By Paul Elias, Associated Press, May 10, 2011
SAN FRANCISCO | Noting that an average of 18 veterans a day reportedly commit suicide, a federal appeals court on Tuesday ordered the Department of Veterans Affairs to dramatically overhaul its mental health care system.
In the strongly worded ruling, the 9th U.S. Circuit Court of Appeals said the department’s "unchecked incompetence" in handling the flood of post-traumatic stress disorder and other mental health claims was unconstitutional.
The appellate court said it took the department an average of four years to fully provide the mental health benefits owed veterans. The court also said it often took weeks for a suicidal veteran to get a first appointment.
"No more veterans should be compelled to agonize or perish while the government fails to perform its obligations," Judge Stephen Reinhardt wrote for the three-judge panel. "Having chosen to honor and provide for our veterans by guaranteeing them the mental health care and other critical benefits to which they are entitled, the government may not deprive them of that support through unchallengeable and interminable delays."
The VA now could:
VA spokesman Josh Taylor declined to comment, citing the pending litigation.
The court said one of every three soldiers returning from Iraq and Afghanistan was treated by the VA for mental health issues, including post-traumatic stress syndrome. A 2008 Rand Institute study found that 18.5 percent of soldiers returning from those countries were diagnosed with PTSD, and the study concluded 300,000 soldiers currently deployed suffer from it or major depression.
The 9th Circuit ruling overturned a 2008 verdict by U.S. District Judge Samuel Conti. After a two-week trial, Conti ruled that a lawsuit filed by two veterans groups seeking a judicial order for an overhaul of the VA was misdirected. Conti said he was powerless to act because Congress narrowly limited the authority that courts have in reviewing VA benefit decisions.
Conti didn’t find a systemwide crisis in which health care is not being provided within a reasonable time to the roughly 5 million veterans enrolled in the VA’s health care system, which includes 153 hospitals and 800 clinics.
The appeals court, however, said there was ample evidence that the VA is falling down in its duty to provide timely care for the mental health needs of the country’s military veterans.
"The delays have worsened in recent years, as the influx of injured troops returning from deployment in Iraq and Afghanistan has placed an unprecedented strain on the VA, and has overwhelmed the system," Reinhardt wrote.
The court said a 2007 report by the Office of the Inspector General found significant delays in timely referrals from VA doctors for treatment of PTSD and depression. Fewer than half of the patients received same-day mental evaluations, and others had to wait as long as two months for a counseling session.
At a trial in 2008, lawyers for the veterans groups showed Conti emails between high-ranking VA officials confirming high suicide rates among veterans and a desire to keep quiet the number of veterans under its care who attempt suicide.
"Shhh!" began a Feb. 13, 2008, email from Ira Katz, a VA deputy chief. "Our suicide prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities. Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?"
Katz wrote in another email that 18 veterans killed themselves daily on average.
After the trial, another email surfaced that was written by VA psychologist Norma Perez suggesting that counselors in Texas made a point to diagnose fewer post-traumatic stress disorder cases. The veterans’ lawyers argued that email showed the VA’s unwillingness to properly treat mental health issues.
The appeals court sent the case back to Conti in the trial court and ordered him to work with the VA and the veterans groups toward a new mental health care plan that implements a speedier process to appeal denied benefits, provides timely mental health treatment and ensures suicidal vets are seen immediately.
If the VA fails to come up with an acceptable plan, the appeals court told Conti to fashion his own plan. Conti scheduled a court hearing for May 27.
Chief Judge Alex Kozinski dissented from Reinhardt’s opinion. He argued that the ruling Tuesday trampled congressional limits on judicial review of VA decisions.
Paul Sullivan, executive director of Veterans for Common Sense, which filed the lawsuit along with Veterans United for Truth, said veterans had their day in court and won.
“Now we urge VA to move forward so no veteran is delayed or denied health care or disability benefits,” he said.
Read more: http://www.kansascity.com/2011/05/10/2865880/court-orders-better-mental-health.html#ixzz1M9j4abTD