Report from Sec. of VA`s Confirmation Hearing

I had the chance to attend the confirmation hearings for Secretary of Veterans Affairs-designate Gen. Eric K. Shinseki (Ret.) this morning. PTSD and TBI have been called by some (including Sen. Tester today) the "signature" health issues associated with the wars in Iraq and Afghanistan, and as a result have raised the profile of mental health and addiction treatment in the Veterans Health Administration. VHA is the nation's largest health care system (with over 5 million patients), and therefore the Department of Veterans Affairs has a direct and immediate impact on the state of addiction treatment in the U.S. as a whole, in addition to the role it serves for veterans themselves.


Gen. Shinseki walks with President-elect Obama on Dec. 7, 2008, before he is announced as Sec. of VA-designate. Photo used with a Creative Commons license from the Obama-Biden Transition Project's Photostream.

Former Sen. Bob Dole (who authored the Dole-Shalala Report on veterans' health care in 2007) and current Sen. Daniel Inouye from Hawaii made brief statements in support of Gen. Shinseki at the start of the hearing. They both highlighted his impressive resume: West Point graduate, twice wounded in Vietnam (including losing most of his foot, after which he fought to remain on active duty), head of peacekeeping operations in Bosnia, Army Chief of Staff, and, perhaps most famously, his testimony before Congress in February 2003 when he estimated that "several hundred thousand" servicemembers would be needed to occupy Iraq (for which he was publicly rebuked and privately ostracized by others in the Department of Defense).

As all the members of the Senate Veterans Affairs Committee made clear, there was no doubt that Gen. Shinseki would be confirmed. With the pressure off, in some ways that made the senators' and Gen. Shinseki's comments all the more revealing. Here are a few highlights:

• Electronic Medical Records are a top priority of many senators on the VA Committee. The VA has the largest EMR system in the country (and it's often talked about as a model for civilian health IT reform), but the committee members want the VA to integrate their system with the Department of Defense's. Many senators mentioned this, including Sen. Tester, Sen. Wicker, and Sen. Huchinson.
• Sen. Sanders pointed out that the VA is the world leader in many health care areas (like amputations and prosthetics), but it needs to become a world leader in mental health as well.
• Gen. Shinseki's opening statement made three main points: (1) that the VA must be client- (as opposed to customer-) focused, (2) performance benchmarks are necessary for progress and success, and (3) his goal was to transform the VA culture through using the world's best practices, knowledge, and technology.
• He also said, "[T]he Department's workforce will be the leaders and standard-setters in their fields." This can never be the case for addiction treatment if the VA does not require its addiction treatment providers to be licensed or certified in addiction! The Department of Defense requires its addiction professionals to have a license or certification in addiction treatment, but the VA does not. In fact, VA facilities are generally exempted from state licensing requirements explicitly. The VA cannot guarantee its standard of treatment (much less make it "standard-setting") unless it creates an internal licensing or certification requirement.
• Since there were so many good feelings all around, there was a lot of levity during the procedings. At one point, a senator from an eastern state joked with Sen. Tester that he didn't know where Montana was. Sen. Spectre told the story of his father, who was a Russian citizen ordered to go to Siberia by the tsar, so he decided to immigrate to Kansas instead. And the 83-year-old Sen. Inouye joked that former Sen. Dole should be able to give his testimony first because he was older (Sen. Dole is 84).

Gen. Shinseki's appointment vote will take place as early as next week. Today's hearing, including video and opening statements from the Committee Chairman and Ranking Member, can be found here.

What do you see as the VA's top priorities for veterans with substance use disorders?