STATEMENT FOR THE RECORD
OF
VIETNAM VETERANS OF AMERICA
SUBMITTED BY
TERRY BAKER
EXECUTIVE DIRECTOR
VETERANS AIMED TOWARDS AWARENESS, INC.
BEFORE THE
COMMITTEE ON GOVERNMENT REFORM
AND THE
SUBCOMMITTEE ON NATIONAL SECURITY, VETERANS AFFAIRS AND INTERNATIONAL RELATIONS
REGARDING
HEPATITIS C:
ACCESS, TESTING and TREATMENT
IN THE VA HEALTH CARE SYSTEM
JULY 12, 2000
Dear Mr. Chairman and other Distinguished Guests of the Subcommittee:
On behalf of Veterans Aimed Toward Awareness (VATA), a support group for veterans with Hepatitis-C, and Vietnam Veterans of America Chapter 83, I am honored to be here a second time in regards to the VA’s handling of the Hepatitis-C epidemic.
Since June 9, 1999, when we last met, I have been traveling around the country talking to veterans, offering them hepatitis C testing and counseling, visiting VA hospitals and clinics, and corresponding with Dr. Garthwaite and his counterparts. I have attended one of the VA’s training on Hep-C and visited the Miami Hepatitis C Center of Excellence.
Members of the committee, other than the efforts of my organization to provide education, counseling and testing—working with some of the VA facilities, I have not seen the proactive and aggressive effort to address hepatitis C among veterans that the VA promised this Committee on June 9, 1999.
Talking with veterans, I have found that the VA’s approach to treatment is only to treat those veterans who have high liver enzyme levels, those who have symptomatic liver disease, and those who are possibly beyond help, instead of treating the veterans who could benefit the most from the dual therapy. In my view the VA is treating the veterans who will benefit the least.
In fact, in a letter to this Committee dated June 28, 2000, Dr. Garthwaite seemed proud of the fact that 78% of veterans receiving treatment within the VA are designated into the “complex care” category. I believe that Dr. Garthwaite intended to impress upon you, Mr. Chairman that HCV cases are being properly reimbursed to the medical centers. Let me offer another possibility—78% of all veterans being treated fall into the complex care category because the VAMCs are treating only those veterans who are sick enough to meet the strict criteria of being a complex care patient in the VA. Furthermore, it is my humble opinion that most treatment is being reserved for complex care patients because VAMCs realize that they cannot afford to start basic care patient on the expensive therapy because they only generate $4,000 per patient per year. They are well aware that the estimated VA HCV patient needs care with an average cost to the VA of between $25,000 and $40,000.
To treat HCV patients who fall into the basic care category would bankrupt the particular hospital delivering this care. The VAMCs must WAIT for their HCV patients to progress to more serious complications, like ascites, in order for the medical records of the patients to note the appropriate DRGs (diagnostic codes) to allow the VAMC to collect the complex care funding to cover HCV pharmaceutical and other costs of initiating treatment.
One of the only VISN’s that treats the virus as the sole enemy is VISN 13 under the supervision of Dr. Sam Ho. If VA ever designates another Center of Excellence in Hepatitis C care, it should be Dr. Ho’s. He and Dr. Petzel treat veterans with real respect and see HCV as a disease that can and should be eradicated from every veteran, no questions asked.
Following last year’s hearing, we approached Dr. Garthwaite about assisting the individual VISN’s with their HCV programs and helping them improve particular HCV-related shortcomings witnessed in various VISN’s. He told us to direct our concerns to the individual VISN’s – which we did by letters to each VISN this past March. To our surprise, instead of working with the particular VISN’s on HCV as originally instructed by Dr. Garthwaite, we received one letter from VA Central Office on behalf of all twenty-two VISN’s. So much for a decentralized system.
Concerning all the correspondence that we have had with Central Office, it certainly seems that someone is trying to placate me! Because there are more important matters to discuss, and there is little time now, I have submitted that material for you to review at a later date.
I have been asked to follow up on the examples that I produced last year. Mr. Chairman, I am sorry to report that these veterans’ lives have gotten dramatically worse. The veteran from Idaho was finally tested, but has not yet been allowed to receive treatment in VISN 19, in fact, he has been told that despite evidence of fibrosis of the liver, his enzyme levels are not elevated enough to consider him for treatment. As for the veteran from Montana, the VA has “done a fine job” – he was never treated for his Hep-C and in November of last year, he succumbed to complications from a liver transplant due to Hep-C. I attended his funeral.
In the case of my personal friend from New Jersey that served with the 173rd Airborne, he is now number 7 on the liver transplant waiting list. Even though we personally hand-delivered his case to Dr. Garthwaite, NO, I repeat NO action has been taken! The VA continues to maintain that this recipient of the Bronze Star for Valor can not show a nexus between his service and his hepatitis C infection because his duty assignment was not “medic.”
So much for serving one’s country and believing that one’s country will “bind up the wounds” of battle. Committee Members, I must stress that while the VA tells us that they are doing the right things and all that they can, the veterans caught in the middle of this war do not have the time for the VA to continually drag their feet. I have personally, along with some fine people, brought forth more awareness from my little office than all of the VA.
I am appalled, and take great umbrage at the duplicitous nature of the VA’s Central Office. There are solutions to these problems, and I think that if a simple, longhaired country boy like me can figure them out, so can these highly educated people. Simple things like letting infectious disease physicians actively assist in providing treatment for this disease—if the VA has a shortage of gastroenterologists then let’s use the currently underutilized infrastructure that was built within the VA to provide treatment for AIDS—let’s use them to treat HCV. After all, the therapy is very similar and HCV is an infectious disease.
If we still don’t have enough manpower—let’s look at flexible hiring schemes!
Another important point to consider is that the VA should really be “One VA” when it comes to this disease. For example, a Vet from Montana should not have to relocate to Phoenix to get treatment—especially when he has fibrosis. VISN 19 should respect the standard of care in the community and provide treatment to all appropriate candidates. This means that the training, like I attended in DC, for HCV must be forced onto VA personnel from all over the country. An analysis by my organization of the 367 persons who attended the first two HCV training programs found that 43% of attendee were from the Eastern Seaboard, 28% from the central United States and only 19% from the Western states. It’s no surprise that Mr. Bryant, whose testimony you will hear today, has experienced such problems in his struggle for care in VISN 20.
For more suggestions, I’d be glad to meet with the committee and the VA to develop a more productive program for our Hep-C patients. In fact I would like to serve on the Advisory Committee that the VA Office of the Inspector General recommended that the VHA establish to deal with the HCV health delivery issues.
Dear Chairman Shays and the Subcommittee, on behalf of the men and women who risked their lives for our country and who now face an even greater battle against Hep-C and the Department of Veterans Affairs, I beg you to examine the actions that the VA has taken regarding the Hep-C issue, and for you, the committee, to TAKE ACTION to ensure that the VA does what it is designed for – and I quote Joe Thompson, Undersecretary for Benefits, in the February/March issue of the VVA Veteran, “We’re the ones who’ve been entrusted by American citizens to HELP veterans. That’s our mission.”
Thank you.
VIETNAM VETERANS OF AMERICA
Funding Statement
July 12, 2000
The national organization Vietnam Veterans of America (VVA) is a non-profit veterans membership organization registered as a 501(c)(19) with the Internal Revenue Service. VVA is also appropriately registered with the Secretary of the Senate and the Clerk of the House of Representatives in compliance with the Lobbying Disclosure Act of 1995.
VVA is not currently in receipt of any federal grant or contract, other than the routine allocation of office space and associated resources in VA Regional Offices for outreach and direct services through its Veterans Benefits Program (Service Representatives). This is also true of the previous two fiscal years.
For further information, please contact:
Director, Government Relations
Vietnam Veterans of America
(202) 628-2700, extension 127
E-mail us at govtrelations@vva.org