Call to Order and Roll Call
The 1st meeting of the Interim Joint Committee on Veterans, Military Affairs, and Public Protection was held on Thursday, July 10, 2014, at 1:00 PM, in Room 154 of the Capitol Annex. Senator Jimmy Higdon, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Jimmy Higdon, Co-Chair; Senators Carroll Gibson, Ernie Harris, Christian McDaniel, Dennis Parrett, Albert Robinson, Reginald Thomas, Whitney Westerfield, and Mike Wilson; Representatives Johnny Bell, Robert Benvenuti III, Regina Bunch, Tom Burch, Denver Butler, Dwight D. Butler, Larry Clark, Leslie Combs, Tim Couch, Myron Dossett, David Floyd, Kenny Imes, Martha Jane King, Jimmie Lee, Donna Mayfield, David Meade, Terry Mills, Tom Riner, Rita Smart, John Tilley, and Russell Webber.
Guests: Dr. Ray Biggerstaff, CPT (RET) 101st Airborne Vietnam; Nick Cook, Community and Economic Development Coordinator, Barren River Area Development District; Col. (Ret.) Bill Lytle, Air Force; Heather French Henry, Commissioner, Margaret Plattner, Deputy Commissioner, and Gilda Hill, Kentucky Department of Veterans’ Affairs; Nicole Luddington, MD, Staff Psychiatrist, PTSD Clinical Team, Cynthia Ramminger, LCSW, Program Coordinator, PTSD Clinical Team, and Mary Sweeney, PhD, Staff Psychologist, PTSD/Substance Use Disorder Specialist, PTSD Clinical Team, Robley Rex VA Medical Center; Danny “Greasy” Belcher, Vietnam veteran, Founder of Task Force Omega of Kentucky; and MSgt. (Ret.) Thomas Vance, Air Force; Molly Sawyers, President, VFW Auxiliary 1170; Victoria Burgin and Kim Callis, KYMMS; Joey Allen, Brian Deel, Sara Penn, and Robert Clark II, Veterans for Medical Cannabis.
LRC Staff: Erica Warren, Daniel Carter, Kristopher Shera, and Rhonda Schierer.
Proposed Bowling Green Veterans’ Center
Dr. Biggerstaff, Nick Cook, and Col. Lytle discussed a handout for members that contained information on a proposed nursing home for veterans in Bowling Green, Kentucky. Col. Lytle discussed the need for the nursing home. There are 22,000 veterans in the area, and there is a potential growth of 22,000 veterans just outside the area. Mr. Cook discussed the Community Blueprint Project that focused on eight areas that would improve if a veterans’ nursing home were built in Bowling Green. These areas are education, behavioral health, family strength, employment, reintegration, volunteerism, financial and legal aid, and housing. There was a kick off meeting in 2013 and a follow up meeting in 2014 with the Warrior and Family Support program, Department of Defense, Washington, D.C. The main goal was to sustain and improve the quality of life for service members, families, and families of fallen heroes. Special projects include updating a community resource guide, the veterans initiative of providing in-home visits, and improving efforts to better identify veterans in the area.
Col. Lytle stated that Warren County has excellent healthcare services to support centers and clinics, including a new primary care center that will assist the VA hospital in Nashville in service to the area. Warren County has two regional hospitals with emergency care services and over 250 practicing and registered physicians who support a vast number of health care services.
Col. Lytle stated that the services available in the area include transportation to a VA hospital in Nashville. The lack of travel support from rural areas is always a problem, the need for a facility is increasing, and congressmen from Kentucky will help Bowling Green get on the VA project list when support and funding is passed by the legislature.
Commissioner Heather French Henry discussed the initial application required for state nursing home construction and acquisition grants, and members were provided a copy of an application from the Kentucky Department of Veterans Affairs.
Gilda Hill said there had not been a completed assessment by Kentucky since the Radcliff nursing home. She discussed the needs assessment criteria on the application. The assessment should include demographic characteristics of the veteran population; the number of VA, state, and community based nursing homes beds and the occupancy rate from the previous fiscal year; waiting lists for existing state home programs; plans for acute medical care/emergency care services as required by state home residents; and availability of qualified medical care personnel to staff the proposed facility.
In response to a question from Chairman Higdon, Ms. Hill stated that it would take at least six months to complete a needs assessment, and that the VA is pushing for more in-home care rather than more nursing homes because in-home care is becoming the preferred model.
In response to a question from Representative Dossett, Commissioner French Henry stated that KDVA is looking to partner with community and legislative offices to spread the word in surrounding areas that the Hanson nursing home in western Kentucky has beds available.
In response to a question from Representative Benvenuti regarding soldiers being on long waiting lists for care from VA facilities, Commissioner French Henry stated that the KDVA would look into his recommendation of a pilot project in Kentucky that allows veterans a medical voucher to use non-VA, private facilities for care if they have been on long waiting lists.
In response to questions from Representatives Bell and Tilley, Deputy Commissioner Plattner stated that the Kentucky Military Behavior Health Initiative has partnered with the Department of Behavioral Health and Community Health Centers to create an infrastructure for mental health services and is creating programs to help veterans. Deputy Commissioner Plattner discussed a vision for tele-mental health services for veterans in rural areas.
PTSD Treatment Options
Nicole Luddington, Cynthia Ramminger, and Mary Sweeney, from the Robley Rex VA Medical Center in Louisville, Kentucky, gave a PowerPoint presentation on post traumatic stress disorder (PTSD) protocols and options. Ms. Ramminger stated that the center treats four types of trauma: combat and war-zone trauma, traumatic grief and loss, military sexual trauma and accidents. Common co-morbidities with PTSD in veterans are substance abuse, depression, traumatic brain injuries (TBI), chronic pain, and insomnia. As of February 2014, there were 350,898 veterans with potential or provisional PTSD nationwide. Individuals with PTSD have elevated risk for substance abuse, suicide, relationship issues, homelessness and risk of poor physical health. Patients who are presumed to have symptoms of PTSD or who are positive for PTSD on the initial screening receive a thorough assessment of symptoms. Other psychological testing is utilized when symptoms are complex and multiple diagnoses are under consideration. When assessing trauma exposure, the clinician considers the veteran’s ability to tolerate the recounting of traumatic material, since it may increase distress and exacerbate PTSD symptoms.
Psychotherapy, trauma focused therapy, eye movement desensitization and reprocessing therapy, and group therapy are the evidence-based treatments for PTSD. Other treatments include motivational interviewing, safety treatment, acceptance, and commitment therapy for anger. The center provides services for couples counseling, cognitive behavior therapy for insomnia, suicide prevention, in-home visits, compensated work therapy program, peer support, homeless services, substance abuse treatment, and veteran’s court. There is no medication proven to specifically treat PTSD, but types of medication used for treatment include antidepressants, mood stabilizers, atypical antipsychotics, anticonvulsants, anxiolytics, and sleep aids. Tele-mental health includes individual therapy services and medication management services available to other VA outpatient offices and to the veteran’s home.
In response to a question from Chairman Higdon, Dr. Luddington stated that she is not aware of any evidence confirming that medical marijuana can be successfully used to treat humans with PTSD, but there is anecdotal evidence that it helps. Studies on animals show that it helps extinguish fear.
In response to a question from Representative Benvenuti, Dr. Sweeney stated that if a veteran is using drugs, he or she will not be admitted to residential treatment but will be treated on an outpatient basis.
Danny Belcher and Thomas Vance testified in favor of medical cannabis treatment for PTSD. Mr. Belcher stated that it helped him get off multiple drugs he had been taking for a broken back and PTSD. Thomas Vance stated that he is a senior advisor and a member of the national group, Veterans for Medical Cannabis Access. He stated that he works with veteran medical cannabis patients to help them with the VA system. Mr. Vance presented handouts with information on the VHA Directive 2011-004. This directive provides access to clinical programs for veterans participating in state-approved marijuana programs. Mr. Vance stated that medical marijuana has helped him with PTSD.
Copies of handouts and presentations are included with the official record of the meeting. There being no further business, the meeting adjourned.