Legislature(2015 - 2016)ANCHORAGE

07/28/2015 09:30 AM MILITARY & VETERANS' AFFAIRS

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Audio Topic
09:37:57 AM Start
09:38:29 AM Presentation: North Star Behavior Health System,
10:36:26 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Location: North Star Hospital, 2530 DeBarr Road
+ North Star Behavioral Health System: TELECONFERENCED
- Counseling for PTSD
- Substance Abuse and Dependence
Discussion by:
- Dr. Debbie Guris & Dr. Michael Alcorn, Staff
Psychiatrists, Military Program; Andy Lanning,
Corporate Military Liaison, UHS Patriot Services;
Admiral William McDaniels, Patriot Support
Advisory Board, North Star Behavioral Health
- Dr. Ann Hutcheson, Interim Chief of Psychology,
and PTSD/SUD Psychologist & Laura MacKinzie,
Chief of Outpatient Alcohol Treatment Program,
Veterans' Administration Healthcare System
- Taya Kyle (Tentative), Author, "American Wife:
A Memoir of Love, War, Faith and Renewal"
-- Testimony <Invitation Only> --
** Streamed live on AKL.tv - AUDIO only **
                    ALASKA STATE LEGISLATURE                                                                                  
   HOUSE SPECIAL COMMITTEE ON MILITARY AND VETERANS' AFFAIRS                                                                  
                         July 28, 2015                                                                                          
                           9:37 a.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Bob Herron, Chair                                                                                                
Representative Gabrielle LeDoux, Vice Chair                                                                                     
Representative Jim Colver                                                                                                       
Representative Shelley Hughes                                                                                                   
Representative Chris Tuck                                                                                                       
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Bob Lynn                                                                                                         
Representative Max Gruenberg                                                                                                    
Representative Chris Tuck                                                                                                       
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION: NORTH STAR BEHAVIOR HEALTH SYSTEM - COUNSELING FOR                                                                
PTSD, SUBSTANCE ABUSE, AND DEPENDENCE TREATMENT FOR VETERANS                                                                    
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
DEBORAH GURIS, M.D.                                                                                                             
Staff Psychiatrist                                                                                                              
North Star Behavioral Health                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Discussed PTSD and substance abuse.                                                                      
                                                                                                                                
MICHAEL ALCORN, M.D., Psychiatrist                                                                                              
North Star Behavioral Health                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Discussed PTSD and substance abuse.                                                                      
                                                                                                                                
ANDY LANNING                                                                                                                    
Chief Master Sergeant, Air Force, (Ret)                                                                                         
Division Director of Military Programs                                                                                          
Universal Health Services Patriot Support Program                                                                               
Kansas City, Missouri                                                                                                           
POSITION STATEMENT:  Discussed program facilities across the                                                                  
country.                                                                                                                        
                                                                                                                                
WILLIAM J. MCDANIELS, M.D.                                                                                                      
Rear Admiral, U.S. Navy, (Ret)                                                                                                  
Universal Health Services Patriot Support Program Board Member                                                                  
Kansas City, Missouri                                                                                                           
POSITION STATEMENT:  Discussed treatment and recovery.                                                                        
                                                                                                                                
LAURA MACKINZIE                                                                                                                 
Alaska Veterans Administration Healthcare System                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Discussed veteran homelessness and alcohol                                                               
abuse.                                                                                                                          
                                                                                                                                
ANN HUTCHINSON, PsyD.                                                                                                           
Interim Chief of Psychology                                                                                                     
Alaska Veterans Administration Healthcare System                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Discussed PTSD and substance abuse.                                                                      
                                                                                                                                
VERDIE BOWEN, Director                                                                                                          
Office of Veterans' Affairs                                                                                                     
Alaska Department of Military and Veterans' Affairs (VA)                                                                        
Anchorage, Alaska                                                                                                               
POSITION    STATEMENT:       Discussed   the    Alaska   Veterans                                                             
Administration Healthcare System payment procedure.                                                                             
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
9:37:57 AM                                                                                                                    
                                                                                                                                
CHAIR BOB HERRON  called the House Special  Committee on Military                                                             
and   Veterans'   Affairs  meeting   to   order   at  9:37   a.m.                                                               
Representatives  LeDoux, Hughes,  Tuck, Colver,  and Herron  were                                                               
present at the call to order.                                                                                                   
                                                                                                                                
9:38:29 AM                                                                                                                    
                                                                                                                                
^PRESENTATION: NORTH STAR BEHAVIOR HEALTH SYSTEM,                                                                               
COUNSELING FOR PTSD, SUBSTANCE ABUSE, AND DEPENDENCE                                                                            
TREATMENT FOR VETERANS                                                                                                          
        PRESENTATION: NORTH STAR BEHAVIOR HEALTH SYSTEM,                                                                    
      COUNSELING FOR PTSD, SUBSTANCE ABUSE, AND DEPENDENCE                                                                  
                     TREATMENT FOR VETERANS                                                                                 
                                                                                                                              
9:39:29 AM                                                                                                                    
                                                                                                                                
DEBORAH GURIS,  M.D., Staff  Psychiatrist, North  Star Behavioral                                                               
Health,  advised  that  substance   abuse  disorder  involves  10                                                               
separate  classes   of  drugs,  including   alcohol,  stimulants,                                                               
opioids, [indisc.] are issues in  the State of Alaska.  [Indisc.]                                                               
activating and  repeated activation  of the [indisc.]  system and                                                               
when  they  are  in  excess behavior  associated  with  these  in                                                               
assessing, many  of which are  not adaptive, and lead  to intense                                                               
[indisc.]   experienced  by   the   individual  [indisc.]   abuse                                                               
[indisc.].  She explained they  diagnose substance abuse disorder                                                               
based  on the  amount [indisc.]  associated with  an individual's                                                               
abuse.  Behaviors can be  classified into three major categories:                                                               
(1) Impaired  control as patients  use larger amounts and  over a                                                               
greater  period  of  time they  originally  intended  and  report                                                               
repeated attempts  to cut down  or [indisc.] and spend  more time                                                               
either  trying to  [indisc.]  or recover  [indisc.].   The  usual                                                               
experience is  then [indisc.] when  exposed to  the environmental                                                               
substance abuser  and that  could lead  to relapsing;  (2) social                                                               
impairment  as  when  individuals  suffer  from  substance  abuse                                                               
disorder over time  they fail to provide  major goal obligations,                                                               
their families, work, and community,  and continue to use despite                                                               
negative consequences in those areas  and ignore [indisc.] family                                                               
obligations  [indisc.].    They  repeatedly  go  into  high  risk                                                               
situations  in  order  for  [indisc.]  substance  infraction  and                                                               
continue using despite  the fact they have  experienced some type                                                               
of  physiological  impairment  from   the  drugs  such  as,  mood                                                               
disorder,  repeated   intoxication  withdrawal,   liver  ailment,                                                               
[indisc.].    With most  drugs,  people  build up  tolerance  and                                                               
increase their  use of  drugs if  they have been  using it  for a                                                               
long  time.   She pointed  out  that with  alcohol, for  example,                                                               
withdrawal  syndrome precipitated  by  discontinuing  use can  be                                                               
dangerous or life  threatening.  There is a very  high problem of                                                               
substance abuse disorder and it can  affect anyone in any walk of                                                               
life.    [Indisc.]  and for  alcohol  [indisc.]  substance  abuse                                                               
disorder  [indisc.].   [Indisc.]  which  increases [indisc.]  for                                                               
inherent and  [indisc.] substantive  function.  She  advised they                                                               
found  that   substantive  [indisc.]  caused  the   disorder  and                                                               
prolonged  use can  lead to  nerve  impairment.   When a  patient                                                               
first arrives, she explained, a  thorough assessment is performed                                                               
to identify  the nature of  the substance abuse  disorder, nature                                                               
of substances  used, the degree  of inherent and  substance abuse                                                               
disorder,  and identify  any  [indisc.]  disorder or  preexisting                                                               
disorder  [indisc.]   if  necessary   perform  neuropsychological                                                               
testing.     [Indisc.]   they  carefully   use  medication   when                                                               
appropriate  to address  any [indisc.]  mood  disorder and  offer                                                               
medication that may  assist with the patient  moving to sobriety.                                                               
Within  group psychotherapy,  the focus  is on  education as  the                                                               
patients learn  about substance abuse  disorder, but  they suffer                                                               
from [indisc.]  and understand there  are triggers  in developing                                                               
coping skills [indisc.].  [Indisc.] suffering.                                                                                  
                                                                                                                                
9:46:58 AM                                                                                                                    
                                                                                                                                
CHAIR  HERRON asked  whether  combat  victims of  PTSD  are at  a                                                               
higher risk  versus post-traumatic events happening  in lives not                                                               
related to combat.                                                                                                              
                                                                                                                                
9:47:10 AM                                                                                                                    
                                                                                                                                
DR.  GURIS  responded that  the  percentage  of [indisc.]  combat                                                               
victims but  certainly [indisc.]  in the  risk factor  in general                                                               
[indisc.].                                                                                                                      
                                                                                                                                
9:47:42 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX surmised that Dr.  Guris could not speak to                                                               
the  percentage of  PTSD soldiers  with substance  abuse problems                                                               
versus the general population.                                                                                                  
                                                                                                                                
9:48:12 AM                                                                                                                    
                                                                                                                                
DR. GURIS responded that she cannot answer that question.                                                                       
                                                                                                                                
9:48:17 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TUCK  noted that  substance abuse  disorders could                                                               
lead to  mood disorders  and asked  whether mood  disorders could                                                               
lead to substance abuse disorders.                                                                                              
                                                                                                                                
9:48:34 AM                                                                                                                    
                                                                                                                                
DR.  GURIS replied  that  often those  events  co-occur and  when                                                               
talking  about   substance  abuse  disorder  it   is  known  that                                                               
depression [indisc.] alcohol, sedatives,  and [indisc.] over time                                                               
can lead to [indisc.]  usually for four to six weeks.   It is not                                                               
known  that [indisc.]  lead [indisc.]  but it  is known  they are                                                               
highly [indisc.].                                                                                                               
                                                                                                                                
9:49:23 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HUGHES  asked whether  suicide risk  and substance                                                               
abuse  is higher  in Alaska  as opposed  to other  places in  the                                                               
nation.                                                                                                                         
                                                                                                                                
DR. GURIS [indisc.] military but  in general substance abuse is a                                                               
high risk  factor [indisc.] assessments improve  their ability to                                                               
assess.                                                                                                                         
                                                                                                                                
9:50:05 AM                                                                                                                    
                                                                                                                                
MICHAEL  ALCORN,   M.D.,  Psychiatrist,  North   Star  Behavioral                                                               
Health, said he  was recently discharged from  the military where                                                               
he had  been working  with the  active duty  military population.                                                               
He  noted  that during  the  first  part  of  his practice  as  a                                                               
psychiatrist  trained  in  a  Veteran's  Administration  Hospital                                                               
regarding PTSD and  substance abuse issues.  He  pointed out that                                                               
PTSD and traumatic  brain injury have been  the cardinal injuries                                                               
of  the Iraq  and Afghanistan  wars, and  statistics reveal  that                                                               
2004-2012  the rate  of PTSD  in  military retirees  rose from  4                                                               
percent to  20 percent.   During the period 2003-2013  the number                                                               
of service connected disability cases  for PTSD rose from 109,000                                                               
to  over 653,000,  and  overall  PTSD is  the  third most  common                                                               
disability amongst  military retirees involving hearing  loss and                                                               
ringing in  the ears.  The  increase overall for PTSD  cases, and                                                               
PTSD  hospitalizations from  2006-2012 increased  by 192  percent                                                               
and  he  noted that  PTSD  is  at  the  point of  condition  that                                                               
requires  a lot  of treatment.   During  his practice  of working                                                               
PTSD patients, and also training  medical students and psychiatry                                                               
residents he pointed  out that it is a very  diverse condition as                                                               
there  are no  stereotypical PTSD  patients.   He said  there are                                                               
typically 20  symptoms when  evaluating a  diagnosis and  among 4                                                               
different  categories   in  that   an  individual  must   have  a                                                               
combination of  6 of the  20 symptoms.   He calculated  there are                                                               
clinically over  636,000 combinations  of symptoms that  can make                                                               
up  the diagnosis  for  a different  patient.   Due  to that,  he                                                               
trains  people  that  PTSD  can   only  be  on  the  differential                                                               
diagnosis partly because  trauma in general is high  even for the                                                               
general population.   Not everyone  that is  traumatized develops                                                               
PTSD  as possibly  one-third  of people  exposed  to trauma  will                                                               
develop PTSD.  He remarked that  the rates are so high he teaches                                                               
people that any mental health  guidelines [indisc.] really anyone                                                               
who is in and out of  [indisc.] screen for exposure to trauma for                                                               
PTSD.  A  person diagnosed with PTSD can look  like they are very                                                               
depressed,  anxious,  preoccupied  with  [indisc.]  concentration                                                               
problems, ADHD, and often before  they come to the clinic develop                                                               
substance abuse  issues, and  no matter what  they come  in with,                                                               
PTSD  is  something  the  doctors   are  always  looking  for  to                                                               
determine whether this is a case.                                                                                               
                                                                                                                                
9:54:37 AM                                                                                                                    
                                                                                                                                
DR. ALCORN  continued that the  symptoms they are going  with are                                                               
very  diverse,  every  patient  with  PTSD  can  take  their  own                                                               
[indisc.]  or  patients will  develop  the  first symptoms  flare                                                               
shortly after they  are exposed to the trauma, but  other times a                                                               
patient  can go  years or  decades without  their first  symptoms                                                               
flare.    Likewise,  he  related, that  some  patients  are  very                                                               
sensitive  and  anything   psychologically  stressful  can  cause                                                               
symptoms  that  flare  whereas other  patients  need  a  specific                                                               
reminder that reminds  them of the trauma, such  as smell, sound,                                                               
or  place.   When  it  comes to  aligning  a  treatment plan  the                                                               
doctors consider out-patient treatment,  in-patient, what do they                                                               
need, and  must evaluate  the patient  where they  are at.   Out-                                                               
patient therapy  has a  good chance  of succeeding  when patients                                                               
are ready  to get  their experience  off their  chest and  form a                                                               
therapeutic relationship  and talk.  Whereas  other patients have                                                               
tried to avoid  thinking about or talking  about their experience                                                               
and for those individuals out-patient  wouldn't work because they                                                               
cannot get  comfortable when seeing  their therapist once  a week                                                               
and  a level  of  trust  can't be  developed  in  order to  raise                                                               
themselves to reveal  the things they've experienced.   He opined                                                               
that sometimes with  PTSD there is a lot of  shame and guilt that                                                               
goes  along  with  it,  and   the  doctors  determine  whether  a                                                               
residential treatment program would be  better where they can see                                                               
their  therapist  every day,  break  through  and build  a  trust                                                               
relationship,  and progress  with  their treatment.   Dr.  Alcorn                                                               
commented  that the  program is  structured in  a manner  that is                                                               
consistent with  the evidence as  the first phase of  the program                                                               
is  working  with the  patient  developing  their coping  skills,                                                               
making  sure they  are comfortable,  and build  a level  of trust                                                               
before  they  are pushed  into  the  next  phase in  starting  to                                                               
address their  trauma and  work through those  issues.   Over the                                                               
last five-seven years,  he noted, there is a  benefit to offering                                                               
a program  in Alaska and working  with the military.   He advised                                                               
they have sent a large number  of patients from the clinic to the                                                               
lower-48  for residential  treatment either  for PTSD,  substance                                                               
abuse, or both.  It has  been successful for some of the patients                                                               
but, he  described, definite challenges  in that it  is difficult                                                               
to provide  family therapy and  services to the family  that will                                                               
need to  work with the  patient when  they return to  their home.                                                               
He offered  there are programs  tied to teleconferencing,  but it                                                               
is not the same and frequently  sees that patients come back from                                                               
the  lower-48  and  look  improved   during  their  first  visit.                                                               
Unfortunately, rapidly  thereafter they  change to how  they were                                                               
before they  went to  treatment and it  triggered an  increase in                                                               
symptoms.   Within out-patient treatment,  he said,  he initiates                                                               
the family  therapy component  and provides  psycho-education for                                                               
the  individual's  trusted  figure  so  at  least  they  have  an                                                               
elementary understanding of PTSD,  and understand why the patient                                                               
experiences  symptoms.   He  noted  that  he includes  discussing                                                               
changes the  family can make  at home or work  so it is  a little                                                               
more tolerable  for the patient.   He conveyed that  having local                                                               
programs available is also beneficial  cost-wise as patients sent                                                               
to the  lower-48 requires  an escort.  [Indisc.] Anchorage  or in                                                               
Alaska  for the  soldier  [indisc.] and  how  [indisc.] with  the                                                               
program  here.   The ability  to treat  both substance  abuse and                                                               
PTSD under  the same  roof is  vital as  many patients  with PTSD                                                               
look for any way possible  to make their symptoms more tolerable,                                                               
he  pointed  out.   Treating  a  person  with a  substance  abuse                                                               
problem  to  fully  engage  in PTSD  treatment  therapy  must  be                                                               
treated at  the same time  otherwise facing their  trauma becomes                                                               
that  much  more difficult  when  treatment  is sequentially,  he                                                               
opined.                                                                                                                         
                                                                                                                                
10:01:22 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE LEDOUX surmised there has  been a huge increase in                                                               
the number of diagnosed PTSD cases.   She asked whether there are                                                               
more  PTSD cases  in those  increased numbers  or whether  it has                                                               
something to do  with the focus put on PTSD  and the diagnoses of                                                               
PTSD.   She pointed out  that the  cases that might  be diagnosed                                                               
now with PTSD may not have been diagnosed previously.                                                                           
                                                                                                                                
10:01:56 AM                                                                                                                   
                                                                                                                                
DR. ALCORN responded there are  a combination of things that play                                                               
into the increase in PTSD.   He pointed out the previously it was                                                               
called  "shell shock,"  and currently  people would  be diagnosed                                                               
with  PTSD,  including schizophrenia.    He  described a  greater                                                               
awareness of  PTSD with regard  to the Iraq and  Afghanistan wars                                                               
including advances in battle field  medicine and technology which                                                               
allows a lot of soldiers  to survive wounds they previously would                                                               
not have.   While that  is a good thing,  obviously psychological                                                               
trauma  becomes more  prominent, especially  later in  life.   He                                                               
noted  that  the  military  must  determine  whether  PTSD  is  a                                                               
legitimate diagnoses, whether they are  they trying to mimic what                                                               
their buddy  just said, or trying  to gain their symptoms.   When                                                               
diagnosing PTSD, there are different  psychological tests and the                                                               
more information  the patient can  offer the more helpful  it is,                                                               
he remarked.                                                                                                                    
                                                                                                                                
10:03:26 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE  LEDOUX asked  whether a  physical injury  must be                                                               
involved or another person's injury observed.                                                                                   
                                                                                                                                
10:03:37 AM                                                                                                                   
                                                                                                                                
DR. ALCORN replied it can  be witnessed or even repeatedly listen                                                               
to  an event  in  stories.   He  related  that  if the  soldier's                                                               
response  at the  time of  observing or  witnessing it  indicates                                                               
they're significantly  affected, a soldier can  be diagnosed with                                                               
PTSD.   He  said it  is fairly  rare that  he has  diagnosed PTSD                                                               
involving [indisc.]  in some way  experienced it  directed toward                                                               
themselves.  He  offered that possibly the soldier  does not have                                                               
the  actual physical  injury, although  [indisc.] five  feet away                                                               
from them  and didn't explode but  assumed they were going  to be                                                               
killed.  He opined that it  is rare someone watching a program on                                                               
television or hears something is diagnosed with PTSD.                                                                           
                                                                                                                                
10:05:02 AM                                                                                                                   
                                                                                                                                
ANDY LANNING,  Chief Master Sergeant, Air  Force, (Ret), Division                                                               
Director of Military Programs,  Universal Health Services Patriot                                                               
Support  Program,  [Indisc.]  said  there  are  over  27  medical                                                               
surgery  facilities across  the country,  including Puerto  Rico,                                                               
Virgin Islands, and  England, with continued care.   He said that                                                               
within  that piece  is  the Patriot  Support  Program and  almost                                                               
eight  percent of  the facilities  are affiliated  with [indisc.]                                                               
and  people are  seen from  [indisc.] down  to 4-years  old.   He                                                               
explained  that  the  Patriots  Support  Program  is  focused  on                                                               
veteran  and  active  duty  service members  and  noted  that  14                                                               
facilities  have dedicated  programs  similar to  the Chris  Kyle                                                               
Program  in  Anchorage with  a  dedicated  treatment program  for                                                               
active  duty members  and veterans.    He explained  that at  the                                                               
height  of the  wars it  was  determined that  veterans react  to                                                               
treatment better  when in groups as  they go through some  of the                                                               
trauma cases,  combat trauma and  stresses of military  life, and                                                               
felt better  corresponding with their  brothers and sisters.   He                                                               
advised that  was the prelude  to opening facilities  in treating                                                               
substance  abuse, combat  trauma, [indisc.]  and military  sexual                                                               
trauma for females and men.   In addition to that, last year they                                                               
have 13 other basic core  service centers with programs [indisc.]                                                               
established,  all  are  best practices  and  repeated  visits  to                                                               
facilities  to  ensure  that  the  core  executive  programs  are                                                               
[indisc.] hit or miss with the  civilian population.  Some of the                                                               
installations are uncomfortable with  that, they may be [Indisc.]                                                               
out in [indisc.]  integration in with the  civilian population is                                                               
actually   beneficial  to   them  to   learn  social   skills  to                                                               
reintegrate  back into  civilian  life after  living solely  with                                                               
military members.   He  referred to  the Military  Advisory Board                                                               
which  includes seven  officers, military  consultants, [indisc.]                                                               
medical integrity programs [indisc.].   He advised he spent a lot                                                               
of  time  at  facilities regarding  communication,  understanding                                                               
military culture,  and providing  training for doctors  and staff                                                               
that  have not  been in  the military  as to  the culture  of the                                                               
military  and when  men and  women come  in, staff  has a  better                                                               
understanding of military life.                                                                                                 
                                                                                                                                
10:09:35 AM                                                                                                                   
                                                                                                                                
WILLIAM  J.  MCDANIELS, M.D.,  Rear  Admiral,  U.S. Navy,  (Ret),                                                               
Universal Health  Services Patriot Support Program  Board Member,                                                               
[Indisc.] advised  an effective way  to treat recovery is  to get                                                               
groups together  and talk it out,  and is involved in  the 28-day                                                               
program [indisc.]  that turns out  to be  phenomenally effective.                                                               
[Indisc.] when  veterans came home  from World War II  they spent                                                               
three weeks  on a cruise ship  with 5,000 buddies all  in unknown                                                               
pain and trauma with  nothing to do on the ship  except talk.  In                                                               
this manner, he explained, the  returning soldiers provided their                                                               
own therapy extremely well [indisc.]  but in fact it was believed                                                               
one of  the reasons it  continued [indisc.] than what  occurs now                                                               
is [indisc.]  blown up [indisc.]  back with their family  with no                                                               
chance  to  decompress  and  no chance  to  compare  events  with                                                               
military friends, and  no chance to talk it out.   He said that's                                                               
hard  [indisc.]  tracking   inefficacies,  rapid  diagnosis,  and                                                               
patient  [indisc.].    The history  of  this  disease  [indisc.].                                                               
[Indisc.] three  two-star and three three-star  adjutant generals                                                               
from the  Army, Navy, and  Air Force,  two two-star and  one one-                                                               
star [indisc.].   These individuals  have all been to  combat and                                                               
dealt  with this  condition [indisc.]  all of  their professional                                                               
lives and all continue to have  the desire to still give the best                                                               
treatment possible to  the people who were once  under their care                                                               
and in  their memories.   He pointed  out that  these individuals                                                               
have  many  opportunities,  as [indisc.]  officers  to  serve  on                                                               
various committees and everyone  wants to just because [indisc.].                                                               
Previously they  very carefully looked  around at  systems trying                                                               
to [indisc.]  and when they  were approached by  Universal Health                                                               
Services  (UHS) as  to whether  they  would be  interested in  an                                                               
endeavor  with  them they  looked  very  carefully [indisc.]  and                                                               
realized that  what UHS  was doing follows  very closely  to what                                                               
they aspired  to do which  is to give  the best help  possible to                                                               
the young men and  women who put their lives on  the line for the                                                               
nation.   [Indisc.]  and that  is what  they do.   [Indisc.],  he                                                               
advised  he  is  an  orthopedic  surgeon  [indisc.]  and  usually                                                               
[indisc.] giving a talk in that very profession but [indisc.].                                                                  
                                                                                                                                
10:13:17 AM                                                                                                                   
                                                                                                                                
CHAIR HERRON  asked what is  the Universal Health  Services (UHS)                                                               
and why did Admiral McDaniel affiliate himself with it.                                                                         
                                                                                                                                
10:13:35 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE LEDOUX  questioned whether  Dr. McDaniel  has seen                                                               
an increase in  PTSD because people go from a  battle zone to the                                                               
states in  a brief period of  time instead of being  on a carrier                                                               
for 18  days having  a chance to  decompress with  their buddies.                                                               
She  suggested  going back  to  a  carrier  system to  bring  the                                                               
soldiers back  to the states  or some  sort of camp  or something                                                               
for them to decompress.                                                                                                         
                                                                                                                                
DOCTOR MCDANIEL responded that they  have [indisc.] with that but                                                               
the  answer is  political as  these  people have  been gone  6-12                                                               
months, they  get [indisc.] if they  know that in the  event they                                                               
show symptoms of PTSD and will  be held someplace for three weeks                                                               
for treatment, he guarantees there  will be no signs or symptoms.                                                               
Then [Indisc.] political windstorm that  no one would survive and                                                               
that  is [indisc.]  war  zones  and can't  see  their family  for                                                               
another three  weeks as  they will  be held  just in  case, would                                                               
never  work.   He offered  that the  idea had  been discussed  at                                                               
length and  disregarded as  it absolutely  politically impossible                                                               
[indisc.].   [Indisc.]  using blood  tests  and behavioral  tests                                                               
before they go [indisc.] and  before they come back [indisc.] but                                                               
people  will  hide  if  they  think  there  is  any  chance  that                                                               
[indisc.]  their  family and  friends.    [Indisc.] there  are  a                                                               
number of groups  around the country that  approached the Patriot                                                               
Support  Advisory  Board  [indisc.]   who  want  to  be  involved                                                               
[indisc.].  A program must  have a majority [indisc.] or military                                                               
associated  programs  [indisc.]   and  must  understand  military                                                               
culture.  He  remarked that some of the  psychiatric groups don't                                                               
[indisc.] they  think any [indisc.]  facts will do.   The Patriot                                                               
Support Advisory Board believes the  culture of having a military                                                               
[indisc.] and  need to have a  program set up so  there are three                                                               
choices in the military and  [indisc.] what you do here [indisc.]                                                               
you have  [indisc.] program and  get up  every morning and  go to                                                               
physical  therapy, which  many veterans  have  twice a  day.   He                                                               
pointed out that there must be  a regiment very akin to what they                                                               
underwent in  the military  and that  is what UHS  does and  if a                                                               
program is  set up as  closely as  possible to what  veterans are                                                               
accustomed  to  in their  military  lives,  the results  will  be                                                               
better.  He said that UHS  offers those programs which is why the                                                               
Patriot Support Advisory Board chose to associate with it.                                                                      
                                                                                                                                
10:17:19 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE LEDOUX asked whether  Universal Health Services is                                                               
a governmental agency or non-profit.                                                                                            
                                                                                                                                
10:17:44 AM                                                                                                                   
                                                                                                                                
DOCTOR  MCDANIELS   answered  that   [indisc.].     The  founding                                                               
gentleman of Universal  Health Services is in  Anchorage and will                                                               
make the  dedication this morning.   He [indisc.]  very patriotic                                                               
and believes  in it totally  which is one  of the reason  for the                                                               
dedication today.  [Indisc.].                                                                                                   
                                                                                                                                
10:18:05 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE HUGHES  referred to previous  discussion regarding                                                               
increases   in   veterans   [indisc.]  active   duty   [indisc.].                                                               
[Indisc.]  Viet  Nam  [indisc.]  so   they  are  managing  it  on                                                               
[indisc.] and help them [indisc.].   [Indisc.] mission but does a                                                               
person once  identified [indisc.]  do they  ever recover  or will                                                               
always require services throughout their lifetime [indisc.].                                                                    
                                                                                                                                
10:19:11 AM                                                                                                                   
                                                                                                                                
DOCTOR  MCDANIELS  responded  [indisc.] there  are  varieties  of                                                               
grief  issues [indisc.]  function  throughout  their lives,  they                                                               
don't have episodes.  He  offered that within his experience when                                                               
they  get stressed  they may  [indisc.].   [Indisc.].   The  vast                                                               
resources are in  that [indisc.].  [Indisc.] a  very small amount                                                               
of [indisc.] just  since [indisc.].  [Indisc.].   He advised that                                                               
he spoke  long ago on  this condition and hired  professionals to                                                               
work  together in  Seattle, and  thought [indisc.]  on the  other                                                               
side of the  bar there are [indisc.].   He said the  Viet Nam era                                                               
[veterans]  have learned  to treat  themselves.   Successfully he                                                               
couldn't say but in fact they get along in the [indisc.].                                                                       
                                                                                                                                
10:20:52 AM                                                                                                                   
                                                                                                                                
LAURA  MACKINZIE,   Alaska  Veterans   Administration  Healthcare                                                               
System,  [Indisc.]  active  duty service  members  and  veterans.                                                               
[Indisc.]  located  at  the  [indisc.]  facility  which  provides                                                               
residential treatment  for both homeless veterans  and [indisc.].                                                               
She said  [indisc.] provides comprehensive  residential treatment                                                               
which is  greatly needed  for this  population.   Substance abuse                                                               
and mental health services [indisc.]  there are an estimated 23.4                                                               
million  veterans  in the  United  States  and approximately  2.2                                                               
million will  [indisc.].  Within  Alaska there  are approximately                                                               
77,000 veterans  and 25,000  active service  members.   She noted                                                               
Alaska  has the  highest per  capita numbers  of veterans  in the                                                               
country.    The  demanding  environment   of  military  life  and                                                               
experiences   of  combat   during  which   they  may   experience                                                               
psychological distress  can be  further complicated  by substance                                                               
abuse and related disorders, she  remarked.  Many service members                                                               
face critical issues, such as  trauma, suicide, homelessness, and                                                               
toward  [indisc.] emotions,  and approximately  [indisc.] percent                                                               
of service members returning from  Iraq and Afghanistan have Post                                                               
Traumatic Stress  Disorder (PTSD)  or depression.   In [indisc.],                                                               
experienced  in traumatic  brain  [indisc.].   Between  2005-2006                                                               
approximately 20  percent [indisc.] substance abuse  disorder, 70                                                               
percent  of   the  total  [indisc.]  substance   abuse  disorder.                                                               
[Indisc.] PTSD,  substance abuse  in the military  population for                                                               
men and women.  More than  [indisc.] PTSD.  [Indisc.] combat does                                                               
[indisc.]  PTSD and  alcohol [indisc.].    [Indisc.].   [Indisc.]                                                               
soldiers  in  the  VA  have  a problem  with  alcohol  or  drugs.                                                               
[Indisc.]  more women  are serving  in the  military than  at any                                                               
point in the  history of this country.  She  pointed out that the                                                               
gender  shift  creates  new  challenges  of  [indisc.]  returning                                                               
veterans  [indisc.]  disorder.    [Indisc.]  military  women  are                                                               
doing.  Included in this  need are service [indisc.] issues arise                                                               
[indisc.]  dominantly  males.   [Indisc.].  [Indisc.]  more  than                                                               
quadrupled the  numbers [indisc.].   Recent  reports in  the last                                                               
[indisc.].     [Indisc.]  hospital  discharge   [indisc.]  nearly                                                               
doubled   [indisc.].  She  related that the  current availability                                                               
of  treatment   provided  for  Alaskans  is   inadequate  because                                                               
[indisc.] communities.   [Indisc.]  over [indisc.].   The  top 10                                                               
percent  per  capita in  alcohol  related  [indisc.].   [Indisc.]                                                               
active  duty [indisc.].   The  VA  provides services  on an  out-                                                               
patient and  residential basis for [indisc.].   Industry programs                                                               
[indisc.]  utilize  [indisc.].     [Indisc.].    Substance  abuse                                                               
treatment provides [indisc.].  [Indisc.].   She conveyed that the                                                               
VA  is   working  on  [indisc.]  grateful   launching  [indisc.].                                                               
[Indisc.]  welcome partnership  in  providing  care for  veterans                                                               
[indisc.].   Additional  treatment [indisc.]  potential providers                                                               
[indisc.]   substance  abuse   treatment   [indisc.].     Welcome                                                               
[indisc.] and support Safe Harbor in Anchorage.  [Indisc.].                                                                     
                                                                                                                                
10:27:41 AM                                                                                                                   
                                                                                                                                
ANN  HUTCHINSON,  PsyD,  Interim   Chief  of  Psychology,  Alaska                                                               
Veterans  Administration  Healthcare   System,  [Indisc.]    This                                                               
position was created  to better serve the needs  of veterans, she                                                               
explained.   [Indisc.] 70  percent of  those suffering  from PTSD                                                               
also  have an  alcohol use  disorder problem  over the  course of                                                               
their life.   [Indisc.] veterans  population that  also parallels                                                               
the Viet  Nam veterans hospital.   She  expressed that is  one of                                                               
the main reason  she developed this position  for better analysis                                                               
and  treatment   [indisc.].     The  evidence   of  psychotherapy                                                               
[indisc.].     [Indisc.]  preferred  treatment  of   the  veteran                                                               
[indisc.]  treatment  of  PTSD and  training  process  [indisc.].                                                               
[Indisc.]   get  that   training  and   get  back   to  [indisc.]                                                               
prevention.    [Indisc.] treated  by  VA  physicians and  as  Dr.                                                               
Alcorn  mentioned,  he  can  see   as  often  [indisc.]  treated.                                                               
[Indisc.]  primary care,  social workers  [indisc.]   She advised                                                               
that shows  her they are doing  a great job identifying  PTSD and                                                               
able to  treat the  condition early for  a brief  behavioral care                                                               
intervention.   A veteran seen  in outpatient care  [indisc.] her                                                               
role  [indisc.].   [Indisc.] offer  a one-time  [indisc.] may  be                                                               
asked  to  go  on  and   take  some  symptom  management  classes                                                               
[indisc.]  identify   different  symptoms  and   offer  practical                                                               
skills.     [Indisc.]  PTSD   is  often   recommended  [indisc.].                                                               
[Indisc.]  gold standards  of treatment  [indisc.] provided  good                                                               
feedback as  it has been  a hopeful group and  the VA also  has a                                                               
[indisc.]  treatment  called  [indisc.] which  is  another  great                                                               
therapy  [indisc.].    [Indisc.]  group  and  individual  therapy                                                               
[indisc.]  the second  is the  [indisc.] version  which are  also                                                               
gold  standards  [indisc.]    The  VA has  the  ability  to  send                                                               
veterans  to  the  lower-48  to  American  Lake  or  Wyoming  for                                                               
residential treatment.  [Indisc.]                                                                                               
                                                                                                                                
10:32:08 AM                                                                                                                   
                                                                                                                                
CHAIR  HERRON  asked  whether the  Veterans  Administration  (VA)                                                               
embraces this private sector effort.                                                                                            
                                                                                                                                
MS.  MACKENZIE   responded  that   the  VA   welcomes  additional                                                               
resources for  veterans and recognizes  that the need  is greater                                                               
than what the VA can meet at this time and is good for veterans.                                                                
                                                                                                                                
10:32:44 AM                                                                                                                   
                                                                                                                                
REPRESENTATIVE LEDOUX  questioned the payments for  the services,                                                               
and whether  Tri-Care pays for  services or whether  the Veterans                                                               
Administration refers  people to  the private health  sectors and                                                               
the VA pays for it.                                                                                                             
                                                                                                                                
MR. LANNING explained  that the VA's column of  money is separate                                                               
from Tri-Care  money as the  veteran's treatment is  paid through                                                               
the VA  or charged to  [indisc.].   [Indisc.] would pick  up that                                                               
cost.                                                                                                                           
                                                                                                                                
REPRESENTATIVE  LEDOUX surmised  that the  VA refers  veterans to                                                               
UHS or a similar  entity when the VA does not  believe it has the                                                               
services in-house.                                                                                                              
                                                                                                                                
10:34:17 AM                                                                                                                   
                                                                                                                                
VERDIE  BOWEN,  Director,  Office of  Veterans'  Affairs,  Alaska                                                               
Department of  Military and  Veterans' Affairs  (DMVA), explained                                                               
that the VA  refers patients to out-patient care  and the service                                                               
can  be paid  in  three  different processes:  the  VA can  offer                                                               
direct payment to the facility  providing care to the veteran; or                                                               
[indisc.] they have a network of  care [indisc.], or they use the                                                               
[indisc.]  which  is  available  for the  next  three  years  and                                                               
veterans [indisc.] as well.                                                                                                     
                                                                                                                                
REPRESENTATIVE  LEDOUX inquired  as to  the veteran's  choice per                                                               
family [indisc.].                                                                                                               
                                                                                                                                
MR.  BOWEN advised  that recently  President Barack  Obama signed                                                               
the  Veterans  Access,  Choice and  Accountability  Act  of  2014                                                               
(Choice  Act) allowing  veterans  to choose  health  care in  two                                                               
ways:  [indisc.]  choice 30/40  program  or  the Veteran's  First                                                               
Program which is  a referral process within the VA  system and is                                                               
utilized for non-critical  care, urgent care is  provided under a                                                               
different  vehicle  which is  [indisc.].    The PT3  contract  is                                                               
nationwide  and is  outside  contracts,  Tri-Care, United  Health                                                               
Care, the  State of  Alaska, and  the VA  system, have  other PT3                                                               
contracts [indic.] which is a  third-party administrator for that                                                               
program as well.                                                                                                                
                                                                                                                                
10:36:26 AM                                                                                                                   
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Special Committee  on Military and Veterans'  Affairs meeting was                                                               
adjourned at 10:36 a.m.                                                                                                         
                                                                                                                                

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