[Senate Hearing 110-278]
[From the U.S. Government Publishing Office]
S. Hrg. 110-278
HEALTH CARE FOR ALASKA NATIVE VETERANS RETURNING FROM KUWAIT AND IRAQ
AND OTHER NATIVE VETERANS LIVING IN ALASKA NATIVE VILLAGES
=======================================================================
FIELD HEARING
before the
COMMITTEE ON INDIAN AFFAIRS
UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
FIRST SESSION
__________
NOVEMBER 30, 2007
__________
Printed for the use of the Committee on Indian Affairs
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COMMITTEE ON INDIAN AFFAIRS
BYRON L. DORGAN, North Dakota, Chairman
LISA MURKOWSKI, Alaska, Vice Chairman
DANIEL K. INOUYE, Hawaii JOHN McCAIN, Arizona
KENT CONRAD, North Dakota TOM COBURN, M.D., Oklahoma
DANIEL K. AKAKA, Hawaii JOHN BARRASSO, Wyoming
TIM JOHNSON, South Dakota PETE V. DOMENICI, New Mexico
MARIA CANTWELL, Washington GORDON H. SMITH, Oregon
CLAIRE McCASKILL, Missouri RICHARD BURR, North Carolina
JON TESTER, Montana
Sara G. Garland, Majority Staff Director
David A. Mullon, Jr., Minority Staff Director
C O N T E N T S
----------
Page
Hearing held on November 30, 2007................................ 1
Statement of Senator Murkowski................................... 1
Witnesses
Angapak, Sr., Nelson N., Vice President, Alaska Federation of
Natives; accompanied by Reverend William Nicholson, Pastor,
Anchorage Moravian Church...................................... 28
Prepared statement with attachments.......................... 30
Davidson, Valerie, Senior Director, Legal and Intergovernmental
Affairs, Alaska Native Tribal Health Consortium................ 38
Prepared statement........................................... 44
Katkus, Brigadier General Thomas, Commander, Alaska Army National
Guard, accompanied by: Lieutenant Colonel Dave Osborn,
Commander, Third Battalion; First Sergeant John Flynn; and
Sergeant First Class Jeffery Kowchee, Alaska Army National
Guard.......................................................... 5
Prepared statement........................................... 7
Spector, Alexander, Director, Alaska VA Healthcare System and
Regional Office................................................ 22
Prepared statement........................................... 24
Appendix
Angapak, Sr., Nelson N., Vice President, Alaska Federation of
Natives, supplementary information............................. 68
Dorgan, Hon. Byron L., U.S. Senator from North Dakota, prepared
statement...................................................... 67
HEALTH CARE FOR ALASKA NATIVE
VETERANS RETURNING FROM KUWAIT AND IRAQ AND OTHER NATIVE VETERANS
LIVING IN ALASKA NATIVE VILLAGES
----------
FRIDAY, NOVEMBER 30, 2007
U.S. Senate,
Committee on Indian Affairs,
Anchorage, AK.
The Committee met, pursuant to notice, at 9:30 a.m. at the
Egan Convention Center in Anchorage, Alaska, Hon. Lisa
Murkowski, Vice Chairman of the Committee, presiding.
OPENING STATEMENT OF HON. LISA MURKOWSKI,
U.S. SENATOR FROM ALASKA
Senator Murkowski. Good morning, and as the Vice Chairman
of the Senate Committee on Indian Affairs, it is an honor, it
is a privilege to be with you this morning and to gavel this
field hearing in. I bring you greetings from the Chairman of
the Indian Affairs Committee, Senator Byron Dorgan. He is from
the State of North Dakota.
Senator Dorgan is not able to join us here this morning. He
extends his apologies, but he has submitted a statement that
will be included into the record. I think it is fair to say
that it is a very bipartisan committee. We work in a very
cooperative fashion. I have a good partnership with the
Chairman of the Committee, Senator Dorgan. I appreciate the
effort that his staff has made, as well as my staff to make the
hearing this morning possible.
This morning, up front, I have with me David Mullon. David
serves as the Republican Staff Director for the Senate
Committee on Indian Affairs. David comes to us from Oklahoma.
He is a member of the Cherokee Nation.
I would also like to take the opportunity this morning to
introduce a new addition to my staff, I believe a very great
addition to my staff of the Indian Affairs Committee, Jerry
Moses. He is an Athabascan Indian, grew up in Fairbanks. His
family is from Stevens Village.
He holds a law degree from the University of Arizona. He
has a Master's Degree in Public Health from Harvard University.
Jerry has most recently come to us from the IHS, Indian Health
Service. We are very pleased to welcome him to the Committee
staff. He has a great deal to offer us and I hope you will make
that connection and know that on the Committee you have got
somebody who is very focused on the healthcare issues of our
Alaska Natives.
Before I offer my opening statement this morning, I want to
just address a few housekeeping details. This field hearing is
going to be conducted in the same manner that we conduct our
hearings in Washington, D.C. We have invited two panels of
witnesses who will speak to the topic of the hearing this
morning.
We will go down the line. We will hear from each of the
individual witnesses. Each one of those witnesses has prepared
a statement. I do believe the statements are all out on the
front table there. We have asked that the witnesses summarize
their prepared statements. When they have finished their
statements, I will then have some questions for them and we
will then conclude the hearing.
It is also the practice of the Senate Indian Affairs
Committee to accept written statements, written comments from
all who wish to submit them. The statements that we receive
will be made part of the Committee record. We will hold the
record open until December 14th for anyone who wishes to submit
a statement.
If at all possible, we ask that the statements and comments
be submitted by e-mail. The e-mail address is
[email protected]. Again, that address is
[email protected]. I will give you this address again
at the conclusion of the hearing. If you can't e-mail your
comments, you can provide written comments to either Jerry or
to David. They will tell you where to mail the testimony.
At this time, I would like to take the opportunity to
introduce our invited witnesses this morning. The first panel
consists of members of our National Guard. We have Brigadier
General Tom Katkus. He is the commander of the Alaska Army
National Guard. He enlisted in the Alaska National Guard in
October of 1977. This was about 30 years ago. He was
commissioned as a Second Lieutenant in 1980, rose through the
officer ranks to assume command of the Army Guard in April of
2007.
In his civilian life, General Katkus was an Anchorage
Police Officer for 21 years, retiring from the force in
December of 2000. We are very pleased to have you with us this
morning, General.
We also have Lieutenant Colonel Dave Osborn. He is the
commander of the Third Battalion. Dave is joined by two of his
NCOs. We have First Sergeant John Flynn from Bethel and
Sergeant First Class Jeffery Kowchee, originally from White
Mountain, also Bethel and I believe currently residing in
Wasilla.
Gentleman, we are very pleased to have you with us this
morning. I would invite you to be seated. I will introduce the
next panel and offer some preliminary comments and then we will
get to your statements.
The second panel that we have this morning is comprised of
Mr. Alex Spector. He is the Director of the Alaska VA
Healthcare System and Regional Office. He is responsible for VA
healthcare delivery within the state of Alaska and the VA
clinic here in Anchorage, also the joint venture hospital on
Elmendorf and the outpatient clinics in Fairbanks and Kenai. We
welcome you, Mr. Spector.
We also have on the second panel, Mr. Nelson Angapak. He is
the Vice President of Alaska Federation of Natives. He serves
on the VA's National Advisory Committee on Minority Veterans.
Nelson served admirably in the U.S. Army from 1969 to 1971. He
has advocated for the interest of our Native Veterans for well
over three decades now and your service is greatly appreciated.
We are pleased to have you with us this morning, Nelson.
Nelson is also joined by Reverend William Nicholson who is
the pastor of the Anchorage Moravian Church. Reverend Nicholson
originally comes to us from Dillingham. He joined the Alaska
National Guard as a Chaplain. He is attached to the Second
Scout Battalion, the 29th Infantry, but I also understand that
you have ministered to the troops from the 1148th Field
Artillery of the Idaho National Guard during their service in
Iraq in 2005. We appreciate your service and very pleased that
you will be able to address us this morning.
The final member of the second panel is Valerie Davidson.
Valerie is the Senior Director, Legal and Intergovernmental
Affairs for the Alaska Native Tribal Health Consortium. ANTHC
is celebrating their 10th anniversary this year. Valerie
received her law degree from the University of New Mexico Law
School, regarded as among the best, certainly among the best
and brightest of our Alaska Native community's cadre of
emerging leaders. We are very proud of you, Valerie, for all of
the work that you do and pleased that you are with us this
morning.
Before we go to hearing from our panels, I want to offer a
few opening comments of my own. Before I do that, I see that we
are already maxed out with our chairs. I apologize for that.
With the Provider's Conference going on and everything
happening, we got the room that we could get.
I don't know whether there are additional chairs that we
can squeeze in on the back, but I am more than happy to have
chairs be put along the side up front so that those folks in
the back don't have to stand for the next couple of hours. So
please, if you need to rearrange things, you are not disturbing
us up here by doing so.
We acknowledge that the month of November is designated as
the National American Indian Heritage month. Today happens to
be the last day of American Indian Heritage month. We also
acknowledge November as being the month that we celebrate and
recognize Veteran's Day. So it is particularly appropriate that
during this month that the Senate Committee on Indian Affairs
reflects on the contributions of our Native peoples to the
defense of this great nation.
It is fitting that we renew our commitment to ensure that
the promises that are made to our Veterans, particularly our
Native Veterans, are promises that are kept. The Department of
Defense has noted that Native Americans have the highest rate
of service per capita when compared to other groups of
Americans.
Now, in many respects, American Indians and Alaska Natives
are no different from others who volunteer for military
service, but they do, according to the studies that are
conducted for the Defense Department, they do have distinct
cultural values which drive them to serve their country and
these values are summed up in the phrase proud warrior
tradition.
The phrase proud warrior tradition embodies values such as
strength, honor, pride, devotion and wisdom. These are the
values that have earned organizations like the Navajo Code
Talkers and the Native Scouts of our own Alaska Territorial
Guard places of great respect in American history.
In his proclamation designating November of 2007 as
National American Indian Heritage month, President Bush
extended our nation's gratitude to the American Indians and the
Alaska Natives who serve in our nation's military and work to
extend the blessings of liberty around the world.
Like other Americans, our Native people have given the
ultimate sacrifice for their service. We find reports that to
date, 40 American Indians and Alaska Natives have given their
lives in Iraq. At this time, we think about those who have
served, who have given that ultimate sacrifice.
Robert Blohm of Kenai, he was a descendant of Cook Inlet
Region shareholders. He gave his life as a member of the 425
Airborne out of Ft. Rich back in 2006. Also, a young man I had
an opportunity to meet at Walter Reed, Latseen Benson, a
Tlingit, who lost both of his legs in Iraq while serving in the
101st Airborne.
As I mentioned, I met him at Walter Reed. The next time he
was back here in the state, it was quite triumphantly when he
competed in the 2006 Veteran's National Wheelchair Games. We
also have Staff Sergeant William F. Brown, an Inupiat Eskimo
from Barrow. He lost his life while serving with the Third
Battalion, the 297th Infantry Brigade with the Alaska National
Guard. Also Staff Sergeant Brown along with Sergeant First
Class George Dauma of Fairbanks, who were both killed in 2006
when their Humvee was struck by a tractor trailer during
training maneuvers near Camp Shelby.
The focus of the hearing today is on the soldiers of the
Third Battalion, the 297th Infantry of our Alaska National
Guard who just recently returned from their year's service in
Kuwait and Southern Iraq. 580 soldiers of the 3-297th came from
all parts of the state.
They represented, we understand, 81 communities throughout
Alaska. They include substantial numbers of Alaska Natives and
other residents of the Bush communities of rural Alaska. Now,
we are blessed. We are blessed that the members of the 3-297
did not suffer any casualties during their year of service
overseas, but don't believe for a minute that this was a picnic
over there.
This unit conducted routine security, route security
operations in full body armor in 140-degree heat. Lieutenant
Colonel Dave Osborn, who commands the 3-297th said that unit
had a number of IED incidents in their area of operations.
Fortunately, they didn't get hit, but again, it was a difficult
situation.
I was very privileged to be able to travel to Camp Shelby
in Mississippi to see the members of the 3-297th, to see them
off in October of 2006. I was equally privileged to be able to
welcome them back home this past October.
During this preceding year, I have conducted many meetings,
many hours of meetings with officials of the VA, the Alaska
National Guard, the Alaska Federation of Natives, our Alaska
Native Healthcare Delivery System, to ensure that the
healthcare needs of our returning guardsmen, who may live in
our Native Villages of rural Alaska, may live off the road
system, that the system is adequate, that the system meets the
healthcare needs not only of those who live in our hub
communities, but those who live in other parts of the state as
well.
The Veterans' Administration and the Alaska Department of
Military and Veterans' Affairs have entered into a Memorandum
of Understanding on how each will address the needs of our
returning Guard members. In that Memorandum of Understanding,
in the preamble, it provides that the growing number of
Veterans returning to rural Alaska from mobilizations in
support of the global war on terror necessitates a
comprehensive and a practical approach toward improving access
to the full spectrum of Veterans' benefits with an emphasis on
healthcare.
It is recognized that a combined effort will augment the
ongoing comprehensive effort to ensure military service members
and their families are honored for their valuable and honorable
service to our country.
Contained within that Memorandum of Understanding is a
provision for a seamless transition. We want to know that there
is a transition that does work, that does provide for the needs
of those who have so honorably served.
Now that the members of the 3-297 are home, it is time to
put that plan to care for them as Veterans on the record, to
inquire whether those plans are adequate to address the need
and to ensure that the plans are going to be faithfully carried
out. So that is truly the purpose of this morning's hearings.
Again, I thank the witnesses for your attendance and your
testimony today and with that, I would like to begin hearing
from the witnesses. We do understand that your written
testimony has been provided so anything that you can share
above and beyond is equally appreciated, and with that, General
Katkus, we will begin with you. Thank you and good morning.
STATEMENT OF BRIGADIER GENERAL THOMAS KATKUS, COMMANDER, ALASKA
ARMY NATIONAL GUARD, ACCOMPANIED BY: LIEUTENANT COLONEL DAVE
OSBORN, COMMANDER, THIRD BATTALION; FIRST SERGEANT JOHN FLYNN;
AND SERGEANT FIRST CLASS JEFFERY KOWCHEE, ALASKA ARMY NATIONAL
GUARD
Brigadier General Katkus. Good morning. I am Brigadier
General Tom Katkus. I am the Commander of the Alaska Army
National Guard speaking to you today on behalf of Adjutant
General of Alaska, Major General Craig Campbell. I am grateful
for this opportunity to speak with you regarding the access and
delivery of benefits and services to members of the Alaska
National Guard and their families living in Native Villages
throughout rural Alaska.
Native members make up 17 percent of the Alaska Army
National Guard. In the last 45 days, the Alaska Army National
Guard demobilized the largest group of soldiers from active
duty since World War II. We are welcoming back hundreds of
soldiers and airmen who have faithfully and voluntarily served
this country in a time of war.
As we send them home to Villages across Alaska, we want to
ensure necessary assistance and medical care is both available
and accessible for these returning heroes. With so many only
recently returned, we have yet to feel the full impact of the
demands on this system. We are closely monitoring the support
that our soldiers receive.
Our soldiers are predominantly stationed in the Kuwait area
of operation. This is often confused with being a relatively
safe assignment. However, two of these companies work daily in
Southern Iraq providing route security, personal security and
traffic control. Others were first responders to frequent
traffic accidents, both minor and catastrophic, outside of the
wire, vehicle-borne IEDs were a daily threat for these
soldiers.
Approximately 15 percent of the 580 soldiers were from
rural Alaska. In anticipation of many of the challenges these
soldiers would face upon returning to Alaska, the Alaska
Veterans' Affairs Healthcare System and Regional Office, the
Anchorage Veterans' Bureau Benefit Administration and the
Alaska Department of Military and Veterans' Affairs signed the
memorandum that you just noted on September 12, 2007.
The MOU does define the mutually agreed upon requirements,
expectations and obligations of organizations to meet the needs
of our soldiers as they return home. This was an initial step
in initiating a comprehensive and practical approach toward
improving access to the full spectrum of Veteran benefits while
emphasizing healthcare.
Some program initiatives also include beyond this, the Home
Station Reunion and Reitegration Workshop for returning
Veterans. That program dictates that within 90 to 180 days of
returning from mobilizations, that the National Guard conduct a
workshop and this workshop will coincide with the Post
Deployment Health Reassessments where soldiers and individual
cases are reviewed and we provide the opportunity to enroll in
the VA system.
We understand our combat Veterans will need continuing
transition assistance beyond this reintegration. We have
established a multi-disciplinary team which visits remote
Alaska for ensuring continued availability of services and the
successful reintegration of Veterans into the communities.
This Mobile Outreach Team's goal is to make sure that a
visit is conducted within 12 months after the unit's return
from the combat zone in the respective battalion areas to
include Bethel, Nome and Juneau.
The National Guard Bureau has initiated several programs to
support soldiers and their families. They have assisted in
funding a Transition Assistance Advisor who provides
information and advocates Entitlements and Benefits for the
soldiers and their families.
We also have two Military Family Life Consultants. These
professionals are able to travel to all locations for
individual and family counseling. This is a free program to all
members of the National Guard. Additionally, we are getting two
other full-time counselors that will be located in Fairbanks
and Anchorage areas.
They will be available in the community for easy access.
Our Family Programs Unit is a team of over 25 people ready to
provide help to families, whether it is direct assistance,
counseling or meeting financial needs.
There are various services and programs available for all
ages under the Family Program's umbrella. Additionally, our
chaplains are available for travel throughout the state to
provide training and assistance as needed.
A Troop Support Team consisting of numerous Veterans
Service Organizations have joined together to build a
comprehensive plan to support our soldiers and family members.
Specifically, their first application was traveling to Camp
Shelby and ensuring that our soldiers were briefed on benefits
and processes to successfully navigate this very complicated
system.
According to the members at Camp Shelby, Alaska was the
only state to do this. Approximately 54 soldiers remain in the
Warrior Transition Unit today. 37 of those are from
specifically the 3rd Battalion.
We, in Alaska, have more significant challenges than other
states. However, we are working diligently to make sure our
program is supplemented through the National Guard Bureau
Programs and that no soldier gets left behind. We stand ready
to assist our soldiers with access to the benefits they are
entitled.
I highly encourage the VA and the Native Health System to
continue to partner together to provide ready access to those
in rural areas. Transportation, travel expenses, access to
facilities and the lack of understanding of the various
cultural issues are hurdles which must be overcome.
We will continue to help our soldiers. However, there is a
tremendous shortfall between the benefits earned and current
access for our rural soldiers.
I would like to thank Senator Murkowski for this
opportunity to appear before this Committee. Thank you, ma'am.
[The prepared statement of Brigadier General Katkus
follows:]
Prepared Statement of Brigadier General Thomas Katkus, Commander,
Alaska Army National Guard
Good afternoon, I am Brigadier General Thomas Katkus, Commander of
the Alaska Army National Guard, speaking to you today on behalf of the
Adjutant General of Alaska, Major General Craig Campbell. I am grateful
for this opportunity to speak with you regarding the access and
delivery of benefits and services to members of the Alaska National
Guard and their families living in native villages throughout rural
Alaska. Native members make up 17 percent of Alaska Army National
Guard.
In the last 45 days, the Alaska Army National Guard demobilized the
largest group of Soldiers from active duty since World War II. We are
welcoming back hundreds of Soldiers and Airmen who have faithfully and
voluntarily served this country in time of war. As we send them home to
villages all across Alaska, we want to ensure necessary assistance and
medical care is both available and accessible for these returning
Heroes.
With so many only recently returned, we have yet to feel the full
impact of the demands on the system. We are closely monitoring the
support our Soldiers receive. Our Soldiers were predominantly stationed
in the Kuwait Area of Operation (AOR). This is often confused with
being a relatively safe assignment. However, two of these companies
worked daily in Southern Iraq, providing route security, personnel
security, and traffic control. Others were first responders to frequent
traffic accidents, both minor and catastrophic, outside the wire all
the while the stress of vehicle borne IEDs was a daily threat for all
the Soldiers. Approximately 15 percent of these 575 Soldiers were from
rural Alaska.
In anticipation of the many challenges these Soldiers would face
upon returning to Alaska, the Alaska Veterans Affairs Healthcare System
and Regional Office, the Anchorage Veterans Benefits Administration,
and the Alaska Department of Military and Veterans Affairs signed a
Memorandum of Understanding on 12 September 2007. The MOU defines the
mutually agreed upon requirements, expectations, and obligations of the
organizations to meet the needs of our Veteran reservists as they
return home. This was an initial step in initiating a comprehensive and
practical approach towards improving access to the full spectrum of
Veteran benefits while emphasizing healthcare.
Some program initiatives include a Home Station Reunion and
Reintegration Workshop for returning Veterans. Within 90-180 days of
returning from a mobilization, we conduct this workshop for our
Veterans. This workshop will coincide with the Post Deployment Health
Reassessments where the Soldiers individual case is reviewed and we
provide the opportunity to enroll in the VA system.
We understand our combat Veterans will need continuing transition
assistance beyond the reintegration. We have established a multi-
disciplinary team which visits remote Alaska for ensuring continued
availability of services and the successful reintegration of Veterans
into the communities. A Mobile Outreach Team goal is that a visit will
be conducted within 12 months after a unit's return from a combat zone
at their respective Battalion Headquarters in Bethel, Nome or Juneau.
The National Guard Bureau has initiated several programs to support
Soldiers and their families. They have assisted in funding a Transition
Assistance Advisor, who provides information and advocates Entitlements
and Benefits for the Soldiers and their families.
We also have two Military Family Life Consultants. These
professionals are able to travel to all locations for individual and
family counseling. This is a free program to all members of the
National Guard. Additionally we are getting two additional full time
counselors that will be located in the Fairbanks and Anchorage areas.
They will be available in the community for ease of access. Our Family
Programs unit is a team of over of 25 people ready to provide help to
the families, whether it is direct assistance, counseling, or meeting
financial needs. There are various services and programs available for
all ages under the family programs umbrella. Our chaplains are
available to travel throughout the state to provide training and
assistance as needed.
The Troop Support Team consisting of numerous Veterans Service
Organizations have teamed together to build a comprehensive plan of
support to our Soldiers and family members. Specifically they traveled
to Camp Shelby and ensured our Soldiers were briefed on benefits and
processes to successfully navigate this complicated system. (According
to Camp Shelby personnel, Alaska is the only state to do this.) The
Soldiers were provided a health questionnaire which exposed various
issues. Approximately 54 Soldiers remain in a Warrior Transition Unit
today, 37 from 3rd Battalion.
We in Alaska have more significant challenges than other states
have, however, we are working diligently to make sure our program is
supplemented through the National Guard Bureau Programs and that no
Soldier gets left behind. We stand ready to assist our Soldiers with
access to the benefits they are entitled.
I highly encourage the VA and the Native Health System to continue
to partner together to provide ready access to those in rural areas.
Transportation, travel expenses, access to facilities, and lack of
understanding of cultural issues are hurdles which must be overcome.
We will continue to help our Soldiers. However, there is tremendous
shortfall between benefits earned and current access for our rural
Soldiers.
I would like to thank Senator Murkowski for this opportunity to
appear before this Committee.
Senator Murkowski. Thank you, General. Gentlemen, I don't
know whether you would like to add a prepared comment or
whether your preference is to take questions from me, but if
you have statements that you would like included, this is
certainly the time to present them.
First Sergeant Flynn. Ma'am, thank you. [Speaking Native
language.] Hello, my name is John Flynn. There are seven
talking points I would like to bring out.
First, history is father--my father, two uncles, three
brothers were in the--either the Territorial Guard or part of
the National Guard and currently I am the only one in the
service right now. Education; this is the most important issue.
We, the National Guard needs to educate our soldiers on a VA
entitlement.
VA must educate the Native health providers. Native health
providers must be able to recognize the VA claims. Not all
soldiers, especially Natives, understand the benefits that are
entitled to them being in the remote areas. It is hard for us
to understand what benefits are available to us.
Travel; with the travels or the airfares sky rocketing in
the rural areas, it--most individuals who do not have jobs need
to come up with at least $1,000 to travel into Bethel or into
Anchorage for VA. This includes airfare, hotel, meals and
transportation.
Healthcare or health aid versus doctors' assessments;
health aides in the Villages are eyes and ears for the doctors
in the hub areas. Health aides assess the individual, then
calls the doctor to determine if it is a necessity for an
individual to travel to the hub areas.
Then the doctor decides if the individual needs more care
then sends him into the hub areas for screening or extra care,
too soon to tell. The post traumatic health reassessment, right
now it is too early to tell--see if the soldiers that were in
the theater (ph) have problems.
It would take up to four to six months to see if an
individual has any problem or any medical issues. Seventy-five
percent of the YK Delta that was deployed to the theater are in
the average age of 28 or younger. These young soldiers have
like--or I'm sorry, these young soldiers will not say that if
they have post traumatic in other words, they suck it up.
Our culture; Native heritage is like most Natives are
willing to bend backwards to help others, but will not stand up
for themselves to ask for help and lastly, ma'am, I would like
to thank you for giving the opportunity to speak. [Speaking
Native language.]
Senator Murkowski. First Sergeant Flynn, thank you for your
comments. Thank you for your service.
First Sergeant Flynn. Thank you.
Senator Murkowski. I appreciate it so much.
Lieutenant Colonel Osborn. Sergeant First Class Kowchee.
Sergeant First Class Kowchee. [Speaking Native language.]
My name is Jeff Kowchee. I am originally from White Mountain as
you know. Good morning, Vice Chairman. Good morning, honorable
members of the U.S. Senate Committee on Indian Affairs. I
appreciate this opportunity for me to talk.
I am currently on active duty, active Guard Reserve, and I
am presently assigned to the Warrior Transition Unit on Fort
Richardson or otherwise known as WTU. WTU is a unit in which
soldiers are placed to focus on resolving their medical issues.
We, the soldiers, comprise of various units and various
Villages and towns across Alaska and Alaska military bases. I
have returned from my 15-month deployment in support of
Operation Iraqi Freedom. I am here to discuss my knowledge and
experience with the VA and the VA benefits in the rural areas.
Prior to the deployment, I had not heard very much about
the VA and the VA benefits. Basically, my experience with the
VA is Veterans calling the Bethel National Guard office
requesting information for the VA such as phone numbers,
addresses, locations and, you know, what benefits do they offer
of which I was able to find information and pass it onto them.
Pretty much, that is the extent of my experience with the VA.
As for information, I have seen a few brief handouts about
the VA, but other than that, that is about it. Now that I have
had the opportunity to work with a regular Army unit in Ft.
Richardson, I have gained a lot of knowledge about the VA and
the WTU has mandatory briefings and classes that we are
required to attend and the VA briefing was one of them.
Within the two-hour briefing that I had over there, it
was--I became somewhat aware of the steps to take to enroll
into the VA once I decided to get out. It was a very excellent
briefing and I was not aware that there were so manyh steps to
take to enroll and see about getting the VA benefits.
I have not attended or I haven't heard this type of
briefing before and I'm not sure and I don't think that there
is a briefing like that anywhere beyond Anchorage or Fairbanks,
you know, in the rural areas.
I know this briefing and information would greatly enhance
the knowledge out there for those soldiers, those Veterans over
in the rural areas. This briefing that I have experienced has
not been the same at all for the briefing here in the Anchorage
bowl area that is offered to the soldiers and Veterans and also
out there to the soldiers in the Villages and Veterans.
Aside from these notes on my way up here, I have--of course
there is a conference going on down there, downstairs, I ran
into four Veterans. One is retired. Three had been separated,
they are no longer members of Alaska National Guard.
They were from Teller, Kwinhagak, Tuksuk Bay and
Nunapitchuk. These four soldiers or, you know, Veterans, I had
asked if, you know, what do they know about the VA? They said
not very much. I asked them a second question. Okay, do you
know what kinds of benefits would be offered if you were
qualified? They said no.
So this information about the VA and the briefing that I
have seen, it would benefit the rural areas greatly and it
would be very helpful to those Veterans, whether it is a Korean
Veteran, Vietnam vets, score four (ph) vets, or OIF Veterans.
I would encourage that any of the Veterans that may be
hearing this testimony now to reach out to the VA to see what
they possibly may be allowed as a benefit and I would encourage
that the VA, you know, reach or provide the same information
that is available here to the rural areas as well.
Thank you again for allowing me to take this opportunity to
discuss this. Thank you very much.
Senator Murkowski. Thank you, Sergeant First Class Kowchee,
I appreciate it and I appreciate the suggestions and I will
follow-up with a specific question to you on that. Lieutenant
Osborn.
Lieutenant Colonel Osborn. That is all we have, ma'am.
Senator Murkowski. Thank you. Let me ask you then, and I
think I will start with you, Sergeant Kowchee, yesterday when I
visited the WTU, you had a suggestion that perhaps one way that
we can do better in getting the information out to our Veterans
about the benefits that are available is to have a level of
outreach and the VA does have some outreach, but we know that
Alaska is big and our Villages are spread far and wide, but we
also appreciate that sometimes the messenger that is best isn't
necessarily the individual that works in the Anchorage office
who comes into the Village and says I am here for two hours.
What questions do you have?
Oftentimes the way that we get the message through is
through the right messenger. Do you have any suggestions as to
how we can do better in networking with those Veterans through
using other Alaska Native Veterans in conjunction with the VA?
Sergeant First Class Kowchee. Yes, ma'am. As we discussed
briefly yesterday, I did make the recommendation that we do
allow soldiers such as First Sergeant Flynn and myself and
other leaders from certain areas have the same briefing or the
same information to them and brought along with them so when
they go back to Teller, Nunapitchuk, Brevig or Chefornak, that
these leaders or these soldiers, you know, capturing this data,
capturing this knowledge, capturing this briefing that I've
seen, bring it along with them from here on out there to the
soldiers that are currently Alaska National Guard members,
having that information available to them so they have this
knowledge about what is available to them.
This would be probably a quick fix for getting information
out, you know, which I would recommend and perhaps the VA
office actually going out there and extending, you know, this
knowledge, this information to other service members who are
Veterans from the Marine Corps or Coast Guard.
Senator Murkowski. And of course, the challenge is just as
you have described from your encounter down in the main hall
here. We have Veterans all over the state that once they have
separated, once they have gone home, we lose them and the
ability to get the information about the benefits that are
available is oftentimes just lost and I know that Mr. Angapak
has been working on this for years trying to figure out how we
can better facilitate that level of communication and to have
an Alaska Native Veteran liaison that really has the ability to
get out and get the information into all of our Villages where
we have so many Veterans.
We have not been successful with that yet. I appreciate
your suggestion there. I want to ask further to all of you
here; you have mentioned, Sergeant Kowchee, that the
information that you have received as part of the WTU has been
exceptional in terms of what benefits that are available out
there, but it is your impression that this information isn't
replicated throughout.
So you have gotten a great deal of assistance, but you know
that there are others that are not out there. Now, I know that
when you all were at Camp Shelby, there were people from the VA
there. I met them, who were there to explain the benefits that
you would receive. Tell me about the adequacy of what you
received while you were there at Shelby. Was it sufficient? Was
it helpful for Sergeant Flynn?
First Sergeant Flynn. Ma'am, I was in that briefing. It is
like--to me, it is in the wrong time of demobilization. It is
when we, soldiers, are thinking of going home is not the right
time to give that information.
Senator Murkowski. So in other words, you are now back on
American soil. You are itching to get home and these people
want to talk to you about benefits down the road. So it is in
one ear, out the other?
First Sergeant Flynn. Yes, ma'am.
Senator Murkowski. So what would your suggestion be in
terms of when would be a good time to give you that information
so that it can be assimilated, you can act on it then?
First Sergeant Flynn. Ma'am, probably it would be either
prior to deployment or in the middle of deployment. I am just
talking here. I have not discussed what would be more
beneficial as far as getting the information to the soldiers.
Senator Murkowski. But not immediately after returning?
First Sergeant Flynn. Yes, ma'am.
Senator Murkowski. Would you agree with that, Sergeant
Kowchee?
Sergeant First Class Kowchee. Yes, ma'am, I would agree
with that.
Senator Murkowski. Lieutenant Colonel Osborn?
Lieutenant Colonel Osborn. Good morning, ma'am. The post
deployment health assessment that was alluded to in some of the
statements, what that is is an Army requirement and so all
soldiers have to get on the website and, you know, you have--
everybody has their personal account and it even has a medical,
you know, piece to it.
So the post deployment health assessment is filled out by
every soldier 30 days prior to redeployment and from those
statements that you put down as an individual soldier, you sit
with a healthcare provider before you leave theater and you
discuss whatever those issues may be, whether it is, you know,
back pain, stomach problems, problems sleeping, whatever those
problems may be.
They counsel the individual a little bit and then once you
get to the redeployment station, which ours was MOB Station
Shelby, you again sit with a healthcare provider and they go
over those issues again.
In our case at Camp Shelby, we did have the WTU from Ft.
Rich present representing both the WTU at Fairbanks as well as
Ft. Rich. They, you know, they--based on what the soldier's
problem may be, then they accepted them into the WTU and we
were lucky enough to bring those soldiers straight back to
Alaska.
My discussion with the healthcare providers at Shelby was
that they normally send them to either Ft. Gordon or whatever,
you know, Ft. Benning, wherever there might be a hospital to
facilitate those requirements that a soldier might have.
I was brutally honest with the Colonel. I told him, I said
listen, you either accept them, let us move them back to Alaska
or they won't be in the WTU and they will go home with whatever
medical issues they have and so they allowed us to bring our
soldiers back to Alaska, especially Alaska Guard. I was like
wait a minute. You can do whatever you want with Army soldiers,
but you know, these are Guardsmen.
So they never--some soldiers were sent downtown to see a
healthcare provider, but at Camp Shelby, they didn't have an
Army hospital to really help people out that might have a
medical issue. Along with that, the VA provided a station where
you checked in.
Now, the active Guard and Reserve soldiers, you know, they
still have a career to fulfill and then they will eventually
get, you know, enrolled in VA, but all of the part-time
soldiers were taken to the station and they should have filled
out the enrollment which also identifies all of the issues you
had during that 15-month deployment.
I think the number was over 250 actually enrolled in VA or
registered with VA and may have, you know, written down that
they had some medical issues while deployed or dental issues.
So between the post deployment health assessment, the
registering with the VA, the majority of the soldiers were
captured, if they have an issue. Now, the follow-up to that,
I'm told, does take awhile to, you know, enter the registration
and get these 250 plus soldiers an appointment with the VA.
The Alaska Guard stands by, of course, to facilitate, you
know, VA support to all of our soldiers throughout Alaska and
even if that requires transportation because we, you know, we
move our soldiers throughout the state every month, not all of
them, of course, but you know, we have training events and we
can, you know, we can work through some of those issues. I hope
that was a little bit clearer on everything that happened at
Shelby.
Senator Murkowski. Let me ask though, I have had some
interesting conversations this week as I have been discussing
Veterans' issues and one of the things that I keep hearing from
those that--these who our young vets that I was meeting with,
they said you know what, kind of the same comment that you made
Sergeant Flynn, when I get out, I am ready to get out and if I
check any box that may delay me, you know, I am thinking about
home.
I am thinking about what I am going to do when I can go on
leave here, when I can just make this break, and so I am not
suggesting that we are not always honest when we fill out these
questionnaires, but at the time, you are feeling pretty fine
because you are going home and it is not until you have been
back home for awhile and you kind of settle back down.
You are no longer running off the adrenalin that kept you
moving while you were over in the desert. You are now back and
you are dealing with family and jobs and other issues and all
of a sudden, you are finding that you have sleep issues, you
have anger management issues.
There are things that are coming up and now you are looking
at it and saying well, I hate to admit it, but maybe I am not
as fine as I thought when I first filled out that
questionnaire. I think we are recognizing that the timing of
when we ask the questions is very important and I appreciate
your comments on that, but we need to know that even if you
have now gone back to Bethel, if you need that follow-up care,
that we are going to be able to provide for you.
Now under the service agreement, you are entitled to a
minimum of two years of free healthcare from the VA.
You are also entitled to the 90 days of free dental
treatment from the VA, but we also know that the clinic is here
and we have got the outpatient clinics that we have in
Fairbanks and on the Kenai, but the question then becomes how
do you get back and forth from, is this benefit that you have
been promised a good benefit? Comments?
We have got a couple from the outlying regions. I know that
you are not in White Mountain anymore, but if your family was
still in White Mountain, what does this benefit mean to you?
Sergeant First Class Kowchee. Well, ma'am, the majority of
the witnesses here or, you know, the members here in Anchorage
and other places may not fully understand the challenges in
getting someone from the rural areas on over here to visit the
VA Hospital, but they----
Senator Murkowski. Well, can you explain because this is
not just to this room, this testimony that we are hearing today
is going to be read by my colleagues back in Washington, D.C.
that have no concept of what it means to be from White Mountain
and getting from White Mountain to Anchorage, Alaska. Can you
just speak to that on the record?
Sergeant First Class Kowchee. Yes, ma'am. As First Sergeant
Flynn was mentioning earlier about the travel in from the rural
areas to here, it is a lot different from traveling from
Mississippi or Washington, D.C. to here, Anchorage. There are
multiple challenges.
If you would imagine going from here on out to Bethel,
Nome, Kotzebue, Barrow by jet, that is a comfort in itself just
getting there. Going out to Nunapitchuk, Teller, Brevig,
Nuiqsut or, you know, some place beyond where there is a jet
that is available to land, it is a little bit more challenging
and much more expensive as well.
Senator Murkowski. What is the cost?
Sergeant First Class Kowchee. It could cost about $1,000 to
get from the Bethel area on over here and going back over and
that includes what First Sergeant Flynn was indicating
yesterday, you know, the airfare, the plane ticket, the car
rental, you know, or the taxi cabs, the restaurants, you know,
and hotels, you know, everything else, so it can get pretty
expensive for someone to get from the Village to here that
depends on a number of issues or a number of things as well,
such as weather, such as flight times, such as available
planes.
It can go within days for someone to get out from the
Village maybe even to Bethel or even to get back for that
matter. So it is not only transportation and hotel efforts here
in Anchorage, but also in Bethel, Nome, Kotzebue and Barrow as
well. So it is a one-step process in which a lot of the Lower
48 people may not understand.
Senator Murkowski. So if you have these benefits that are
promised to you, you know that they are out there, but you have
to fund yourself, your travel, your lodging, your
transportation, food to come in for the promised benefits, how
likely is it that you will use them?
Sergeant First Class Kowchee. As in being paid or the cost
of it?
Senator Murkowski. Well, if you know that you have got to
fund your travel to come into town to go to the VA clinic for
the care that has been promised to you for your service, you
have this two years free healthcare, 90 days free dental, is
this a benefit that works if you live in a remote or an
outlying Village where the cost to come to town are what we
know them to be? I want to know whether or not this is a good
benefit or whether we need to enhance it.
Sergeant First Class Kowchee. For the VA benefits for a
Veteran out there, I think it would offer good services for
those Veterans out there in the rural areas, I think it would
be excellent for them.
Senator Murkowski. General?
Brigadier General Katkus. I stated in my last segment,
access is very difficult. I've been in the Alaska National
Guard for over 30 years and one of our biggest challenges is to
move people from point to point. As Sergeant Kowchee just
indicated, everything from weather to mechanical issues on
aircraft to just other bad luck can change things and one
important key that you didn't hit on there is it took several
weeks to get this appointment.
After the soldier or the Veteran goes through all of the
effort to get here, if in fact they got stayed along the way
anywhere along there, such as the aircraft went down or weather
held them up, now they get here to Anchorage one day late. They
might as well go home and reschedule again.
So there are no contingency backup dates set within a
window. It is a specific time and if they miss that time, they
get to reinvest all of that time, effort and money once again.
So again, that just adds to the preponderance or the stacked
tolerances of why that benefit is really a challenge for anyone
living in remote Alaska.
Lieutenant Colonel Osborn. I have a comment, ma'am.
Senator Murkowski. Lieutenant Colonel.
Lieutenant Colonel Osborn. One of the issues that we have
worked through for numerous years is we do have Department of
Defense health providers in rural Alaska, U.S. Public Health
Service. We, you know, to stay current in your status in the
Guard and Reserve, you have to have physicals, you have to have
dental check-ups, et cetera.
We have been lucky enough to be able to work through that
within the Guard, but I don't understand why the VA can't use
those DOD or, you know, Federal officers who are also doctors,
dentists, et cetera in rural Alaska to facilitate a VA benefit
and we have discussed that at the State level, of course,
several times and everybody just shrugs their shoulders and it
is, you know, that whole cooperation, partnership issue needs
to be worked through. It really does.
First Sergeant Flynn. Ma'am, to answer your question on
airfare----
Senator Murkowski. Yes.
First Sergeant Flynn.--I am originally from Chefornak, but
I work in Bethel. If you compare the Anchorage to Seattle
flight, it is like $250 special round trip. It is $300 round
trip from Bethel to Chefornak, which is a 45 minute flight.
Senator Murkowski. And that just gets you to Bethel?
First Sergeant Flynn. Yes, ma'am.
Senator Murkowski. The access issue is very, very real and
if the funding is not available for the transportation and all
of the ancillary costs that are associated with it, it makes me
wonder how valuable a benefit is.
If you can get into the facility and get that treatment,
that is good, that is the preferred, but we recognize that we
have different challenges in this state where you have
communities that are not part of a road system.
We don't have the systems that other states have and it
puts us in a very distinct and a very unique category. Now out
in, whether it is Chefornak or White Mountain, certainly
Bethel, there at YKHC, we have got the community--the health
centers, we have got the clinics. Is this where you would go
for the care if you are looking at this and saying I simply
don't have the money for the plane ticket? Is that a correct
statement?
Sergeant First Class Kowchee. Yes, ma'am. That is where the
majority of the rural areas do get their healthcare, is in the
hubs, the major hubs such as Bethel, Nome, Kotzebue. So the
majority of the treatment is there in Bethel and if there is
anymore severe treatment that is needed for the medical
condition, then they would be sent over here to Anchorage.
Senator Murkowski. Let me ask a question, and I don't know
whether any of you will feel necessarily comfortable in dealing
with this in this particular forum, but knowing what you have
gone through this past year over in Kuwait, knowing the men
that stood by you and the tasks that you dealt with, what kind
of post deployment issues, health issues, concerns should we be
looking for? Do you have any sense of that at this point in
time or is it yet too early?
First Sergeant Flynn. I can probably answer that.
Senator Murkowski. Sergeant Flynn.
First Sergeant Flynn. Ma'am, the rate, like I said earlier,
the average age of soldiers in the YK Delta was 28 or under.
The health issue that probably will come up later on in their
mid-30's to early 40's will be lung--some--they will have lung
problems due to high dust or sand inhalants due to some sand
storms.
Senator Murkowski. Anything else any of you would care to
add?
[No audible response.]
Senator Murkowski. Let me ask then a question about the
family support. This is something that I have taken on just
with a very personal interest, not only for our Guard, but for
our active.
It is very important that we recognize that you all can't
do the job that we have asked you to do without the support
back home, without knowing that your families are being cared
for and that basically all is well so that you can focus on
your mission. Did your families have the level of support that
you had hoped for prior to you going over?
Sergeant First Class Kowchee. The----
Senator Murkowski. Sergeant Kowchee.
Sergeant First Class Kowchee. Yes, ma'am, the family
support group was available, you know, because we did move here
to the Anchorage bowl area and it was somewhat sustained and
maintained throughout my deployment here, but I feel that maybe
a little bit more effort in maybe checking on my wife would
have been good for her and my family as well.
Senator Murkowski. Any other comments on family support?
First Sergeant Flynn. Probably it is--my wife was working
for the region in Bethel and it is probably an okay--for the
families, but it was--for her, it was hard to reach out to the
outlying areas. It is like mainly it was beneficial for the
hub, not the outlying areas.
Senator Murkowski. General.
Brigadier General Katkus. Ma'am, I would like to address
family support in some general areas that this is a fairly new
challenge for the Alaska National Guard to deploy in the
numbers that we have and certainly standing up the family
support groups in the manners that best supported the troops,
we are still working on because family support is going to
continue now, probably more challenging now than ever, and I
think our cooperation with the National Guard Bureau and some
of the efforts we are taking are very positive and we are going
to have continued challenges.
So I think the jury is still out on how effective we are
going to do there as most of the troops have only recently
deployed and I see the lion's share of family support is
addressing issues now that they have returned home also. So
there is still that part of the equation we will be evaluated
on, I'm sure.
Senator Murkowski. We are still learning. Lieutenant
Colonel Osborn.
Lieutenant Colonel Osborn. Ma'am, I want to back up to the
post-traumatic stress that you mentioned earlier. I guess I am
the one that probably needs to answer that. Some of the
missions that soldiers were on, you mentioned response to
accidents, but some of those calls, I mean, those were like
weekly.
Kuwait is one of the most dangerous places in the world to
drive. There were accidents in our--where we resided in our
bases weekly. Soldiers had to respond to secure the areas
because, you know, you never knew if the accident was staged
and there would have been, you know, an explosion to perhaps
injure first providers.
So at some of the camps, they had to respond to these
accidents and these accidents were quite catastrophic. A lot of
people died in the short time that we were there on the
highways. In addition to that, there was the stress--I mean, we
didn't really have days off. I mean, you are working seven days
a week whether you are shift or however your commander ran your
shifts, but you mentioned a little bit, the heat.
I went straight from Afghanistan to meet up with the
Battalion. It was a lot hotter in that part of the Middle East
than it was in Afghanistan and I was in Southern Afghanistan,
which is pretty much desert terrain as well, not up in the
mountains, but I mean, it is 140 degrees many, many days.
You are wearing all of the body armor that is required
across the border in Iraq and although the missions many times
were not, you know, direct contact type missions, they are very
monotonous and, you know, there were--so these guys had
missions of reconnaissance of routes, looking for IEDs.
So it was very monotonous and with that heat and the
pressure put on them and their shifts, and they worked every
day, every single day, they were out, you know, working. So
that whole post-traumatic stress, I have no idea how to even
analyze it.
In my, you know, experience in the Army, I have talked to
people that were in Desert Storm One, et cetera, and they
didn't even know they had PTSD until several months after
redeployment and then something triggered whatever it is inside
them and they realized they have a problem. So again, what John
Flynn said, it is a little early to be analyzing that there is
no problem with our soldiers.
Senator Murkowski. Well, let me follow-up with that and it
maybe requires a response from you, Lieutenant Colonel Osborn
or from you, General Katkus. I had received a letter earlier
this year from Mr. Spector over at the VA kind of outlining the
plan based on the Memorandum of Understanding and in that
letter, it states that the current Guard Unit, the 3-297, has
been stationed, and this is from the letter, has been stationed
behind the lines in Kuwait and therefore, they should have less
need for mental health services associated with combat.
You have just described the situation over there,
Lieutenant Colonel Osborn. We know that you were out looking
for the IEDs. Just because they don't blow you up doesn't mean
that doesn't cause a great deal of stress and anxiety. In your
judgment, is the VA's planning assessment flawed just because
you weren't on the front lines, just because you are not out in
Baghdad is the situation different? Can you respond to that?
Sergeant First Class Kowchee. I will respond first on that.
Let me back up to just an experience with the Anchorage Police
Department, just because you are assigned in Anchorage or you
are assigned in Wasilla, which is much smaller, your risk is
always there and that is stressful and you always face that.
So if you are in Kuwait or whether you are in downtown
Iraq, you are at war and you are going to have the stress and
as Lieutenant Colonel Osborn just commented, those soldiers
were at war every day and they have to be mentally prepared and
they have to be ready to perform their duties. That is
stressful.
They are exposed to it and it is just by luck or happen
chance that they didn't have a direct engagement. So I would
say that the stress is there wherever their assignment, whether
it was Kuwait or into Iraq itself.
Senator Murkowski. Well, then, given that and recognizing,
as you have said, you don't come home with a sign all of a
sudden on your chest that says, you know, I woke up and now I
have got PTSD, it is something that may kind of creep up on
you. You may think, again, that you are fine.
We are still learning a great deal about the mental damage
that is caused by war and what we are seeing in these OIE and
OIA (ph). We are learning a lot in a very short time period.
Given this scenario, do you feel that we are prepared to handle
that aspect of the damage that is a consequence of war, and
this is the mental side. Do we have what it takes? Sergeant
Kowchee, you are over there at WTU. Lieutenant Colonel Osborn,
you have got a great deal of insight on this. Are we ready to
do right by our service men and women when it comes to the
mental care that will be required?
Lieutenant Colonel Osborn. If I could, ma'am, just to set
the record straight, the Battalion resided in Kuwait. We worked
for area support group Kuwait Commander. We had two separate
missions in Southern Iraq. Two companies ran those missions,
not simultaneously, you know, one mission moved into another
area.
Those two companies, you know, you are talking 200 and
probably about almost 300 guys operated in Iraq throughout that
deployment. So, almost two-thirds of the soldiers operated in
Southern Iraq, IEDs, small arms fire, threat of hijacking and
the whole, you know, the whole thing. So I don't know where
that statement came from. I would like to know.
My experience, just to set the record straight as well, I
lived in the YK Delta for quite awhile. The transportation
issue, I was a Battalion Commander in the YK Delta. The YK
Delta alone is like the size of South and North Dakota combined
without roads.
Many times soldiers are using their personal snow machine
or boat just to get to their drill period. If we don't have a
helicopter available or a cruise available, and it is really
tough to move people around, my full-time job is the Operations
Officer for the Brigade and we are moving people around the
state continuously and it is really difficult and we have
assets at our fingertips, so just a little bit of insight into
transportation.
Senator Murkowski. Did anyone care to comment on whether or
not you think we have got the mental health specialists, the
behavioral health specialists to assist?
Lieutenant Colonel Osborn. That was my next issue. Being a
former YK Delta resident, there--everyone should know that we
have a high rate of suicide in Alaska, especially rural Alaska,
and I can't say that we have the facilities and care per, you
know, needed for people that aren't Veterans. Joe.
Senator Murkowski. Anything further?
Sergeant First Class Kowchee. Yes, sir, ma'am. The level of
healthcare out there, it--I don't think the mental health
workers, I'm not sure, you know, this is my opinion, and I'm
not sure if they are educated on, you know, PTSD for those
soldiers out there that return from supporting the Operation
Iraqi Freedom. I don't think they are aware of the signs and
the, you know, what to look out for and I am not sure if they
are prepared to help them out.
Senator Murkowski. General.
Brigadier General Katkus. Ma'am, directly to answer your
question, it is unfortunate, but I don't think we will see a
lot of these cases independent and by themselves.
It is going to be combined with some type of alcohol
influence and/or domestic violence or some type of a physical
demonstration where either the paramedics and/or the local law
enforcement are going to show up and they are not going to be
properly trained in evaluating that this is PTSD. They are
going to see this as an alcohol problem or a family fight and
probably take the wrong tactics in applying the--or trying to
solve the solution.
So we don't know how big the problem is yet because our
soldiers are just recently back, but overall, we have got a lot
of soldiers coming back to Alaska, not just in our rural area
and as first responders, I think that we really do need to make
sure everyone is onboard on the training so that they have got
a wide-open mind when they go to calls such as this because,
again, it is not going to be a sterile environment where we are
interviewing a soldier and discover we have PTSD. We are going
to have a problem when we see this on the street, in a house,
in a local area or in a rural area.
Senator Murkowski. And this is where it goes far beyond
just the VA kind of help?
Brigadier General Katkus. Absolutely.
Senator Murkowski. The whole community must be involved in
this.
We are going to hear from Pastor Nicholson in just a few
moments. We are going to need the clergy. We are going to need
the community. We are going to need the health aides. We are
going to need everybody to be that support and to be aware that
there may be issues that come up and to understand kind of what
to look for.
There is a great deal of education that needs to go on and
as all of you have indicated, we are still just learning what
we are dealing with. So the action plan can't be fully sketched
out until we know better what we are dealing with.
General, let me ask you; when I was over at the WTU
yesterday at Ft. Rich, during that visit, I learned that if one
of our returning Guardsmen is found to have a medical issue
after they have been discharged from active, that the Guard
then has the option of reactivating the individual so that they
can receive care for that particular issue through the WTU,
through the War Transition Unit, in the military medical system
as active duty.
Do you intend to utilize this program to get the
Government-funded care and maintenance for those who, for
instance, might be out in a Village and that access to care is
very, very limited? Do you see this as potentially one of the
ways that we can work through this?
Brigadier General Katkus. Ma'am, that is a very good option
to use. It may be cumbersome and we are not familiar with
exactly how it works, but that is a very good option to go
through. Another challenge though, is the soldier that has left
service, that is not available to them. So those are some of
the challenges also.
Senator Murkowski. So it really depends on your status as
to whether or not this option is available?
Brigadier General Katkus. Correct. That is not a cure all.
That is an option and each case, we hope to be able to evaluate
specifically and individually and if that is the best option to
address it for the soldier, that is exactly what we will do,
but again, there will be other situations where they are either
not in the service or some other challenge prohibits that from
happening.
Senator Murkowski. Right. Let me ask just a couple of more
questions of you, General Katkus. We are going to hear a little
bit more about the Memorandum of Understanding that the State
and the VA have entered into. When I have discussed this with
your boss, General Campbell, we have certainly encouraged the
VA to think outside the box when it comes to providing the
healthcare in rural Alaska.
In terms of the provisions in this MOU, the key components
in your opinion, what do you think the VA should do, must do to
most effectively serve our returning Guardsmen?
Brigadier General Katkus. To get a specific solution, I
don't have right now, but it is a communication tool and that
is probably the best effort, is education and communication.
The lively discussion that I spent with my staff yesterday in
preparation for today's testimony gave me a very broad
experience or gave the ability to watch my senior leadership
not totally know what the VA benefits are that available out
there.
So if I have got folks that have been in the Guard as long
as I have that don't thoroughly understand it, the challenges
are going to be there trying to get the soldiers at the lower
end of the food chain there, those 28-year and younger soldiers
to understand it, are going to be extremely challenging.
What that MOU does is really start a dialog and that dialog
needs to be continued. If we look at the MOU is this the
solution. This is what we are going to implement, I think we
are going to fail. That is just breaking the ice to get started
and it has got to continue on and take all of the challenges we
discussed this morning and figure out with multiple people
looking at problems, identifying those solutions. So it is a
communication tool, ma'am.
Senator Murkowski. Well, it is and the one thing that I
really like about this MOU, it has got four goals and the
fourth goal is commit to meet regularly to address and work on
the issues. To me, this is something that is very fluid, but
you have got to have that ongoing discussion.
To just say that, well, we have signed an MOU and now our
Guardsmen are being addressed and taken care of, it is just
words on paper. So, I am with you on that.
Brigadier General Katkus. That is exactly right.
Senator Murkowski. You know, when I was out there at Shelby
when you all were taking off, we all remember how hot it was
that day. It was October. Who would have thought it would be
100 degrees and 110 percent humidity and I was dying in the
heat. You all were standing out there in full uniform, standing
as you listened to, you know, your high mucky mucks speak to
you and I was quite concerned.
I am looking out at this group of Alaskans from Chefornak
to White Mountain to Bethel to Angoon and I am thinking I don't
know how they are going to do it over there, and I have to tell
you that the men that came back were men who had accomplished a
mission with a level of pride and satisfaction in work very
well done, truly came back as a very proud and unified unit of
soldiers and you made us all proud.
As Alaskans, you made us exceptionally proud. As Americans,
you made us proud, but I want to ask you, General, because I
want you to have the microphone in front of you to tell
Alaskans how this unit performed over there in conditions that
those of us at this table, I don't know could have handled. So,
if you can just brag on the men and their mission for a few
minutes, I would be honored to listen to you?
Brigadier General Katkus. Ma'am, the members of the Alaska
Army National Guard performed magnificently. That is the bottom
line. I have to be careful not to brag too much on just the
Third Battalion because our aviators are out there in harm's
way and they had risky missions, as is our security force
currently deployed out there, but every deployment we have had
so far, our soldiers have stood the test.
They've answered the call. It is a volunteer organization,
yet they are out there doing the missions required of them and
they are doing them exceptionally well. They have not missed a
requirement. They have not seceded in any of the missions that
were asked of them. They performed and they performed
absolutely remarkably.
Senator Murkowski. Well, we are exceptionally proud of all
of you and for what you have done and for your continued
service. I think we recognize, particularly out in some of our
smaller communities, the role model that you serve to the young
people out there, to the elders who served with pride and
distinction in the Territorial Guard.
You truly are examples of proud warriors and we honor and
we respect you. What we are trying to do today in putting some
of your words on the record is to make sure that when we say we
support our troops, we are doing more than just giving a bumper
sticker slogan, that we are carrying through with that show of
support by giving you the services that you have earned and
showing you the respect that you have earned as you have served
us.
So let's make sure that we continue this dialog. It doesn't
necessarily have to be over a witness table, but we need to
make sure that we are doing right by you and your service and
in order to do so, we need to know what is happening across the
state as you are dealing with those who have served us.
So I would encourage you to keep up the communication with
us. Our door is open always, but again, thank you for all that
you have done, your continued service, and thank you for your
testimony this morning. It is greatly appreciated.
With that, we will turn to our second panel.
So, at this time, I would like to have join us at the
table, Mr. Alex Spector, the Director of the Alaska VA
Healthcare System and Regional Office here in Anchorage, Mr.
Nelson Angapak, the Vice President of Alaska Federation of
Natives, also accompanied by Reverend William Nicholson, who is
the Pastor of the Anchorage Moravian Church, and Ms. Valerie
Davidson, the Senior Director of Legal and Intergovernmental
Affairs at the Alaska Native Tribal Health Consortium based
here in Anchorage.
We will also have General Katkus at the end of the table in
case we have further questions, keep him on the hot seat for a
little while longer. We appreciate that, General.
Let's make sure everyone has got water and what we will do,
since we have already heard from General Katkus, we will go
from you, Mr. Spector, on down in delivering your testimony.
We do have your written testimony, which will be included
as a full part of the record, so any summary or add-ons that
you would like to make at this time are welcome and
appropriate. We are pleased to have you as part of the hearing
this morning and appreciate what you do in your service at the
Veterans' Administration. Thank you, Mr. Spector. You may
proceed.
STATEMENT OF ALEXANDER SPECTOR, DIRECTOR, ALASKA VA HEALTHCARE
SYSTEM AND REGIONAL OFFICE
Mr. Spector. Thank you, and good morning, Madam Vice
Chairman and members of the Committee. I am Alex Spector,
Director of the Alaska VA Healthcare System, and I thank you
for this opportunity to provide information regarding the
Alaska VA Healthcare Systems' delivery of healthcare services
to Alaska Veterans and our ongoing efforts to prepare for the
return of servicemen and women who have served in Iraq and
Afghanistan. It is my honor to be here today.
The Alaska VA Healthcare System and Regional Office
delivers care to eligible Veterans through clinical care sites,
also sharing joint venture sites with our DOD facilities,
referral to the closest VA facility and purchase of care.
That Alaska VA provides medical care to Alaska Veterans
through a series of VA clinics located in Anchorage, Fairbanks
and Kenai. In addition, we are pending approval for a clinic in
the Mat-Su Valley. The Alaska VA also participates in one of
nine nationally recognized VA/DOD joint venture relationships
with the Third Medical Group, Elmendorf Air Force Base and an
Inter Service Sharing Agreement with Bassett Army Community
Hospital at Fort Wainwright.
If care is not available at an Alaska VA clinic or through
one of the VA/DOD facilities, care is referred to the nearest
VA facility, the VA Puget Sound Healthcare System in Seattle.
If these facilities are not able to meet the medical
urgency required for consultation or treatment, Federal statute
allows VA to purchase care from non-VA facilities. This same
statute indicates such fee for service, fee care, will be
consistent with what is provided in the contiguous United
States.
As for preparations and outreach for Operation Enduring
Freedom/Operation Iraqi Freedom, OEF/OIF actions, these actions
have included hiring of dedicated staff for outreach to
soldiers and families. We have an OEF/OIF Program Manager,
Transition Patient Advocate and a Social Work Case Manager for
these returning soldiers.
We have hired additional mental health staff. We have
provided education to Alaska Native Regional Hospital staff and
to Village clinic staff and we have developed, as mentioned
previously, a Memorandum of Understanding with the State of
Alaska National Guard to provide mutual support to our
returning National Guard soldiers.
As a result of established partnerships, the Alaska VA has
through the Alaska Federal Healthcare Partnership, Alaska VA
staff were invited to present at six Alaska Native Regional
Health Corporations on VA eligibility benefits and healthcare,
post-traumatic stress disorder and reintegration issues.
In addition to the educational aspect of these sessions, VA
staff and the Alaska Native Tribal Health staff focused on
providing a pathway of care for each system to work together in
order to assure that soldiers returning to their respective
areas and other Veterans living in these rural areas could
seamlessly use their Alaska Native health benefits as well as
use their benefits through the VA Healthcare System.
Each person participating in these sessions was given a
packet of information with names and phone numbers to be able
to contact individuals at the VA to bust through bureaucracy to
make that seamless transition, if necessary.
Added mental health staffing has placed the Alaska VA in
good position to begin tele-mental health, which has been
initiated in our VA community-based outpatient clinic in Kenai.
This will prepare us for our next trial of tele-mental
health, which we hope to do with the Yukon Kuskokwim Health
Corporation in Western Alaska. We met with YKHC staff in
September to begin these discussions on how this process could
work between the VA and YKHC.
The Alaska VA has been able to establish relationships with
the Alaska National Guard and the Department of Defense. VA
staff regularly participate in active duty and National Guard
pre and post deployments in addition to ongoing contact with
the Warrior in Transition units located in Ft. Richardson and
Ft. Wainwright.
In summary, the Alaska VA has spent this last year
preparing for our returning servicemen and women by adding
staff and working closely with our Federal and State partners
in assuring a seamless transition from DOD and Tribal Health
System care to the VA care.
Madam Chairman, Vice Chairman, thank you again for this
opportunity to speak about VA care in the state of Alaska and I
will be happy to answer any of your questions.
[The prepared statement of Mr. Spector follows:]
Prepared Statement of Alexander Spector, Director, Alaska VA Healthcare
System and Regional Office
Good morning Mr. Chairman and Members of the Committee.
I am Alexander Spector, Director of the Alaska VA Healthcare
System. Thank you for this opportunity to provide information regarding
the Alaska VA Healthcare System's current partnerships with Indian
Health Services (IHS) and our on-going efforts to prepare for the
return of service men and women who have served in Iraq and
Afghanistan. It is my honor to be here today.
Current VA/IHS Partnerships: The Alaska Federal Health Care
Partnership (AFHCP) provides a strong mechanism through which VA takes
care of Alaska Native veterans by active cooperation with Federal and
tribal entities which provide direct health care services in the State
of Alaska. The Alaska VA Healthcare System is a very active participant
in the AFHCP--a formal, voluntary organization which works to leverage
resources, optimize capabilities, and promote innovation. The Alaska VA
Director serves as the Chair of this group. Members include VA, Alaska
Native Tribal Health Consortium, Alaska Native Medical Center, Indian
Health Service, U.S. Army, U.S. Air Force, and U.S. Coast Guard.
The following are a few examples of the many accomplishments of the
AFHCP and programs underway that increase access to high quality, cost-
effective care for over 280,000 tribal/Federal beneficiaries, many of
whom are veterans. The AFHCP programs are vital in VA's ongoing work to
provide Alaska Native veterans a pathway to care.
The Alaska Federal Health Care Access Network is one of the largest
medical facility and forward telemedicine systems in the world. The
system is heavily utilized in the rural areas of the state, providing a
tool for Alaskan Native Clinic Health Aides (CHAs), who are the sole
primary care providers in many of the villages. The AFHCAN system
allows a Health Aide to build a case on the telemedicine cart and
forward to a licensed provider for further care, and to provide
oversight of the Health Aide's work. This system has expanded access to
Alaska Native veterans and improved oversight, and thereby the quality
of the care provided by the CHAs.
The AFHCP Federal Education Sharing Group conducts joint education
and training sessions for AFHCP members. VA has taken the lead in
applying for an education grant to conduct a two-day education summit
on Traumatic Brain Injury for Federal and community providers in FY08.
The Alaska Federal Health Care Partnership Teleradiology Project
has brought enhanced x-ray capabilities and digital capability to over
50 communities in the state, most of them rural native communities
without roads. This technology allows a trained health aide, in a rural
frontier area, to take x-ray studies and forward them electronically to
a radiologist in a metropolitan area for interpretation, cutting this
processing time from days to minutes. In addition, this program
eliminated the environmental health hazards in the Alaska Native
communities posed by the chemicals used in wet x-ray processing.
The Alaska Home Telehealth Monitoring Initiative, modeled from VA's
Care Coordination/Home Telehealth (CCHT) program, is now providing
services to participating organizations in rural Alaska. Currently,
four regional health corporations are placing home monitoring devices
in the homes of Alaskan Native patients, many of whom are veterans, to
provide regular monitoring of chronic conditions. This allows timely
intervention when a condition begins to deteriorate, rather than
waiting for the patient's unmonitored condition to worsen to the point
at which they must be seen in the Emergency Room or require admission.
The U.S. Army Medical Department Activity-Alaska is also participating
in this initiative. The program is monitoring patients in both urban
(Anchorage, Fairbanks) and rural areas (Delta Junction, St. George,
Kotzebue, Dillingham, Togiak, False Pass, Whittier) both with and
without a road system. This is yet another example of VA providing our
Alaska Native veterans a pathway to receive high quality health care.
Additionally, the Alaska Federal Health Care Partnership has more
projects in the planning stage that will bring expanded access to our
veterans living in rural Alaska such as:
AFHCP Tele-Behavioral Health Agreement--This agreement reflects the
cooperation between DoD, VA, and the Alaska Native Health Corporations
in providing mental health care to DoD beneficiaries and veterans. The
Alaska Federal Partnership's new program will assure a telemedicine
connection for veterans returning to rural Alaska with the VA, as well
as active duty DoD and DoD family members. Through the use of live
clinical videoconferencing, the patients will be seen at the location
where they generally receive care, and will have access to a
psychologist or psychiatrist located at the Anchorage VA Clinic, DOD
site or community Tricare provider, as appropriate. This will greatly
expand mental health services to Alaska Native veterans located in
rural Alaska.
We believe these cooperative efforts with Federal partners enhance
both access and quality of the health care to our veterans in the
state, particularly those who are seen primarily in the Alaska Tribal
Health System.
Access to Alaska VA Health Care: Ensuring access to high quality
health care and veteran's benefits to Alaska's veterans is challenged
dramatically by the geography and population demographics in Alaska. In
order to provide these services, the Alaska VA Healthcare System and
Regional Office (AVAHSRO) draw upon an array of traditional and non-
traditional VA resources. The AVAHSRO provides medical care to Alaska
veterans through a series of clinics located in Anchorage, Fairbanks,
and Kenai. The Alaska VA also participates in one of nine nationally
recognized VA/DoD Joint Venture relationships with the 3rd Medical
Group (MDG), Elmendorf Air Force Base, and an Inter Service Sharing
Agreement with Bassett Army Community Hospital at Fort Wainwright. If
care is not available at an Alaska VA Clinic or through one of the VA/
DoD facilities, care is referred to the nearest VA facility, the VA
Puget Sound Healthcare System (VAPSHCS) in Seattle, WA. If these
facilities are not able to meet the medical urgency required for
consultation or treatment, Federal statute allows VA to contract with
non-VA facilities for care. This same statute indicates such fee-for-
service (fee) care will be consistent with that provided in the
contiguous States. In FY07, the Alaska VA purchased $39,150,000 in
health care for veterans within Alaska.
Our Anchorage VA facility became operational on May 5, 1992. At the
time of the opening, VA was providing care and services for
approximately 4,000 veterans through contract community providers. This
represented 90 percent of the Alaska VA operating budget. Opening the
Anchorage facility permitted expansion of the number of veterans served
by VA medical staff. The new site also expanded the types of services
directly available to Alaska's veterans.
Improvements to the delivery of services have enhanced quality,
access, productivity, operational efficiency and patient satisfaction.
The Fairbanks VA Community Based Outpatient Clinic (CBOC) was activated
in 1997 and is located within Bassett Army Community Hospital (BACH) on
Ft. Wainwright as part of a VA/DoD interagency sharing agreement. The
Kenai VA CBOC was activated in November 2001. The numbers of veterans
served by the Alaska VA has steadily increased. In FY07, the AVAHSRO
provided a total of 167,237 outpatient visits (112,273 VA clinic visits
plus 54,964 visits purchased from community providers) for 14,383
unique veterans. There are 27,335 Alaska veterans enrolled in VA
Healthcare System.
In addition to AVAHSRO direct sites of care, a VA contact
representative is located in the Juneau Federal Building to provide
general information on VA health care and provide veteran benefits
information and services for the Regional Office.
According to VA's strategic planning methodology, 74 percent
of Alaska veterans live within 60 minutes driving time to VA
primary care (see table below for distribution of Alaska
veteran population). The other 26 perecent of veterans outside
the road system may be eligible for reimbursement of travel
expenses to VA sites of care provided they meet VA's statutory
criteria for beneficiary travel benefits.
The beneficiary travel budget for FY07 was $2,467,502 compared to
$1,878,056 in FY06.
Distribution of Alaska Veteran Population
------------------------------------------------------------------------
Vet Pop Percentage
------------------------------------------------------------------------
Anchorage/MatSu/Kenai 41,722 63
Fairbanks Area 10,908 17
Southeast Alaska 6,859 10
West/SW Alaska 2,188 3
Northern Alaska 2,209 3
Kodiak 1,221 2
Valdez/Cordova 1,141 2
------------------------------------------------------------------------
(As of 9-30-2006 VA Website)
Consistent with the Secretary's CARES Decision of May 2004, the
AVAHSRO is following through on plans to construct a new replacement
outpatient clinic to support health care operations in the Anchorage
Bowl. Construction of the replacement clinic will be on 10 acres of Air
Force land adjacent to the Joint Venture Medical Facility, Air Force
3rd Medical Group Hospital. The construction contract was awarded in
June 2007, and site work started in July. The target completion date is
January 2010. The new clinic will provide space to meet projected
demand for primary care, specialty care, and outpatient mental health
services through 2022.
Development of a CBOC in the Mat-Su Valley is in the 2008 VISN 20
Strategic Plan. A business plan has been developed and submitted. It
will assist the AVAHSRO by mitigating, to the extent possible, the need
for a primary care waiting list for appointments in Anchorage, as well
as provide medical care closer to home for patients currently enrolled
at the Anchorage VA Clinic. The AVAHSRO has been greatly challenged by
a lack of available clinic space at the Anchorage facility; due to
increased missions, increased demand by new patients, and new employees
(e.g. OEF/OIF and mental health initiatives). Providing local access to
this target population would relieve the access and physical space
issues.
Outreach for Operation Enduring Freedom/Operation Iraqi Freedom (OEF/
OIF) Veterans
Preparation has included:
Hiring of dedicated staff for outreach to soldiers and
families.
Additional mental health staffing.
Providing education to Alaska Native regional hospital staff
and to village clinic staff.
Development of a Memorandum of Understanding with the State
of Alaska National Guard to provide mutual support to our
returning National Guard soldiers.
In our ongoing efforts to ensure a seamless transition from DoD
care to VA healthcare, the Alaska VA has continued to enhance staffing
and designated positions for Operation Enduring Freedom/Operations
Iraqi Freedom (OEF/OIF) outreach. We have a designated OEF/OIF Program
Manager, Transition Patient Advocate, and a Case Manager to work with
OEF/OIF veterans. There is special emphasis placed on care to those who
are injured and severely wounded OEF/OIF veterans. For those OEF/OIF on
Active Duty status, DoD maintains responsibility for healthcare
services.
Our dedicated team has worked closely with the Warrior Transition
Units (WTU) located on Ft. Richardson and Ft. Wainwright, to ensure a
smooth ``hand off'' of soldiers to the VA system. They visit the WTUs
on a monthly basis during the WTU town hall meetings and more
frequently as needed. During FY07, VA OEF/OIF staff provided 20 VA
briefings to Active Duty, Guard, and Reserve members. Currently the
Alaska VA is seeing Active Duty members of the 4-25th Battalion as they
return to Ft. Richardson. VA staff have been present during the
demobilizations at the invitation of the Army. As of November 21, 2007,
they had briefed over 1,368 soldiers about VA benefits. Alaska VA will
continue to staff a VA information table until the entire battalion has
returned.
Alaska VA Healthcare has increased staffing in our Mental Health
Service. We currently have three psychiatrists and two psychiatric
nurse practitioners. Since returning soldiers present as a high risk
for suicide, a full-time suicide prevention coordinator reported for
duty August 20, 2007. A Recovery Coordinator has been hired to work
with community resources for chronically mentally ill patients. We are
also working with the VA Puget Sound Health Care System and Alaska
Brain Network in support of veterans with Traumatic Brain Injury. Two
Peer Support Technicians have been hired in our Homeless Veterans
Service--one to work with our outreach social worker in the community
and one to work with veterans in the Domiciliary Residential
Rehabilitation Treatment Program and VA Supported Housing Program. The
VA Community Based Outpatient Clinics (CBOC) located in Fairbanks and
Kenai now have social workers hired and in place at both locations.
Telepsychiatry has been initiated with the VA CBOC in Kenai. This will
prepare us for the next trial of Tele-Psychiatry which we hope to do
with the Yukon-Kuskokwim Health Corporation (YKHC) in western Alaska.
We met with YKHC staff in September to begin discussions on how this
process could work between the VA and YKHC.
In preparation for the returning Alaska National Guard 3rd
Battalion 297 Infantry, a VA outreach team, consisting of staff from VA
Healthcare, Veterans Benefits Regional Office, and the Vet Center,
partnered with the Alaska Native Tribal Health Consortium to provide
proactive education on VA eligibility for benefits and healthcare, Post
Traumatic Stress Disorder, and Reintegration Issues to several Alaska
Native Health Care organizations from September 11-28, 2007. The
following organizations responded to VA's offer to provide this
education: South East Alaska Regional Health Consortium (SEARHC) in
Juneau and Sitka, Arctic Slope Native Association in Barrow, Norton
Sound Health Corporation in Nome, Yukon-Kuskokwim Health Corporation in
Bethel, and Bristol Bay Health Corporation in Dillingham. Over 150
village health aides, behavioral health specialists, mental health
staff, primary care providers, nurses, and administrative staff
participated. Some of those participating did so through video
teleconferencing.
The team will travel to Maniilaq Health Corporation in Kotzebue on
December 10. In addition to the educational aspect of these sessions,
VA staff and Alaska Native Tribal Health staff focused on providing a
pathway of care for each system to work together in order to ensure the
soldiers returning to their respective areas (and other veterans living
in these rural areas) could seamlessly use their Alaska Native health
benefits as well as use their benefits through the VA healthcare
system. Each person participating in the sessions was given a packet of
information with names and phone numbers to be able to contact
individuals at VA. Regular follow-up with organization points of
contact will occur by our VA OEF/OIF Manager to ensure that non-active
duty Alaska Native veterans have access to the VA healthcare system.
On September 11, 2007, the Alaska VA Healthcare System, Anchorage
Regional Office Veterans Benefits Administration, and the Alaska
Department of Military and Veterans Affairs signed a Memorandum of
Understanding (MOU). The specific goals of the MOU are written as
follows:
1. Ensure Seamless Delivery of Health Care Services to Rural
Veterans.
2. Enhance Home Station Reunion and Reintegration Workshop for
Returning GWOT Veterans to Include Post Deployment Health
Reassessments.
3. Create Multidisciplinary Mobile Outreach Teams.
4. Commit to Meet Regularly to Address Work Issues.
The National Guard has included designated VA staff in all Post
Deployment Health Risk Assessment (PDHRA) sessions for returning
soldiers to answer questions and enroll new veterans into the VA
healthcare system. In FY07, the Alaska VA OEF/OIF staff participated in
the National Guard's four PDHRAs involving 154 returning service
members. In October, the Alaska VA sent OEF/OIF staff to meet the
Alaska National Guard 3rd Battalion 297 Infantry at Camp Shelby,
Mississippi. Each returning service member was given a VA information
packet about enrollment as well as phone numbers for designated OEF/OIF
points of contact and sites of Alaska VA healthcare, benefits and Vet
Centers. VA staff were able to assist 352 returning service members in
completing VA health care applications on site.
Of the 600 National Guard members who were deployed, approximately
49 percent live in the South Central Alaska, 25 percent in Western
Alaska, 11 percent in Southeast Alaska, 8 percent in Fairbanks, 6
percent in Nome/Barrow, and the remaining 1 percent in Kodiak. The
National Guard has also invited VA OEF/OIF staff to travel with them as
they go to the rural armories to conduct Re-Integration activities on
drill weekends.
Mr. Chairman, thank you again for this opportunity to speak about
VA health care in the state of Alaska. At this time, I am happy to
answer any questions.
Senator Murkowski. Thank you, Mr. Spector. I appreciate
your testimony and we will next go to Mr. Nelson Agapak.
STATEMENT OF NELSON N. ANGAPAK, SR., VICE PRESIDENT, ALASKA
FEDERATION OF NATIVES; ACCOMPANIED BY
REVEREND WILLIAM NICHOLSON, PASTOR, ANCHORAGE
MORAVIAN CHURCH
Mr. Angapak. Good morning.
Senator Murkowski. Good morning.
Mr. Angapak. Welcome to Alaska. This gentleman from
Fairbanks was telling me earlier today that he has never heard
of the Village of Nunakauyak.
Senator Murkowski. Well, we will have to get him out there.
Mr. Angapak. And I accused him of having limited his access
to Fairbanks area and he ought to travel throughout.
Senator Murkowski. It is a challenge to.
Mr. Angapak. Madam Chair, on behalf of the Alaska Native
community, we congratulate you for the support, but in
particular, the confidence of the other U.S. Senators for
appointing you Vice Chairman of this Committee. I think it will
go a long ways toward dealing with issues that impact the
Veterans in the State of Alaska.
For the record, my name is Nelson Angapak, Vice President
of Alaska Federation of Natives. Dealing with Veterans' issues
have become a passion for some of us. If the lessons we learned
from Vietnam, conflicts are to apply, Madam Chair, those must
be applied.
Some of our returning troops from Vietnam survived the
bullets of the other side only to be killed by the bullets of
the red tape from the Veterans' Administration. The VA has
absolutely no presence in rural Alaska, absolutely none at this
point.
Last Friday, I met with Gene Peltola, President and CEO of
Yukon Health Corporation, and he advises the following; VA had
not visited Bethel until such time that you had called them. He
tells me there have been two visits by VA, but he says there
are no tangible results on the ground, where rubber meets the
ground.
I applaud the efforts of the VA, but I think efforts of the
VA must go beyond words. There must be delivery of what was
promised us. I am a Veteran. I served from 1969 to 1971. At the
time of my separation, Madam Chair, I wanted to get out of
service so quickly. I wanted to separate myself from service so
quickly that when I was asked these questions dealing with my
health issues, I told the people there I am all fine. I am just
fine. I think the same thing has happened with our troops from
out there. They want to get out of separation so quickly that
they are telling them I am fine.
Pastor Nicholson is free to hit me when I tell you this;
among one of the conversations that we had together at the time
of his separation, he told me without being very specific that
he did the same thing.
I think, Madam Chair, VA must truly go beyond words in
dealing with the issues that impact our Veterans in rural
Alaska. Let me quote you something that is part of my
statement. Veterans in rural Alaska and America; the challenge
of providing services to rural and isolated Veteran population
extends beyond the boundaries of Native Americans and Alaska
Natives.
It affects all Veterans living in rural and isolated areas
of the continental United States and its territories. We
recognize and we compliment the United States Department of
Veterans' Affairs for its strides in identifying and
implementing systems and programs for rural and isolated areas.
Yet, challenges continue to affect the minority Veteran
population, and in particular, the Alaska Natives living in
rural Alaska. I believe that this affects the returning members
of the 3rd Battalion.
I've walked through VA. I have met with Mr. Spector a
number of times, but I think VA can do a lot more. VA must
promote culturally and geographically relevant outreach
programs and efforts throughout the state of Alaska. If it is
necessary, Madam Chair, I hope you will push for additional
funds to do that.
VA must improve diversity at all levels of VA Alaska with
Veterans of various military backgrounds and rand reflective of
both officer and enlisted members to ensure equitable
representation of Veterans and their experiences.
You know, I don't think I need to elaborate that, but for
example, in the Yupik society, one of the most important
factors in our society is our family unit, our parents, our
grandparents. That is the kind of culturally relevant outreach
VA should consider.
Reaching out not only to the Veterans, but to the family
members who are in the position to assist those Veterans in
dealing with the ghosts of their deployment overseas. I think,
Senator Murkowski, if necessary, the United States Congress
should consider legislation that would mandate the United
States Department of Veterans' Affairs to address the medical
needs of Veterans living in rural America and in particular,
Alaska Native Villages, including the mental health needs of
the relevant--I'm sorry, returning members Third Battalion, 297
Infantry.
If there are no meaningful strikes in this area, perhaps it
is time that the United States Congress considers asking
General Accounting Office, GAO, to do an independent evaluation
of the services that VA provides to our Veterans in rural
Alaska.
I think if such an independent study is done, that might be
beneficial, not only for VA, but for our returning troops in
rural Alaska, and finally, if this does not get the job done,
maybe there should be an IG inspection as to why the delivery
of healthcare to our Veterans in rural Alaska are not included,
really.
Finally, I would like to request that my letter of June, I
believe, July 5, to Secretary James Nicholson addressing the
alternative needs of delivery and benefits to the Veterans
living in rural Alaska be included. I also would like to
request that my letter to you of July 14, asking you to assist
us in this area, be incorporated into the record of this
hearing, and finally, this morning I got a letter from the
Department of Veterans' Affairs under Secretary for Health
dealing with the returning members of OIF and OEF issues.
It talks about--it is a form letter. Dear Veteran, but I
won't read the whole thing, but there are the following issues
of additional warnings that may include PTSD; hopelessness,
rage, anger, seeking revenge, acting reckless, that type of
thing.
I would like to request that this letter also be
incorporated into the record of this hearing so that you will
see firsthand how the VA may try to improve the delivery of
healthcare of our Veterans. Thank you.
Senator Murkowski. All of those mentioned will be included
as part of the record from this field hearing, and thank you
for your testimony and for your service.
Mr. Angapak. Thank you.
[The prepared statement of Mr. Angapak follows:]
Prepared Statement of Nelson N. Angapak, Sr. Vice President, Alaska
Federation of Natives
Introduction
Good morning Madam Vice Chairperson Lisa Murkowski:
Honorable members of the U. S. Senate Committee on Indian Affairs
and gentlemen:
On behalf of the Alaska Natives and the American Indians,
congratulations for being appointed to this position recently. This
promotion demonstrates the confidence and the trust of the other U.S.
Senators of your talents and capacities that you have as a member of
the U.S. Senate.
For the record, my name is Nelson N. Angapak, Sr., Vice President,
Alaska Federation of Natives (AFN). For your information, AFN is a
statewide Native organization formed in 1966 to represent Alaska's
100,000+ Eskimos, Indians and Aleuts on concerns and issues affecting
their rights and property interests. I am a veteran and I served in
active duty in the U.S. Army from 1969 to 1971; I was honorably
discharged.
On behalf of AFN, its Board of Directors and membership, thank you
very much for inviting me to submit this statement to the U.S. Senate
Committee on Indian Affairs on the access to and delivery of healthcare
services to the returning members of the 3rd Battalion, 297th Infantry
Brigade, Alaska National Guard who have recently returned from their
deployment in Kuwait and Iraq and other Alaska Native veterans residing
in Native villages of rural Alaska.
I want to take this opportunity to thank you and the U.S. Senate
for having worked with AFN and the Alaska Native Community during the
past millennium on issues of concern to AFN and the Alaska Native
Community. During the last millennium, U.S. Congress passed a series of
historic legislation that benefited the Alaska Native Community. Some
examples of such legislation include, but are not limited to: P.L. 92-
203, the Alaska Native Claims Settlement Act; Indian Child Welfare Act,
the Indian Self-Determination Act, Title VIII of the Alaska National
Interest Lands Conservation Act; just to name a few.
I would like to bring the following points to your attention up
front:
1. As the 20th century closes, there are nearly 190,000 Native
American military veterans. It is well recognized that,
historically, Native Americans (including Alaska Natives), have
the highest record of service per capita when compared to other
ethnic groups. The reasons behind this disproportionate
contribution are complex and deeply rooted in traditional
American Indian culture. In many respects, Native Americans are
no different from others who volunteer for military service.
They do, however, have distinctive cultural values which drive
them to serve their country. One such value is their proud
warrior tradition. \1\
---------------------------------------------------------------------------
\1\ http://www.history.navy.mil/faqs/faq61-1.htm.
2. The Native American's strong sense of patriotism and courage
emerged once again during the Vietnam era. More than 42,000
Native Americans, more than 90 percent of them volunteers,
fought in Vietnam. Native American contributions in United
States military combat continued in the 1980s and 1990s as they
served in Grenada, Panama, Somalia, and the Persian Gulf. \2\ I
would venture to say that 100% of the members of the 3rd
Battalion, 297th Infantry Brigade volunteered to serve this
nation in its Armed Forces.
---------------------------------------------------------------------------
\2\ Ibid.
3. The outbreak of World War II brought Native American
warriors back to the battlefield in defense of their homeland.
Although now eligible for the draft by virtue of the Snyder
Act, which gave citizenship to American Indians in 1924,
conscription alone does not account for the disproportionate
number of Native Americans who joined the armed services. More
than 44,000 Native Americans, out of a total Native American
population of less than 350,000, served with distinction
between 1941 and 1945 in both the European and Pacific theaters
of war. Native American men and women on the home front also
showed an intense desire to serve their country, and were an
integral part of the war effort. More than 40,000 Indian people
left their reservations to work in ordnance depots, factories,
and other war industries. Native Americans also invested more
than $50 million in war bonds, and contributed generously to
the Red Cross and the Army and Navy Relief societies. \3\
---------------------------------------------------------------------------
\3\ Ibid.
Please note that these three points were excerpted from a website
of the Department of the Navy--Naval Historical Center; 805 Kidder
Breese SE--Washington Navy Yard; Washington DC 20374-5060. This is
public information that is readily available for the people of the
---------------------------------------------------------------------------
United Stated of America.
The Need for this Hearing on the Delivery of Healthcare and Other
Benefits to our Troops in Alaska Native Villages in Rural
Alaska
Thank you for demonstrating your concern for the well-being of all
of our veterans; and in particular, the Alaska Native veterans living
in remote rural Alaska villages. You've demonstrated your concern for
the well being of our veterans in multitude ways; arranging this
meeting of individuals and organizations concerned with the healthcare
and other issues impacting our veterans, this public hearing, etc. I
for one appreciate the commitment that you've demonstrated by your
actions on veterans' issues.
Please allow me to quote the comments you made on November 10,
2006--Veterans' Day:
Thousands of Alaskans are serving in Iraq and Afghanistan
today. We have extensive deployments from our military bases in
Fairbanks and Anchorage. Additionally, over 600 members of the
Alaska National Guard's 3rd Battalion who hail from nearly
every community in Alaska--Southeast to Barrow. They've
survived the summer heat at Camp Shelby in Mississippi. They
will perform with valor in the Middle East.
But they will have quite an adjustment ahead when they return
home--many to remote places where veterans' services are hard
to come by. They will be seeking the sympathetic ears of
soldiers, sailors, airmen and marines who have been there and
done that. I know Alaskans will provide that support and more.
\4\
---------------------------------------------------------------------------
\4\ Quote from Press Release of November 10, 2006.
I know deep in my heart, that you have a genuine interests for the
well being of the Alaska Native and other veterans in Alaska, and in
particular, those living in rural Alaska. Your intentions and concerns
for the well-being of our veterans is genuine and you have demonstrated
that time and time again by your actions and those actions speak louder
than your words. Thank you very much for this.
I know many of the returning members of the 3rd Battalion, 297th
Infantry Brigade National Guard, many of them on a first name basis;
from the Yukon Kuskokwim area. I've seen the National Guard members
themselves when they are on R&R from their deployments and you know,
some of them are different, their spouses and other family members also
have told me that the guard member from their families are different;
they appear the same physically but are different in other ways. I
think the other ways they are referring to may be the manner in which
the guard members are dealing with their deployment in Kuwait and the
incursions many of them took into Southern Iraq. I think we can say we
understand what these guys are experiencing but until we've been in
their shoes, I don't think we can understand what they are going
through. Many of the family members have told me these things because
of the trust they have on their clergy. I serve as an acolyte in the
Anchorage Moravia Church; and it has been in this capacity that people
from the Yukon/Kuskokwim have told me these things. The best way of
describing an acolyte in the Moravian Church is that we are
commissioned by our church to carry out the duties of a pastor in
absence of one--baptizing, officiating the Holy Communion, officiating
marriages just to name a few.
The biggest concern I've expressed time and again is the delivery
of benefits our troops earned during their deployments overseas.
Present paradigm: a veteran has to travel to Anchorage or other urban
settings for their initial evaluation--they may not have the financial
resources to accomplish this; and if they, when push comes to shove,
the returning member will likely chose to help their family members
rather than themselves if they find having to help their families or
take care of their personal ghosts.
Alternative means of delivering healthcare and other benefits to
our veterans living in rural Alaska villages exist and may include, but
are not limited to:
1. Utilization of telemedicine where available assuming VA's
system is compatible to what is exists out there; (If VA's
software is not compatible to the software utilized by the
providers of telemedicine in rural Alaska, it seems such
software can be developed for this purpose.) This capability
exists and it has a great potential of being an innovative
means of delivering healthcare and other benefits to the
returning members of the 3rd Battalion, 297th Infantry Brigade,
Alaska National Guard who have recently returned from their
deployment in Kuwait and Iraq and other Alaska Native veterans
residing in Native villages of rural Alaska.
On Saturday, October 27, 2007, the delegates to the 2007 AFN
Convention passed the attached resolutions:
Welcoming home the 1st, 2nd, and 3rd Battalion 297th Army
National Guard: This resolution welcoming the returning troops
was passed unanimously by the delegates to the 2007 SFN
Convention in Fairbanks, Alaska.
2. Utilization of existing health care facilities that exist in
rural Alaska with VA reimbursing them for treating veterans in
these facilities. This may require legislation to treat non-
Alaska Native veterans if the health care facilities in rural
Alaska are for Alaska Natives. I think this has the greatest
potential of being an alternative method of delivering
healthcare and other benefits to the returning members of the
3rd Battalion, 297th Infantry Brigade, Alaska National Guard
who have recently returned from their deployment in Kuwait and
Iraq and other Alaska Native veterans residing in Native
villages of rural Alaska.
Healthcare facilities in rural Alaska and VA care for
veterans living in rural Alaska: This resolution was passed
unanimously by the delegates to the 2007 SFN Convention in
Fairbanks, Alaska urging VA to utilize healthcare facilities as
a means of addressing the healthcare needs of our veterans
living in rural Alaska.
I've raised these points over and over in the past with the VA
personnel and to date; I have not seen any earth shaking and convincing
evidence and documents whereby VA promises that they have found
different means of dealing with the delivery of these benefits our
veterans have so rightly earned.
As a matter of fact, I met with Mr. Peltola, President and CEO of
the Yukon Kuskokwim Health Corporation on Friday, November 23, 2007 and
we discussed this hearing and the fact that I was invited to testify in
front of this committee on Friday, November 30, 2007. Mr. Peltola
advised me that he met with you, Senator Murkowski, in August of this
year (2007) in which he advised you that he has not met with anybody
from the Alaska office of the U.S. Department of Veterans Affairs. He
then advised that shortly after he had informed you of this fact,
someone from Alaska VA offices have flown to Bethel to meet with him
and his staff twice on the issues impacting the returning members of
the 3rd Battalion, 297th Infantry Brigade. To date, he has not seen
anything developing from these meetings; his conclusion was--this was
all talk as he has not seen any developments on the delivery of
healthcare and other benefits promised our troops from the time they
were in active duty in the U.S. Armed Forces.
Senator Murkowski, I've been involved in a number of meetings where
VA personnel were present a number of times and to date, I've heard
discussions of some plans or things VA is doing or plans to do in
Alaska on the delivery of healthcare and other benefits to our veterans
in rural Alaska; but to date, I have not seen any tangible things that
Alaska VA is doing on finding ways and means of improving the delivery
of the benefits promised our veterans in living in rural Alaska and in
particular, the Alaska Native villages.
Mr. Peltola and I have one common major concern: our returning
troops, just like the other members of the OEF/OIF veterans across this
nation will be experiencing mental health issues and we are not certain
that VA in Alaska is ready to address this issue head on.
VA in Alaska has no presence in rural Alaska any place. They live
in accordance to their present paradigm of operation--veterans living
in rural Alaska must pay their own way to the urban settings in
Anchorage to be even considered for their initial evaluations; I do not
see this paradigm changing anytime soon; not for the veterans of World
War II, not for the veterans of `Nam Conflict, not for the veterans of
the Kosovo Conflict, nor do I see VA changing its paradigm even for our
troops from rural Alaska who deployed pursuant to OEF/OIF.
Veterans in Rural Alaska and America
The challenge of providing services to a rural and isolated veteran
population extends beyond the boundaries of Native Americans and Alaska
Natives; it affects all veterans living in rural and isolated areas of
the Continental United States, and its territories. We recognize and we
compliment the U.S. Department of Veterans Affairs for its strides in
identifying and implementing systems and programs for rural and
isolated areas; yet, challenges continue to affect that minority
veteran population; and in particular, the Alaska Native veterans
living in rural Alaska. This affects the returning members of the 3rd
Battalion, 297th Infantry Brigade.
There are some things that VA in Alaska must consider and some of
those include, but are not limited to the following:
Promote culturally and geographically relevant outreach programs and
efforts throughout the VA, by
Increasing and funding more fulltime positions for the
training and hiring of Minority veterans, including Alaska
Natives in Alaska in areas, where there is a large minority
veteran population. At the present time, I do not think that
there is a single Alaska Native on the staff of Alaska VA in
any policy making position. We recommend that VA Alaska
considers hiring Alaska Natives in policy making positions who
understand the needs of the veterans living in rural Alaska,
and in particular, the Alaska Natives.
Increasing outreach, responsiveness, and formal consultation
with tribal governments and tribal leaders, particularly out in
the field. This issue has been the subject of several
presidential addresses:
-- Richard M. Nixon, ``1970 Special Message to the Congress on
Indian Affairs;''
-- Ronald Regan, ``1983 Statement on Indian Policy;''
-- George H.W. Bush, ``1991 Statement Reaffirming the
Government-to-Government Relationship Between the Federal
Government and Indian Tribal Governments;''
-- William J. Clinton, Executive Memorandum (April 1994),
``Government to Government Relations with Native American
Tribal Governments'', and Executive Order 13175 (November
2000), ``Consultation & Coordination with Indian Tribal
Government;''
-- George W. Bush, Executive Memorandum (September 2004),
``Government-to-Government Relationship with Tribal
Governments.''
Improving transition processing for Reserve and National
Guard personnel returning from deployments.
Improve diversity at all staff levels of the VA Alaska with
veterans of various military background and rank reflective of both
officer and enlisted members to ensure equitable representation of
veterans and their experiences. There is no need to elaborate on this
matter; but the following should be included, at the very least:
VA must establish and monitor intensive training program for
Senior VA leaders, managers, and their staff, on cultural
diversities and language competencies within the veteran
population being served.
VA must employ or train personnel to be conversant in the
predominant language or dialect within its sphere of influence
and/or operation in order to assure the highest level of
customer service. As an example, I think the Yupik language is
the easiest language one can learn; many from my generation did
not have to go to school to learn to speak Yupik; that is how
easy this language is.
The United States Congress, if necessary, should consider
legislation that would mandate U.S. Department of Veterans Affairs to
address the medical needs of veterans living in rural America and in
particular, Alaska Native villages, including the mental health needs
of the returning members of the 3rd Battalion, 297th Infantry Brigade.
Finally, if VA Alaska does not demonstrate any visible means of
addressing the needs of our veterans living in rural Alaska, maybe it
is time for U.S. Congress to consider asking the United States
Government Accountability Office (GAO), ``the investigative arm of
Congress'' and ``the congressional watchdog'' to investigate what VA
Alaska is doing on the delivery of healthcare to the veterans of OEF/
OIF in rural America and in particular, in rural Alaska villages and
report its findings to Congress. I think such an investigation would be
impartial and have credence since that is the job of GAO.
GAO supports Congress in meeting its constitutional
responsibilities and helps improve the performance and ensure the
accountability of the federal government for the benefit of the
American people, in this instance, veterans in America. GAO's work
includes oversight of federal programs; insight into ways to make
government more efficient, effective, ethical and equitable; and
foresight of long-term trends and challenges. GAO's reports,
testimonies, legal decisions and opinions make a difference for
Congress and the Nation. \5\
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\5\ http://www.gao.gov/.
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This final recommendation is a result of having thought of this
over and over but in the end; it may be something that Congress might
consider on the national insofar as the delivery of healthcare and
other benefits to our veterans living in rural America and Alaska,
especially in the Alaska Native villages.
I incorporated the two resolutions that were passed by the
delegates of the 2007 AFN Convention in Fairbanks, Alaska as part of my
statement.
I thank you for allowing me to submit this statement; I ask that my
oral and written comments be incorporated into this hearing record.
If you have any questions concerning my statement, please feel free
to ask them.
Attachments
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Murkowski. Reverend Nicholson, welcome.
Reverend Nicholson. Yes. I would like to thank Mr. Nelson
Angapak for inviting me to appear before you, Senator
Murkowski, and mainly to share from the standpoint of a pastor
and chaplain. I would like to share that recently I met with
the Bishop Nikolai, the top religious official in the state of
Alaska, and he assured me, and I know there are many other
clergymen throughout the state of Alaska that are praying for
our men and women in uniform who are in harm's way, and
certainly we pray for our leaders from President Bush on down
to the congressional people and so forth and our prayers go out
for you.
I would like to thank you, Senator Murkowski, for allowing
me to share a few brief words. My name for the record is
William Nicholson. I have served in the U.S. Army during OIF
III. I am an Alaska Native from the Bristol Bay region and now
live in Eagle River.
I've served as a pastor for a long time, but recently in
the Anchorage Moravian church for just about seven years. Soon
I will finish 11 years in the Alaska Army National Guard as a
chaplain. Let me share this; I don't think that we should
minimize the problems that our vets and our families are
suffering.
As a civilian clergyman and chaplain of the 207th Brigade,
Alaska Army National Guard, in the last month and a half, I
have dealt with families that are disintegrating, that are
suffering because of deployment to Iraq. Two families that had
soldiers in Kuwait and another one that served in the striker
brigade, who is now in the Alaska Army National Guard. I
believe from my experience that post-traumatic stress disorder
is a real concern.
Also, the long deployment away from the family is weakening
what really should have been good relationships and certainly
there are many other--this is the tip of the iceberg. There are
many other families and soldiers that need help out there.
As one caregiver, I had done my part to do, my job and I
would like to commend all of the other caregivers, whether it
is family support or the mental health officials, whoever is
involved with these families and vets are to be commended for
their part.
I know one of the very proactive, very positive activities
that I looked at and participated in were the predeployment
briefs that occurred down in the YK area before the soldiers
left for Kuwait and I was happy as one clergyman to be invited
and I know there were several other clergy from other
denominations that were invited to listen in on the
predeployment briefs and out of that came an interest on the
part of several clergy.
I was one of them. I, in turn, went back to our conference,
the 23 churches, the Synod of the Alaskan Moravian Raven Church
and also briefed them that we had soldiers going overseas and
family members left behind that need to have support and I
think that was a very good gesture. I personally gave a
presentation to our Synod and prepared the clergy to be
sensitive of the needs of the families and soldiers needing
help.
Now that our soldiers are back, it is a wonderful time, but
it is also a painful time. One proactive idea that I would like
to throw out here as far as follow-up which I plan on executing
myself is to provide training for our clergy. We have our Synod
every January, but I really feel that the clergy in our own
denomination as well as the clergy within the state of Alaska
who live and work in the rural areas should understand very
clearly what post-traumatic stress disorder is, what the
symptoms are, and how to refer our soldiers who are really
experiencing difficulty.
Thank you, Senator Murkowski. I will be free to remain and
answer questions. Thank you so much.
Senator Murkowski. I appreciate the testimony and your
service. Ms. Davidson, welcome.
STATEMENT OF VALERIE DAVIDSON, SENIOR DIRECTOR, LEGAL AND
INTERGOVERNMENTAL AFFAIRS, ALASKA
NATIVE TRIBAL HEALTH CONSORTIUM
Ms. Davidson. Good morning, Madam Vice Chair and for the
record, members of the Committee. [Speaking Native language.]
Good morning, my name is Valerie Davidson. I am from Bethel and
my mother's family is Yup'ik from Kwigillingok originally.
We want to thank you for the opportunity to testify today
about this very important issue. One of the things that we all
know is that every Veteran regardless of geography, where they
live or regardless of race, who need medical care, whether that
is primary healthcare or behavioral healthcare, should have
meaningful access to care.
In Alaska, we always say, and I know you are great at
reminding your colleagues in the Senate that Alaska is
different, and for people who live in rural Alaska, rural
Alaska is really different.
There are a number of barriers, including the lack of VA
infrastructure in rural Alaska, the lack of funding and
authority to support the already existing rural health system
and also the lack of systems that provide meaningful medical
information throughout various different health systems.
The most effective and efficient way to be able to extend
the VA's capacity to be able to provide healthcare to Alaska's
rural Veterans is by enhancing the Tribal health system's
capacity to be able to provide healthcare and I want to
emphasize that I want you to know that for the record, I didn't
specifically limit that comment to Alaska Native Veterans.
In many of the rural communities, in fact almost all of
them, the rural healthcare system, the Tribal healthcare
system, is the only healthcare system that is available to
provide healthcare to anyone regardless of whether they are
Alaska Native or not.
Specifically, we recommend two things. One is the creation
of a VA clinical encounter rate that is flexible enough to
include both behavioral health as well as telemedicine to
reimuburse IHS, and in Alaska, those are Tribally operated
facilities that provide care to Veterans and their families.
That precedent already exists for contracted community-
based care in the Lower 48 states and surely if they can do it
in the Lower 48 states, they should be able to extend that
authority here in Alaska where our challenges to care are even
more acute.
The other challenge that we run into is both the IHS and
the VA are both considered payers of last resort and any time
you are dealing with two combating payers of last resort, which
one really is the payer of last resort. In our opinion, the
payer of last resort truly should be the Tribal Health System
which is funded at a much less rate than the VA currently is.
In addition, we also think that care should be extended to
family where it is appropriate in order to be able to provide
the best and most culturally appropriate care to allow Veterans
to be able to reintegrate back into the community.
NTHC, as you know, has been a really proud partner in the
Alaska/Federal Healthcare Partnership and those comments and
the extent of our involvement have been already outlined by Mr.
Spector in both his written and oral testimony.
In the interest of time, I am not going to delve into
those, but I use that as an example to show that when we do
pool our resources together and when we do work together, it is
amazing what we can accomplish together, but I think regardless
of that, I think we all agree, and what we have heard today
from the previous panel is that despite our best efforts, we
can work really hard. We can try really hard. We are missing
the mark.
There is more work that needs to be done to ensure that
Veterans who live in rural communities have the same access to
care that Veterans who live in Anchorage or in the Mat-Su
Valley do. Extending the healthcare, the VA's ability to
provide healthcare through the Tribal Health System and through
our 216 health facilities in rural Alaska and throughout Alaska
really is the obvious answer.
The Tribal Health System just for the record and for those
who don't know it as well as you do, is a voluntary affiliation
of over 30 Alaska Tribes and Tribal Health Organizations that
provide care throughout Alaska, throughout rural Alaska and we
serve approximately 130,000 Alaska Natives, the majority of
whom live in rural Alaska and interestingly enough, the
majority of the patients that we serve live in communities of
the average size of 350 people.
The level of care in each community really depends on the
location and the size. Typically, half of our patients receive
their healthcare in 180 small Village clinics through 550
community health aides or practitioners statewide, 125
behavioral health aides who have training in both mental health
and substance abuse and alcohol training, 12 dental health
aides therapists, about 20 dental health aides, which is a
lower level of dental health aide therapists, and 100 personal
care or home care attendants, and again, half of our patient
encounters in the Tribal Health System occur at those small
Village clinics in Villages of approximately 350 people.
Additional services are provided through referrals through
the subregional clinic, through the regional hospitals. There
are six regional hospitals and, again, those are the only
hospitals that are available in that entire region.
As an example, the Yukon Kuskokwim Health Corporation's
hospital in Bethel is the only hospital that is available in
the region about the size of the state of Oregon or 75,000
square miles and there are no roads connecting any of those
communities.
Of course, for tertiary care, our patients come in here to
Anchorage. In addition to that care that already exists, we
also can extend the care and extend that through our
capabilities with telemedicine where local providers in our
community can access care through the telemedicine system to
providers outside of our health system and outside of our
communities.
One of the things that we know is our Veterans--we hear
repeatedly that the current picture of healthcare for Veterans
who live in rural Alaska is really complicated and almost
inaccessible. Transportation is extremely expensive.
You are lucky if you live in a community where you can get
a $400 roundtrip plane ticket to come to the nearest clinic.
Some communities, just to get from that community to Anchorage
is a $1,000 roundtrip airfare and that is airfare alone.
The other challenge is that if the Veteran doesn't fall
within the correct priority level or percentage of disability
or income requirements, the VA can't pay for travel and so that
is an additional complicating factor.
One of the other tenets of our ability to provide care to
people who live in rural Alaska, and specifically right now I
am going to speak to Alaska Natives, is our ability to be able
to provide culturally appropriate care, not only to the
Veteran, but also to the entire family.
We know from our own experience that culturally-based care
combined with family involvement is often the most effective
way and the only effective way to treat our patients. At its
absolute basic, Alaska Natives are more likely to seek
healthcare in a system in which they feel comfortable.
People who look like them, people who speak the same
language, being able to go talk to a health aide, being able to
speak to that health aide in Yup'ik, somebody who knows who
they are, who knows what their experience has been and who also
knows what their family experienced while they were gone.
The other thing that is really critical, sometimes I think
we miss in terms of access to primary care is the role that
access to primary care plays in relationship to behavioral
health. There is a critical link in terms of behavioral
healthcare access since a majority of behavioral health issues
are actually diagnosed in primary care visits and not by a
referral to a behavioral health specialist.
There are recent studies that have done--that indicate we
can absolutely expect behavioral health issues to arise and we
are not going to see them through a mental health professional.
We are going to see them at our primary care visits.
For example, a recent study looked at 100,000 Veterans who
separated from active duty between 2001 and 2005, who sought
care from a VA medical facility, and they looked at combination
diagnoses, medical diagnoses of any kind and more than gunshot,
more than anything else, the most common dual diagnosis was for
post-traumatic stress disorder and depression, and in addition
to that--and that is more than any other physical ailment.
In addition to that, young soldiers were more than three
times more likely than Veterans over 40 years old to be
diagnosed with post-traumatic stress disorder and other mental
health disorders and I am recalling the comment that was made
earlier that the average age of the Veteran in the YK region is
28.
The other issue is--so we know that those folks are going
to--we can expect that. We just know that from the research and
this is among regular Veterans.
It is among Veterans who are also experiencing the huge
cultural differences of moving from a community in which
everyone speaks Yup'ik to a completely different foreign
country where you speak to your Commander in English and then
you are in another community that speaks another language
entirely and I can't even begin to comprehend the strain of
marching around in heavy armor at 140 degrees when our bodies
are made for 20, 30 below, is just perfectly comfortable with
us. So that is pretty close to a 200-degree comfort zone
temperature difference.
The other is outside of the military realm, there was a
recent multinational study that was done unfortunately of
people who had successfully committed suicide and what they
found is that only one-third of those individuals, who
unfortunately had taken their lives by suicide, had seen a
mental healthcare specialist of any kind in the year before
they took their lives.
In contrast, 77 percent of those people who had ultimately
taken their lives by suicide had seen a primary care provider.
Seventy-seven percent had been to see a primary care provider
and what is most startling is that during their primary care
visit, they identified vague, nonspecific conditions like I'm
having trouble sleeping, I'm having trouble eating.
I'm experiencing a variety of physical manifestations that
really indicate an underlying behavioral health issue and that
we know that with a proper nine-question screening test,
behavioral health screening test that takes two or three
minutes at their primary care visit, that they would have
resulted in a behavioral health referral.
We also know, as was noted earlier by the previous panel,
that Alaska Natives suffer rates of suicide at much higher
rates than the other average American population or any other
population and we are just very concerned that with the
additional strain that our soldiers and their families are
experiencing, that we need to be able to do those screenings at
every single visit, whether it is a primary care visit, whether
they are going to see the dentist or their health aide or
whatever that may be.
The other is that the issues that were identified earlier
like post-traumatic stress disorder that may take awhile to be
able to surface, but they are also very common for Veterans who
are returning from recent military service, we know that those
issues have a much better chance of being caught by people who,
not only know the Veteran, who know their families, but can
also provide access to immediate culturally appropriate care
and within the context of their own homes, their families and
within their communities.
We also know that these same kinds of issues that are
behavioral health issues also apply to people who are needing
services after they have been treated for--who are experiencing
traumatic brain injuries as well. There are some regions like
the YK region who is providing behavioral health screening at
their primary care visits and I think that is something we need
to do more as a system.
One of the things that we should be very mindful of is the
significant impact of communities and our healthcare system is
the impact that families are undergoing. The transition between
departure, the absence and the return of the soldier extends
way beyond the soldier, but extends to the family and also to
the community and when we have Veterans who are Alaska Native
who come from very traditional communities, those cultural
differences really exacerbate those challenges and they
complicate the transitions.
Quite frankly, those challenges are really difficult for
people outside of the Tribal Health System to comprehend, to
appreciate and to incorporate into culturally appropriate
treatment, and as First Sergeant Flynn indicated before, you
know, we just--Alaska Native people, especially traditional
Alaska Native people, we are taught don't complain, just take
it, don't complain and we generally don't ask for help, and a
part of that is--and that is especially true when you
complicate that with your first medical encounter being with
somebody who doesn't speak your language and somebody who is
asking you in English how are you doing?
Even if you encounter somebody on the street and you ask
how are you doing, what is almost 99.9 percent of everybody's
response? I'm fine, even if you are not. Unfortunately, we know
that the VA doesn't typically extend care to the family and we
know that families are going to be tremendously impacted.
We expect the Tribal Health System to be seeing a huge
increase in services that are going to be necessary for the
families of Veterans and we also know that since the VA doesn't
typically provide that service to families, that we are going
to see the impact.
You know, we want to be clear that the Tribal Health System
really stands ready and we are proud to be able to serve our
returning Veterans. We have done so since the beginning of
time. We take care of our own and we are proud to do it.
That said, the Tribal Health System is only funded in
Alaska at about 50 percent of the level of need and we simply
cannot continue to absorb the additional costs of subsidizing
care for our returning Veterans. This isn't something that is
necessarily commonly talked about, but there are at least three
Tribal Health Organizations in our state who are currently
experiencing rifts, who are cutting services and cutting
programs because of the lack of basic funding to be able to
provide our healthcare and this is coming at a time in which we
are expecting our services to increase, not to decrease.
So additional appropriations along with the payment
authority for the VA to pay us for services that we provide
just makes the best financial sense. Just in terms--from the
testimony that was provided by the VA, it appears that in 2007,
and I am not an expert in VA, so I am going--please pardon my
creative math here, but from what I could tell, it appeared
that in 2007, Veterans had approximately 6.12 outpatient visits
per Veteran and that is some Veterans didn't get outpatient
care, some did of those who were enrolled in VA.
If we estimate that there are approximately 6,000 Alaska
Native Veterans plus the Veterans who are receiving care who
are not Native, but who are getting care in rural communities
because we are the only place to go and you multiply that,
those 6,000 times 6.12 times, the IHS encounter rate of $405,
that is about 15 million dollars just in terms of providing
primary care and we are not getting reimbursed for the services
that we provide and it is something that--we should do
something about it. We can't continue to be able to subsidize
that kind of care.
I guess one of the things that we need to remember is that
at the end of the day as various healthcare systems, whether it
is VA, whether it is the Tribal Healthcare System, whatever it
is, we have to ask ourselves if we are providing the very best
care to our Veterans and these are people that we are obligated
to be able to provide care for and the Alaska Tribal Health
System and the VA has mutual beneficiaries.
We have separate appropriations. We have distinctly
different budgets, but we have very similar missions. We know
that we are underfunded and although the VA budget has
increased by 40 percent, I think from 1999 to 2005, we know
that their resources are not unlimited as well.
We think that because the VA has increasing enrollment for
eligible Veterans and limited capacities in the facilities in
rural Alaska--well, they have no facilities in rural Alaska,
that a marriage between access and services between the VA and
the existing Tribal Health System on behalf of Veterans is the
most effective and most efficient and the most appropriate way
to be able to provide that care.
By continuing to increase the VA's appropriations and
creating a clinical encounter rate, Alaskan Veterans can be
assured of meaningful cultural appropriate access to care in
the communities in which they live and together we can
accomplish this shared mission and our mutual beneficiaries,
those Veterans who live in our communities will be better for
it.
As General Osborn indicated, we are really proud of the
fact that our National Guardsmen performed with excellence and
he said they did us proud and they hit the mark every single
time and for those Veterans who did that for us, isn't it time
that we perform with excellence for them, that we hit the mark
in providing access, meaningful, local, culturally appropriate
access to them?
Wouldn't it be great if we were held to the same standard
that they were and the service that they provided to our
country. And in closing, and I think we can. We just have to
eliminate those barriers. We have to make it possible and we
have to do them proud just as they did us proud.
I think I have probably talked long enough and in closing,
we want to thank you again for your leadership and Committee
for addressing this very critical issue on behalf of our
families. [Speaking Native language.]
[The prepared statement of Ms. Davidson follows:]
Prepared Statement of Valerie Davidson, Senior Director, Legal and
Intergovernmental Affairs, Alaska Native Tribal Health Consortium
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Senator Murkowski. Thank you, Ms. Davidson. I appreciate
your testimony and the level of detail and really, I believe a
very positive solution. We have got issues of access that we
need to address as our men and women are coming home.
We don't need to reinvent the wheel. We have systems in
place. They have proven to be effective systems even given the
very challenging nature of where they are. We have figured out
a way, you know, we don't have a doctor in every Village, we
don't have a PA in every Village, but we have figured out a
system out in our Villages in rural Alaska where we are able to
provide for a level of healthcare that is able to meet that
immediate need and to do the follow-up afterwards.
I appreciate a great deal your recognition in your oral, as
well as your written testimony, that what we are likely going
to see happen here as the preferred alternative to provide the
services to our Veterans is that they will go to the existing
facilities within the Indian Health Service.
That is where they are located. You avoid the cost of
travel and the transportation expenses, and nobody wants to
leave their family when you need help. We need to have that
support locally, but when you recognize that you are putting
one Federal entity, the IHS, in a situation where they are
providing for that level of services that ordinarily would be
required or provided through another Federal entity, that of
the VA and you don't have a reimbursement going back and forth,
that to use your words, you are effectively subsidizing the VA
for their obligation.
Now, what we have heard from Alaska Natives who have said
I've got to get my healthcare somewhere and I will go to the
clinic or I will go into Bethel, but as a Veteran, am I not
entitled, have I not earned the right to have that Veteran
healthcare?
So we have got issues of access that we recognize. The
challenge for us is how we truly meet that need, how we truly
deliver on that promise.
Mr. Spector, I want to go to you for just a moment. You
have had an opportunity to hear from several, not only on this
panel, but in the previous panel, the concern about just the
logistics in coming to the VA and coming to the clinic here in
Anchorage or even to the outpatient facilities there in Kenai
and in Fairbanks.
With the, I guess the benefit that is guaranteed to our
returning Guardsmen, right now there is a two-year benefit that
is provided in terms of the healthcare that is available as
well as an additional or 90 days of dental care. You have got a
two-year period where the Guardsman is able to take advantage
of this. What happens after that two years?
Mr. Spector. Well, my understanding on the two-year benefit
is that that is given in order for the soldier to have time to
apply through our Benefits' Administration for his benefits and
establish service--connected service. That is the purpose of
why it was set at two years, is my understanding.
Senator Murkowski. So it gives them that window then. Give
me a clear understanding, because we heard a little bit from
Ms. Davidson that there is certain criteria that if you do meet
it, transportation is provided, if you don't meet it,
transportation is not provided. Can you clarify for us here
today what the VA is authorized to provide in terms of air
transportation, meal allowance, lodging for those that are off
the road system who would come to town for care? What are
ground rules?
Mr. Spector. Travel eligible Veterans are those that are
Veterans that are rated 30 percent or more service connected
for travel relating to any condition, Veterans rated less than
30 percent for travel relating to their service connected
conditions, and Veterans receiving VA pension benefits,
Veterans with an annual income below the maximum applicable
annual rate of pension for all conditions and Veterans
traveling in relation to a compensation and pension exam.
Those Veterans that meet that criteria are also eligible
for some lodging eligibility and for Veterans that are on
flight schedules where they miss their return home after
traveling in, we give them lodging and things like this.
Senator Murkowski. Is there a cap on either the travel
allowance or the housing allowance, do you know?
Mr. Spector. No, there is no cap. There is income criteria,
annual income criteria for one group of eligible Veterans. Our
lodging is--we have contracts with several hotels in Anchorage
that we provide that lodging for. We pay them directly.
Senator Murkowski. So if you haven't established your
eligibility criteria yet, would VA be able to pick up the cost
of transportation and lodging if that has not yet been
established? How do you handle that?
Mr. Spector. That would be considered a non-service
connected Veteran and they would fall under a category of
Veterans with an annual income below the maximum acceptable
annual rate of pension. They would be eligible for cost of
travel.
Senator Murkowski. If they meet a certain income
requirement?
Mr. Spector. Correct.
Senator Murkowski. And do you know what the income level
requirement is?
Mr. Spector. If I can ask my experts here?
Senator Murkowski. Yes.
Mr. Spector. Approximately $12,000 a year.
Senator Murkowski. So if you earn less than 12,000, we will
fly you in?
Mr. Spector. Correct.
Senator Murkowski. That is pretty low, incredibly low. What
about Veterans from prior conflicts? We have got a Vietnam vet
out in Chefornak, are they being provided any level of
transportation or lodging accommodations to come to town for
their service issues?
Mr. Spector. That same eligibility that I stated is for all
Veterans.
Senator Murkowski. Okay, so it would depend if they had a
30 percent disability or greater, then they would be eligible
for the compensation?
Mr. Spector. They are eligible for travel, yes, and if they
have 30 percent or less, they are eligible for travel if they
are being treated for that condition. So if they have 20
percent for a back injury and they are coming in for treatment
for a back injury, they would be eligible for travel because of
the 20 percent for back.
Senator Murkowski. Then I just want to make sure that I
understand what happens in this two-year period. The gentlemen
that were in front of us in the first panel here, they've just
come home. You have got a minimum of two years free healthcare,
90 days dental. They have not yet gotten their disability
compensation. They haven't done any of that. Are they eligible
to come to town?
Mr. Spector. Under the criteria I just stated, yes.
Senator Murkowski. Under the income criteria?
Mr. Spector. If they are not in service connected. But I
would say in addition, this gets back to our Memorandum of
Understanding with the National Guard, we are going to work
together and look at situations as they occur and figure out
how to get people in if they really need care and we have
agreed to look at individual cases and try to figure out how we
can move people.
In addition, we do have social workers that work with
Veterans that are not eligible for travel to find other
resources possible that they could possibly use to get their
travel taken care of.
Senator Murkowski. What if I am a Veteran, I have gone back
to Chefornak; I believe I need to come back into town for this
treatment. Let's just say it is an ear issue. I talked to
somebody yesterday, hearing loss. If it hasn't been determined
that this hearing loss is a service connected disability, do I
take a gamble in hoping that you are going to pay for my
transportation and lodging in?
What if I get here and you determine that, sorry, you have
been out, you know, you go out hunting and you don't use
protective covering over your ears and it is hunting related as
opposed to--is that a risk that the individual runs?
Mr. Spector. When Veterans enroll for healthcare in the
healthcare system that we have, we do obtain information from
our benefit side as to their percentage of service connection
that is in their record, their healthcare record.
So we would know prior to someone seeking an appointment
whether they are eligible for travel or not and would inform
them.
Senator Murkowski. I am just trying to understand whether
what we are offering these Guardsmen that we just saw here,
whether we are offering them a viable benefit if you happen to
live in a remote and an isolated area where transportation
costs are as high as they are.
If I understand what you are saying, if you make below
$12,000 a year, you are going to be taken care of in terms of
transportation. Well, if you get a Permanent Fund and if you
get a dividend from a Native Corporation, you are probably over
that $12,000 there, but you know, looking at what people are
paying for fuel costs anymore out in our rural communities,
that 12 grand can disappear in an instant.
So I am just trying to understand whether we need to be
doing something different because of the issues that we face
here in Alaska with our isolation and our just very expensive
cost of living?
Mr. Spector. I would say that based on the travel
eligibility, the benefit package for travel eligibility, it
still leaves many challenges for Veterans in rural areas for
their transportation to VA care in Fairbanks, Anchorage and
Kenai. There are many Veterans who struggle with this issue. So
this is not an extensive benefit that supports all of our
Veterans in rural areas.
Senator Murkowski. Have you raised through your chain of
command the question of whether or not the VA should establish
a policy of paying the transportation and lodging for these
vets from these roadless areas across the board so that they
can meaningfully receive these benefits? Has that been an issue
that has been presented?
Mr. Spector. Well, I would say that one of my roles as a
Director of VA Healthcare in Alaska is to advocate for Alaska
and make our Washington and my regional directors aware of the
unique situations in Alaska and I think over the years, we have
increased their awareness as to some of these unique challenges
and have presented to them information that has enlightened
them and educated them as to the situation in Alaska.
So I would say yes, I have advocated and have stated and
have tried to get, just as you and Senator Stevens tried to
get, as many visitors up here to see. You have to see it to
believe it. I have brought VA officials up here and I have
taken them out to the Villages so they can get the picture that
our situation is different, so yes.
Senator Murkowski. We need them to get the picture so that
we can get the funding because if we can't get the funding, you
have got a great benefit on paper, but it doesn't materialize
if that individual simply cannot provide for that trip into
town for the care.
Given that situation then, and this goes back to the
comments raised by Ms. Davidson, it certainly seems very
prudent for the VA to enter into partnerships with the Alaska
Native Healthcare Delivery System to provide for a level of
care through the regional hubs.
Does the VA have the authority to purchase the care for
eligible vets through the Native Healthcare Delivery System?
Mr. Spector. There are certain Veterans that are eligible
for purchased care based on their service connection and other
categories of care. There are certain requirements that care be
preauthorized, that a treatment plan be done and that payment
can occur when VA services are not available.
We do work with the ANTHC system to partner with them as
far as a handoff of patients, but the direct payment to the
Tribal System for care that they provide is not something that
the VA does.
Senator Murkowski. And that is something that I have raised
with Secretary Principi and Secretary Nicholson and now the new
nominee to be Secretary of Veterans' Affairs, General Peak. It
just seems to me that this is where we have got to do it.
If we don't have the authority to do it, if we need the
legislation to make that happen, you have got a system in place
that we can utilize. Let's figure out--you have got one Federal
agency over here and one Federal agency over here. Let's not be
so stovepiped in how this funding works.
In looking at the Memorandum of Understanding between the
VA and the Department of Military and Veterans' Affairs, I note
that in the Goal One, seamless delivery of healthcare services
to rural Veterans, the last bullet is an acknowledgment that
due to lack of access to a VA facility for healthcare, rural
Alaska Native Veterans will probably utilize the Alaska Tribal
Health System.
So there is an acknowledgment that it is happening, but it
seems to me that part of the plan then is to allow for the
Indian Healthcare System to provide for the care for our
Veterans and they will pay for it and we have got to get to the
point where you are taxing an agency that is already
underfunded and VA is essentially getting the coverage that
they need for our Veterans provided through another Federal
agency and I know that this isn't--you and I have talked about
this.
We are on the same page, I think, but we have got to get to
a point where we can get beyond the stovepiped systems because
the care has got to be provided and we have got to figure out a
way that we provide for the transfer of funding from the VA to
reimburse IHS if they are going to be the ones that will
provide this service.
They have been providing the service and we have got to
figure how we make that actually happen, otherwise you are
going to further max out a system that is facing some financial
strain.
One of the things that I find interesting with the
Memorandum of Understanding and I am very pleased as I said,
that one of the goals is this ongoing dialog and discussion.
Let's keep working this through so that we really are moving
ourselves to that point where you have got a seamless
transition. And I have to tell you with all respect to those
that entered into the MOU, when I use the term seamless
transition at the--whether it was at the WTU or when I met with
the vets at the Vet Center up in Wasilla, they all laughed.
They do not believe that we have a seamless transition at this
point. So we recognize that we have got a fair amount to do
there, but the Memorandum of Understanding is between the VA
and the State of Alaska recognizing the need to work with the
Native Healthcare System, but yet, we don't have the Alaska
Native Healthcare System as party to the Memorandum of
Understanding.
So is there an understanding or are you working to provide
for that further cooperative effort between the Alaska Native
Healthcare System and the VA?
Mr. Spector. I think I agree with General Katkus. This is
the beginning. This was a statement between the National Guard
and the VA to work together and it was a message to the rest of
Alaska and our community services and others, come on and join
us and help us in this area and we have had discussions with
Mr. Paul Sherry through the CEO of Alaska Native Tribal Health
Consortium and a member of our Alaska Federal Healthcare
Partnership of bringing, not only ANTHC, but DOD, active duty
Army and Air Force on similar agreements.
They have been at the table with us from the beginning. We
are having ongoing monthly meetings, not only with them, but
also other community social agencies joining this discussion.
So this MOU was a good catalyst to begin a discussion and keep
it going for the future. So it is just a beginning.
Senator Murkowski. Has there been any discussion between
the VA and the Alaska Primary Care Association about perhaps
utilizing the community health centers to deliver care as yet
another option or another vehicle? This is something that I
know has been utilized in at least one other state down in the
Lower 48. Is this something else that we could look at?
Mr. Spector. I think we should look at that, yes. We have
not had extensive discussions about the community health
clinics and also the legal instrument to share with them. These
are things that we are exploring and I am familiar that there
is one state in the Lower 48 and I am very interested to see
how they are doing this so we can learn. Yes, I will explore
that.
Senator Murkowski. Well, we are looking into that as well.
I think what I am taking away from this particular hearing as
well as the series of meetings that I have had over the past
couple of days is we have got to use all of the tools in the
toolbox and to just say that you are a Veteran, so we just go
to--if we build a Veteran's hospital here in Anchorage, we have
solved that problem. That does not solve the access issue to
our Veterans in this state and we are going to have to utilize,
whether it is the Alaska Healthcare Systems through ANTHC,
whether it is our community health centers, we have got to be
utilizing all of it and I think we have got to get beyond the
traditional model that the Lower 48 can use because they are
all connected down there.
I think we have got to stop looking at them as the way that
we operate and we agree that we have to be innovative and if we
are not innovative, we are letting down those who have served
us. So this is an opportunity for us all to kind of get out of
that box and really work on it. So the MOU is a start, but we
need to view that as a very, very preliminary start.
One more question to you, Mr. Spector, and then I will move
onto the rest of the panel here. Mr. Angapak very eloquently
kind of outlined the situation that many of our Veterans
experience, that there just isn't a VA presence out in rural
Alaska that is a meaningful presence.
How can we do a better job of that VA outreach? Do you get
any kind of funding to conduct this outreach? What do we need
to be doing better because it is clearly not satisfactory?
Mr. Spector. Well, we have made several initiatives in
outreach to rural areas. Mr. Angapak mentioned the Bethel area
and YKHC. We have been out there more frequently than he
expressed and most recently, we took a team of eligibility
healthcare experts and mental health experts to all of the
regional or to most of the regional hospitals that accepted our
offer.
We presented information to the healthcare systems and the
regional hospitals regarding Veterans' eligibility, Veterans'
benefits and we presented information on post-traumatic stress
syndrome disorder from our psychiatric staff, presented in-
service education to the primary care physicians and mental
health physicians and behavioral health aides.
We were connected on the video conferencing to the small
Villages in each of those areas and talked about signs and
symptoms and warnings for this problem. We provided information
with our OEF/OIF manager and our transition patient advocate of
how to get people into our system.
If you have people that enter the--Veterans who enter the
Native Healthcare System that would like to come into the VA
system or have a medical or mental health problem that the
regional hospitals need assistance on, here is who you get a
hold of, here is how you get them into the system to bust that
red tape that you hear about and offer these services.
It is still early, as the General mentioned, in the return
of our soldiers to see the effectiveness of our outreach. We
are also working closely with the National Guard again to
return to the National Guard sites and armories throughout
Western Alaska on return visits, 180 days out, one year out
with our mental health staff, with our OEF/OIF manager and
address individual problems if they occur later.
So we continue to have outreach efforts. Our service
organizations in Alaska, also the American Legion, VFW and DAV
visit on frequent basis to these sites also.
One other effort that we are trying to get started, and
Nelson has helped us on this, is what we call our Tribal
Veteran Representative Program, and last year, we offered some
training to Tribal Veteran representative, people from the
various Villages that are trusted Veterans, trusted members of
their Tribe that could present benefit information and
healthcare information, how to access healthcare.
We started out small. We only had two requests, but we are
going to do our training again in February or March. We have
made some other contacts, especially in the Nome area that we
think we are going to increase our representation.
I heard from the earlier panel a good idea of recruiting
some of our returning soldiers perhaps. So we want to explore
that further to provide more information.
I agree with the panel members that I think the number one
complaint I hear from Veterans is we don't know what our
benefits are. We don't know how to access the care and we
continue to try to improve that and work on it and brand that
in areas, but we still have a long ways to go.
Senator Murkowski. Well, I think it is going to be very
important that the VA be viewed as a favorable partner and not
this stranger that you occasionally see somebody from town come
out to the Village.
So to have the Tribal representatives, to have the local
contact within the community is going to be key, but again, who
is going to provide for the funding for this Tribal
representative to get around from community to community?
You can't expect them to pull 400 bucks out of their pocket
to travel from Chefornak to Bethel or wherever. You can't
really ask the IHS to, again, pick up that. You can't shift
those costs. We have got to say well, if we are going to really
provide for meaningful benefits and make sure the people
understand them, we are going to have to figure out how we get
out there again.
So, it is not just allowing for a training and designating
somebody, you then have to give them the ability to get out and
communicate that message. So we have got to be working with you
on that.
I look at the makeup of this table and whether you are
active, you are Guard, the folks within the Healthcare System,
the clergy, the Native leadership, the VA, the Federal
agencies, everybody has got to be sitting down and talking
about what is really happening.
I love goals, they are wonderful, but if you hear that your
goal is not being implemented by General Katkus' guys that are
out there and Valerie says well, you know, this is what we are
getting coming into the clinic here, we have got to have a
level of a clear understanding as to what is really going on.
We have got to figure out how we can make what is available
through the VA and the benefits that have been earned,
understandable so that they are usable, otherwise, they are
nothing more than kind words on paper. And you mentioned, Mr.
Spector, that we are still kind of figuring this out.
I think the frustration that I hear in Nelson's voice is
hey, us guys from Vietnam, we came back 30 years ago plus and
we still haven't received the outreach that we earned and we
deserve. We are still waiting for somebody to come and visit us
and explain to us our benefits.
So we need to recognize that this is an ongoing education.
It is not just with OIE/OIA. This obligation is for as long as
we are going to be around.
Valerie, you wanted to jump in there?
Ms. Davidson. I appreciate your question and your comments
and I think there is another model where that kind of outreach
and education can occur. We have the same challenge in getting
people enrolled in Medicaid, Medicare and SCHIP, and I was
noticing that Commissioner Karlene Jackson is in the audience
today and the State Department of Health and Social Services
really has done an excellent job of providing resources to
Tribal Health Organizations to be able to do outreach and
enrollment efforts for Medicaid, Medicare and SCHIP, which are
also very complicated programs, very challenging for folks to
apply, et cetera, and that is a model that we can look to, to
provide those resources in the local community to be able to
get that message out there, to educate people that there is a
benefit, to clarify and help people fill out the enrollment
forms, and there is one thing that is a little bit interesting
here that we should take advantage of our captive and helpful
audiences where we can.
For example, these folks who are returning are typically
men. If they are married, they have wives. If they are not, the
probably have girlfriends and these ladies are typically the
ones who seek out the benefit and typically the ones who seek
out and encourage them to get healthcare and these are also the
ladies who these returning soldiers are highly motivated to
please after being gone and absent for extended periods of time
and I would venture that if we did outreach efforts to the
ladies in their lives, whether those are their mothers, their
wives, their girlfriends if they are not married or to their
grown daughters, that we are going to have one heck of a
network out there and I, of course, don't have to explain the
power of a lady to you, but it is amazing how much influence a
good woman has in the life of a good man. So I think that is
something we should look at.
Senator Murkowski. It is an excellent idea. You know, when
you think about how, and you all have been there, how your
benefits package is presented to you, and we heard this from
First Sergeant Flynn, who said you know, I get a big packet of
stuff and I am thinking about other things. Who knows where
that packet of stuff went, but when he got home, his wife
probably unpacked things and went through that, but we need--if
we can, again, to kind of think outside the box here.
Maybe we are not using the right messenger to deliver the
important message about the benefits that are available. I
think we can be a little bit more creative. I appreciate that
and I think Reverend Nicholson, you know, from your perspective
as a member of the clergy, the outreach, again, that can go on
from within those circles.
You are not the VA Benefits' rep, but you are in a position
to know and help share information that can be helpful to, not
only the 28-year-old vet, but to some of the more senior vets
as well.
Mr. Spector. Ma'am, if I could address some of that? We had
that very discussion this week about the clergy in Alaska and
reaching out to them and having some sort of educational
session for them. I now have a source, it looks like, to go at
least for the Moravian conference in January perhaps that we
can present some information because many of the clergy will
see problems and people will seek advice from them and, again,
the more information they can have.
If I could address the packets of information in Camp
Shelby? We gave out 300 packets of information to soldiers
recognizing that they probably would not read them there, but
take them home.
Since the return, we have over 200 applications for
healthcare through our system. We have almost processed all of
those. Most of the soldiers are not asking for an appointment
at this time. Most of the Veterans are not asking. They want to
be enrolled in case they need that in the future. So we have
made some progress with the returning soldiers even already.
Senator Murkowski. Let me ask a question to you, Mr.
Angapak, and possibly to Reverend Nicholson as well. Earlier
this week, I was out in the Valley, went out to the Vet Center
there, and I am told that one of the parts of the VA that seems
to be working well is the Vet Center.
They go, they can get some counseling, they get some help,
just kind of understanding the whole process of the benefits
and how it all works, kind of how you work with the system, but
of course, as you know, we don't have any Vet Centers in rural
Alaska.
Should we be asking for the bricks and mortar out there in
rural Alaska, some other way that we can get out to more
Veterans? We recognize that is limiting because then again,
that is in just one regional hub, say Bethel or Nome.
You talk about the outreach that we would like to have,
whether we need to have greater coordination with Native
Veteran outreach and advocacy. What can we be doing better to
address the outreach issue that you have very clearly raised,
Nelson, and you have certainly suggested, Reverend?
Mr. Angapak. Thank you very much, Senator Murkowski. Let me
respond to that question in the following fashion. I am hopeful
that this public hearing is opening the door of us getting out
of the paradigm, thinking outside of the box.
Now, I think as part of that thinking outside of the box,
in the immediate term, I think Vet Centers in rural Alaska is
probably not the best idea in the world. I would venture to say
that VA should consider utilizing the existing healthcare
systems that are already in place.
The infrastructure is there, but I think in order to
utilize the existing healthcare facilities out there, VA should
consider, and including the Indian Health Service, should
consider training our physicians in rural Alaska to deal with
issues that are faced by our Veterans.
I say this because while a psychologist who deals--
psychiatrist and psychologist that deal with general issues of
the public, I think those psychologists and psychiatrists have
to be trained to recognize issues that are faced by our
Veterans, mental health issues like PTSD, that type of thing.
So I think in the immediate term, it seems that the right
thing to do would be to utilize the existing systems. However,
there must be some method whereby the existing healthcare
facilities in rural Alaska are reimbursed for the services that
they provide to our troops out there.
Senator Murkowski. I appreciate it. Reverend Nicholson.
Reverend Nicholson. Yes, let me share just some very brief
comments here. I certainly appreciate in the interest in
allowing the clergy to be involved. I am just one, but I know
that there are a good number of clergy, some top religious
officials that are interested in the welfare of our Veterans
and I can speak from experience during my recent ADSW (ph) for
the Alaska Army National Guard (temorary duty), I spent about a
week visiting to the top bishops and archbishops of the big-
named denominations within this state and I shared with them
the need for Army chaplains in the military, but on the side, I
had an opportunity to find out what their thoughts were in
regards to the welfare of soldiers and their families and I
think there is a lot of information that can be shared and I do
know that, as I alluded to, Bishop Nikolai of the Russian
Orthodox Church, he says Chaplain, come on down. I need you to
speak to all of the clergy in this state during their
conference and address ministry to troops. We know there are
needs there and we are praying daily as clergy, and I suspect
that there are many other mainline denominations that would
like to be involved, but need the information to respond.
I appreciate the fact that spiritual caregiving is treated
as important along with the healthcare delivery. The clergy
within rural Alaska are seen as leaders within their
communities and if there are any problems, usually the clergy
are some of the first responders and that has been my concern.
I know in Panel A, General Katkus shared that United States
Army chaplains within the Alaska Army National Guard context
are available to travel and I have done some of that during
this deployment to meet in the Villages and I have lived in
rural Alaska.
Now I live in Eagle River and getting out there with the
weather and so forth is very, very difficult. We will set the
mission in place. We are going to visit X-number of Villages,
but then we find that only just a small proportion of those
Villages are actually visited.
I think lastly, let me share this, that again, it is a
reiteration that we need to train our clergy since they are
first responders in many cases to recognize PTSD and how to
refer and some of the information that needs to be disseminated
is where to refer them. So that is a key too.
Senator Murkowski. Absolutely.
Reverend Nicholson. Thank you.
Senator Murkowski. General Katkus, I am going to give you
the last word as the leader of these proud warriors. You have
had, anything final that you might like to add at this point in
time, we would certainly welcome that.
Brigadier General Katkus. Senator, thank you for the
opportunity to sit through this panel also and to be here
today. It is very important for me to be aware of what is going
on all across the board.
To tell you that I have been busy the past nine months I
have been in this position would be an understatement. The
opportunities to always hear a good idea are always present and
today was a great opportunity to hear one of the best ideas was
the target audience for some of the benefits being the family
members.
Having been down in Shelby and both, two points of friction
were created as a result of the soldiers initially identified
to WTU staying locally, that caused a lot of friction to get
that turned around where they could come here and our numbers
went from near to 0 to 37 just in that small thing alone. To
say any friction, that was an understatement also.
The other one was slowing down the train on getting them
back to Alaska. The soldiers are so anxious to get back here.
That is absolutely the wrong time to try to get anything to
them. Obviously, when I turned off some jets back there, they
got pretty excited about that, but it was a necessity that had
to be done because those soldiers weren't doing anything except
focus on coming home.
So like I said, I live with the friction I create, but for
the best reasons and I think I will get a lot more bang for the
buck by talking to family members.
So thank you for the opportunity of really driving that
home today. Thank you, ma'am.
Senator Murkowski. I thank you. I thank all of you for
giving us your insight, your testimony today. I think it was
very valuable. I do hope that we take from this, that this is
truly a collaborative effort.
When we say there needs to be a comprehensive plan for our
Alaska Native Veterans, for all of our Veterans, quite
honestly, that means that we all need to be engaged. I think we
have had some good suggestions here today. There is a lot that
we can follow-up on. We will certainly do that on our end and I
would urge you within your respective capacities to do that as
well.
We have got a great deal to offer. We have great successes
in this state despite our challenges and we need to remember
that instead of getting overwhelmed by some of the obstacles
that we face.
Once again, I will remind those that the record on the
hearing will remain open until Friday, December 14th, so if you
want to supplement any statements or anybody else who would
like to provide to that testimony, you can submit it by e-mail
to indian.senate.gov. You can mail it or fax to the Committee
as well.
We do appreciate all of those who have joined us to listen
and, again, I would urge you to in your respective capacities
do what you can to help our Veterans as they come home and
start by first thanking them and then ask what you can do to
help them get a job. With that, we will conclude the hearing
and, again, thank you very much.
[Whereupon, at 12:19 p.m., the Committee was adjourned.]
A P P E N D I X
Prepared Statement of Hon. Byron L. Dorgan,
U.S. Senator from North Dakota
I regret that I cannot join my colleague, Senator Murkowski, at
today's hearing in Anchorage. I am pleased, however, that Senator
Murkowski is chairing today's hearing to receive testimony on the
access to and delivery of health care services to members of the 3rd
Battalion, 297th Infantry Brigade, Alaska National Guard. I understand
these soldiers, many of whom are Alaska Natives, have recently returned
from deployment in Kuwait and Iraq. Today's hearing is one more example
of Senator Murkowski's commitment to improving health care for Native
Americans and Alaska Natives.
I am aware that a higher percentage of Native Americans have served
in the armed forces, and continue to serve today, compared to the U.S.
general population--24 percent versus 19 percent, respectively. I am
also mindful that Alaska Natives play a significant role in the Alaska
National Guard.
I share the Vice Chairman's concern that Native Americans--in
Alaska and in the ``lower 48'' states--who serve in the Middle East and
in Iraq, in particular, face challenges in having access to health care
upon their return from deployment. I look forward to reading the
testimony from today's hearing and learning the recommendations of
today's witnesses regarding how the Department of Veterans Affairs, the
Indian Health Service and the Alaska Native health care delivery system
can improve on providing for the needs of returning veterans. I thank
Vice Chairman Murkowski for her initiative in seeking answers about the
health care services to Alaska Native veterans. I also appreciate that
the witnesses have made time in their schedules to present testimony at
today's field hearing.
______
Supplementary Information of Nelson N. Angapak, Sr., Vice President,
Alaska Federation of Natives
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