happen. the problem is you pay that debt forever, and that is not just. the punishment is supposed to fit the crime, and i am confident this is not what our founding fathers wanted when the constitution -- the personal and professional annihilation of someone that made a mistake, and i have to agree with her. bob, winchester, california. republican line. go ahead. is right on.guest i was a priest -- a prison minister and a priest for 15 --rs, and i hope set up the i cannot think of it anymore -- the freedom fund. about. what it is

prisons are now a cottage industry. they are built a company that bids on the prisoners, and then they stuff full of prisoners. is 2.7% of the world's 25% ofion, and we have the world's prisoners. your guest is so right on. see, it is about getting them into the system. once a young man gets into the system, and unless you are smart, like i was, i saved my son -- you cannot get them out. -- for forgiving this this for myforgive son.

he was one of the first 17 that landed in afghanistan. president clinton gave me , but your guest is so right -- they want you to be there. they want you to get in prison. man, they getng caught, they get in the system, and there is no way out. bob. let's get a response, let's hear from bernard kerik. guest: peter, here is the thing -- two issues. one, it is an $80 billion a year industry, so there are a lot of lobbyists out there. oute is a lot of industry there that wants as many people in prison as physically possible , but i agree with your caller on this one point. that is these young men and ,omen that come into the system

you are creating, in my opinion -- you are creating an enormous amount of recidivism where they will come back into prison and here is why. you take those young men that i was talking about earlier -- 19 aars old, gets arrested for conspiracy, five grams of cocaine, you sentence him, 10 years of prison. he does 8.5. , heng that 8.5-year period gets no life improvement skills. he is physically in a prison. foron is a training ground commonality -- you learn how to lie, cheat, steal, manipulate, gamble, and flight. your disagreements -- flight. .- fight you disagreements are usually in extreme verbal confrontations or

physical confrontations. so, that is your education in prison, and then we let them out to go back into society. they cannot get a job. they cannot get public assistance for education. they cannot find an apartment. they cannot get a place to live unless they have somebody on the outside that is going to take care of them. at what point do they basically give up? at some point they give up and they have to revert to crime or they have to go do something stupid to take care of themselves or take care of their families, and that puts them right back into the system. they need in education -- a real education, and they need real programs. we put tons of people in prison today for addiction. people that aren't it did to -- people that are addicted to drugs need treatment. they do not need prison. they need treatment. we put mentally ill in prison.

they belong in treatment centers. they need to be taken care of by clinicians, not sitting in a jail cell, a prison cell. all of this stuff leads to enhanced recidivism, and the numbers continue to turn over. one last thing on your caller's description, i think we are about 5% of the world's population, but we are 25% of -- we hold 25%ns of the world prisoners. how is that possible? how is it possible we have more prisoners than russia or china? the insanity of the system is

one of the reasons i have testified before the congress and talk about this constantly is because the general public doesn't understand the damage that the system does. if you have -- haven't experienced it firsthand, if you haven't been there, if you haven't dealt with it through some personal discourse, a family member, a friend, or otherwise, you have no idea, and the reason i know that is because i was in the system. the largest law enforcement organizations in

this country. i ran the nypd and iran rikers island and new york city jails system. you are right. people can criticize, but the i have seen the system. have laws that are crippling our economy and devastating families and crucifying children and we've got to do something about it. host: the prison policy initiative group put out this 2 million people are currently locked up on a day-to-day basis in the u.s.. state prisons contain the most. federal prisons, 216000 and local jails, 7000.

this group also says that about 12 million people a year siphon through the u.s. prison system. calvin, newark, independent mind , please go ahead. caller: good morning, mr. kerik. i want to first thank you for coming on and sharing your story and trying to make a change. i want to say that. i am from new york. i want to say thank you for that. my comment is there are -- i read somewhere where they spend about $40,000 per inmate -- either the taxpayers, the government, or both, and as for children in the education system, it is only 8000. now, it seems like there is an incentive for these prisons to keep being built when it is paying $40,000 per inmate. that is a lot of money per inmate and it gives them incentive to keep locking up more and more people. that is my first comment.

my second comment -- i was diagnosed with a mental illness. ever since being diagnosed with a mental illness, i have had to do with the criminal justice system, and since having it, i have dealt with several charges because of the mental illness. to speak on that, i believe that drug users need treatment, people with mental illness need treatment, not jail, like you said. thank you for having me. host: -- thank you for having me. host: thank you, calvin. bernard kerik. guest: i understand what he is saying. back to the financial issue, the

economic issue, you run -- depending where you are at, and depending on the system, you could say that an inmate costs $25,000 to $100,000 a year depending on where they are being held. the bottom line is state government across the country, it cannot sustain these costs. that is why you see a lot of state governments across the united states that are looking at alternatives to incarceration. they are looking at criminal justice reform. they are looking at reducing mandatory minimums. they are looking at the overall criminal justice systems in an intent to reduce bed space, prison population, and i have to give credit to the state of texas, governor perry, some of the other states out west -- right on time states -- crime states that are really addressing criminal justice reform.

for whatever reason, a lot of this has to do with economics. you cannot sustain these budgets. you only have so much money in the budget and once you run out of money, no one is coming to your aid, so you have to do something about it. in the federal system -- in 1980, there were 25,000 prisoners in the united states federal system. today, it is 216,000, i think it is around 218,000. not one year since 1980 has there been a reduction in the bed space. it has increased every year right up to this year. the federal government prints money. they keep putting money into it, and at some point the american people have to realize it is an economic cost that is written in them -- burdening them, the

american taxpayer, and i do not see this being sustained. i think at some point in time it has to be addressed. i give the attorney general and the president credit in trying to do something about it. i just hope the members of congress will get on board, cut the polarization, across party lines, and do what has to be done. right now you have senator booker from the state of new jersey, rand paul, and a number of others that are truly looking at criminal justice and prison reform. i hope others jump on board and do it needs to be done to get the laws changed. host: and at 9:00 a.m. this morning, c-span will be covering the hearing by the house judiciary over-criminalization task force live on c-span three today and it is about the need for criminal code reform and the

over federal is a in federal ization federal i criminal law. in criminal law. 9:00 a.m., c-span3. next is mark from fort lauderdale, florida calling in. hi, mark. caller: hi, how are you doing? host: good. caller: thank you for c-span and mr. kerik for bringing this to the front. i called and the inmate -- called in on the inmate line because i served some time myself. you had a tweet that stole my thunder -- the shoe is on the other foot. mr. kerik, as you are climbing the ladder, and even when you reached the top of the food chain, you always thought that permitted -- prisoners and --

>> good afternoon. i very much appreciate the opportunity this afternoon to welcome back my friend, minister onodera. ofhas been in the state most the week. he was recently in omaha and brought me back and asked -- a nebraska pin, which he is proudly displaying over here. and if you are wondering what that flower is, that is the goldenrod, the nebraska state flower. everything about nebraska, but that is a good start. we will give you a quiz later, but i appreciate his thoughtfulness in recognizing my home state. in, is our sixth meeting

think, a little over a year. and i want to thank mr. -- personalonodera in the -- in the role that he has played in strengthening our relationship. made a trip not just to to brusca, but to -- to nebraska, but to other states to get acquainted with what we are doing, which is important in our alliance and in our partnership and friendship. when he was in omaha on , he not only visited our strategic command headquarters, but he also got a eak, andstate -- st he, i'm told, stopped by the university of nebraska at omaha, where he visited my senate

archive. he asked to see my old university of nebraska at omaha yearbook and examined my picture. i don't know if he asked to see my grades or any other in-depth questions, but we hope not. [laughter] minister, your visit means a great deal. it means a great deal to me personally, but to our two countries and our partnership and our alliance. we are not just partners, but friends. know thatf you may when secretary kerry and i visited japan last october for , ittwo plus two meeting happened to be my birthday. some of you may have been on that trip and some of you might recall that minister onodera gave me a birthday present. he gave me headphones that i can

use when i swim. he assured me that they would allow me to swim longer and , but alas, to no avail so far. but i keep trying. minister, i know that you are a tennis player and you don't swing very often, so i wanted to present something to you that may help your game. present is -- to this is a university of nebraska at omaha tennis shirt. [laughter] a university of omaha tennis team outfit. you shall be trimmed, slim, fast on the court, and you will live

longer. >> thank you. [laughter] [applause] >> today, the minister and i discussed in our meeting prior to this conference what the united states and japan are doing together to modernize our it hase, and to ensure prepared this alliance to address emerging threats and challenges. as you all know, last week on the day that marked the 60th of japan's self-defense forces, prime minister abbé's moved to interpret the japanese consulate jin -- constitution to allow for self-defense. bold the historic, landmark toision will enable japan

significantly increase its contribution to regional and global security, and expand its role on the world state. -- world stage. our government strongly supports the this jin made -- the decision made by prime minister abbé and his cabinet. the japanese government's decision will also enable historic revisions to the u.s.-japan guidelines. meeting lastus two october, we announced then a comprehensive review of these guidelines. i discussed the review with prime minister abe and mr. onodera -- minister onodera today, and we confirmed that those new guidelines should be in place by the end of this year. together, japan's collective self-defense decision and the allowd guidelines will japan to participate more actively in areas such as defense, missile

counterclaim proliferate in, counter piracy, peacekeeping, and a wide range of military exercises. and japan willes also be able to work more closely together on maritime security, humanitarian assistance, disaster relief, and other areas. we can raise our alliance to a new level, and we intend to do that. has 50,000n also american troops and their families, and we thank them for their continued hospitality and support. this troop presence is critical to our asia-pacific rebalance and we are working together to ensure it remains sustainable over the long term. we are continuing to make ofgress toward construction the replacement facility, and the relocation of our marine air station. remains committed to being a good neighbor and to mitigating the impact of our military presence in okinawa.

next week, we will begin a kc-130ing akc 130 -- and we discussed additional steps we intend to take. we also discussed security in the broader asia-pacific region. we held trilateral meetings with south korea and australia in may and we will build on that progress. and i reiterate america's long-standing position on the sink coup islands, which are administrative control, and therefore fall under our mutual security treaty. as i have said clearly and consistently, secretary kerry noted this as well, the united states opposes any attempts by any country to change the status quo through destabilizing unilateral actions and we oppose to restrict

overflight. you are working on a constructive relationship with the dialogue,p which concluded yesterday in and bothis an example, japan and china are input -- are 20ticipating, along with other asian nations from around the world. the united states and japan's treaty alliance has been a foundation for peace, prosperity, and stability in the asia-pacific region for more than six decades. minister onodera and i are committed to making sure it remains that way for decades to come. minister, thank you for your partnership. thank you for your friendship. particularly for not asking about my college transcripts. now, i will ask minister anna for his- onodera comments and then we will take

questions. thank you. >> thank you. [speaking foreign language was beckett -- foreign language] >> [translator] i am delighted to be here, and delighted to travel to omaha and two washington, d.c. in omaha, i enjoyed a nebraska steak. i would like many japanese people to enjoy this delicious beef. seealso, i was delighted to a picture of young secretary hagel, and it is very disappointing that i cannot share the picture with you. but he was like a rockstar to me.

and regarding his transcript, i guess this is classified information. and thank you for the beautiful gift. to use the like training gear, so i can train myself. still use theu headset, which is by sony. and i heard that you listen to the beatles music, so i appreciate you enjoying them. but first, i explain the summary of the recent security legislation. specifically, i will explain that they're in in mind that u.s. forces and the self-defense forces closely cooperate and respond seamlessly to varying .ituations

the government as a whole will work on issues, such as self-defense measures article ninender of the japanese constitution, as well as legislation to protect weapons and u.s. forces engaged in act in defense of japan. as well as u.s. forces. hagel has offered support, as it will enhance japan's role in the regional alliance and contribute to peace and stability. based on the decision, secretary hagel and i agreed to continue to focus on the revision of the 1997 guidelines for the japan-u.s. defense cooperation and the interim report on the revision will be released at an appropriate timing, so we can provide transparency for related

chemistries -- countries. we also agreed to further deepen the specific bilateral cooperation on equipment and technology. and we would like to deepen our corporation -- cooperation in accordance. realignmentto the of the impact mitigation in okinawa, i explained the progress of the construction project at the replacement facility. secretary hagel and i agreed to quickly implement the realignment of u.s. forces in japan, including the relocation of a camp in hinoko. secretary hagel and i agreed we onld close the work together

c-130location of the squadron. in this context, i raised the issue of the aircraft flying from the outside. affirmed thatl the u.s. is committed to reducing the u.s. presence in okinawa. regarding the regional situation, we agreed to continue a policy of any lateral cooperation -- any unilateral cooperation in the china sea area. i explained updates on the relationship between japan and north korea. and i gave a thorough explanation about the japanese abductees within north korea. and also, i explained our position regarding ballistic

missiles, receiving the north korean launch of ballistic missiles just recently. through close communication with the japan-u.s., bilateral cooperation should be and it will strengthen our regional peace. and contribute to economic growth of japan, as well as the age of -- asia-pacific region. thank you very much. questionsis time for for each site. >> mr. secretary, a set -- a question for you about the israeli bombing in gaza. i know that your office put out a statement today saying that you had talked to the minister of israel come are reaffirming

israel's right to defend itself, while also urging restraint. can you be more specific about the acceptable limits of israeli action in gaza? would you draw the line, for example, of the use of ground forces in gaza? and lastly, how do you respond to critics who say that the campaign is -- their campaign is violating international law? with the israeli minister for some time this morning. as you know, president obama spoke to prime minister netanyahu last night, and we essentially covered the same language and the same issues. i spoke to the minister this morning on updates as to the questions. first, i think it is important obamaember, and president mentioned this yesterday, and i did today, that israel has the

right to defend itself. any country does. includes what they think they need to do to defend themselves. we made it clear, both president obama last night and in my conversation with the minister that we want to do everything we can to help stop what is going sides tocourage all not escalate and not let these hostilities get out of control any more than they are and that we would be available to play a role in helping to that. thoseimportant that furtherto rein in any

escalation be worked on, and we are committed to do that. so we will stay in touch with the israelis on this. there are possibilities of third parties that could help out in this effort as well, so we are exploring all options to assist in this effort. >> will the introduction of ground forces change the picture? >> i am not going to get into any of the what-ifs. i think i would just let stand what i have just said. i will take a question from the japanese press. this question is for both nodera.r o recent decision includes

responding to so-called great zone situations where infringement from the outside does not amount to an armed attack, in essence allowing the use of collective -- japan will revise the guidelines that reflect the recent cabinet repeatedlyhile china invades the territorial islands, -- while the tengion in the tension in the east china sea increases, if infringement like this takes place in the islands, will japan and the u.s. jointly respond to the situation? what will the new guidelines change, sponsored by the china and the united states? so i would like to take the answer.

discussions regarding the guidelines for u.s.-japan defense cooperation are ongoing, and we are not an appropriate timing to provide any appropriate content yet, but i will continue working on this vigorously based on the cabinet decision. and when we evaluate the timing a it is appropriate, we will release an interim report. and also with japan with related countries. the guideline is to ensure stability and peace in the region, that this is not for puttingrtain responses. but we would like to consider that japan and the u.s. cooperate seamlessly in

peacetime for contingencies, including great designs. so we would like to achieve regional peace and stability. i would like you to understand that guidelines are not for specific scenarios, but for ensuring security and safety in the region. secretary hagel, i would like to ask one more question, which is what kind of roles and missions do you expect from the forces based on the recent cabinet decision, in reference to the previous question? >> i would think just as minister onodera said, they are in the process of defining this guidelines. what exactly they mean, what are the definitions. and that is the responsibility of the japanese government and people of japan. thank you. >> next question. >> mr. secretary, correct sayingy officers are

that iran and russia are conducting attacks on sunni targets in iraq. militarily responsible for the u.s. not to coordinate the iranians and the russians, given the number of u.s. man to man surveillance flights? presence of u.s. troops on the ground? >> united states is not coordinating military efforts or exercises or omissions with iran or russia. what we are doing is assisting the iraqi security forces. and that is what we will continue to do. as you know, we are just finishing up with our assessment teams there, and they will be providing some recommendations and guidance based on those assessments. we are aware of the iranian and

russian efforts to help the iraqis, but we are not involved in coordinating any missions. sicko their hagel, this is a question about north korea. -- secretary hagel, this is a question about north korea. the japanese have lifted their own sanctions on north korea, because [indiscernible] -- haveapanese conducted the investigation. regarding japan going into the situation, can you share opinions on this matter, and opinions did you exchange with minister onodera?

i am sorry, go ahead. >> thank you. i did talkodera and about this issue, and he explained to me as he and his government have explains this situation and actions taken to our government, as he has explained, and we are aware,, the japanese government has lifted some of the unilateral sanctions against north korea. we understand that there are humanitarian issues involved for the japanese people. onodera made clear, as well as we have been told by the japanese government, that nuclear threats, missile threats, are still a threat to all of us. that does not change. we are in absolute agreement on that point, and we will continue

to work together, and we are with the republic of korea. one of the points that minister this issue, as well as other issues, was the importance of transparency, of letting their partners know of what they are doing and why they're doing it, and that i think is particularly important, and i applaud the japanese government for taking that approach to this issue. thank you. >> we're done for today. >> thank you. [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute] [no audio] tomorrow, a discussion on the class action lawsuit that group

has filed on behalf of thousands of children who have crossed the u.s.-mexico border and could be deported. then a look at the concept of religious liberty and how it is being debated in u.s. courts and the legislative branch. a talk about efforts to increase security at overseas airports with direct flights to the u.s. your phone calls, facebook comments, and tweets. journal" is live saturday at 7:00 a.m. and every weekday at 7:00 a.m. eastern on c-span. an event tomorrow at 10:00 a.m. eastern, and later in the day, a that will talk

about education and job training ideas, starting at 11:00 45 eastern, also on c-span. baseball it does strike me -- i do not want to get metaphysical about this -- i am the anti-metaphysical school of baseball -- that is a good sport to be the national pastime of the democratic nation, because -- because democracy is about compromise and settle in and baseball is like that. there is a lot of losing in baseball. everything that goes to spring training knows they are going to win 60 days, lose 60 games, you play the whole season to sort out the middle 42. to win 10 out of 20 games, you are by definition meteor occur. 11 games, you have a good chance to play in october. latestge will on his book about baseball, sunday

night at 8:00 eastern and pacific on c-span. members of veterans who have committed suicide testified yesterday before the house veterans affairs committee. this is one in a series. this is close to three hours. >> if i could get everybody to take their seats, please. this hearing will come to order.

i would like to ask consent for to sit at the purchase of a. i would like to welcome everybody to the full oversight committee hearing entitled service should not lead to suicide. following an investigation which uncovered date of mini facilitiesd harm at all across this nation, this committee has held a series of full video oversight hearings over the last several weeks to evaluate the systemic access and integrity failures that have consumed the of the a health care system. perhaps none of these hearings have been presenting the all too

human face of the failure so much as today's hearings today will do. recently the committee heard from a veteran who had attempted to receive mental health care at a community-based clinic in peace knowing you -- in pennsylvania. the veteran was told that he would be unable to get an appointment for six months. left thememployee another v.a. employee leaned in to tell this veteran that if he just told her he was thinking of killing himself, she would be able to get him an appointment much sooner, in just three months, instead of six. that veteran was not considering suicide.

but what about those veterans who are? how many of the tens of thousands of veterans that v.a. has now admitted have been left on waiting lists for weeks, months, and even years for care were seeking mental health care appointments? or edgingre suicidal toward suicide as a result of the inability to get the care that they earned? despite significant increases in da's mental health -- v.a.'s budget and staff in recent years, the suicide rate among veteran patients has remained more or less stable since 1999. with approximately 20 to -- committingng suicide every day. most recent v.a. data has shown over the last three years rates of suicide have increased by nearly 40% among male veterans under 30 who use ca health care

services, and by more than 70% of veterans between the ages of 18 and 20 four who use ca health care. this morning we are going to hear testimony from three somers andthe others. they will tell us about their and brian.el, clay, on iraqi freedom careans who sought following comment. each of them faced a after barrier in their struggle to get help. each of these young men eventually succumbed to suicide. hand,ote he left the daniel summers wrote that he felt that his government had abandoned him and referenced coming home to face a system of dehumanization, neglect, and

indifference. and clay andiel brian so much more than that. with that, i yield to our ranking member for his opening statement. >> thank you very much, mr. chairman, for holding this very important hearing. we have had many discussions and debate about how to deliver the best health care services to our and how toterans ensure accountability within the leadership ranks of the department of veterans affairs. the course of these recent hearings, and escutcheons, we have touched on a number of important issues, but one we have not cured in too much yet has been access to mental health care and suicide prevention services for our veterans. that is why this hearing today is so important. i would like to thank all of the panelists were joining us today, particularly i want to thank the family members joining us who

have lost a loved one. i know they are speaking about a loss of a loved one, or to give only a child, can be an incredibly difficult and exhausting experience. but in this case, i think we have to listen to your stories. wrong, and wewent can take action to ensure that those failures are not repeated again. , very to thank you very much for joining us today to share your stories. 22 veterans commit suicide each day. that is 18 to 22 brave and women who are system has let down. it is totally unacceptable. when a veteran is experiencing oppression or other early warning signs, that may indicate mental health issues or even suicide, that must be treated like immediate medical crises, because that is exactly what it is. veterans in that position should never be forced to wait months

on end for medical consult because quite frankly that is time that they may not have. we have taken steps to help put in place programs and initiatives aimed at early detection him and we have significantly increased our funding. the department of veterans affairs spending on mental health has doubled since 2007. it is not working as well as we would have hoped, and we have to figure out why and how we can correct these problems. our veterans are the ones paying the price for this dysfunction. a 2012 ig report found that vha data on whether it was providing timeless -- timely access to medical services is totally unreliable. year,ao report from that not only confirmed that disturbing finding about but also said that inconsistent and limitation of vha scheduling policies made it difficult, if

not impossible, to get patients the help that they need when they need it. that is why we have to look at this situation. that is a problem that we have seen repeatedly as we dig into andv.a.'s dysfunction enough is enough. our veterans and their families v.a. that delivers timely health services, covers a spectrum of need from ptsd to counseling for family members, two veterans commit urgent round-the-clock response to a veteran in need. report found that in one facility patients waited up to 432 days, well over a year, for care. once again, we are finding that our veterans deserve much better than what the care that they are receiving. all of the areas we must

address, we have to look at a -- look at it comprehensive it, and fixing mental health services is one of the most important areas. i look forward to rape her discussion of will begin today as we look forward to try to solve some of the problems with a dysfunctional department that we are seeing over the last several months. i want to thank you, mr. chairman, for having this important hearing and for the panelists for coming today to tell your story. i yield back the balance of my time. >> thank you very much, mr. ranking member. we are humbled and honored to be joined by our first panel of familyes this morning, members of the three veterans who sadly and tragically lost their lives to suicide, and i am sure that i speak for each of my colleagues when i say that each of you have our deepest

sympathies to you for your loss. i am both grateful and at the same time angry that you have to be here to share your stories of your son's with each of us. so if you could approach the witness table, please, joining us is dr. howard and jean somers, susan and richard selk e, the parents of clay hunt, and porwine, the mother of brian portwine. honored to have josh schler.

thank you for your service. mr. chairman, we are grateful for this opportunity to testify today. we are especially pleased to see arizona representative ann kirkpatrick and another who have been great allies to us in our efforts to advance reforms in the ncaa based on experiences of our son. >> as many of you know, our journey started on june 10, 2013, when daniel took his own life following his return from his second deployment in iraq. at that time, he suffered from posttraumatic stress disorder much romantic brain injury, and gulf war syndrome. years spent nearly six trying to access the vha health benefits systems before finally collapsing under the weight of his and despair. we have attached the story of

daniel so much to our testimony, which provides details of his efforts, and we hope you will read it if you have not already done so. today it is our objective to begin the process which will ultimately provide hope and care to the 22 veterans today who are presently ending their lives. >> over a year ago and four days after daniel's death, feeling fortunate that we at least had a --ter from him, howard and i howard is a urologist -- set his with daniel's wife and mother, a psychiatrist, and together we sought uniquely qualified to prepare a report. we have shown that document with several of you over the last year, and it is attached to our testimony. the purpose of the report remains the same as when we improve access to first-rate health care at the

v.a., to make the v.a. accountable to veterans it was created served, and make every v.a. employee and advocate for each veteran. >> at the start, dana was turned away from the v.a. due to his national guard in active ready reserve status. upon initially accessing the v.a. system, he was essentially denied therapy. innumerable problems with the a staff being uncaring, insensitive, and adversarial. literally no one at facility advocated for him. administrators frequently cited paa for not being able to use modern technology. >> the appointment system is at best inadequate. it impedes access and lacks basic documentation. the v.a. information-technology infrastructure is antiquated and prevents related agencies from

sharing critical information. there is a desperate need for compatibility between computer vbatems within the vha, the , and dod. there was no succession planning. >> no procedures in place for handoffs, no contracts in place refusal to a outsource anyone or anything. at the time daniel was at the phoenix v.a., there was no pain management clinic to help him with his chronic and acute fibromyalgia pain. there were few coordinated goals, policies, and procedures. the fact that the hearing -- formularies are separate and different makes no sense, since many dod patients who are stabilized on a regular -- on a particular medication regimen us

readjust it when they go to the v.a. >> there was no way for daniel to obtain the status of its benefits claim. there was no vha, vba interfacing, nor procedures. interest of communication between disability termination and vocational rehabilitation. this report is offered in the spirit of a call to action, and reflects the experiences of dana services program beginning in the fall of 2007 until his death last june, through our eyes. theur concern was that impediments that daniel and counted were symptomatic of deeper and water issues in the v.a. potentially affecting the experiences of a much broader population of service members and veterans. unfortunately, this has been proven true come as evidenced by

recent revelations. many of the reforms outlined in our report will require additional funding for the v.a. with that new funding, should come greater scrutiny and a demand for better, measurable results. there is an alternative to attending through. the existing broken system. we believe congress should seriously consider fundamentally revamping the mission of the v.a. health system. the new model we envision, the da would transition to a center of excellence, specifically for war-related injuries, by the more routine care provided to the system would be open to private-sector service providers much like tri-care. that approach would compel the current model to self improve and compete for veterans businesses. this would allow all veterans to seek the best care available allowing the v.a. to focus resources and expertise on a treatment of comics injuries

suffered in modern warfare. time,thank you for your and we would be happy to discuss our regulations and suggestions. we hope that the systemic issues raised here for will provide a plaque to them -- platform to bring together lawmakers, veterans, and private-sector medical professionals and administrators for comprehensive review and reform of the entire v.a. process. and if the v.a. committee or congress as a whole makes a decision to involve other stakeholders in a more formal reform process, we would be honored to be among those chosen to represent the views of affected families. thank you. >> thank you. thank you, but. of the image members committee, thank you for the

opportunity to speak with you today about this critically important topic of mental health suicideess at the v.a., among veterans, about the story and experience of our son clay. , and i'ms susan selke here today as the mother of clay hunt, a combat veteran who died by suicide in march 2011 at the age of 28. clay and listed in the marine corps in may 2005 and served in the infantry. in 2007, he was deployed to iraq. shortly after arriving in iraq, he was shot to their written by a look that barely missed his head. in californianed to recuperate, clay began experiencing symptoms of posttraumatic stress, including panic attacks and was diagnosed later that year. following recuperation from gunshot wounds, he graduated from the ring core scout sniper school in march of 2008. weeks after

graduation, he deployed again to afghanistan. i his experience during his deployment to iraq, he experienced the loss o of fellow marines during his second poet. he received a 30% is ability grading from the v.a. for his pts. appealed the rating only to be met with significant bureaucratic barriers, including the v.a. losing his files. 18 months later, and five weeks after his death, his appeal finally went through and the pts 100%.d clay's he exclusively used the v.a. for his medical care after separation. afterward, he lived in the los angeles area and proceed care at the v.a. nickel center in l.a.

concernantly voice about the care he was receiving, as well as the treatment he received which consisted of medication. he received counseling only as far as a brief discussion regarding whether the medications he's was prescribed was working. if not, he would be given a new medication. he uses a i am a guinea pig for drugs. i would have side effects and they put on something else. 2010, he moved to colorado where he also used the v.a. there, and then finally to houston. the houston v.a. would not refill their prescriptions that clay received from the grand junction v.a., because they said prescriptions were not transferable, and a new assessment would have to be done before his medications could be re-prescribe. appointments in general if ever at 2011 and

neither was with a psychiatrist. it was not until march 15 that clay was able to see a psychiatrist at the houston the a medical center. after that appointment, clay called me on his way home and said, mom, i cannot go back there. the v.a. is way to shuffle and i issa where i can go. i will have to find a better center. two weeks after his appointment with the site has shift at the houston v.a. medical center, clay took his eye. after his death, i went to the houston v.a. medical center to retrieve his medical records, and i encountered an environment that was highly stressful. was atge crowds, no one the information desk, and i had to flag down a nurse to ask directions to the medical records area. i cannot imagine how anyone even with mental health injuries could successfully access care in such a stressful setting without exacerbating their systems. clay was open about having pts and survivor's guilt.

he worked hard to move forward and found healing by helping people. inluding participating humanitarian work in haiti and chile after the devastating earthquakes. he also started a public service advertising campaign aimed at easing transition for fellow veterans, and he helped wounded warriors in biking events. he participated in iraq and afghanistan veterans of americans annual storm on the hill to advocate for legislation to improve the lives of veterans and families. his story details the urgency in addressing this issue. despite his proactive approach to seeking care to address his injuries, the a system does not adequately address his needs. today we continue to hear about both individual and systemic failures by the v.a. to provide adequate care and address the needs of veterans. not one more veteran should have

to go through what clay went afterh with the v.a. returning home. not one more parent should have to testify before a congressional committee to compel v.a. to fulfill its responsibilities to those who have served and sacrificed. mr. chairman, i understand you are introducing the suicide prevention for american veterans act. the reforms directed by this legislation will do critical to helping the v.a. after serve and treat veterans suffering from metal injuries during war. had the v.a. been doing this all along, it may have saved his life. we appreciate you hearing her story and her recommendations about how we suggest the v.a. will properly care for america's veterans. thank you. >> thank you for your testimony this morning. you're recognized for five

minutes? >> thank you, mr. chairman, distinguished committee members. my son brian gave a hundred percent to every task he performed. his military service was no exception. by the time he was 19, he was awarded the purple heart and the army commendation medal. i am before you today to share brian's store. at 17 he enlisted in the army after his training in infantry. he was deployed to baghdad where he patrolled in sadr city. it was an extremely daunting service. this occurred before the surge of troops. he lost 11 tour, brothers. while serving in iraq in 2006, his tank was struck, and flames quickly engulfed the tank, and the men fought for their lives as the driver was unable to hydride ugly lower --

hydraulically lower the rent. they scramble to the flames, annually lower the rent, and exited with injuries. ryan suffered a concussion along with lacerations to his face and legs and bone fragments. this was his first experience with traumatic brain injury. on yet another mission, brian and his first sergeant were in a humvee when his sergeant signaled to brian to switch seats with him. they switched seats. hit thees later an ied humvee, killing the sergeant and throwing brian from the vehicle. besides these incidents, he experienced six other explosions during his 15-month deployment. i like the policy are and ask them isn't this enough to warrant a thorough evaluation and further testing? the powers that be apparently thought of sending brian to

walter reed hospital, but did not. aren't his experiences with the physical and mental injuries enough to possibly exempt him for another appointment -- deployment? apparently, the v.a. felt his enough to stamp a no vote on his form, but then it was crossed out and written "go." how why this decision was made is beyond me. after the first deployment, he was ecstatic to be home. he enrolled in college and worked in the admissions counseling office. he created videos to share resources with students, hosted events, and make students with employment around their school schedules. brian suffered with short-term memory loss. he would have to write everything on his computer, his iphone, or his calendar.

many times his friends told me when he was out within he would say, where are we going again? i have scrambled brains from iraq. to help cope he posts all his advance on his computer, his calendar, and his phone. brian0, military recalled wendover for the college year ended. he immediately dropped his classes, ones that he excelled and when i asked him why, he said, mom, there's no point. yet you keep your mind in a completely different place. if no idea what is coming. during the second deployment, brian did not e-mail or from phone to any family or friends. little did we know how he was struggling with anxiety attacks, panic attacks, traveling the same roads as the first tour. he knew the statement of admitting ptsd as most soldiers do. so he just manned up and moved on. be turning from the

second deployment. he was evaluated and diagnosed with depression and excitedly. at this time i would like to refer to the documents that you s medical brian' documents. he cannot remember the questions asked in the therapist during the interview. he had extensive back pain. he could not sleep. was a risk for suicide. nonetheless, he was immediately discharged and told to follow up. how in the world you could ask someone who cannot remember the questions asked to follow up with the v.a. is beyond me. brian deteriorated quickly from december 2010 to may 27, 2011, when he took his life. he could not stand how he would be angry and depressed, anxious, but he did not know how to cook.

it took a toll on his relationships. a assessedand the bryant, for suicide risk, it was their duty to treat him, but he received nothing. he applied for disability, but was unable to wait. has lost three others to suicide since the 2008 tour. suicide surpassed him bat fatalities for the first time in history. it is a very slippery slope from ptsd and pti to death, something our ta should realize. our soldiers never had is traded in that mission to protect our country. now it is time for the fev.a. to prove their commitment our soldiers. i think he felt if i could survive two tours i could survive anything.

think if a life-threatening situation like this should be shared with the family, so we are able to help. the v.a. needs to work with the service organizations, including the families, and the plan for care. i am requesting, i am picking this committee to pass act 2182, the save act. this has been a most devastating war in history in terms of suicide. our whole nation continues to and everyday we continue to lose 22 brians. i promise that i would stop this injustice. these are quality young man who potentially have so much to offer society. and supportthe act in the legislation that gives soldiers the timely and loving care that they deserve. thank you. you, mrs. portwine.

you're recognized for your statement. member,man, ranking members of the committee, i appreciate the opportunity to discuss the mental health care, and i want to acknowledge the loss and the courage of these family members ensuring that they were not in vain. similarruggle with the stories, as an infantryman who and so many in the iraq war injured and chuckled with the thoughts of suicide, from overwhelming chronic pain and injuries, i just thank you all for being here. my experience with the v.a. health care system began in 2008 .

sorry. >> that is ok. you have plenty of time. >> after i was medically retired from the army due to severe injuries from a mortar blast in --q excuse me. have been a patient, but i am also an advocate for other warriors who are struggling with employment-related traumas. months, if about 12 did receive excellent mental health care out of the a facilities. you provided easy one-stop access to deployment health models staffed by medical, mental health, pharmacy, and social work providers. unfortunately, hospital administrators decided that this well-staffed injured and was welled care was to -- staffed interdisciplinary care

was unsatisfactory. i had to find myself around a sprawling facility to access the kerry needed. navigating around itself.ty producing some drop out of care altogether. there's lessons to be learned here. veterans with mental health issues will not discuss painful and private issues with a clinician they have never met. they're more likely to describe service-level issues, like difficulties sleeping. it takes time to build the trust to talk about the deeper issues. but every clinician is skilled at winning the trust or whenhtful enough to sense there are deeper problems. working with the team increases the hood of someone who see something that others may have missed. suicideapplications for prevention as well. veterans will rarely say they

are contemplating suicide. there are not necessarily obvious signs that a veteran is a suicide risk. one thing is for sure, we will not prevent suicides by doctors from mechanically going down a mandatory list asking questions like have you contemplated suicidal thoughts lately or harming others? andtimes there is red flags an astute clinician can spot them up like a breakup a of a relationship. in the treatment system where i building 61, to see a psychiatrist to see about sleep problems, no one is getting the pole pitcher. it is likely no one is going to see if my life is spinning out of control. health careated system, the v.a. can provide the kind of care that i once received from a health team. there the team member shares

observations and could see problems before they became explosive. i think the most important step is the v.a. can take to prevent suicide is to improve its mental health care delivery. but we have issue, to ask ourselves, access to what? access to mental health care is not enough unless that care is effective. providers who work with combat veterans need to understand the warrior mentality and they may have to work to win trust. if a clinician lacks that awareness or has too many patients give it each enough time, veterans will get frustrated and drop out. veterans who are not ready for intense exposure based there be will drop out of these alti-week treatment progress, -- programs. bottom line is that the eight care must be veteran center.

that has to mean recognizing each veteran's unique situation and preferences in building a flexible system to meet the needs and preferences for mama the other way around. the warriors do not come in for anxiety because when the textbooks say they should. most do not come into treatment until they have reached a crisis point in their lives. a veteran who finally asks for help for combat-incurred total health conditions needs to get into treatment immediately. we will not solve that problem by establishing an arbitrary requirement like a 14-day rule. gets not helping warrior to assessed within 14 days, but not actually begin treatment within three months. this is the way that the v.a. is currently lamenting such policies. they have added an additional steps to get into treatment, so that you can see someone within 14 days. i have added a second intake

process, so now you can take to finally get the treatment you need. wayow that some believe the to solve the veteran problem is to expand access to non-v.a. care. i doubt that is any silver bullet solution. the big concerns with that is 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. v.a. could benefit from a greater use of purchased care, where and when it is available from and when it can be effective. it would not help veterans just to be seen by providers who are not equipped to provide effective care. whether because of lack of training in treating combat -related ptsd or cultural confidence or other reasons. it is not a matter of access, but access to web. it has to be effective treatment. i believe there are facilities

that are providing veterans with timely access to effective patient-centered care, but it is not systemwide. my perspective the starting point for leadership at all levels is to adopt the principle of providing timely, effective mental health care for those with service-incurred conditions must be a top prior to the. -- priority. does the a to achieve that with veterans to combat homelessness recently. that tells me that the v..a can have an impact it when artificial performance requirements to not create distortions and when clinicians have managed to provide the care, improving mental health care requires a comprehensive approach. one part is should need to institute the team-based model i described earlier. the core of any approach has to sit on the veteran and that and preference.

we need a system that serves the veteran, not one that requires the veteran to accommodate the system. that this hearing brings us a step closer to that kind of a. care system. i thank you for your time and will be happy to ask questions that you may have. >> thank you, sergeant. sergeant, if i could go back to you since you were the most recent person to testify, you talked about this interdisciplinary care team that you had for 12 months, and then after that, you added to the fact that the hospital director or somebody said that it would cost too much to do it that way. i think we would all benefit from it elaborating an little bit about how that occurred and what did you transfer to, what type of care. >> yes. in 2008 until 2009, the v.a. rolled out i believe four

different health care models nationwide. the deployment health care model i speak of was one that was rolled out in washington state for the american lake v.a. medical center, and it was put together by dr. steve hunt with the v.a. this model provided one wing of a hospital floor in which an interdisciplinary care team for , for post-9/11 veterans exclusively. they had a pharmacist, psychiatrist, on one team, and we today would need to discuss the caseload of that team. the wait times were short 14. the quality of care was up. the management of her medications were the best and we had seen within the v.a. 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 v.a. is that that was a temporarily funded program and it was too costly to provide this level of care to exclusively post-9/11 v.a. -- war veterans within the v.a. facility director has to ride 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 the population was not practical. mrs. somers, i would like for you to elaborate if you would just a little bit on the fact that you talked about daniel having innumerable problems with the a staff being ---- with v.a. staff being uncaring and adversarial, saying no one at the facility advocated for him. could you give us any specific examples, or generic examples?

>> absolutely. probably the most -- if i do not make it to this, howard will finish -- the most egregious event was when daniel presented to their e.r. -- >> if it daniel a lot to go to the v.a. facilities, and some of the things that have been mentioned here were part and parcel of the fact. 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 was not the one speeding. if he was going by on the highway at the time, it was difficult for him to drive down to the v.a. that he presented there in crisis. he presented there to one of the departments, to the mental health department. he said he needs to be admitted to the hospital.

this is something that we have aen told by his wife, who has degree in nursing, and his ather-in-law, who was psychiatrist, and he told them this on multiple occasions. so he was told that the mental department, they had no beds, and he was told by the same department that there were no cats in the emergency department. ro this brings up anothe few issues come up with fact was he went into the corner, he lay down on the floor, he was crying. there is 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 v.a. division issue is another issue that we need to discuss at some point. he was told that you can't stay

here, and when you feel better you can drive yourself home. example of the lack of advocacy, the lack of compassion, that we know that encounterediel has to the v.a. system. we have met other veterans, specifically in oklahoma city, who had very, very similar circumstances at different v.a.'s. >> you know if he ever spoke to any v.a. official about how he was treated? >> we do not. the other problem is that these visits are never -- the appointment system is so antiquated that things are not even documented. there's no way to go back into the system and to document the

contact in the system. aware,ar as we are daniel did not speak to any buddy at the v.a. about this. it is just something he would not do. he just would not do. --was a feeling of i tried and this is just another example of what the pressures that are brought to bear. he brought not only the vha, but into account, and these are things that altogether just became overwhelming. >> my belief is he still had the military mentality, you know, this is what somebody in authority told you, i have to accept it, i cannot go above and beyond. i just need to accept what they are telling me. >> thank you. very much, mr. chairman. i want to thank the panel for coming today to talk about your and is and your family

really appreciate it. i know it cannot be easy. my question is, can you go into further detail on about why you think it is important to encourage every veterans suffering with pts and bat issues to supply a list of points of contact and get a hipaa waiver? >> interesting that you say hipaa, because once summit he says that, that stops the conversation. we have been trying to deal with this issue because it takes a village, aarge -- 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 rectus, and gene can tell you that. what you come to learn, what how iteally says is not is practiced. p.r. bowl -- people are afraid because they take the regulation that is there and take it to the nth degree. he have options under hipaa, especially if you feel somebody is a threat to themselves or the community, where you can reach out to family members or a caregiver in a situation like that. we feel it is absolutely prior toto identify deployment, during deployment, and after deployment, what we call the support network so that these people can be educated as lovedt experiences their

1 -- or maybe not a loved one, maybe it is a football coach or a math teacher or maybe your best friend from the second these people can be educated as to what the been, whatmight have the signs and symptoms of crisis might be, and educated to the fact that you do not take no for an answer. and if you see that somebody is in trouble, that you can direct them to the proper treatment, the proper authority, to the proper ethical facility. and that is not actually something that you have to worry about thiwith hipaa. that is why we feel hipaa does not even come into the equation. the equationnto when you're in treatment, and if you're in treatment and there is an issue, then the therapist should certainly take the contact theto

closest people to the patient. >> thank you. >> the department of veterans administration where v.h.a. employees have not talked to v.b.a. employees and they used the excuse of hipaa. have you had that problem with your son? >> we haven't heard that that was a hipaa issue. we just felt that it was a total communication breakdown issue, the fact that the computer systems were incompatible within the v.a. 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. 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 andreas that was four years old. and he had been involved with the v.b.a. and with the v.h.a. over that entire period of time. >> thank you. my time is quickly running out for mr. and mrs. silk. how long had clay been taking medication and how long was he denied medication through the v.a.? >> he began taking medication 2007 when he was back at 29 palms recuperating from the gunshot wound in iraq. my understandinging 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 v.a. care, he was never denied medication. what happened when he moved to houston, he was told that they could not refill his prescriptions that followed him from the l.a. v.a. and he had been in grand junction, colorado, for a short time. he basically was having to start over as a new patient and i had this reinforced yesterday in a meeting that it was, that was one of his major frustrations and that i have heard from fellow veterans of his, that when they go from another to another facility, ey have to go back through everything, all the re-- just recounting everything. that seems ridiculous to have to have that type of redundant

system. when he was told in houston that they could not refill his prescription, he was told you need to call the v.a. 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 ok and he took care of it and did get it from the grant junction v.a. 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 you saw the psychiatrist on march 15. so his first appointment was january 6.

second appointment february 10 or 11. finally march 15, he sees a psychiatrist. also part of that issue was en he was active duty, lexapro was finally found to be the drug that worked the best for him, name brand drug, no generic, but he had been on paxil, he had been on zoloft, he had been just on 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 v.a. system, apparently generic drugs are the drugs of choice and he was given, i believe it's the generic for he is levela which but se, but -- celexa, it's not the same thing. at this time there was not a generic for lexapro. when he arrived at the houston v.a. 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 side psychiatrists, he said, ok, i understand from your background that that's worked before and he did give him a prescription for lexapro. so clay leaves on march 15, the psychiatrist office goes downstairs to the pharmacy at the v.a. to fill his prescriptions. 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. i have more on that that i want to share with you. and then he was given, told that they could not give him lexapro. they don't stock it because it's 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 10 days that he would get this.

a couple issues there, if you know aboutant depressants, anti-anxieties medications, you can't stop them cold. you can't wait for it to come in the mail and then expect that it's 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 my way home, i can't go back there. the doctor at the houston v.a., i have spoken with him several times since clay's death. he has been very forthcoming. i appreciate very much the information that he has 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 have died of suicide and they have been on ambien for sleep problems. whether there is a connection or not, i don't know, but it's a high number that are given that when they have sleep problems. sleep problems are a 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 wouldn't 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.

it's prazacim. he said that really is the drug that actually works best for that type of sleep difficulty. 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 had been given over and over different times before. so that haunts -- that has been something that has 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 had called 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. we went to a movie. richard and i went to a movie with him that evening. 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. we have done everything we can to try to find out answers. >> thank you. >> mr. lamborn for five minutes. >> i want to thank you all for being here. you have given so much and i thank you. i know the committee thanks you. i know our country thanks you. i would like 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 10th special forces at fort carson, colorado, where i help and he took his life and she is an advocate for a program that has a wholistic approach involving families, whether it's 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 v.a. or is there a lack there? >> we certainly, during the time that daniel was with the v.a., certainly feel that 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 all would like to say we did not have dysfunctional families, but we know that there are disfunctional families out there. that's why we started using the term support network. a lot of young men and women undoubtedly join the service to get away from families, but it doesn't mean that they don't have a support network. so we kind of like to get away from the whole blood kinship viewpoint and say the support network. i think it goes without saying, i recently read a report by national association of 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's why howard and i have actually been trying to work with the d.o.d. to try to get them to identify a support network. 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 could have identified right then and said, daniel, give us a support network for you. who would you write down? i mean, he had really, really good friends. we hope we would have been on it. certainly 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 hopeful 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. >> ok, ok. anyone else? mr. selke. >> thank you. our experience like most, probably a lot of families is we didn't know what p.t.s. was.

we had no idea. clay was, again, very open about it, told us that he had been diagnosed with it, told us that he was on medication seeking counseling. we didn't know the ramifications of that. and like most of our warriors, they're strong. so he was putting on a real good act. even known the extent of what he talked to his counselors about, the idea that the somers have broached about regardless of the hipaa let's of that, for if in fact somebody has that conversation with their 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's going on

and to say this person needs help. clay, looking back, there was all kinds of things going on in his life that were just red flags and we didn't know. there is a lot of literature out there. information.t of i believe that any family who has an individual involved in the military, after they come back or at any time, they should probably just assume that there may be some sort of p.t.s. 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 y'all. he actually addressed the issue and then lied about it to us. a huge part plays

in really being advocates for the individual and being able to just watch and watch for signs and then maybe able to do something about it. >> in conclusion, i would just have to say the v.a. needs to learn best practices and have programs available that include families everywhere. >> if i can add something to that, going back through clay's medical records, for whatever reason when he died, i immediately wanted his medical records. i just wanted to read everything i could and try to grasp what was going on. he had apparently as early as vember or december of 2009 spoken to someone in the v.a., in the l.a. v.a. about suicidal ideation. suicidal thoughts. that is 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 y'all. i just can't. i think in his mind he believed i'm thinking these thoughts, but i could never do that. as far as we know, there are 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. another time he spoke with a close friend and then after that second time, he shared with me and with all of us. so we knew in 2010 at the end of the year, we knew that 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 v.a. 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 core for four years. my medical care is to come from the v.a. 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 war. i don't want to go to a private, private care. 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. they need to be feel that they can be taken care of. >> thank you very much. my heart goes out to you. >> mcmcconnell, you are recognized for five minutes. >> thank you, mr. chairman. it's very difficult to listen to your stories. i'm very touched by them. i definitely want to thank all of the families for being here today. so let me ask this question, ms. selke, i believe a lot of veterans have that same feeling and, therefore, i do believe that we have to, it's 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 being a burden to their families financially.

i am very much open to making it easier for nonv.a. care to be available. with that, i wanted to ask dr. somers, you are also a medical doctor, dr. somers? >> i'm a urologist. >> can you tell me -- you're from the phoenix area? >> actually, i practice in phoenix. we currently live in san diego. >> oh, in san diego. i'm from riverside, which is . rth of san diego as you know i went to visit my own v.a. in loma linda. 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 the director of that kaiser facility told me --

i asked him if there was -- what shortages he was experiencing. he identified behavioral health and psychiatry. 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. one. nly reimbursement is 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 v.a. system just because he couldn't be seen in phoenix. there was just no availability, no mental health available. i think you have to divide psychiatry and psychology. i think with these people who are suffering from ptsd, it's

the psychologists and the psychiatric social workers who are providing most of the care as opposed to the psychiatrists themselves. by psychiatry and psychology are incredibly important. what happens is, if we try to recruit into the v.a., then the community is losing that mental health component. it's a huge issue. it's an issue that has to be addressed by our medical schools, by society in general. it's not just an issue here and there. > here is the thing. >> i represent titus and there was a bill offered that would increase the number of residencies at v.a. hospitals. i expect a number of those, if we approve it, a number of the residents would stay and some would go into the community as

well. my thing is if we do approve the v.a., make it more easier, easier for the vets to use that in areas like mine, they're still going to have trouble finding that care. they're having trouble in the community of people who are aware of the military culture and aware of the issues veterans face. again, that brings up a whole other issue, a whole other series of issues. >> i wish i had more time. maybe i can get information through my staff. i'm trying to understand your criticisms of the medical records and there is an issue of the interoperability of the v.a. and nonv.a. practitioners. >> that is something we addressed also, especially if we're going to be trying to, with the p.c. 3 program and with the other issues that are being promulgated now, there has to be comnication between

he v.a. and the provides who are seeing the veterans that are 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, we got to try to get it right in the v.a. facilities because of that xpectation that ms. suke and the sulkes son had, that was the comfort zone. we got to do both things at once. make sure that every v.a. center has excellent mental health care as well as try to provide some options. >> yes, sir. my concern with a bill that just increases the number of practitioners at a hospital were not serving 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. euro, you're recognized for five minutes. >> thank you, mr. chairman. i think as a father of three and a veteran, i appreciate your courage to come here today and speak. it's really heart-warming and i know it's very difficult for you to do. it's been difficult to sit and listen to the testimony, there are a good number of veterans sitting up here. i'm a veteran of the vietnam era and i just want to thank you for that and 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 1960's who all legal scouts.

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. thank you for your courage to be here. know it's very difficult. sergeant, you bring up a great point, all of you have today in the coordinated effort that you brought effort. that team approach is i think very good. i certainly do understand what the v.a. was saying was that if this works for the o.e.f. veterans, it should work for all veterans. the majority of the suicides that are occurring are veterans of my age, so i think that this needs to be expanded if that method that you put forward, it looked like it worked extremely well, should be looked at and dr. and mrs. somers bring up an

incredible point. dr. somers, you probably dealt with as i did in your private practice in urology. as a urologist, patients share a lot of things with you and dealing with this is very complicated. s you all have pointed out and ms. sulke so eloquently pointed out that this approach of caring for people with p.t.s. or chronic mental illness is extremely difficult. dr. somers and i can go in the operating room and remove a tumor. that is easy. this is much more difficult to do. those signs and symptoms are very difficult to spot because, ms. sulke, you saw his son when he was actually, you thought, doing very well that week before he passed. i think as a doctor, that's been one of the things that troubled me all of my career was trying to figure out when you would have a patient that would take their life, say why

did this happen and many times that week or two before, things seemed to be going well. you thought things were going better. i think dr. somers, you and your wife brought up something extremely important, that a good friend is probably as important as a good doctor, a good person to lean on. i think you have to do what the sergeant was talking about to have this very sophisticated team together for people in need. you also just need someone, it may not be a family member like you pointed out, a coach or pastor or whoever it could be in your life, it could be a of that mber. together is a real challenge. we'll hear later from the v.a. on what they plan to do. any further thoughts along that line would be helpful, if anyone would like to share your thoughts about what we can do. >> i think it's 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, they make it like an iraqi town. so they learn how to control crowds, take buildings and all that, but when they come back, it's just boom, you're there for a week and then you're out in the community. there is no transition. why can't they use those centers that 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, use these resources that we have, say, ok, you need to go down laundry, give them a list of things to do, see if they're able to do that and 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 has been in war is going to understand so they don't open up. the most people they open up to is their brothers. michigan has a program called buddy to buddy that they put together one veteran that's been home with the veteran so that if they have any problems, they're going to open up to that person much more than they re a therapist or have group therapy. let the veterans talk among themselves. they can have a group of eight, 10 veterans and then have group therapy and maybe they could confide in each other because it's going to take a while to build up trust with a therapist if you do. >> i totally agree, thank you very much for your courage of being here. mr. chairman, i yield back. >> you are recognized -- i apologize, ms. kirkpatrick, you

are recognized for five minutes. >> thank you, mr. chairman. i want to thank all of you for your courage and being here today. i appreciate what you said about once a diagnosis is made and medication is prescribed staying on that medication. i really want to know how often our veterans have to refill those prescriptions and i would just like to hear from each of you what you have learned about that experience. are they given a 30-day supply, they have to go constantly back, sergeant, can we start with you and 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 con fusing and i formally mess it up pretty well so my wife has to manage that for me for the most part. you have to be able to put in a request three weeks before you need it and i usually forget untim