Wounded Warriors Joint Health Care Ombudsman Act

Mr. Chairman, I offer an amendment.

Mr. Chairman, with four in 10 members of the military in Iraq and Afghanistan serving in the Reserve component, it is clear that our National Guard is no longer a strategic reserve, but an operational reserve. And as such, we must change the way we treat the Guard if we want to maintain recruitment and retention because it is the right and fair thing to do.

After 5 years of mobilization, both involuntary and voluntary, our National Guardsmen are still navigating the system that was intended for use by the active duty rather than our current nearly even blend of Reserve and active components.

My amendment to H.R. 1538, the Wounded Warriors Act, is simple. It allows members of the National Guard and Reserve who are returning from theater with minor injuries or other outpatient care needs the option to seek treatment at the military medical treatment facility closest to the member's home rather than closest to the base from which the member was deployed.

When an active duty soldier with certain injuries comes back to the United States, he gets treated at the medical facility closest at his home base where his family lives. But for Oregon Guardsmen and Reservists and soldiers from about a dozen other States that have no bases, our troops must remain for weeks at the base they deployed from for follow-up care. These can be hundreds or even thousands of miles away from home and family.

In 2004, I spoke with Monica Davey of the New York Times about the problem as she covered the issues in a series of front-page news stories. She quoted one spouse as saying, ``Having him in Iraq was hard enough. When he got hurt, I said, `Well, at least he can come home now and get better here with us.' But it is a strange thing. He came home, but he is not home at all.''

This problem is old news and no longer on the front page, but it still goes on. Here are a couple examples of what happens when these Guard troops request treatment upon demobilization:

An Oregon Guardsman who returned months ago is still on the east coast base with medical issues. He and his wife have several young children; and, as can happen with lengthy deployments, the separation has strained their relationship to the breaking point. He has seen his family only once in the last 3 months. That soldier should have the option of seeking treatment at Fort Lewis in Washington State, much closer to his home.

Another story involves an enlisted man with a wife and young children who has seen his young family stateside only three times in the last 3 months, once because the Army sent him home for convalescent leave, and the other two times over the holidays because his wife drove their children out to the east coast military treatment facility where he was awaiting care because they couldn't afford to fly.

These stories are heartbreaking; and, despite years of work on trying to get the problem fixed, little progress has been made. Since the start of the Iraq war in 2003, tens of thousands of Reservists and Guardsmen have been placed on medical hold.

As the New York Times reporter Ms. Davey aptly put it 3 years ago, ``Unlike the most gravely injured soldiers receiving around-the-clock treatment at the finest military hospitals, these are ordinary soldiers with more ordinary wounds. The loneliest and the impatient can elect to go home even if they still need medical attention, but that could be a very expensive trade-off. Military rules dictate that they lose their active duty salaries, even though they may still be too injured or ill to return to their civilian jobs.''

Today, four out of 10 soldiers in Iraq and Afghanistan are Guard or Reserve, and it is long past time for the DOD to adjust their policies and make improvements to the demobilization process for Guard members in States like mine that have no military treatment facilities. I ask for your support of this amendment so we can finally give soldiers from the Reserve component the flexibility to be treated for certain injuries at military medical treatment facilities nearest their homes and families just like the active component.

I yield to the gentleman from New Jersey.

Mr. Chairman, I yield back the balance of my time.

Mr. Chairman, I ask to claim the time allotted for debate of the amendment offered by Ms. Johnson, although I do not oppose the amendment.

Mr. Chairman, I certainly support this and so many other amendments on this bill which are so very, very important not only to our veterans, but it serves as a model, as do so many veterans programs, of something we could be doing for other Americans.

Let me speak first to the point of what these do when we manage and coordinate patient care. We had an issue recently in the Energy and Commerce Committee which I serve on doing this, another aspect, and it was a very lively discussion. But recognize that someone who is wounded, as well as someone who has other medical illnesses, a single diagnosis is usually not something that stands loan. For example, a person with diabetes may have several other endocrine problems, problems with their kidneys, with their diet, their circulation, their limbs, their mobility, and of course there are emotions, too, all of which can be very, very complex to deal with.

When the University of Pittsburgh Medical Center did a study on coordinating the care of people with diabetes, for example, they found when they assign people to work on these cases, they reduce rehospitalization by 75 percent. Washington Hospital in Washington, Pennsylvania reduced rehospitalization of folks with heart disease by 50 percent. These are extremely important aspects. And we have to look upon these as things that not only save money, but they save lives and they save a lot of care.

Let me also point to an amendment offered by my dear friend, Mr. Kennedy of Rhode Island, when he talked about mental illness. When we are talking about the wounds of war or the wounds of life, not all of these wounds are visible. They are not necessarily scars one can see, they are not something you can put a bandage on, but they are very real. The psychological wounds of war are such that they can break up a family, keep someone from holding a job, perhaps lead someone to try to self-medicate their problems away with drugs or alcohol, all too common problems among our veterans.

And then when they are not dealt with, we find people who become more dependent upon others, that with difficulties with their families, with their

children, perhaps become hopeless, have trouble holding a job. And all of those continued effects of wounds of war go on.

It is extremely important that we recognize in Mr. Kennedy's amendment, as well as Ms. Johnson's amendment and other aspects of this whole bill that what is vitally important is we treat the whole person.

The time is long past due in this country where we look at medical symptoms and medical disease as something that shows up on an x-ray or a blood test or some other sophisticated test. Indeed, the wounds of war are not always visible, nor are they things that appear soon after the battle. Post traumatic stress disorder, other anxiety disorders can remain latent for years and suddenly reappear. I remember meeting a veteran at a VA hospital who ended up with some problems after 20 or 30 years after the Vietnam War. He had recently had a liver transplant.

Under the medications and other aspects, he suddenly began having nightmares that he never had before. He had all this psychological trauma that was never showing up before.

What is so important is that we work to train people to understand these issues, which the gentlelady's amendment talks about, that we work to deal with the mental illness issues, which Mr. Kennedy's amendment talks about, and we work as a unit, as a whole, as a Congress, as a Nation to recognize that many times the illnesses and wounds of war are things that may not be there now, may not be visible, but are aspects we have to treat in the long run.

I call on all of my colleagues to enthusiastically support these amendments.

Mr. Chairman, I yield back the balance of my time.

Mr. Chairman, I offer an amendment.

Mr. Chairman, I yield myself as much time as I may consume.

Mr. Chairman, first, I want to thank the chairman of the committee, and I want to thank all those who contributed to this underlying legislation. I thank them for their good work on behalf of our Nation's veterans.

I myself am not a veteran. I did not serve my Nation in uniform. My grandfather did. He served during World War II. My father did. He served during Korea. My brother did. He served during the Cold War. So I have the highest respect for the men and women who serve our Nation in uniform.

Mr. Chairman, as we approach the annual debate on our budget, one thing that I think that we hold in common, although there are many differences in our parties, is that we all believe that our veterans and especially our veterans health care ought to be one of the most important priorities that we have as a Nation. And as we continue to fight this war on terror, we know we are creating more veterans with more health care needs.

During the last congressional recess, I spent a lot of time visiting with the veterans of the Fifth Congressional District in Texas that I have the honor and pleasure of representing. I heard many good comments, frankly, about VA health care and some complaints. And I suppose, Mr. Chairman, that one of the most important complaints I heard was the complaint on the waiting time in order to actually get the appointment that the veteran has requested.

Now, I know that great strides have been made in reducing these waiting times. I know that the veterans health care system is serving entire new populations that they didn't serve years ago. And this is a good thing. But I still would hope that, number one, we could understand exactly the challenges that our veterans are facing and see if there are not some commonsense solutions, as earlier the gentlelady from Texas, my colleague, said, that essentially we can save time and save money and still help our veterans.

This amendment is a very simple amendment. I hope it is a very noncontroversial amendment. It simply directs the Secretary of Veterans Affairs to study the average length of time between the desired date for which a veteran seeks a scheduled medical appointment and the date in which the appointment is actually completed.

Now, I know that the vast majority of appointments are completed within this 30-day window, but I don't believe this body knows if that means the bulk of them happened on day 29 or the bulk of them may happen on day six. This is important information we ought to have.

I represent a district that is urban, suburban, and rural; and this study would not just concentrate on our urban areas but our rural areas as well, where a number of our veterans go to retire.

Additionally, this amendment would ask for the Secretary's recommendations on what we might do to shorten the length of time to 15 days and provide recommendations to our body to do that. Not only veterans in the Fifth Congressional District of Texas, but if you look at the independent budget supported by numerous of our veterans service organizations, they speak to the need to see what we can do to reduce, in many cases, excess waiting times, something they flagged as a strong concern.

So I know the VA has made great strides, but there is still work that we can do to serve these people who serve us and protect freedom, the greatest commodity that we have in our land. And by supporting this amendment, Congress can make just one more small step in the direction of supporting our veterans.

Mr. Chairman, I reserve the balance of my time.

Mr. Chairman, I want to thank the gentleman for his support. I know when to take ``yes'' for an answer.

Mr. Chairman, I yield back the balance of my time.

Mr. Chairman, I offer an amendment.

Mr. Chairman, I ask unanimous consent that my amendment be modified with the text that I have at the desk that proposes text changes in section 107 of the bill.

Mr. Chairman, this amendment proposes text changes to section 107 of the bill, the section that deals with improved training for health care professionals, medical care case managers and servicemember advocates on particular conditions of recovering servicemembers.

As of March 1 of this year, over 24,000 servicemembers have been wounded in action since the onset of Operation Enduring Freedom and Operation Iraqi Freedom, according to the Department of Defense. The Government Accountability Office has found that servicemembers injured in combat face an array of medical and financial challenges as they begin their recovery process in the health care systems of the Department of Defense and the Department of Veteran Affairs. A GAO report was recently released on March 5 and entitled ``DoD and Va Health Care, Challenges Encountered By Injured Service Members During Their Recovery Process.''

According to the report, Mr. Chairman, the Department of Defense screens servicemembers for post-traumatic stress disorder, but it does not ensure that further mental health evaluations occur.

DoD health care providers review questionnaires, interview servicemembers, and use clinical judgment in determining the need for further mental health evaluation. Sadly, DoD found that only 22 percent of the service members who may have been at risk for developing post- traumatic stress syndrome were actually referred by the Defense Department health care providers for further evaluation. In addition, the Defense Department never identified the factors as health care actually used to determine which servicemembers needed the referrals.

Although our wounded warriors may obtain mental health evaluations for treatment for post-traumatic stress through the VA, and the VA may face a challenge in meeting the demand for these services, VA officials estimated that follow-ups for veterans to get treatment for this stress syndrome may be delayed up to 90 days.

Now, Mr. Chairman, I spent my professional career as a psychiatric nurse with the Veterans Administration. I can tell you that we could save time and money if we had the proper people in place to diagnose early, or at least get a referral. We miss a lot of early symptoms that later causes long-term unemployment, long-term financial stress and long-term hospitalization simply because we have not put the well- trained people in place, professional social workers, professional nurses that would diagnose and know that something needs to be done to prevent further deterioration, and that is my reason for bringing this.

My 15 years of hands-on inpatient program care were specialized in mental health. And I have my credentials to show that. And my amendment strengthens this section because I feel that more emphasis needs to be made on adequate training by health care professionals to recognize these signs, including suicidal tendencies, so that the early intervention can come, and it will shorten the recovery period.

I urge my colleagues to support this amendment.

Mr. Chairman, I reserve the balance of my time.

I yield 1 minute to Mr. Andrews from New Jersey.

Mr. Chairman, I have no further requests for speakers. I want to thank both sides for their support, and I urge adoption.

Mr. Chairman, I offer an amendment.

Mr. Chairman, I yield myself as much time as I may consume.

Like all of my colleagues, I was greatly disturbed by the conditions at the Walter Reed Army Medical Center which were depicted in The Washington Post. Last week, I introduced H.R. 1580, the Wounded Warriors Joint Health Care Ombudsman Act. My legislation is intended to create a single point of reference for recovering servicemembers and their families to ensure they are receiving prompt responses and information to their questions.

The amendment that I am offering today is a modified version of my legislation, and it creates a Department of Defense-wide ombudsman office within the Office of the Secretary of Defense. The functions of the office are to provide policy guidance and oversight to each military department. Specifically, the office would develop policy guidance with respect to providing assistance to and answering questions from recovering servicemembers and their families on a variety of important issues.

The policy guidance developed by the ombudsman office should allow recovering servicemembers to get information on administrative processes, financial assistance, the transition to care from the Department of Veterans Affairs and the support services available upon the member's return home. Very important.

The office would also establish accountability standards for the military departments. These standards would cover issues such as creating and maintaining case files for specific questions received, as well as tracking the response for all such questions. The office would also set timeliness standards for responses.

Under my amendment, the office can also require each military department to submit status reports of actions taken to address individual concerns raised by the recovering servicemembers and their families.

In closing, Mr. Chairman, everyone agrees that our military servicemembers should receive the highest quality of care and services possible. As they recover from their injuries, our wounded warriors should not have to battle bureaucracy to get the care and benefits they have earned. It is important that the ombudsman office be an advocate for servicemembers during every phase of treatment and the evaluation process as well.

I urge my colleagues to support this important amendment. I would also like to thank Chairman Skelton and Ranking Member Duncan Hunter for their assistance.

I yield to the gentleman from New Jersey.

I yield to the gentleman from California.