TRANSCRIPT

Walter Reed and Beyond

Anne V. Hull
Monday, June 18, 2007; 11:00 AM

On Monday, June 18 at 11 a.m. ET, Post reporter Anne V. Hull discussed the latest findings in the ongoing examination of the treatment of men and women coming home from the war with physical and mental wounds.

Follow the series at washingtonpost.com/walterreed

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Anne V. Hull: Hi everyone. We're here.

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Lyme, Conn.: To what degree where the problems of veterans health care limited to Walter Reed, and to what degree were these institutional problems that veterans health care was being neglected across the country?

Anne V. Hull: They aren't limited to Walter Reed but WR is supposed to be the gold standard for everything medical in the Army, including psychiatry. The first day's story wasn't about WR at all. It was about the difficulty getting accurate records, getting an accurate evaluation and getting help.

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Vernal, Utah: What can be done to help? Reading these stories of men and women who come home and get lost in the system make me want to cry with outrage. They are the ones giving up the ultimate sacrifice and yet they are treated as though it's "their" fault when they get home?!?! I hope these actions held against our soldiers would be accidental and not intentional. Please get them the help they deserve.

Anne V. Hull: Basically keeping attention on the issue. The government seems ready to help, it's now a question of serious follow-up and disposing of people's old ways of thinking--and of course overcoming stiffling bureaucracy. Now that's hard.

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Suwanee, Ga.: How long have you been reporting on the issue of PTDS

Anne V. Hull: Four months, but we've been following these issues since early fall 06, both at Walter Reed and beyond.

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Amherst, Ohio: God Bless you!! Just called the Congressional Veteran Affairs Committee in Washington, they said they just had a meeting on your article this morning. I said, I hope this brings real change. They said, "We'll see.".......not promising.. I hope America speaks out.

Anne V. Hull: This is one place concerned readers could write or call.

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Rockville, Md.: Hi, with some of the issues that Walter Reed has faced over the last year what changes have occured to improve treatment for these men and women?

Anne V. Hull: Lots of positive changes began happening for Walter Reed's outpatients in Feb of this year, and that includes a new structure to account for the hundreds of wounded soliders. The case mgmt ratio dropped from 50 soldiers to one soldier, to 15 to 1. There is talk fo standing up a PTSD center of excellence at WR.

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Ligonier, Pa.: Did Joshua Calloway come forward to tell his story after the initial Walter Reed story broke, or was he one of your original sources? When did you realize that the mental health facilities at Walter Reed were as broken as the basic outpatient care?

Anne V. Hull: We met Josh last fall. He was among the soldiers we met at Mologne House. He had just arrived and was a mess. We continued to follow him through the months of treatment until he left in May. Still checking on him.

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Chevy Chase, D.C.: Congratulations on continuing your excellent (and, unfortunately, fairly unique) coverage of how our leaders have started a war and, like sorcerer's apprentices, essentially walked away from the aftermath, saying 'oh, well'.

Any insight on what effect these reports are having in a really tangible sense with those-who-are-supposed-to-be-in-charge? If the army chief psychiatrist says "It's not our mission", there is a HUGE problem.

Any hopes that those who are running for president will address these issues in a substantive way, rather than the usual soundbite moments?

Anne V. Hull: Don't know about presidential candidates but WR staff, DOD staff and Hill staff have apparently be actively discussin the issues in the stories today.

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North Attleboro, Mass.: It is my understanding that WR already has an outstanding PTSD center it's just that no one can get into it. Any talk about that changing?

Anne V. Hull: That's the DOD center, which is kind of like renting space at WR. It's tiny, takes in about 65 soldiers a year, only some of them from WR, and got squished into a small space in March. They are, to some people's thinking, a model for what should be done but because they are "DOD" owned and not "Army" owned, the Army hasn't really taken advantage of them. Typical parochialism. It's called the DOD Deployment Health Clinical Center.

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North Attleboro, Mass.: How much do you attribute the issues within the military mental health system to stigma alone? Do you see any moves being made to address this stigma issue?

Anne V. Hull: Acting Surgeon Gen. Pollock says she is on a campaign against stigma but it's a very difficult problem to get at. It's not only commanders (especially NCOs) who make it clear sometimes that soldiers with psychological problems are just wimping out, but soldiers themselves who sometimes don't want to identify themselves as having these issues. One effective way to combat it is to have the top commanders, the "warfighters" let their soldiers see them go to counseling and talk about the importance of it.

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Anonymous: Does anyone have statistics about whether this situation is affecting recruitment? Have potential recruits refused to enlist because of the rocky treatment they can expect if they are either physically or emotionally wounded?

I worked with a man who is now a major "player" in the PTSD program of the Israel Defense Forces and they seem to have their act together. Have we been working with them?

Anne V. Hull: On the contrary, they've been giving more people with psychological problems waivers to reenlist. Haven't heard they are working with IDF.

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North Attleboro, Mass.: I have read in several places that therapists are leaving the military health organizations in droves. What is the reason for this? Is it pay or is it the constant battle against the system?

Anne V. Hull: The pay is low, and though the work is rewarding, according to many mental health providers in the military, if you are active duty you are subject to deployment. Many uniformed providers at WR have deployed to Iraq, as well as other providers around the country. Everyone is stretched impossibly thin, fighting burn-out and dealing with declining number of recruits joining the mental health care ranks in the services.

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Detroit, Mich.: I just read your story and I was wondering if there is any way to contact Josh Collaway, to offer him support?

Anne V. Hull: contact me at hulla@washpost.com

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Dayton, Ohio: According to the Post, Joyce Rumsfeld knew about the problems last October, so I would assume her husband also knew. So why hasn't Donald Rumsfeld been criticized for ignoring the problems?

Anne V. Hull: We don't know what Mrs. Rumsfeld told her husband. As you know, he made frequent visits to WR but I don't think he has been back since he left.

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Suwanee, Ga.: I have to have my say as a parent of a Combat Iraq Vet. My son is in the trama recovery program at the Atlanta VA, however the next phase cannot be started because they do not have enough Veterans to have the program. He has been told the funding is there but there has to be a cetain number. Well what does he do now? It is not easy for him and it is hard for us to watch. If your son or daughter is not getting the help they need, contact your congressmen and Senators. We did and boy did things get moving. Contact your State Veterans Advocates office. They are not with the Federal Government, they are State Level and they are there to help. In Georgia they are across the street for the Atlanta VA. They are great.

Anne V. Hull: just passing this along...

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Stratford, Conn.: What is the status of reform measures in Congress, if any, which will update the antiquated and clealy punitive VA disabilty process so that veterans are given the benefit of the doubt on claims rather than being made to prove their case (or being made to play the "pre-existing condition" game") while relying on a chain of evidence held by the government?

Anne V. Hull: The latest and more comprehensive legislation was introduced last week by Sen. Levin. It has bipartisan support.

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Bloomfield Hills, Mich.: What specific congressmen and senators have oversight on these issues. And, what are they saying and doing in re: to your articles?

Do you think they are trying to push this issue under the rug?

Anne V. Hull: Basically it's Armed Services Committees

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Morgantown, W.Va.: The growing literature on PTSD including the Adverse Childhood Experiences study shows that trauma (regardless of the specific event be it domestic violence, combat, or natural disaster) has a lasting effect on the survivor if the person is not treated. It has been hard to get other therapists to understand that there are ways to treat people without years of long-term relationship therapy. However, if a psychiatrist, psychologist, social worker, or other therapist received his/her education and training prior to 2000 it is certain that he/she got NO information on assessing for trauma, let alone on how to treat it. Even now, few graduate programs have any mention of the trauma-related conditions.

Just hiring more therapists will not meet the current shortage of qualified therapists. There has to be a push to train the trauma specialists and there are few agencies in place to do so. We have been training trauma therapists in a method that is brief and effective but we are met at every turn by demands that we show that our results can be measured by a randomized, placebo-controlled, double-blind study, something our small agency cannot do with its limited staff and resources. The demand for evidence-based treatment should be replaced by acceptance of practice-based evidence. Such acceptance would allow the soldiers to get the care they need. Most laypeople have no idea how much professional knowledge has been accumulated about PTSD. They are right to demand that our troops get what they need.

Linda Gantt, Intensive Trauma Therapy, Morgantown, WV

Anne V. Hull: Just passing this along.

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Amherst, Ohio: I hope people understand that your article, while it focuses on active duty soldiers, mirrors the problems with mental health within the Veterans Administration. As both have policy set by the same people.

Anne V. Hull: Actually, Jeans Cruz is no longer active duty and Sylvia Blackwood got treatment at a VA residential clinic. She's a reservist.

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Alexandria, Va.: Will we have another generation of veterans like those from Vietnam plagued with homelessness, mental illness, and drug abuse?

Anne V. Hull: Hopefully not. There is a lot more awareness, and money, now than back then, which makes the weaknesses in the system all the more inexcusable.

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North Attleboro, Mass.: Is anyone tracking the suicides? I read in Penny Coleman's book "Flashback" that more men have killed themselves from the Vietnam conflict than are actually listed on the wall. In your opinion, from what you have seen,could we be heading for something like this for Iraq and Afghanistan?

Anne V. Hull: The VA has done a giant study on suicides among vietnam vets. It's not released yet. I guess we could, but really, the public support for vets is so different now than back then.

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Jim Bob: Have you considered highlighting the pro bono efforts of attorneys who are helping veterans file and appeal compensation claims with the VA? There are a number of organizations starting to do good work for veterans.

It might be something helpful for vets if you were to feature this in your articles. And it would get the word out to attorneys looking to do pro bono work on behalf of people defending our nation (rather than just helping alleged terrorists at Gitmo).

Anne V. Hull: Yes, this effort is just getting off the ground in Washington. The lawyers have made their initial contact with WR. They will also be taking cases across the country. We don't have the info in front of us, but call the DC chapter of teh American Bar Assn as they may have it. Also, try googling for the news story that broke 3 weeks ago about this effort.

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Baltimore, Md.: Thank you so much for this article: I'm sure I'm asking a question that you'll hear a lot today. I don't have a background in mental health, and I have no connection to the military, but I want to help. What can I do to improve the lives of these returning soldiers? I don't have money, but I have time. I need a way to help that will make a difference.

Anne V. Hull: Well, this is kind of a problem since we've discovered that WR doesn't exactly have the capacity to funnel all the volunteers. You could check out our website, which lists lots of volunteer groups. washingtonpost.com/walterreed

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Arlington, Va.: Thank you for this important story. My Marine son has mentioned concerns about some new enlistments as the recruitment standards (h.s. graduation, past convictions, previous drug use) have been to be dropped to meet recruitment goals. It seems that people who haven't coped well in civilian life will be even less able to manage ptsd and even larger numbers of them are likely to have disability claims or assistance denied because of "pre-existing conditions." If the Army and Marine Corps must lower their recruitment standards even more, we've only seen the tip of the iceberg. Care to comment?

Anne V. Hull: Recruitment standards have been dropped as the need for fresh troops continues. Evidence shows that young people, and those with a history of depression or have had a traumatic event in their childhood, are more prone to PTSD and other forms of combat stress.

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Pentagon: I'm an active duty senior officer that voluntarily sought treatment at both Wards 54 and 53 for major depression and suicide ideation in early 2006. My experience there was very disappointing and, though I'm not a combat vet, I can empathize with the stories in the Post.

My disappointment is due to the fact that Walter Reed's primary objective for in-patient psychiatric care (to include Ward 53) is not recovery and remission of disorders, but a quick and orderly clearinghouse to identify and discharge mentally ill patients from the military ranks.

Somehow, I survived Wards 54 and 53 and am still active duty. But cleary their focus isn't patient-centered. I should have known better and never self-referred while in uniform...the Army is barely interested in the hard work and investment necessary to achieve patient recovery from a treatable mental disorder.

Anne V. Hull: Ward 54, like most inpatient psychiatric units, is meant to stabilize and do early assessment. The real treatment begins after stabilization. The avg length of stay on Ward 54 is a week or 10 days. Then they are released to outpatient status. It is here that soldiers can linger for months, in part because they are waiting for the cumbersome medial evaulation and physical evaulation board processes to be completed. While evidence show that treatment is best when time limited and highly focused, soldiers at WR languish for long periods as they wait on their disposition.

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Outer Banks, N.C.: Currently, there is a strong bias against seeking help among active duty with high security clearances ... fear that a diagnosis of PTSD will derail career and prevent them from certain future assignments. Is this being addressed? Is there an alternative to the "system" for active duty?

Anne V. Hull: Supposedly the Army is working to adjust this as we speak. They realize the process doesn't work. Just having had a psychological issue is not supposed to disqualify you from getting a clearance but not all the clearance people are even clear on this.

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South Carolina: Why isn't the treatment improvements moving faster? and how long will it take for the public to see that TBI and PTSD are just as serious as amputations and open wounds

Anne V. Hull: I has the best chance of moving forward right now, given all the initiatives and attention. Sec Gates has said he's commited to treating the "invisible wounds" of this war, TBI and PTSD. let's see.

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Washington, D.C.: Given all the negative attention that WR has received recently, do you believe that it will be closed early or that there will be a groundswell to transform it into the health center that people want it to be, and remain open for many more generations?

Anne V. Hull: Frankly, it is still scheduled to close and for all the soldiers and medical staff to join a bigger Bethesda Naval medical center. That's likely to remain on track, at this point.

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Washington, D.C.: Can you please comment on any marital and family therapy that is effective in dealing with PTSD as well as personal or group therapy. There are many marriages and families suffering out there too in relation to this conflict.

Anne V. Hull: Well, practioners tell us that marriage and family counseling is one of the most effective ways to get initial help to soldiers suffering from combat stress. It's the gateway into more specialized care. The army realizes this and has launched an initiative to train primary care providers in this area.

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Washington, DC: What was Jeans Cruz's MOS? An "Army Commendation Medal during strategic combat operations" doesn't, by itself, mean he was on the front lines of combat. He could have gotten that award working in the rear area. His comments about seeing dead children may or may not be true, again, that by itself would not be proof. There has to be some standard of verification, otherwise anyone could claim benefits simply on self-identification alone.

Anne V. Hull: In his case, the army failed to list his ACM with Valor on his DD214.

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Anne V. Hull: Thanks for joining us. See you next time.

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