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United States. Congress. House. Committee on Veter.

Viewpoints on Veterans Affairs and related issues : hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, One Hundred Third Congress, second session, May 4, 1994 online

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VIEWPOINTS ON VETERANS AFFAIRS AND
RELATED ISSUES



Y 4. V 64/3; 103-47

Uieupoints on Uetenns Affairs and...

HEARING

BEFORE THE

SUBCOMMITTEE OX
OVERSIGHT AND IN\^STIGATIONS

OF THE

COMMITTEE ON VETERANS' AFFAIRS
HOUSE OF REPRESENTATIVES

ONE HUNDRED THIRD CONGRESS

SECOND SESSION



MAY 4, 1994



Printed for the use of the Committee on Veterans' Affairs

Serial No. 103-47






4 KV,




U.S. GOVERNMENT PRINTING OFFICE
82-621 cc WASHINGTON : 1994



For sale by the U.S. Government Printing Office
Superintendent of Documents. Congressional Sales Office. Washington. DC 20402
ISBN 0-16-046124-3



VIEWPOINTS ON VETERANS AFFAIRS AND
RELATED ISSUES



\. V 64/3; 103-47

ipoints on Uetenns Affairs and...



HEARING

BEFORE THE

SUBCOMMITTEE OX
O^^ERSIGHT AND IW^STIGATIONS



OF THE



COMMITTEE ON VETERANS' AFFAIRS
HOUSE OF REPRESENTATIVES

ONE HUNDRED THIRD CONGRESS

SECOND SESSION



MAY 4, 1994



Printed for the use of the Committee on Veterans' Affairs

Serial No. 103-47



uy




U.S. GOVERNMENT PRINTING OFFICE
82-621 cc WASHINGTON : 1994



For sale by the U.S. Government Printing Office
Superintendent of Documents, Congressional Sales Office. Washington. DC 20402
ISBN 0-16-046124-3



COMMITTEE ON VETERANS' AFFAIRS
G.V. (SONNY) MONTGOMERY, Mississippi, Chairman



DON EDWARDS, California

DOUGLAS APPLEGATE, Ohio

LANE EVANS, Illinois

TIMOTHY J. PENNY, Minnesota

J. ROY ROWLAND, Georgia

JIM SLATTERY, Kansas

JOSEPH P. KENNEDY, II, Massachusetts

GEORGE E. SANGMEISTER, lUinois

JILL L. LONG, Indiana

CHET EDWARDS, Texas

MAXINE WATERS, CaUfomia

BOB CLEMENT, Tennessee

BOB FILNER, California

FRANK TEJEDA, Texas

LUIS V. GUTIERREZ, Illinois

SCOTTY BAESLER, Kentucky

SANFORD BISHOP, Georgia

JAMES E. CLYBURN, South Carolina

MIKE KREIDLER, Washington

CORRINE BROWN, Florida



BOB STUMP, Arizona

CHRISTOPHER H. SMITH, New Jersey

DAN BURTON, Indiana

MICHAEL BILIRAKIS, Florida

THOMAS J. RIDGE, Pennsylvania

FLOYD SPENCE, South Carolina

TIM HUTCHINSON, Arkansas

TERRY EVERETT, Alabama

STEVE BUYER, Indiana

JACK QUINN, New York

SPENCER BACHUS, Alabama

JOHN LINDER, Georgia

CLIFF STEARNS, Florida

PETER T. KING, New York



Mack Fleming, Staff Director and Chief Counsel



SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

LANE EVANS, Illinois, Chairman



MAXINE WATERS, California
BOB FILNER, California
LUIS V. GUTIERREZ, Illinois
JAMES E. CLYBURN, South Carohna
MIKE KREIDLER, Washington
JILL LONG, Indiana



THOMAS J. RIDGE, Pennsylvania
SPENCER BACHUS, Alabama
TERRY EVERETT, Alabama
JACK QUINN, New York



(II)



CONTENTS



Page

OPENING STATEMENTS

Chairman Evans 1

Hon. Luis V. Gutierrez 10

Prepared statement of Congressman Gutierrez 45

Hon. Maxine Waters 17

Prepared statement of Hon. Spencer T. Bachus, III 45

WITNESSES

Benecke, Michelle M., Co-Director, Servicemembers Legal Defense Network ... 34

Prepared statement of Ms. Benecke, with attachments 160

Blecker, Michael, Executive Director, Swords to Plowshares 24

Prepared statement of Mr. Blecker 143

Cabrera, Antonio Molina, El Universal Newspaper 32

Prepared statement of Mr. Cabrera, 158

Edwards, Dwight D., Executive Director, The Vietnam Veterans Health Ini-
tiative Commission, Department of Health, Commonwealth of Pennsylva-
nia 6

Prepared statement of Mr. Edwards, with attachment 55

Ensign, Tod, Director, Citizen Soldier 4

Prepared statement of Mr. Ensign 53

Fitzpatrick, Richard, Executive Director, National Coalition for Homeless

Veterans 22

Prepared statement of Mr. Fitzpatrick 129

Liebert, John Arthur, M.D., Seattle, WA 11

Prepared statement of Dr. Liebert, with attachments 81

May, Maceo, Housing Director, Swords to Plowshares 20

Prepared statement of Mr. May 125

Neely, Michael "Mike", Director, Homeless Outreach Program 19

Prepared statement of Mr. Neely 119

Richardson, Edwin Strong-legs, Ph.D., Alexandria, VA 39

Prepared statement of Dr. Richardson 185

Ross, Mary Candice, R.N., Ph.D., Tampa, FL 2

Prepared statement of Dr. Ross 47

Russell, Nancy A., National President, Gay, Lesbian & Bisexual Veterans

of America 37

Prepared statement of Ms. Russell, with attachment 175

Sarembe, Ingrid E., Enlisted Women Veterans Group 30

Prepared statement of Ms. Sarembe, with attachment 147

Shay, Jonathan, M.D., Ph.D., Cambridge, MA 15

Prepared statement of Dr. Shay 110

Woods, John, Dallas, TX 13

Prepared statement of Mr. Woods 98

(III)



VIEWPOINTS ON VETERANS AFFAIRS AND
RELATED ISSUES



WEDNESDAY, MAY 4, 1994

House of Representatives
Subcommittee on Oversight and Investigations,

Committee on Veterans' Affairs,

Washington, DC.

The subcommittee met, pursuant to call, at 8:30 a.m., in room
334, Cannon House Office Building, Hon. Lane Evans (chairman of
the subcommittee) presiding.

Present: Representatives Evans, Waters, Gutierrez, Kreidler,
Everett.

OPENING STATEMENT OF CHAIRMAN EVANS

Mr. Evans. Good morning. Today's hearing has been scheduled
to coincide with the 13th Annual Conference on the Concerns of
Veterans. Begun initially to give Vietnam era veterans a rallying
point in our nation's Capitol, the Conference on the Concerns of
Veterans has grown and evolved over the years.

At first it focused attention almost exclusively on the concerns of
veterans of the Vietnam era. It served era veterans well by bring-
ing them together to discuss, examine, and exchange information
on issues of special importance to them.

Today, the scope and purpose of this conference have been broad-
ened. Issues which are now addressed are not the exclusive concern
of one group or era veterans, but true to its original purpose, the
conference continues to bring veterans and interested public offi-
cials together to learn from and to educate one another.

This year's conference has continued to facilitate communication,
information, and understanding among its participants.

Over the years many people have contributed to this conference.
No one, however, is more responsible than Dr. Paul Camacho for
its continued success. Paul has been an untiring advocate for veter-
ans and this subcommittee, in particular, appreciates the help that
Paul has so willingly provided this year, as he has in the past, in
preparation of today's hearing.

Paul, we would like for you to stand and be recognized with a
round of applause. [Applause.]

Dr. Camacho. Thank you. It is an honor to be here today.

Mr. Evans. Thank you, Paul.

Toda/s hearing will highlight the diversity of concerns within
the veteran's community, and the subcommittee expects to receive
testimony on a wide range of issues. Some testimony will be di-

(1)



rectly related to veterans' affairs. Other testimony will address is-
sues not within the strict jurisdiction of this committee.

We look forward to hearing from each of the witnesses scheduled
to present testimony today.

The House Armed Services Committee is also holding an impor-
tant meeting this morning to consider pending legislation. As a
member of that committee, the chair expects to participate in those
deliberations as required throughout the morning.

Each witness is again requested and reminded to observe the
five-minute rule. The prepared statement of each witness will be
included in its entirety in the written record, without objection.
Witnesses are to limit their remarks to five minutes and are re-
minded that a red light on the witness table will signal the end of
the five-minute period.

The chair notes with regret that Congresswoman Jill Long is un-
able to be with us today due to a death in her family. She has been
a strong supporter of veterams of all eras and we are sorry she
could not be here. We obviously extend our sincerest sympathies
and condolences to her and the other members of her family.

We will now start with our first panel. The members of the first
panel are Dwight Edwards, Dr. Mary Candice Ross, Arthur Wright,
and Tod Ensign. Please come forward to the witness table at this
time.

Dwight is Executive Director of the Vietnam Veterans Health
Initiative Commission, State of Pennsylvania. Dr. Ross is a flight
nurse in the Air Force Reserves and instructor in the University
Nursing Program in Tampa, FL. Arthur is an Army veteran and
community activist focusing on veterans issues in Seattle, Wash-
ington. Tod is the Director of Citizen Soldier, a veterans advocacy
organization in New York, and as I indicated, your entire state-
ments will be made part of the record. We will start with you. Dr.
Ross. You may begin.

STATEMENTS OF MARY CANDICE ROSS, R.N., Ph.D., TAMPA, FL;
DWIGHT D. EDWARDS, EXECUTIVE DIRECTOR, THE VIETNAM
VETERANS HEALTH INITIATIVE COMMISSION, DEPARTMENT
OF HEALTH, COMMONWEALTH OF PENNSYLVANIA; AND TOD
ENSIGN, DIRECTOR, CITIZEN SOLDIER

STATEMENT OF MARY CANDICE ROSS, R.N., Ph.D.

Dr. Ross. Good morning.

I appreciate this opportunity to come to you today to talk about
women veterans and women veterans' health care and health care
issues in the future of the VA.

In a personal survey of mine, in addition to my research that has
been published, I have asked hundreds of veterans if they would
select a VA health care facility above a private care facility, and
I received a unainimous no. I would like to point out some of the
problems that have created these kinds of feelings among veterans.

I will say that veterans have been very appreciative and praising
of the Vet Centers and their counseling.

The VA offers substandard care. There are long waits for clinics,
clinic appointments, and when you get there, you still wait long
hours.



The professional nurse-patient ratio is far below the private sec-
tor. There are many elderly, complex, high risk patients to be cared
for, and yet we offer fewer professionals to do that.

We must direct dollars to nursing care and nursing care re-
search. One patient told me he far preferred any other health care
hospital, any facility, besides the VA because he did not like shar-
ing one tiny, little, black and white TV that seldom worked with
a large ward of men and one portable telephone with 40. It was
easier for me to call home from Saudi than it is for the average VA
patient.

This substandard care will not be tolerated by tomorrow's veter-
ans. The new vet is a more informed consumer. One point, one mil-
lion of these vets are females. The number of females using VA
health care facilities has increased by about eight percent per year.
Yet less than 50 percent of the females that found themselves ad-
mitted to a VA hospital were even questioned in their medical his-
tory about gynecological problems and less than 20 percent re-
ceived pelvic exams. It makes me wonder why me continue to edu-
cate physicians with large numbers of male patients.

Female veterans are unique. Not only do they feel pretty ridicu-
lous in baggy men's pajamas and really respond negatively to the
lack of privacy in sharing community showers, waiting in line and
hoping that the elderly gentleman will see the occupied sign on the
shower door; they are given little privacy in a VA facility.

Women veterans are most unique in medical care. Their cardiac
conditions, thyroid conditions, vascular, orthopedic, and cancer
cases cannot be treated the same as male counterparts. They are
different and must be treated differently.

Our physicians must be educated that women are different. It is
amazing that of the women veterans, 20 percent have been a victim
of domestic violence, yet less than 50 percent of the medical schools
have any word whatsoever in the content of their curricula that ad-
dresses domestic violence. These women veterans who have been
victims of violence also are very likely to be homeless.

I recommend substantive changes to modernize VA health care
facilities and update care and increase the professional nursing
staff. If you have seen the news recently, you Imow that you cannot
treat a bed sore by having aides trip in and out of a patient's room
or having wonderful physicians diagnose, sure enough it is a bed
sore. Anyone can tell you that, but it takes professional nursing
staff to monitor these patients and to make sure they are getting
the right kind of care to do something about that.

We need to increase the staff to improve clinic responsiveness to
their patients. We need to train nurse practitioners in VA health
care facihties. This is a cost-effective approach to delivering care
much more rapidly and much more sensitive to patients, as the re-
search has shown.

We need to expand programs for women who are victims of vio-
lence and homeless programs, especially for women. We cannot ex-
pect women veterans to go into facilities that are designed for
homeless men. This is not a safe or a private environment.

We need to expand our adult day care facilities. This is cost-effec-
tive, and it will also keep our veterans out of the acute care facili-
ties.



We definitely need a PR campaign. If we are going to improve
conditions, we have to let people know that they are improved. We
also need to educate M.D.s and other staff on customer relations.

I think that concludes my remarks. Thank you.

[The prepared statement of Dr. Ross appears on p. 47.]

Mr. Evans. Thank you, Dr. Ross.

The chair is pleased to recognize the gentleman from Washington
State for any opening statement he may have.

Mr. Kreidler. Thank you very much, Mr. Chairman, for holding
this hearing. I look forward to hearing the testimony.

Unfortunately I am not going to be able to stay for the entire
hearing, but I very much look forward to reviewing the testimony
of those presenting information before the committee today.

Thsink you, Mr. Chairman.

Mr. Evans. I appreciate your attendance. I know this is a busy
day for everybody in Congress as there are various committee
markups.

I am pleased to recognize the gentleman from Alabama.

Mr. Everett. Thank you, Mr. Chairman.

I, too, congratulate you for holding this hearing. Unfortunately it
is one of those days. I have a markup in military construction, and
I, too, will not be able to stay for the entire hearing, but I will care-
fully review all of the testimony that we have been given.

Thank you very much.

Mr. Evans. Thank you both for coming. We appreciate you stay-
ing as long as you can.

Mr. Ensign, you are recognized to present your statement at this
time.

STATEMENT OF TOD ENSIGN

Mr. Ensign. Thank you.

It is a pleasure, Mr. Chairman, to be here today and have an op-
portunity to present some of the views of my organization. Citizen
Soldier.

We are a small veterans and GI rights advocacy group founded
in 1969.

Many things, of course, could be said about the concerns of veter-
ans today. I will limit my remarks to two groups on behalf of whom
this subcommittee has struggled for a long time. Specifically atomic
veterans and those who were exposed to Agent Orange in Vietnam.

We have benefitted in the last few months by the new round of
concern about the human health effects of radiation. I refer to the
Secretary of Energy Hazel O'Leary's disclosures in December not
only about the tests on humans, but also her disclosure that there
had been many more tests at Nevada than were previously ac-
knowledged. She also admitted that our plutonium stockpiles were
roughly 50 percent in excess of the weapons grade plutonium need-
ed for our weapons. In other words, we had half again as much plu-
tonium as we even needed.

At the same time, we were told that the Fernald plant in Ohio
and the Savannah River and Hanford, Washington production
plants had to be kept operating even though it was clear from most
environmental studies that they were dangerous polluters. We
were told these plants had to be kept operating because of national



security and the Cold War, and yet now we learn that we actually
had almost over 50 percent in excess of what we needed for our
warheads. I think this raises serious questions.

At any rate, since these disclosures, there has been a news flur-
ry, and we in Washington know that these things tend to happen
in waves. Periodically, we will have a wave of publicity about an
issue such as Agent Orange or others, and then it seems to die
down.

I am concerned today about how atomic veterans are going to be
treated in light of these new developments. The White House has
now appointed an Advisory Committee on Human Radiation Ex-
periments. As you know from my prepared remarks, I am asking
your subcommittee today to consider seriously the composition of
this panel.

Now, I realize that this is a Presidential commission and that it
is obviously autonomous. But I believe this committee has a re-
sponsibility to protest the appointment of Kenneth Feinberg to this
panel. Those of you who know the Agent Orange story know that
Kenneth Feinberg played a very active role as a representative of
Judge Jack Feinstein in Brooklyn in winning, or shall we say, pres-
suring the Agent Orange settlement back in 1984.

I know that your subcommittee knows that virtually no veteran
in this country feels this settlement was just or fair. We are talking
about total payments of $3,500 to the families of deceased veterans.
We are talking about maximum payments of $12,000 to a veteran
who is 100 percent disabled. These are clearly amounts that are
not significant in terms of helping people.

You also, I am sure, know that just two months ago the Supreme
Court turned down our appeal in which we tried to restore the
right of veterans to sue in state courts today for Agent Orange in-
juries that occurred eight years after the settlement. The federal
court in New York has ruled that these cases could not be brought
because they were bound and barred by the settlement.

One question I put for your consideration is: what happens at the
end of next year when the settlement fund is totally exhausted,
and some poor veteran who has recently developed soft tissue can-
cer or non-Hodgkins lymphoma is told he must come to the fund.
He says, 'Tou tell me I cannot sue. I do not have any other claim.
I just developed this cancer. What do I do?"

And they say, "Well, you are covered by the settlement. There is
no money, but you are covered by the settlement."

You obviously cannot do anything about the ruling of the Su-
preme Court, but I think we should be aware of its long-term impli-
cations for Vietnam veterans.

Mr. Feinberg, I believe, bears a heavy responsibility for this set-
tlement, and I do not think that he should be allowed to continue
as the only representative of the legal community on that panel.
Again, I realize your function is different than the advisory panel,
but I would ask you at least to consider looking into it because this
panel is going to recommend the scope of the compensation, if any,
for veterans.

Is this advisory panel just going to consider cases of people who
were deliberately tested? And by that I mean the poor kids in Mas-
sachusetts that were fed plutonium in their breakfast cereal or the



poor patients that checked into some hospital, and the next thing
they knew they were being injected with plutonium.

Finally, we see that the number of radiation claims being award-
ed by the VA is very small, fewer than one in ten. Out of 15,000-
odd claims, 1,400 have been granted. Why is that? Is that because
90 percent of these veterans are malingerers, cheats, or just trying
to get a free lunch?

Of course not. One reason for it is the way the VA evaluates
these claims; the way the dose is reconstructed, and this is another
area I invite your subcommittee to investigate.

We have got to find a way to help these people, many of whom
now are in their advanced years suffering these cancers. Many
have already died. We have got to keep faith with these people, and
I believe that Clinton's administration needs to seriously consider
compensating them as well.

As I said, we want to compensate this group. We want to help
these people, and I say let's include the atomic veterans in the Ad-
ministration's program to compensate victims of radiation testing.

Thank you.

[The prepared statement of Mr. Ensign appears on p. 53.]

Mr. Evans. Thank you very much. We appreciate it.

Mr. Edwards.

STATEMENT OF DWIGHT D. EDWARDS

Mr. Edwards. Good morning, Mr. Chairman.

I am the Executive Director of the Vietnam Veterans Health Ini-
tiative Commission of the Commonwealth of Pennsylvania, Depart-
ment of Health.

The commission was created in 1987 by the Pennsyvlania Gen-
eral Assembly as the result of the ongoing issues and concerns of
Pennsylvania veterans relative to health risks associated with their
service. The commission was mandated and designed to implement
educational programs for health care professionals regarding the
adverse health effects of Vietnam service; conduct outreach to bring
Vietnam veterans into the treatment mainstream; and to conduct
research with regard to the impact of the Vietnam War on Penn-
sylvania veterans.

The Research Triangle study in 1988 indicated a majority of
Vietnam veterans have not sought treatment from the VA for their
health concerns. The study also determined veterans are seeking
treatment from private or other health care facilities.

The commission through hearings determined that physicians
and other health care professionals have limited knowledge of the
psychological and physiological impact of the war on Vietnam
veterans.

These aforementioned factors led us to develop a two-phase edu-
cation program. One was a booklet entitled "The Vietnam Experi-
ence," which is included with the testimony that I have submitted.
This booklet outlines the various conditions associated with Viet-
nam service, both physiological and psychological. It has been pre-
sented to physicians and health care professionals throughout the
Commonwealth of Pennsylvania with the assistance of the Penn-
sylvania Medical Society.



The second phase of our program was to implement a series of
seminars, educational programs, which impact on health care pro-
fessionals of a broad range. Eight of these will be completed by
June of 1994.

Through these programs we have developed communications
with health care professionals, and as a result of that, we found
that some of the physicians and health care professionals that were
trained at VA facilities as interns and residents came into those fa-
cilities with a lack of respect for those that they would treat. They
came in with the understanding that their prime focus was to learn
the mechanical kinds of medical procedures that they were to per-
form: injections, learning about how to give injections; learning
about how to place IVs; things of that nature. They were not really
concerned about the veteran who they served.

It is shameful to say that these types of situations probably are
the rule in that this person or these physicians that confided with
me said that the other students, their fellow students, felt the
same way.

I think that veterans in VA hospitals are deserving of much bet-
ter treatment than that, and these students, residents, interns
should be sensitized to the needs of those veterans, as well as sen-
sitized to the service that those veterans have provided.

With regard to sensitization, I think that some of the profes-
sionals that are already in the VA need to be sensitized to those
cultural differences that exist, for example, differences in Afro-
Americans, Hispanic veterans, so that they can serve that popu-
lation or those populations better.

There is an indication in the Research Triangle study that 30
percent Hispanics have been affected by post-traumatic stress dis-
order; 20 percent of blacks have been affected by post-traumatic
stress disorder. The numbers of Hispanics and blacks that receive
PTSD benefits are low, and we need to look at that.

It may be that people are not aware of those basic cultural dif-
ferences; listen to a person of another race or culture presenting
symptoms; and are perceived in a negative light. The individuals
are then given their diagnosis of personality disorder or something
of that nature without being really considered for PTSD. So we
need to be aware of those cultural differences and biases.

In sensitizing physicians, sensitizing that health care system, we
need to alert them to the fact that there are differences, and they
need to be aware of those, and they need to take those into consid-
eration when they diagnose and/or treat veterans.

The other area is outreach, and our commission has been in-
volved in outreach efforts throughout the Commonwealth. It has


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Online LibraryUnited States. Congress. House. Committee on VeterViewpoints on Veterans Affairs and related issues : hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, One Hundred Third Congress, second session, May 4, 1994 → online text (page 1 of 23)