Protecting those who have protected us

David Shulkin, secretary of the U.S. Department of Veterans Affairs, will deliver the 2017 Disabled American Veterans Distinguished Lecture at Harvard Law School (HLS) on Thursday. This is the fourth annual event in the DAV Distinguished Speaker Series, which provides a forum for national leaders to address critical issues facing America’s disabled veterans and to engage in conversation with the local community. The series is co-hosted by the Veterans Legal Clinic at the Legal Services Center of HLS and the HLS Armed Forces Association.

 In advance of his visit, Shulkin answered a few questions about the Department of Veterans Affairs and the services it provides.

HLS: A VA study found that 20 veterans commit suicide each day. What is the Department of Veterans Affairs doing to increase the availability of mental health services for all our veterans? And what is being done to increase the availability of these services for individuals who — due to PTSD or other mental health issues incurred during their service — may have left the military with less-than-honorable discharges and therefore may not be eligible for benefits?

SHULKIN: Nothing is more important to me than making sure that we don’t lose any veterans to suicide. Twenty veterans a day dying by suicide should be unacceptable to all of us. This is a national public health crisis and it requires solutions that not only the VA will work on, but all of government and other partnerships in the private sector and nonprofit organizations.

Within weeks of becoming secretary, I authorized emergency mental health services for those who were less-than-honorably discharged. That is a population of veterans at very high risk for suicide. Under this initiative, former service members with an OTH [other than honorable] administrative discharge may receive emergency mental health care for an initial period of up to 90 days, which can include inpatient, residential, or outpatient care. During this time, the Veterans Health Administration and the Veterans Benefits Administration will work together to determine if the mental health condition is a result of a service-related injury, making the service member eligible for ongoing coverage for that condition.

HLS: How is the VA responding to the changing nature of warfare and science and its effects on veterans’ health?

SHULKIN: Advances in emergency, trauma, and general medicine at the Department of Defense have improved the survival of seriously injured service members. It starts with the training of an entire team, from combat medic to the surgeon and those providing care during and after evacuation. It is truly an amazing system. As a result, many veterans from the most recent wars in Iraq and Afghanistan are coming home with multiple and more severe long-term injuries. In addition, these veterans are experiencing some injuries at higher rates than seen in past wars, including post-traumatic stress disorder (PTSD), amputations, and traumatic brain injuries. The VA has in turn improved its ability to better diagnose and treat these conditions in veterans who fought in previous wars, such as the case of PTSD in Vietnam-era veterans. Advances in prosthetics, medical, and mental health treatments have also improved the quality of life for veterans with these conditions.

HLS: The effects of environmental toxins on service members are much better understood today than they were years ago. How is the VA addressing these challenges?

 SHULKIN: The VA works closely with its counterparts at the Department of Defense and the Centers for Disease Control for a synergistic approach to care and for sharing of information, joint campaign efforts, and studies on environmental exposures. We have a better understanding of the implication of environmental toxins such as Agent Orange, burn pits, and environmental hazards. The VA is a leader in efforts to research, diagnose, monitor, and treat these exposures, and this will likely have implications for civilian environmental exposure concerns as well.

HLS: As secretary of Veterans Affairs, you head the largest integrated healthcare system in the U.S. Coordinating the safety, availability, and quality of care in such a large system is complex. Recent news stories report serious incidents of substandard care, including at the VA hospital in Bedford, Mass., and at a facility in New Hampshire. How will you address these issues?

SHULKIN: I have made clear that the VA will hold employees accountable when the facts demonstrate that they have failed to live up to the high standards taxpayers expect from us. In May, I established the VA Office of Accountability and Whistleblower Protection to help protect employees who expose problems and assist in using all available authority to discipline or terminate any VA manager or employee who has violated the public’s trust and failed to carry out his or her duties.

In June, the president signed into law the VA Accountability and Whistleblower Protection Act. This is an important step forward for our modernization of the VA. It allows us to hold ourselves accountable for the work we do for our veterans. Recently, the VA became the first agency to post information on employee disciplinary actions online. The VA is posting weekly online wait times for every one of our 168 medical centers across the country. No other health system in the country has done anything like that, and no one is as transparent as we are.

Regarding the Bedford facility, once I heard of the incident I reminded Veterans Health Administration leadership that I expected them to make decisions involving employee accountability independently in the interests of veterans. Since I was made aware, the VA has taken a number of actions on this issue.

This interview has been lightly edited.

The 2017 DAV Distinguished Lecture event will be held Thursday (Nov. 2) at noon in Milstein East B on the second floor of Wasserstein Hall on the Harvard Law School campus. The event is open to the public.