Military Construction and Veterans Affairs Appropriations Act, 2008

MILITARY CONSTRUCTION AND VETERANS AFFAIRS APPROPRIATIONS ACT, 2008 -- (Senate - September 05, 2007)

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H.R. 327

Mr. COBURN. Mr. President, I wanted to spend a few minutes noting some things in the press about H.R. 327 and my hold on that bill. This is a bill which is very well intended. It is to help prevent suicide among our veterans.

I have been in the medical field since 1978--1979, that is. Approximately 6 to 10 percent of my practice has been associated with depression, treating clinical depression, suicidal ideation, post-traumatic stress disorder, and other issues.

We need to offer our veterans whatever we can offer them in terms of helping them deal with what they have been through and also helping our veterans who have no connection with their war experience in terms of treatment of depression.

Our veterans have the right to expect the legislation we craft to deliver on good intentions. H.R. 327, frankly, does not do that. One of the serious flaws with H.R. 327 is that every veteran is preconditioned with a mental status exam. So if you are a World War II vet and you have a sore throat and you go to the VA clinic in Muskogee, under 327 you have to undergo a thorough mental status exam before you can have your sore throat treated. That is Congress hitting a gnat with a cinder block. It is wasteful of our dollars. It portends to have Congress practicing medicine, when, in fact, we do not know how to practice medicine, and you cannot.

What this bill sets up is that Congress is going to mandate the doctor-patient relationship or the patient-PA or the patient-nurse practitioner or the patient-social service or licensed medical social service masters. What we have decided is to interject, because of the tragedies that we have seen in the last couple of years, a mandated form of treating suicide, depression, and risk of harm.

I have reached out to Senator Harkin on this bill. I offered to make some simple changes. We were rebuffed. Then what we saw in the press is that I wanted to hold this only because of how somebody might not be able to have their second amendment rights guaranteed. That is hardly the situation at all. What I really am holding this bill for is because, first of all, it is bad medicine. No. 2, it duplicates and mandates things we should not be doing. It takes away from the professions within the VA who know what they are doing. It steps on and it interrupts what the VA is already implementing to a good extent and to a great degree.

There is another very serious concern with this, which is that it mandates the tracking of veterans who have mental health issues. The vast majority of our veterans do not have mental health issues, but the assumption under this bill is they all have to be screened for it. That would be like me, with every patient that I ever see in my practice, the first thing I have to do is make sure, because they were in the military, that they do not have some type of mental health disturbance coming back. It is insulting to our military men and women who have given their lives, given their blood, given their time, given their honor, and given their sacrifice to assume they cannot do that without having some disruption in their capability to function in this society. So it is highly insulting to the vast majority of our veterans.

Now, the question is, How do we solve the problem of depression and post-traumatic stress disorder that leads to suicidal thought, ideation, and behavior? That is what we ought to be doing. And what we are doing is creating a set of circumstances that may have an impact probably not any greater than what the VA is doing now but will, in fact, take away great resources from other mental health issues as well as other health issues within the VA.

Let me give you some statistics, if I may. The VA is 3 years into a mental health strategic plan that has been markedly successful in improving the quality of care and ensuring that high-risk factors such as suicidal ideation are considered when veterans are assessed or impact or enter the VA system. The VA has suicide prevention coordinators in every VA facility in this country. They have a hotline 24/7. They have hired over 3,000 mental health staffers just since the end of 2005. So they have recognized what was the problem. They are responding to it. They have two suicide prevention centers of excellence that are geared up and working on the very specific issues associated with our military and post-traumatic stress disorder from combat.

Between 2002 and 2007, the VA spent 2 1/2 times the percentage of their budget as we spend in all other health care on mental health. So they are already addressing the issue.

The other thing that is disturbing is this tracking of what they will do. They are not going to be tracking the data, they are going to be tracking individual veterans under this bill. That violates their own civil liberties. If, in fact, you have encountered the VA and because you were screened, not of your choice and not because you had signs or symptoms, because of that, that becomes a part of your record. You automatically are limited in lots of things that you cannot do in this country because you served your country.

Now you have a mental health screening, an indication on your VA chart that would forbid you from becoming a police officer, an airline pilot, or an EMS, many other professions within this country. The idea that we are going to track individual veterans and their mental health status rather than the data--this bill specifically states that we are going to track the veterans, not the data--is wrong.

Finally, this bill sets out a peer counseling provision that has already been proven in the literature to not be effective. Yet it is mandated in this bill. So what this bill is about is the Senate practicing medicine and mandating ways to do things that the VA itself has already started. It is 3 years into a program of which they are using experts in the field to guide them, and we are using emotion and response.

I am going to continue to hold this bill until we work on the issues to guarantee freedom of veterans in terms of tracking of their data and them individually, in terms of securing the data about them--the VA has had two serious leaks on veterans health care data in the last 7 years--and also working to make sure we use a mental status exam when it is indicated and not create a system that is an affront to all the people who have served the country.

With that, I yield the floor.

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