Alarming Rate of Veteran Suicides

VA stalling on care, judge told at S.F. trial
Bob Egelko, Chronicle Staff Writer

Tuesday, April 22, 2008

(04-21) 17:30 PDT SAN FRANCISCO -- More than 120 veterans of the wars in Afghanistan and Iraq commit suicide every week while the government stalls in granting returning troops the mental health treatment and benefits to which they are entitled, veterans advocates told a federal judge Monday in San Francisco.

The rights of hundreds of thousands of veterans are being violated by the Department of Veterans Affairs, "an agency that is in denial," and by a government health care system and appeals process for patients that is "broken down," Gordon Erspamer, lawyer for two advocacy groups, said in an opening statement at the trial of a nationwide lawsuit.

He said veterans are committing suicide at the rate of 18 a day - a number acknowledged by a VA official in a Dec. 15 e-mail - and the agency's backlog of disability claims now exceeds 650,000, an increase of 200,000 since the Iraq war started in 2003.

Justice Department lawyer Richard Lepley countered that the VA runs a "world-class health care system." He said the changes the plaintiffs seek in their lawsuit - better and faster mental health care, and more rights for veterans appealing denials of benefits - are beyond the judge's authority.

"Of course we're obliged to provide health care," Lepley said, but "the court does not have standards to determine the speed or the scope or the level of that care."

U.S. District Judge Samuel Conti is presiding over the nonjury trial, scheduled to last two weeks. Conti, a conservative jurist and World War II veteran appointed to the bench by former President Richard Nixon, ruled in January that the case could go to trial. In doing so, he rejected the government's argument that civil courts have no authority over the VA's medical decisions or how it handles grievances.

If the advocates can prove their claims, Conti said in his ruling, they would show that "thousands of veterans, if not more, are suffering grievous injuries as the result of their inability to procure desperately needed and obviously deserved health care."

He also ruled that veterans are legally entitled to five years of government-provided health care after leaving the service, despite federal officials' argument that they are required to provide only as much care as the VA's budget allows in a given year.

But at a later hearing, Conti indicated he was uncertain about his authority to require spending on particular types of health care. The lawsuit plaintiffs - Veterans for Common Sense in Washington, D.C., which claims 11,500 members, and Veterans United for Truth, a Santa Barbara group with 500 members - want him to order the VA to provide immediate treatment for suicidal veterans and prompt care for those suffering from post-traumatic stress.

The trial follows publication of a Rand study last week that estimated 300,000 U.S. troops returning from Afghanistan and Iraq, or 18.5 percent of the total, suffer from major depression or post-traumatic stress.

The lawsuit is a proposed class action on behalf of 320,000 to 800,000 veterans or their survivors. The advocacy groups say the VA arbitrarily denies care and benefits to wounded veterans, forces them to wait months for treatment and years for benefits, and gives them little recourse when it rejects their medical claims.

"The time delays are staggering," Erspamer, the plaintiffs' lawyer, told Conti on Monday. Although the VA says it decides the typical claim for benefits in six months, he said, the agency takes far longer to review post-traumatic stress claims, and four years or more for the government to hear veterans' appeals of denied treatment.

Veterans who seek benefits within the VA's grievance system have no right to a lawyer and no right to demand records or question opposing witnesses, Erspamer said. The plaintiffs want Conti to grant those rights and to require the agency to set a timetable for deciding claims.

Lepley, the government's lawyer, said the VA has undertaken a "huge staff increase" - 20 percent in mental health, 25 percent in claims processing - and now provides one mental health staff member around the clock at every VA center, as well as a suicide-prevention hot line.

For those who do not need immediate care, he said, the agency has a policy of scheduling a mental health appointment within two weeks, and has reached that goal at 80 percent of its facilities.

"These kinds of medical decisions are not something that this court can inject itself into," Lepley said. He referred to the plaintiffs as "single-interest groups" and said the legal rights they seek in the VA benefit system, such as the involvement of lawyers, are "not in the patients' interest."


E-mail Bob Egelko at begelko@sfchronicle.com.