In Federal Suit, 2 Views of Veterans’ Health Care

VA struggles to meet the demands of an increasingly over-burdened system 
By NEIL MacFARQUHAR, New York Times

SAN FRANCISCO — The Department of Veterans Affairs is struggling to meet the skyrocketing demand for medical services as an unanticipated flood of former soldiers from Iraq and Afghanistan seek help along with a parallel surge of claims from aging Vietnam veterans, according to both sides in a trial that opened Monday in federal court here.

The lawsuit was brought by two groups, Veterans for Common Sense and Veterans United for Truth, seeking to force the government to streamline its procedures for treating former soldiers, particularly those suffering from combat trauma and other mental health problems…

Opening arguments painted sharply different pictures of the department’s success. The veterans groups said the department was ignoring a mental health crisis and was so swamped that former soldiers were dying needlessly. The defense countered that the country’s largest medical care system was adding the personnel needed to cope.

“Our ultimate goal is guaranteed health care, timely health care, timely decisions on disability payments,” Gordon P. Erspamer, the lead lawyer representing the two veterans groups, said in an interview.

“The system is choking on the claims; the delays are unconscionable,” Mr. Erspamer said.

The trial, before Judge Samuel Conti, an Army veteran of World War II, does not seek monetary damages but asks the court to appoint a special master or otherwise intervene to make the department run more efficiently.

Claims for help from the department jumped 25 percent in recent years, hitting 838,000, Richard G. Lepley said in his opening statement for the government.

The defense said the jump was generated by a combination of veterans returning from Iraq and Afghanistan, where head injuries that can lead to stress problems are a signature issue, as well as an upswing of Vietnam veterans seeking help for medical conditions associated with aging. News coverage from the current wars has also led to new mental health problems among Vietnam veterans, said Kerri J. Childress, a spokeswoman for the veterans department in Palo Alto, Calif.

“I don’t think anybody had any idea how long the war was going to go on,” Ms. Childress said, referring to Iraq. She added that there was no way to fully anticipate the demand for medical care from Vietnam veterans.

The department is falling short of its goal of addressing claims within 125 days, saying that it was now closer to 180 to 185 days, Mr. Lepley said. But he said the department had added 3,700 mental health care professionals in the last two years, bringing the total to 17,000, and started a program where anyone feeling suicidal could get attention within 24 hours and a follow-up appointment within two weeks, he said. The program started last summer, he said, so it is too new to measure its effectiveness.

Over all, there are 6,600 suicides per year among the 25 million veterans of all wars, representing about one in five suicides in the country, Ms. Childress said. There are an estimated 1,000 suicide attempts per month among the 7.8 million veterans treated by Veterans Affairs, she said. The suicides tend to be more frequent among older veterans, she said, citing statistics from data collected by the Centers for Disease Control and Prevention.

The number — 126 suicides a week, higher than the 120 published in previous studies — was in a December e-mail message from Dr. Ira Katz, the head of mental health services for Veterans Affairs, to Dr. Michael J. Kussman, the under secretary for the Veterans Health Administration in the department. Mr. Erspamer displayed the message in his opening argument.

The department has long been reluctant to release specific numbers regarding suicides or suicide attempts, lawyers for the veterans groups said. “We certainly think there was a cover-up in some sense,” said Heather Moser, a lawyer for the plaintiffs.

A second department e-mail message from Dr. Katz shown at the trial starts with “Shh!” and refers to the 12,000 veterans per year who attempt suicide while under department treatment. “Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?” it asks.

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