By D.E. Ford, M.S.W., Commander Jeff Huber, U.S. Navy (Retired), and I.L. Meagher
for ePluribus Media
Part 2- AGAINST OUR WILL: RATION & REDEFINE
This article is the second of three parts exploring the impact of politics on the funding, diagnosis and treatment of the combat damaged veteran suffering from Post Traumatic Stress Syndrome. This part 2 explores how institutional barriers prevent utilization despite the overwhelming public support for mandatory healthcare funding for our military and how a redefinition of medical disorders as "spiritual" may shift treatment for PTSD and substance abuse to faith based, non-medical providers.
"Our pain from seeing these slanderous attacks stems from something much more fundamental, that if one veteran’s record is called into question, the service of all American veterans is questioned… there is nothing complicated about supporting our troops, and the leaders of this nation should make it clear that the members of our military will not only be supported when they wear the uniform, but also when they return home to the land they fought to defend. Their valor and their wounds, both physical and psychological, make them heroes for as long as they live…"Max Cleland, August 25, 2004 ( letter to President Bush)
The government’s parsimonious actions toward the military are counterproductive and contrary to the will of military and civilian populations alike. A 2005 Military Times Poll demonstrated dramatic decreases in the confidence of the career-oriented military that their civilian leaders have their best interests at heart: the military rates the President at 58%, down 11 points and they rate Congress at 31%, less than half the number from one year ago. The decline is attributed to pay issues, inadequate funding of veterans’ healthcare benefits, bipartisan acrimony in the Iraq debate, and combat equipment supply problems. According to a 2004 survey conducted by Princeton Survey Research Associates, 95% of all Americans think it is important to fund healthcare for veterans and that veterans should not have to wait to receive their benefits, 87% support mandatory funding, and 75% say such funding is either a top or a high priority.
Despite the Bush administration’s admonitions to "Support the Troops," veterans encounter formidable barriers to benefits and services, which constitute covert rationing strategies. Knight Ridder newspapers, in their award winning series on veterans’ struggles with the VA bureaucracy, found that more than 13,700 veterans died before their claims were resolved, that over half a million veterans may be missing out on their disability payments, and that the VA gives out completely incorrect or minimally correct information 45% of the time. Veterans’ watchdog reports claim that chronic under funding of the VA medical system has resulted in substandard care. These reports state the VA paid out more than $105 million in malpractice settlements in 2005. On Veterans Day weekend, retired Marine General J.P. Hoar, the former U.S. military commander in the Middle East, excoriated Mr. Bush for consistently under funding veterans healthcare and for repeatedly attempting to shift more of the cost to the veterans themselves, a plan veterans groups state will soon be defined as a "critical readiness issue" by those who would divert those funds to armaments.
Disorders of the Spirit
There is also evidence that the Bush administration, under the guise of the Faith Based Initiative, may be attempting to ration medical care by the enactment of the Cato Institute policy that advocates deregulation and the dismantling of the so-called "medical monopoly." The director of health policy at the libertarian think tank, the Cato Institute, is none other than Michael F. Cannon, who formerly served under the chair of the Senate Committee on Veterans Affairs, Larry Craig’s (R-ID) direction as health policy analyst in the Senate Republican Policy Committee. As the VA is the largest recipient of federal funds in the healthcare industry, Cato-inspired policymakers would then predictably target the VA to break the medical "monopoly" by opening the system up to "free market" providers such as spiritual healers.
The redefinition of increasingly prevalent, chronic, costly disorders like PTSD and substance abuse as "spiritual" disorders or "moral" issues could open the door to outsource them to unregulated faith based care providers rather than to medical treatment. Licensure strictures, oversight requirements and malpractice suits are avoided. It shifts the burden of responsibility from government to the patient, effectively rationing the medical care of the veteran who suffers from service connected disorders and putting them at risk for additional harm from unregulated providers.
In 1996, then Governor Bush implemented "Charitable Choice" which exempted Texas faith based substance abuse treatment facilities (which treat substance abuse as a "sin" and eschew medical care) from state regulations and licensing requirements designed to protect the consumer. The experiment reportedly resulted in a lack of accountability for taxpayer funds, misleading and distorted efficacy rates, and dangerous, substandard care for patients:
Under Texas’ new, permissive regulatory structure, faith-based drug treatment centers must simply register their religious status with the state to be exempt from virtually all health and safety measures required of the vast majority of treatment facilities, including: state licensing, employee training requirements, abuse and neglect prevention training, licensed personnel requirements, provisions protecting clients’ rights, and reporting requirements of abuse, neglect, emergencies or medication errors.
By redefining the diagnoses of PTSD and substance abuse as disorders of the "spirit" in which the "medical care" may be provided by faith based providers, care is shifted away from licensed and regulated providers such as physicians, psychologists and social workers. The cost is dramatically lowered. This "shifting" may well violate medical ethics by making budgetary concerns the primary issue rather than the moral and ethical obligation of putting veterans first.
But get ready for it: Outsourcing veterans’ PTSD treatment to private faith based contractors appears to be on the national horizon. On December 27, 2005, one of the authors received an unsolicited e-mail¹ urging his help in obtaining a government contract for faith based PTSD treatment services:
Dear Fellow Veteran,
It is my privilege to announce the results of Webb & Associates Chaplaincy Consulting, operational-combat stress prevention (OCSP) pilot program, implemented with the 2nd Battalion, 11th Marine Regiment, and 1st Marine Division from January 2004 to June 2005. These 632 Marines deployed to Iraq for 7 months performing 1200 missions and driving nearly 1,000,000 miles.
An unprecedented 95% reduction in PTSD was achieved. This represents an ANNUAL savings of $921 Million for all troops currently deployed to Iraq and Afghanistan, considering only VA treatment and compensation costs. These savings will help ensure our obligations to current veterans are maintained. Help us prevent stress in our newest veterans by supporting OCSP standard.
Please click on this link [deleted by authors] and register to send a letter to Congressman Duncan Hunter, House Chairman of the Armed Services Committee. Your letter will urge funding and implementation of the Webb & Associates Operational-Combat Stress Prevention model within the entire U.S. Armed Forces.
As a veteran myself, you have my sincerest thanks for your generous efforts to support our military service members, past, present and future.
God Bless, Tom Webb
President
Webb & Associates Chaplaincy Consulting
A Service-Disabled Veteran-Owned Small Business
Webb trained at the Dallas Theological Seminary and employs a Critical Incident Stress Management (CISM) model with the 2nd Battalion, 11th Marine Regiment (2/11), the debriefing component of which was shown in the APA review of the literature and other studies to fail to prevent PTSD. Webb’s Executive Summary fails to describe the inclusion of mental health professionals on his team as mandated by the CISM model, even though he is listed as a faculty member at the International Critical Incident Stress Foundation. Webb’s account of his success lacks the accepted conventions of scientific study such as a detailed description of the sample, operational definitions, rigorous statistical analysis, and limitations of the study. In addition, the added value he offers the taxpayer is that "participants were linked with community members from churches and other religious groups who provided support in the form of prayer (20,000 people prayed for the 2/11 every day), recreation and entertainment, limited financial aid, emotional support, and resource referral." The financial aid consisted of buying a pair of glasses for a service member’s wife. No other examples were provided.
Webb claims to have reduced the PTSD rate from 20% to less than 1%, yet given the reluctance of PTSD victims to acknowledge their symptoms and their need for help, the often delayed nature of the disorder, the barriers to treatment, and the current culture of blame, his claims were not supported. "Recommendations" are an accepted convention in scientific study for proposed future research. However, Webb’s only recommendation is that he should be immediately funded.
Furthermore, Webb fails to document how the study itself was funded but notes that he was there "…per the invitation of the 2/11 Commanding Officer Lieutenant Colonel Mike Frazier." Webb concluded his study in May of 2005. The VHA Handbook dated March 2005 states that "The VHA does not authorize ‘volunteer chaplains’ or any volunteer to provide spiritual and pastoral care and counseling activities" and "Under no circumstances may community or Authorized Faith Representatives be used in lieu of an employed chaplain." It would seem that regulations were loosened on this occasion for Webb, who had been a Navy chaplain from 1989-2000 but who was a not a military chaplain during the time he spent conducting this study with the Marines.Oddly enough, the handbook has redefined the role of pastoral care in VA treatment facilities "…to ensure that veterans who need medical care (including counseling for their religious or spiritual needs) are referred to VHA. "[emphasis added] "Describing care as pastoral may refer to the motivation and or attitude of the caregiver. In the VA, pastoral care refers to care provided by a chaplain, professionally educated and endorsed by a particular faith tradition to provide such care." In fact, "Chaplains are responsible for ensuring that religion is not imposed on any patient."
Christian fundamentalists are firing on the various military branches for endeavoring to maintain religious sensitivity and to prohibit proselytizing by the chaplains. Considerable political pressure is being exerted on the military to condone advancement of fundamentalist Christianity above other faiths. Webb’s alma mater, Dallas Theological Seminary has been identified as one targeted by evangelicals for recruitment of military chaplains to aggressively convert non Christians.
While religious counseling is commonly seen as a sometimes beneficial adjunct to medical care, it is not commonly defined as medical care per se. The influential healthcare policy analysts at the Cato Institute cite medical economists who warn against a physician cabal who use regulations and licensure to protect physicians against competition from other groups of providers. Cato advocates for a free market where unregulated herbalists, spiritual healers and others are given free reign and are predicted to dramatically lower healthcare costs.
The Texas experiment thoroughly demonstrates that the intersection of economics, politics and religion has degraded the quality of healthcare. Let the buyer beware.
Notes
1 Private e-mail to J. Huber dated 12/27/05
PTSD RESOURCES:
Soldier’s Heart
PTSD Education Page
Infinity Publishing
Military Veterans PTSD Reference Manual – comprehensive online book
National Center for PTSD
Veterans with PTSD Fact Sheet
Managing Stress Fact Sheet
The Iraq War Clinician Guide, 2nd Volume
MSN Groups
PTSD – Iraq Discussion Forum
PTSD Support Group for Family Members
Aftermath of War – Coping with PTSD Forum
THRIVEnet
Guide to Listening to War Veterans for Family Members
Department of Veterans Affairs (VA)
Seamless Transition – resources for OEF and OIF vets
PTSD Counseling Centers
Vietnam Veterans of America
PTSD Benefits Guide
Veterans for Common Sense
PTSD Resources Page
National Gulf War Resource Center
Self Help Guide for Post Traumatic Stress
US Marine Corps
Leaders Guide for Managing Marines in Distress
Iraq and Afghanistan Veterans of America (IAVA)
Resources for Vets – formerly Operation Truth
Kirt Love – Gulf War Veteran and Advocate
Gulflink
Kirt’s bio and contact DSBR@gulflink.org
About the Authors:
D.E. Ford, M.S.W. is a clinical social worker with concentrations in depressive and anxiety disorders, trauma, and substance abuse. She was a pioneer of humor therapy with inpatient psychiatric populations, teaching comedy improvisation techniques in group therapy settings. She has served as Utilization Management Director of a psychiatric hospital, as a managed care consultant, and as a corporate behavioral health consultant. On the ePluribus Media board of directors, she also serves as an editor, on the public relations team, and as a citizen journalist.
Commander Jeff Huber, US Navy (Retired) was a flight instructor, operations officer of Carrier Air Wing 9 and the aircraft carrier USS Theodore Roosevelt, and commanding officer of VAW-124, an E-2C Hawkeye squadron. Jeff’s satires on military and foreign policy affairs have appeared in Proceedings, The Navy, Military, and GlobalEar. His essays have been required student reading at the U.S. Naval War College, where Jeff received a master’s degree in national security studies in 1995. He recently co-authored an article on command and control of naval forces for Jane’s Fighting Ships. Stop by Pen & Sword. He is an editor and citizen journalist with ePluribus Media.
I.L. Meagher is an activist and citizen journalist with ePluribus Media. She holds a Highest Honors A.A. in English, and is working to complete her B.A. in Journalism at Northern Illinois University. Fluent in Hungarian, she has also completed foreign studies abroad and has traveled extensively in North, South, and Central America, Europe, and the Caribbean. She is the owner of a Midwest content development and online publishing firm and is currently researching the 1956 Hungarian Revolution (her parents fled following her father’s taking up arms against the Soviets on the streets of Budapest) as well as cataloguing cases of combat-related post-traumatic stress disorder. Her diaries on PSTD are at: ilona’s commentaries.
Other ePluribus Media contributors include: Zan, Stoy, Cho, Standingup, Vivian, JeninRI, lilnubber, kfred
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