the syst system. we just don't have the time to get into specifics right now. to answer your question, for sure we would like to be involved, if at all possible. >> thank you. >> absolutely. we would be happy to do whatever we can to help. i want to kind of shift the focus a little bit off of us as parents who lost sons and lost childr children. words can't describe that, but i sit here and look at sergeant

rensler and listen to his story, and we are surrounded by veterans behind us, a lot of them from the iva group. if there is any blessing or silver lining in clay's death, we have become friends with so many of these young veterans that have enriched our lives. i don't know where i'd be without them. i mean that sincerely. they just have enriched our lives so much. so whatever we can do. we can't do anything to bring back clay or brian or daniel, but what we can do is do something, whatever it is, to make life better for all these veterans behind us and all of them all across the country, all veterans. not just iraq, afghanistan, but all of them. we shouldn't have to be reminded of that, and yet we seem to have to be reminded that we need to

do a better job. so we are happy to do whatever we can to help. >> thank you. >> any time, any place, we're available. part of the process for us to heal, and i think for everybody at this table is to have the opportunity to go beyond our personal losses and to address the veteran community as a whole, and to do whatever we can to take care of those fine men and women. so the opportunity to be in this community here and to be able to talk and to be able to be heard by people who hopefully have, i believe certainly have the heart and hopefully have the ability to make some things happen. the va is very, very complicated. it's a huge animal. i know there are a lot of things that need to be dealt with. there's a lot of really good

stuff it does. there are some big problems. i think if we can just focus on the individuals, just focus on them as people in need, as patients on their care. what do they need today? and then build the system, modify the system, do whatever based on that. i think that will take us a long way. the focus needs to be these veterans. >> thank you. >> totally. >> my time has expired. miss portwine and sergeant rensler, would you indicate if you would like to be involved perhaps in a more formal way to include your ideas? >> it would be an honor for me to help make a change for the veterans. it would be like paying it forward. >> thank you. >> any time, any place. i not only bring my battlefield

perspective, but all the veterans i work with. i can only offer that much. >> thank you. >> mr. cooke, you are recognized for five minutes. >> thank you, mr. chair. i want to thank the group for being here. i know this is really, really tough. sergeant, for your input, this is tough to listen to and it's even tougher for you guys. the comment about the parents not knowing, i'm not surprised. a lot of people, the worst thing in the world, after my second purple heart, i didn't want my parents to know what was going on. this is going to be the problem that i think all of you are sharing, that common denominator. you know, everybody that goes through these experiences will have huge psychological problems, but who are they going to share it with? are they going to share with a psychiatrist or a psychologist

that doesn't understand the military culture, the veteran culture? they are not going to open up. you need that connection. i think the sergeant made a great point. your comments about the wounded warrior program where they have that, the actual battalion where when somebody's got a problem, they go into that system there. i just want to get your feelings. maybe i'm going down the wrong road because i think they need somebody that has a problem, they need an ombudsman, somebody that's going to look out for their interests. that if they have a particular hospital, that they can go to the administrator. they can go to anybody and say, hey, wait a minute.

this is an immediate situation. this is general quarters and we need to have a meeting right now or somebody is going to die on your watch. can you comment a little bit more on that? it's pretty much what you were talking about, buddy-to-buddy, the same things over and over and over again, but to cut through the red tape right then and there with individuals that understand severity of the problem. >> yes, sir. this is a crucial element is to have somebody to come alongside of these severely injured, cut through that red tape and get treatment now. this is something we experienced first hand. i've experienced. i shared with some of the folks from wounded warrior project recently. we did a crisis intervention on attempted suicide. we got him in a position of stability and i found out he never accessed care at the va

facility. he went down and he was denied treatment and told he would be able to be seen in three months after telling somebody he had attempted suicide the night before. i went down there and met with that veteran and we walked in and i said this is an unacceptable answer. we got the department head to come out and say i will take him today. we have a program we can start him in next week. that saved that veteran's life that day, but there are thousands more a day that are getting the no and not getting the extra answer because they don't have somebody to advocate for them. i'm not saying that to toot my own horn. ifa advocating for these veterans, we would get better care. >> i just got back from camp lejeune. i saw some of the folks, including my platoon sergeant,

he was my platoon sergeant 47 years ago. we talked about the infantry unit. you never forget the marines you lost. 13 may, 1967. horrible, horrible day. you never forget their names, the occasion. just like you are never going to forget this. what you have to do is try to make the system better. right now i think it's broken in terms of not capturing those individuals and those thoughts, the morale is just down to the point where they are going to do something bad. if we don't correct it now, it's our fault. comment? >> it's a systems issue within the va. and our feeling is everybody who works in the va should have only one purpose in mind and that's to advocate for the veteran. it's the person who sits in the corporate office to the person who cleans and empties the waste baskets at night. that's the only, only thought they should ever have.

>> doctor, that concept of the ombudsman or for lack of a better term, somebody that is ultimately responsible or somebody that is that advocate for that person in trouble. >> we agree there needs to be an ombudsman. we know about the navigator program. that's a great program. we know that they are doing a much better job of that out in san diego. it's not only the ombudsman. it's not only the navigator. it's every single person. >> it should be an sop. >> standard operating procedure for every hospital. i yield back. >> thank you, colonel. ms. brown for five minutes. >> thank you, mr. chairman. let me thank each and every one of you. i recently did work with marines and they would be very proud of you, your sons. thank you very much for your

service. you know, i have to say we are talking about the va, but this is not just the va. it's dod. this hearing should be va/dod because it's dod that send people over and over and over again to combat. it's not transitional as far as when they come back, so it's a bigger problem. to sit here and say it's the va, that's just not true. it's just not true. we need to deal with the problem. the fact is we've been fighting a wall with reservists. and we've sent them over and over again. and they didn't have the support that they need. i've gone out when they're deployed. they don't have all of the other, that the other military branches have. we're not doing the wars the way

we need to. and the system is fragmented. so as we develop a comprehensive system, let's get everybody in the room. let's deal with the system the way we need to deal with it. now, you mentioned the formulary. we insist they negotiate the prices of the drugs to keep the costs down. what is wrong with the way we're doing that? because in the regular market, it is illegal for the secretary to negotiate the price of the drugs. which i think is dumb. >> there is no problem negotiating the price of the drugs. the problem is the drugs aren't the same so that, for example, lexopro, you would want the dod

formulary as opposed to the va formulary, no doubt about it. i know first hand you can basically get anything you need with relatively little hassle. >> but i thought the va was the one that was doing a lot of the research, not the dod. >> research has nothing to do with anything. the only thing that has to do with it is the actual drug you are being prescribed by your provider. you can do research. that was one of daniel's issues. there is a problem doing research because of the fear of the fda and dea and schedule one medications and things like that. that's a totally different issue. the problem is the formularies aren't the same. i've got patients, not only veterans being discharged, but retired military who are being seen at a dod hospital and at a va medical center and they are eligible to be seen in both, and they are under medication

restrictions because the formularies are different. we need to make it a single formulary. bottom line. >> okay. >> excuse me. in addition to that, it's like if a person is doing really well on a drug, they should be able to stay on that drug. >> the doctor can override that. >> just because you can get it for 10 cents cheaper, it can have major effects on their body. >> absolutely, but the doctor can override that. >> what gina is saying is different. it's still a generic, but as i said before, it's a different formulation of the generic. >> right. >> especially as was said. that's what's so important to have these groups of the multispeciality groups, the interdisciplinary committees that are going to communicate among themselves.

>> i think that is something we can work on. miss portwine, i think you made a very important point. your son, you realized was having serious problems, yet he was redeployed. >> yes. >> he wasn't given the medication. it should have been a time-out at that point. >> well, even on the form you can see it said "no go." that was crossed through and somebody stamped, the coordinator that sends the people put "go." >> but that's dod. >> that tells me they had hesitation sending him to begin with. >> that's dod. >> yes, ma'am. >> thank you very much. i'm saying it's a lot of work that needs to go on. it's not just va. thank you again for your service. >> thank you very much. >> thank you, mr. chairman. thank you to the panel for being here. i can assure you that this is

how things change in this country is when brave men and women step forward and say to a concerned body like this of republicans and democrats sitting here listening to your story, i can't even imagine, i can't pretend to imagine how tough it is to sit here and relive this. i think i can safely say we are committed to bringing right to all of this wrong. every one of you have hit the nail on the head by saying, every one of you have said the story is about the individual veteran. i've only been on this committee 18 months, but the last three months, the chairman and ranking member led an intensive investigation into what the heck happened to the va. from the day it started to the mission today. and every layer of this onion we peel back comes down to the same core issue. nobody is advocating for the veteran. the culture itself, when we talk

about systemic problem and the culture itself, and secretaries removed and a bunch of people removed and we are trying to help america reset a button. because americans believe in our veterans. they send us here to fight for our veterans. i want to applaud your effort. you made such a huge difference here today. this is how laws change. this is how policy becomes correct, and this is how we move forward in this country. we do it together. unfortunately, sometimes it takes the disaster that we had in a bureaucratic system of the va. the frustrating thing for me is, i have 54,000 veterans in my district. every time i describe my veterans, i talk about, i have 54,000 veterans and their families in my district. i want to applaud your effort on two huge issues we can address in this congress and help move forward on this issue of mental health. one is the support network. i can't even tell you, and i know you know how much

constituents called our office in indiana. the wife or husband is in tears and begging and advocating for the spouse that the va says hipa prohibits me from allowing you to get involved in this. i've gotten personally involved, calling the directors trying to advocate for my constituent on behalf of a spouse. the answer is still no, hipa overrides. do you have a different law? do you describe to a different definition than we do? the answer was no. hipa overrides. just having a support network to be able to come in and be that bridge between somebody who is dying and the system. i applaud that effort. i'm going to make sure we do everything we can to get that part of the law changed because we can bring advocates into the lives of these struggling men and women. for the spouses that are trying to hold families together, we can do that, too. i want to thank you for your commitment, as well, on the

issue of keeping this focus where it belongs. i think some day, i don't think this is a quick turnaround, but i think you brought light, transparency and accountability to another layer america need to hear. while you are talking to us and we are trying to relate and share your grief and find solutions to move forward, you had an opportunity to talk to the american people today. i guarantee you that every single person you are an influence to that followed your story, i'm going to hear from my constituents today and say, i relate to that mom and that father and i relate to my fellow servicemen. i think it's a tribute today. this is how government works. we have a commitment to make sure we restore, not your sons, but certainly the america that they have been fighting for. certainly our trust and their trust in us as a government who asks them to go, fight for freedom and fight for liberty. our finest heros in that nation.

reinstitute by continuing to root out the bad actors and bad policy in the va and together set a reset button. i want to applaud your efforts and thank you for helping us reset an organization that started out as a great effort and has become a bureaucracy run amuck. you have my commitment none of what you experienced will be in vain. thank you. i yield back my time. >> i would like to yield the first minute to my colleague mr. peters who represents the somers. >> thank you. i want to thank the chairman and the committee for allowing me to be a guest. we are not members of this committee. i don't think there is any place we would rather be this morning. it takes a lot of courage to do what you are doing. thank you for that. also to let you know beyond the power of your stories, it's the education you provide that only you can provide. these are insights that only you

have. it's been very valuable to us. while we are new here, i can tell you that from time to time you see testimony that's going to make a difference. that is certainly what's happened today. you can feel very confident that those brothers you talked about and sisters will be heavily affected and helped by the time you put in and effort you put in today. i also just want to thank in particular howard and jean somers for your leadership, the time you put in on behalf of daniel and the education you've given me. i look forward to continue working with you to make these issues, to resolve these issues and make things right with the veterans that the va sees. thank you. >> thank you, chairman. thank you all for being here. i'm sorry i never got the chance to know daniel or brian. i did have the privilege and honor to know clay. not only know him but work with him on veterans' issues. the profound loss is felt by everyone who came in contact

with him. it shook me to the core because of someone so strong and your point on we don't, you are not going to notice it. these are very special individuals. you and i have become friends over the years. we were in st. paul a few weeks ago working on wounded warrior projects. you hear it from the colleagues. this is a committee of heartfelt folks that want to get this right. i would mention, and i think all of you get this. at this point and the frustration we all feel, solutions and results are all that matter. i'm done with it as you all are. i'm done with the talk. i'm done with the pilot programs. there are suggestions that are concrete. i want to read you something. i came here on the 3rd of january '07, the 9th of january i worked on a bill. one of our colleagues of vietnam veteran pilot leonard boswell. here is a couple of things it

said. secretary of veterans affairs should develop a comprehensive program to reduce the incident of suicide among veterans. staff education for compassion amongst them. recognizing respect. proper protocol, screening of veterans receiving medical care. tracking of veterans in a timely manner. on and on and on. they did not do it. it was in law. we passed it. we gave the speeches. we had the signing ceremonies and went back home and said, gee, we made a difference. it's the very same thing just like you said. i guess the thing i would ask of all you, this is the second, va is the second largest governmental agency behind the dod. yet we have one of the smallest committees. we have committees i don't know what they do and they have 80 staff on them. we can give lip service or get serious how we are going to do it. we can have this or allow if

this crisis passes and the american public's attention focuses elsewhere. there are veterans behind you from vietnam and others. they've seen this before. here is what i think is different. there is no doubt the american public wants to get this right. they are entrusting us as their representatives to get this right. the commitment i've seen from this chairman and ranking members, members of this committee, this is different than the seven years i've been here. it's different how we are fo focusing. we can't let this pass. what i would tell you. you mentioned a thank you for this. chairman miller and representative duckworth and myself along with iva paul and vfw. we are going to introduce 2182. here is what i would say is different. this is a well-intentioned bill.

we are going out. this is the silver lining. there is no silver lining when your son is not coming home. you've asked for a solution. i would ask each of you as 2182 starts to move and senator walz does it in the senate, let's together make sure it doesn't end up as this act. the secretary had the authority. the american people through us said do this and they did not do it. i would only state to each of you as my colleague mr. o'rourke said, this is how democracy can work best. this idea of wringing our hands of who could have anticipated this. really? this bill was started in 2007. here we sit in 2014. keep the faith. we have to. again, i would say this. the cameras, tv, stuff that's there, whatever, none of it means a damn thing. if we don't get results this

time, shame on us because here's the thing. i'm not going to get to meet daniel or brian. you've got the right guys up, the right commitment from the public. now it's going to be, can we do it. with that i yield back. >> thank you. >> i, too, would like to thank you for your courage being here today. please know that your efforts today will make a difference at the va. i want to thank you. mr. and mrs. somers, i want to thank you for that 15-page primer there. i appreciate you all taking the

effort to put together a document like that. mr. and mrs. selke, i was disturbed by the comments you found that the environment of the houston va was stressful. could you elaborate on that? what specifically led to that conclusion? have you been there since? has it changed? tell me more about that. >> i went by myself that day and have not been back there since. for whatever reason, i just felt compelled to go and quickly get his medical records. i wanted to see them. it was again be, for ten weeks' worth of care there so there were not a lot. you drive up to the facility. it's huge, as they all are huge. there were so many people milling around out front. big crowds. lots of people that i don't know if they were there waiting for appointments or if they just

don't have anywhere else to go and hang out there. you go inside and i likened it to an airport terminal in a way. you go in and it's just a hub. very busy. lots of people milling around, lines. the cashier lines looked like in an airport where you would line up to get your tickets or something. it was very stressful for me and of course i was in a grief mode, but not a post traumatic stress mode. i just couldn't imagine -- i could visualize clay going in and i could understand why when he left that day and he called and said i can't go back there, no one was at the information desk. you walk in the front door and they were on a break or something, but no one was there. i looked around and finally found somebody that could direct me to where the medical records are and went and retrieved

those. before i left, i remember standing there for a few minutes and just imagining if i were a veteran, if this were clay. >> how do you negotiate this. you mentioned another thing. that was your son had voiced concerns about the care he was receiving. were there specific concerns he raised? >> i'm not sure i remember what you are referring to. >> okay. let me ask sergeant renschler a question. you wrote that combat veterans in particular often approach mental health care as hesitantly or distrustfully. how would you suggest we change the dynamic to ensure that veterans who need mental health care feel more comfortable accessing the care? >> yes, sir. thank you. it kind of starts with what she was just sharing. even at our facility we have

seattle and american lake. seattle is a large hospital building, not laid out very user-friendly. myself, i have a traumatic brain injury i've overcome very well. i get lost and confuse in that place real bad. there are not a lot of friendly people to direct me. i get better customer service at best buy, quite frankly. a little bit of care training would go a long way within the va medical centers. my other medical center closest to me is a campus with many, many buildings. the building numbers don't make sense. i'll be in 81 and told to go to building 3 which is right neck door. building 61 is across the campus. the numbers make no sense. the facility is confusing, overwhelmingly packed in and not a lot of people to help guide and navigate a very confusing situation. for one, just recognizing who

the audience of a veteran is and making an environment conducive to healing would be a start. another one would be, as i discussed earlier and keep bringing back to that interdisciplinary team, it takes rapport. developing a relationship and rapport with a veteran to get him to go beyond surface level issues with a physician. i'm going to go in and triage myself. on active duty and in the infantry culture, sick call was very discouraged. if you went to sick call you were a wuss and you got crap for it for the rest of the day. so we don't go to sick call unless something is debilitating in nature. that sticks with you the rest of life. as i'm muscling through ridiculous pain my wife will stop and say when are you going to see a chiropractor and get

help? it's the mentality to suck it up and drive on. when they get there, it is a crisis and needs to be treated as such. there is a two-fold answer here. number one, the va needs to recognize there is going to be a lot of crisis and come back in three months is not acceptable. come back in 14 days to intake so you can intake in another 14 days to get treated in three months, still not acceptable. instead, to have a team to say, welcome here. this is your place, this is your team. these are the people caring for you. this is what we are going to do for you and provide better customer service, for one. for two, develop a relationship of trust and rapport so i can know i can confide in these people to provide the quality care that i know they should. >> thank you. >> i hope that answers, sir. >> thank you very much. i'm out of time.

>> thank you, mr. chairman. thank you, all, for being here. your stories are just tragic and heart wrenching. i hope you can take some comfort knowing what powerful advocates you are. you have told your stories so eloquently, so ordinarily, so thoroughly that it really will help us to move forward. i've just been noting down some things we need to address. i think we are at a point where we really can make a defense. in addition to the things you suggested, i want this committee and the people in the room and i ask you for your help on this, for us to address some other things that i think are also related to the problem. first, you are obviously very loving families. you were there for your children. many of our veterans don't have families like that. there are many homeless veterans, they are sleeping on the streets, they don't know where to go. they don't have somebody they

can turn to. so we need to figure out a way how we can address the problem for those veterans as well as for those like your children. i want us to not overlook that. a second thing is the vsos are there to provide services to veterans. when they don't have that ability to bond like they do while they are in the military, the vso is there, they can't be there 24/7 like your band of brothers and sisters can, but they're there. maybe we need to look at some ways we can help them to do more outreach and better fill that gap for when people come out. also, we heard some horror stories about the medicine and all the different drugs. i think we begin to hear medical marijuana is a possible way to address ptsd. let's don't leave that off the table as we move forward. even something as simple as the

notion of companion dogs. that is something you hear, too. many vets, if they have a pet, that helps them get through some of these troubled times. let's keep that on the agenda. you mentioned about being a firefighter. when veterans come back, they don't just need health care, both mental and physical, but they need to be able to transition into civilian life with easy access to education so some of their training counts towards college credits or employment, to retrain and have jobs so they have something to look forward to that takes a little of that burden off. those are all things we need to look at the big picture. i just thank you very much for committing to continue to go down this path with us. i would ask you, too, don't leave anything off the table. anything you can think of no matter what it might be, now's

the time for us to address it. i don't know if you want to comment. i don't want to put you through more questions. >> i have one more comment. >> the door is open. >> i know that the va has the emergency crisis line, 1-800-273-talk, but i work for an insurance company. we have what we call nurse line. any time a member can call 24/7, 365 days a year, why do we have to wait till it's a crisis to have anybody to talk when they are starting to feel depressed would be a great time for a nurse to be able to assess and triage what this person needs. can it wait tomorrow, routine two, three days what do they need? waiting till it's a crisis line, you are more down that slippery slope. >> if i might add, we are fairly

new at this whole political thing, but i came across something called the independent budget, which if i'm interpreting correctly the vso put together for congress. i would ask that next time that comes to you, you really look at that really, really closely. these are your veterans talking to you. >> i'd like to just add quickly. one of the things that clay said over the years that sticks with me and it just is wrong. he would say over and over, i have to grovel for my benefits. i just think we need to wake up as a country. our veterans should not have to grovel for anything. it just should not be so difficult to get the carehe