Call to Order and Roll Call
The 4th meeting of the Interim Joint Committee on Veterans, Military Affairs, and Public Protection was held on Thursday, October 9, 2014, at 10:00 AM, in room D010 at the Robley Rex Louisville Veterans Affairs Medical Center. Senator Jimmy Higdon, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Jimmy Higdon, Co-Chair; Representative Tanya Pullin, Co-Chair; Senators Carroll Gibson, Ernie Harris, Christian McDaniel, Dennis Parrett, Albert Robinson, Reginald Thomas, and Mike Wilson; Representatives Robert Benvenuti III, Tom Burch, Denver Butler, Dwight D. Butler, Larry Clark, Tim Couch, Jim Glenn, Kenny Imes, Martha Jane King, Terry Mills, Tim Moore, Tom Riner, and Russell Webber.
Guests: Marylee Rothschild, MD, Interim Medical Center Director, Laura Schafsnitz, Activation Team Public Affairs Officer, Helen Booker, Christmas Angel Program, Hugh McCarty, Polytrauma Program Manager, Kelly Marcum, OEF/OIF/OND Case Manager; Eddie Reynolds, Program Manager, and Sara Peterson, Veterans Outreach Coordinator, Brain Injury Alliance of Kentucky; John Mustain, Coordinator of Veterans Services and Community Outreach, Epilepsy Foundation of Kentuckiana.
LRC Staff: Erica Warren, Kristopher Shera, Jessica Causey, and Rhonda Schierer.
Chair Higdon called for a motion to adopt the September 2014 meeting minutes. A motion and a second were made, and the minutes were adopted.
Veteran Access
Dr. Mary Lee Rothschild stated that, since 1952, Robley Rex Veterans Affairs Medical Center (VAMC) has provided services for more than 150,000 Kentuckiana veterans living in 35 counties. It has 107 medical, surgical inpatient beds, psychiatry, and 16 Substance Abuse Residential Recovery Treatment Program beds. There are outpatient clinics in Carrollton, Dupont, Fort Knox, Grayson County, Newburg, and Shively, Kentucky. A new patient access center has opened to provide centralized scheduling of veterans new to Robley Rex VAMC. VAMC has hired additional clinical and scheduling staff to support additional outpatient clinics and has added a primary care team at the Scott County and Ft. Knox community outpatient clinics. The new patient clinics are open Monday through Friday and most Saturdays. New and established patients have less than a 30 day waiting period.
In response to a question from Representative Benvenuti, Dr. Rothschild stated that VAMC accommodates acute urgent patients as needed, and those patients are not included in the less than 30 day waiting period figure because they are seen very quickly.
In response to a question from Senator Gibson, Dr. Rothschild stated that VAMC is assembling an Ebola team and has guidelines for preparation in case of an outbreak.
Replacement
Laura Schafsnitz discussed the replacement of the Robley Rex VAMC. The VA is studying the environmental impact of new medical center construction on the Brownsboro Road site to comply with the National Environmental Policy Act. From 2014 to 2016, design phases will continue to work out details to build the most efficient and effective spaces possible for veteran care. Construction will begin in 2016, subject to Congressional approval and funding. The anticipated grand opening of the Louisville VA Replacement Medical Center is 2023.
In response to a question from Representative Clark, Ms. Schafsnitz stated that the new hospital will be located further from the University of Louisville hospital and the doctors there that help treat VA patients, but other hospitals are transitioning further east. Thus, many of the doctors may actually be closer.
Veterans Access, Choice, and Accountability Act of 2014
Helen Booker discussed the Veterans Access, Choice, and Accountability Act of 2014, which was signed into law on August 7, 2014, by President Obama. National mechanisms are being developed to ensure that the legislation is applied correctly and consistently. The VA medical centers will continue to use their existing authority to see that veterans receive care from other health care organizations when the VA is unable to provide it. Ms. Booker gave a fact sheet to members that explained non-VA emergency care. The fact sheet is part of this official record.
OEF/OIF/OND Program
Kelly Marcum stated that the OEF/OIF/OND Program name is going to be changed soon to the Transition Care Management Teams as large scale missions end and evolve. The post-deployment healthcare team provides a seamless transition from the military to VAMC through case management, referral, and healthcare services. The VA screens for depression, substance abuse, post traumatic stress disorder, military sexual trauma, and traumatic brain injury. The team includes a program manager, two social workers, two RN case managers, VA/DOD liaison, transition patient advocate, chaplain, and program analyst. The team treats walk-in combat veterans and referrals from primary care clinics, VA specialized clinics, emergency departments, inpatient settings, other VA medical centers, family, and friends.
Polytrauma
Hugh McCarty stated that the Polytrauma Traumatic Brain Injury (TBI) Program’s mission is to provide comprehensive traumatic brain injury evaluations and the necessary follow-up for veterans with TBI or polytrauma. Polytrauma consists of two or more injuries, one of which may be life threatening, sustained during the same incident that affect multiple body parts or results in physical, cognitive, psychological, or psychosocial impairments and functional disabilities. The TBI program team includes a polytrauma coordinator, social work case manager, medical doctor, nurse practitioner, neuro-psychologist, patient administrative assistant, physical therapist, occupational therapist, and speech therapist. The clinic is primarily driven by returning combat veterans that screen positive on TBI, but it is open to all veterans. As of October 2, 2014, the Polytrauma TBI Clinic manages 545 cases: 502 males and 43 females. Of the 545 cases, 362 have been injured by blast or explosion. The Robley Rex VAMC had 12,468 returning combat unique patients from FY02 through FY14. A detailed PowerPoint presentation is part of this official record.
Brain Injury Alliance of Kentucky: Grant Update
Eddie Reynolds gave a brief PowerPoint presentation on the mission of the Brain Injury Alliance of Kentucky (BIAK). BIAK’s goal is to reach Kentucky veterans who have returned from overseas deployment with mild TBI. Concussions are the most common cause of mild TBI, and blast injuries are the most common cause of the combat concussions. Under and over pressurization of a blast injury can cause microscopic injuries to the brain that modern imagining technology cannot detect. It is important that soldiers report even the slightest brain injury. The military relies on self-reporting from soldiers before it will consider treatment, and many soldiers deny problems to get home faster. Existing problems may be overlooked a family that is excited to be reunited with the soldier. Some co-occurring symptoms of TBI with PTSD are fatigue, insomnia, depression, irritability, and anxiety.
A brain injury is not considered mild when it effects employment, education opportunities, family relationships, or drugs and alcohol are used to treat the symptoms. The effects upon society when TBI is not properly treated are unemployment, broken homes and domestic violence, substance abuse, homelessness, and incarceration. BIAK’s goal is to reach as many veterans as possible with information about mild TBI, offer a confidential contact, connect them with the appropriate resource for diagnosis, help them learn the benefits they may receive, offer tips to cope with some of the symptoms, and offer a community of other veterans. BIAK works with the Kentucky National Guard, Kentucky Department for Veterans Affairs, Kentucky Department for Behavioral Health, Kentucky Appalachian Rural Regional Network, Joint Executive Committee of Veterans Organizations, VA Hospitals, veteran centers, and the Association of the United States Army to identify and serve veterans. Mr. Reynolds introduced BIAK’s new Veterans Outreach Coordinator, Sara Peterson. BIAK’s PowerPoint presentation is part of this official record.
Epilepsy Foundation of Kentuckiana: Grant Update
John Mustain testified about the Epilepsy Foundation of Kentuckiana’s work with veterans who experience seizures. One in 26 people will develop epilepsy. There are nearly 500 new cases every day, and the risk of developing epilepsy is increased in veterans. There is a significant probability that these veterans will develop Post Traumatic Epilepsy (PTE). Mr. Mustain discussed Operation Outreach, which has a mission to raise public awareness of PTE in the OEF/OIF/OND veteran population, raise clinician awareness of PTE and psychogenic non-epileptic seizures, and assist veterans in connecting with services to improve quality of life. Operation Outreach maintains its presence through a website, FaceBook, LinkedIn, Twitter, and Tumblr. These links are listed on the PowerPoint presentation that is part of this official record.
There being no further business, the meeting was adjourned. Upon adjournment, committee members and staff toured the Robley Rex Medical Center.