15 November, 2018 05:46

USA Today: Feds find ‘blatant disregard’ for veteran safety at VA nursing home among the nation’s worst
Donovan Slack, USA TODAY, and Andrea Estes, The Boston Globe
Published 7:00 a.m. ET Nov. 14, 2018 | Updated 6:25 p.m. ET Nov. 14, 2018
BOSTON – Staffers at the Department of Veterans Affairs nursing home in Brockton, Massachusetts – rated among the worst VA nursing homes in the country – knew this spring that they were under scrutiny and that federal investigators were coming to visit, looking for signs of patient neglect.
Still, when investigators arrived, they didn’t have to look far: They found a nurse and a nurse’s aide fast asleep during their shifts. One dozed in a darkened room, the other was wrapped in a blanket in the locked cafeteria.
The sleeping staffers became a focal point of a new, scathing internal report about patient care at the facility, sparked by a nurse’s complaint that veterans were getting substandard care, according to a letter sent late last month to President Donald Trump and Congress by the agency that protects government whistleblowers.
“We have significant concern about the blatant disregard for veteran safety by the registered nurses and certified nurse assistants,” agency investigators wrote in a report about the 112-bed facility. The Brockton facility is a one-star nursing home, the lowest rating in the agency’s own quality ranking system.
VA spokeswoman Pallas Wahl said officials took “immediate corrective action,” and the employees caught sleeping no longer work there.
The problems at the Brockton nursing home are the latest to surface in a review of VA nursing home care by USA TODAY and The Boston Globe.
In June, the news organizations revealed the VA’s secret quality ratings showed that care at more than 100 VA nursing homes across the country scored worse than private nursing home averages on a majority of key quality indicators last year.
In response to questions from USA TODAY and the Globe, the VA released nursing home ratings that had been kept secret for years, potentially depriving veterans and their families of crucial health care information.
At the time, the VA said it was releasing inspection reports the agency withheld from the public for nearly a decade. Five months later, none has been released.
VA spokesman Curt Cashour told USA TODAY that the agency is working with an outside contractor to remove patient information from reports. He said the VA expects to release "publicly redacted versions of the most recent reports" around Christmas.
That’s not good enough for Leslie Roe, whose husband of 38 years walked out of a supposedly secure unit at the VA nursing home in Tuskegee, Alabama, last year and was never found.
Roe, who had Navy veteran Earl "Jim" Zook declared dead this year, wants the VA to immediately release three years’ worth of inspection reports – the standard for private-sector nursing homes whose reports are posted on a federal website, NursingHomeCompare.
"It’s just a shame the way the VA is," she said. "It can’t help Jim, but maybe it can help just one other person."
The reports can include incidents of poor care and conditions that can be a tip-off to prospective or current residents and their families about problems with staffing or neglect at a facility.
"What are they hiding? Why wouldn’t you release it?" asked Amy Leise, whose uncle, Vietnam veteran Don Ruch, suffered from malnutrition and bedsores last year at a VA nursing home in Livermore, California.
"It feels like the government is immune from accountability and responsibility, where in other settings that wouldn’t be the case," she said.
At the nursing home in Brockton, residents were, on average, more likely than residents of other VA nursing homes to deteriorate, feel serious pain or suffer from bedsores, according to agency data. They were nearly three times as likely to have bedsores than residents of private nursing homes.
Licensed practical nurse Patricia Labossiere said she complained to the Office of Special Counsel, a federal whistleblower agency, this year after supervisors in Brockton ignored her alerts.
“I am a no-nonsense nurse who took a vow to take care of patients,” said Labossiere, who quit in July. “We are there to be kind and treat others as we would want to be treated. I could not believe that this was how we treat the people that fought for our country.”
Labossiere said she saw instance after instance of poor patient care at the facility within days after she started working there last December. She told the federal whistleblower agency that nurses and aides did not empty the bedside urinals of frail veterans. Nurses failed to provide clean water at night and didn’t check on the veterans regularly, as required, she said. They often slept when they were supposed to be working.
She offered some specific examples: One patient had trouble breathing because his oxygen tank was empty. Another fell – his feeding tube got disconnected, and the liquid splashed onto the floor – and didn’t appear to have been monitored by staffers for hours.
The VA investigators did not substantiate those allegations, saying the patient with the empty oxygen tank suffered no ill effects. Investigators couldn’t confirm that the patient who fell had been neglected because the records were shredded “in accordance with the local policy.”
‘Routinely receiving substandard care’
Wahl, the VA spokeswoman, noted that the investigators “did not find evidence of veteran harm or neglect.” She said the facility’s one-star rating is undeserved and not an “accurate reflection of the quality of care delivered to our patients."
The Office of Special Counsel ordered the VA’s Office of Medical Inspector to investigate Brockton after Labossiere’s complaint. The office turned over its report in September to special counsel Henry Kerner, who sent the findings to Trump and Congress on Oct. 23.
“Because a brave whistleblower came forward, VA investigators were able to substantiate that patients at the Brockton (nursing home) were routinely receiving substandard care,” Kerner said in an emailed statement.
This is not the first time the Brockton facility has come under fire by the Office of Medical Inspector.
In 2014, a doctor at the nursing home alleged that three veterans with significant mental health issues received “inappropriate medical and mental health care.”
Two of them went years, he alleged, without appropriate treatment. A third allegedly received psychotropic drugs for more than two years against written instructions.
Investigators largely substantiated the allegations, finding that two veterans with significant psychiatric issues did not receive adequate treatment for years. They did not substantiate the allegation that a third received improper medication.

PR Newswire: VA Rates 70 Percent of its Nursing Homes as Failures
WASHINGTON, Nov. 14, 2018 /PRNewswire/ — The national commanders of the nation’s two largest veterans organizations are demanding that Department of Veterans Affairs Secretary Robert Wilkie bring immediate attention to his nursing home program that currently has 70 percent of its 132 homes receiving failing grades by the VA’s own rating system.
The call by Veterans of Foreign Wars of the U.S. National Commander B.J. Lawrence and American Legion National Commander Brett Reistad is in response to a series of scathing articles by two USA Today and Boston Globe reporters who documented substandard and negligent care at the VA nursing home in Brockton, Mass., which is one of 45 nursing homes that received the VA’s lowest rating of one star. Forty-seven homes received two stars, 16 homes three stars, and 15 homes four stars. Only nine nursing homes received the VA’s top five-star rating.
"While much of the media’s attention has been on the proper implementation of VA healthcare legislation, we cannot forget about 46,000 mostly senior veterans who reside in these nursing homes," said the two national commanders, who collectively speak for more than 4.6 million members and their auxiliaries.
"The media reports about sub-par care, patient neglect and safety violations at VA nursing homes are more than just disturbing," said the Legion’s national commander. "Legionnaires, our friends in the VFW, and anybody who respects veterans should be angered by this," said Reistad. "These people should not be viewed as forgotten patients in a home. These are people who in the prime of their lives risked their lives, and made enormous sacrifices on behalf of our country. America’s veterans deserve better. We not only expect VA to fix these problems immediately, but we want transparency. Those who sleep on the job and ignore the best interests of their patients need to find a different employer."
Echoing his counterpart, the VFW national commander said "These veterans earned the right to receive high quality care in a fully-staffed and well-managed facility. Their families deserve to know that their loved ones — their heroes — are not being abandoned or abused, and America needs to be reassured that the VA is honoring our nation’s promise to those who have borne the battle," said Lawrence. "The VA must improve its delivery of quality care at these facilities. It must recruit and retain only the best healthcare professionals and support staff, and it must hold all employees accountable for their actions or inactions. It is not a right but a privilege to work for America’s veterans, and anything less is unacceptable."

Military.com:Millions in Cost Overruns Hit Effort to Merge VA, Military Health Records
14 Nov 2018 | Military.com | By Richard Sisk
VA officials acknowledged Wednesday that a $16 billion project aimed at finally providing common, easily searchable electronic health records for the VA and the Department of Defense has already been hit with a $350 million cost overrun.
John Windom, executive director of the VA’s new Office of Electronic Health Record Modernization, said the original estimates for the program had not included the $350 million projected costs over 10 years for the salaries of the government employees who would work on it.
At a hearing of the new House Veterans Affairs Subcommittee on Technology Modernization, which was formed in July primarily to oversee the project, Windom said Congress had been forewarned that the salaries of the employees would not be included in the contract with Cerner Corp., but he was met by skepticism.
"I find it hard to believe that such a basic part of the program — government salaries — could be overlooked," said Rep. Jim Banks, R-Indiana, the subcommittee’s chairman.
Banks said the cost overrun emerged "before any real work actually began" on the project to make health records of two huge departments compatible.
"How can that be?" he asked.
"I’m not ready to sound the alarm yet," Banks said, but added that the cost overrun increased his concerns over whether the program was feasible.
"The more I learn, the more daunting it has become," Banks said. "Some thought we could merely install the Cerner system. That apparently is not enough."
Windom said he expected efficiencies would be developed as the project proceeds to hold down future costs.
"There are going to be efficiencies gained we can’t forecast at this point," he said.
Previous attempts to mesh the electronic health record systems have either failed or been abandoned, most recently in 2013 when then-Defense Secretary Leon Panetta and then-VA Secretary Eric Shinseki dropped an integration plan after a four-year effort and the expenditure of about $1 billion.
In the latest effort, then-acting VA Secretary Robert Wilkie in May awarded a $10 billion, 10-year contract to Cerner, of Kansas City, to develop an integrated electronic health record system. Related costs over the course of the contract were estimated to put the total cost at about $16 billion.
In comments at the hearing, and in his questioning of witnesses, Rep. Phil Roe, R-Tennessee, chairman of the full committee, said he had warned Wilkie, who was sworn as VA Secretary in July, of pitfalls in the enormously complex task of meshing VA and DOD health records.
"If we don’t get this right, you and I need to go in the witness protection program," Roe said he told Wilkie.
Even if the VA and DOD systems could be successfully merged, "what are we going to do about outside practitioners?" Roe said.
Roe noted that about 35 percent of the veterans currently receiving VA health care have chosen to opt for private care, and that number was expected to rise under the VA Mission Act signed into law by President Donald Trump earlier this year to expand community care.
"That is a challenge, definitely," said Dr. Laura Kroupa, acting chief medical officer of the VA’s Office of Electronic Health Record Modernization. "We’re working on that."
Problems have already emerged in Seattle and Spokane, the first sites chosen by the VA for the installation of the new EHR systems, said John Short, chief technology integration officer at the newly established office.
Nearly all of the five-year-old computers in Seattle and Spokane will have to be replaced to adapt to the new system, Short told the subcommittee.

Military Times: New bill would ease GI Bill transfer rules for vets, military families, like never before
By: Natalie Gross | 20 hours ago
A new proposal would eliminate the Pentagon’s recent Post-9/11 GI Bill transfer restrictions and, for the first time in the history of the benefit, allow some vets to pass it to their family members.
Sen. Cory Booker, a prominent New Jersey Democrat, plans to introduce the Veteran Education and Transfer Extension Act in Congress this week.
“We know that our nation’s veterans face unique challenges when returning to their communities, so we have an obligation to provide them the resources they have earned and deserve,” Booker said. “Allowing veterans who eventually have dependents to transfer their education benefits would put them on equal footing with veterans who had dependents while on active duty. It’s vital that we ensure our veterans are empowered for success as civilians, and this legislation takes an important step in fulfilling that commitment.”
Booker’s bill would allow veterans who did not have dependents when they left the military to transfer the benefit should they get married or have children later in life. Under current rules, the transfer must happen while the eligible service member is still in the military.
In addition to this significant expansion of the benefit, Booker’s bill would also wipe away DoD’s controversial new transfer rules. That DoD policy would block service members who have been in the ranks for more than 16 years from transferring their GI Bill benefits to their dependents, beginning next July. The changes also eliminated certain exceptions to the rule that service members must be able to serve four more years into order to transfer their benefits — including in cases of mandatory retirement, high-year tenure or medical issues.
The new policy, which does not apply to active-duty Purple Heart recipients, has generated pushback from Congress as well as the veteran advocacy community.
DoD spokeswoman Jessica Maxwell said transferring education benefits “is directly tied to recruitment and retention."
“The recent DoD policy changes were made to better align the benefit to those purposes. If the law changes, we will modify our policies accordingly,” she said.
Booker’s VET Extension Act would also allow student veterans who are required to take remedial college courses to boost math or English skills before they can take higher-level classes to do so without eating into their 36 months of GI Bill entitlement.
“By expanding education benefits for the men and women who served in our Armed Forces, including increased eligibility for remedial courses, we are boosting both their employment rate and earning potential after graduation," he said.

Military Times: Price tag of the ‘war on terror’ will top $6 trillion soon
By: Leo Shane III | 22 hours ago
WASHINGTON — The price tag of the ongoing “war on terror” in the Middle East will likely top $6 trillion next year, and will reach $7 trillion if the conflicts continue into the early 2020s, according to a new report out Wednesday.
The annual Costs of War project report, from the Watson Institute for International and Public Affairs at Brown University, puts the full taxpayer burden of fighting in Iraq, Afghanistan and Syria over the last 17 years at several times higher than official Defense Department estimates, because it includes increases in Homeland Security and Veterans Affairs spending, as well as new military equipment and personnel.
“Because the nation has tended to focus its attention only on direct military spending, we have often discounted the larger budgetary costs of the post-9/11 wars, and therefore underestimated their greater budgetary and economic significance,” the new report states.
Direct military spending in Iraq and Afghanistan make up nearly $1.8 trillion in costs, but researchers estimate the long-term health care of veterans from those wars could equal or surpass that figure in coming decades.
They also charge that the Defense Department’s base budget has grown more than $900 billion over the last 17 years because of increased missions, recruiting costs and service member benefits brought on by the conflicts overseas.
“High costs in war and war-related spending pose a national security concern because they are unsustainable,” study author Neta Crawford said in the report. “The public would be better served by increased transparency and by the development of a comprehensive strategy to end the wars and deal with other urgent national security priorities.”
She also blasted current U.S. national security policy as “no strategy to end the wars other than more of the same.”
About 23,000 U.S. and NATO forces are currently operating in Afghanistan in a non-combat, training-and-support role. About 14,000 of that group are American troops.
More than 4 million veterans in America today served during the Iraq and Afghanistan war era.
The full report is available on the project’s web site.

Stars and Stripes: Marijuana-PTSD study reaches target enrollment of 76 veterans
By NIKKI WENTLING | Stars and Stripes | Published: November 14, 2018
WASHINGTON — Researchers who are trying to determine whether marijuana works to treat post-traumatic stress disorder enrolled their final veteran needed for the study on Veterans Day.
The Scottsdale Research Institute in Phoenix, which is performing the study, achieved its total enrollment nearly two years after they first began recruiting veterans into the study – and eight years since the Food and Drug Administration approved it.
“A nearly 10-year saga for this PTSD-cannabis study,” lead researcher Sue Sisley wrote in an email. “Almost at [the] finish line.”
The study is the first government-approved research into marijuana’s effects on PTSD. When it’s done, Sisley aims to have a definitive answer of whether marijuana benefits people with PTSD, and if there are negative consequences.
All of the study’s participants are veterans.
Once researchers began recruiting veterans for the study in February 2017, they immediately ran into problems. By September 2017, they had screened thousands of veterans but enrolled only 26 who met the eligibility criteria.
For a while, there were concerns the study would have to broaden to include non-veterans.
At issue was the researchers’ lack of access to the Department of Veterans Affairs hospital in Phoenix, just 20 miles from where the study is being conducted. Sisley saw potential there to find a large group of veterans who might be resistant to other PTSD treatments and looking for an alternative.
The VA said federal law restricted the agency from researching medical marijuana or referring veterans to projects involving the drug.
“Despite the refusal of the [VA] and Arizona’s public universities and hospitals to assist with recruitment for the study, the trial is on track to finish on time,” read a news release from the nonprofit Multidisciplinary Association for Psychedelic Studies, which is sponsoring the research.
To enroll, veterans had to be diagnosed with chronic PTSD brought on by military service. Researchers wanted a range of ages, as well as men and women. The study needed 76 veterans to be viable.
It’s a random, controlled trial. The veterans participating are given 1.8 grams of marijuana each day of differing potencies. They choose how much to smoke, and they’re asked to keep a daily journal.
Participants visit Scottsdale Research Institute 17 times during 12 weeks, and then are scheduled for six-month follow-ups. Researchers intend to publish their findings sometime in 2019.
“Hopefully, we’ll be able to finally answer the question, ‘Does cannabis help with PTSD?’ That’s our goal,” Sisley said at the start of the study in 2017. “That’s why we’ve been fighting so hard to get this underway.”
More veterans have spoken out in favor of medical marijuana in recent years. The American Legion passed a resolution supporting the study, and the chairman of the House Committee on Veterans’ Affairs, Rep. Phil Roe, R-Tenn., also voiced his support for more research into the drug.
There are efforts in Congress to allow VA doctors to recommend marijuana to veterans in states where the drug is legal. Separately, a bipartisan group of lawmakers, including Roe, urged VA Secretary Robert Wilkie for the agency to conduct its own research into marijuana as a treatment for PTSD, chronic pain and other ailments that disproportionately affect veterans.
When asked about medical marijuana last week, Wilkie was adamant that the VA wouldn’t explore it as a potential treatment until the federal government makes marijuana legal.
“Marijuana is against the federal law,” he said Friday during an event at the National Press Club in Washington. “If the laws change and there’s medical evidence there, of course we look at that. But the law is pretty clear at the federal level.”