Legislature(2007 - 2008)CAPITOL 106
02/07/2008 09:00 AM House MILITARY & VETERANS' AFFAIRS
| Audio | Topic |
|---|---|
| Start | |
| Presentation by the Alaska Brain Injury Network | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE SPECIAL COMMITTEE ON MILITARY AND VETERANS' AFFAIRS
February 7, 2008
9:08 a.m.
MEMBERS PRESENT
Representative Bob Roses, Chair
Representative Anna Fairclough
Representative Gabrielle LeDoux
Representative Jay Ramras
Representative Robert L. "Bob" Buch
Representative Scott Kawasaki
MEMBERS ABSENT
Representative Nancy Dahlstrom
COMMITTEE CALENDAR
PRESENTATION BY THE ALASKA BRAIN INJURY NETWORK
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
JILL HODGES, Executive Director
The Alaska Brain Injury Network
Anchorage, Alaska
POSITION STATEMENT: Gave the presentation by the Alaska Brain
Injury Network.
CAPTAIN (DR.) RICHARD BARKER, Clinical Psychologist
Elmendorf Air Force Base
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation by the
Alaska Brain Injury Network.
STEPHANIE TANNER
Anchorage, Alaska
POSITION STATEMENT: Testified during the presentation by the
Alaska Brain Injury Network.
RICHARD WARRINGTON, Ambassador
Alaska Brain Injury Network
Kenai, Alaska
POSITION STATEMENT: Testified during the presentation by the
Alaska Brain Injury Network.
ACTION NARRATIVE
CHAIR BOB ROSES called the House Special Committee on Military
and Veterans' Affairs meeting to order at 9:08:09 AM.
Representatives Fairclough, LeDoux, Kawasaki, Buch, Ramras, and
Roses were present at the call to order.
^PRESENTATION BY THE ALASKA BRAIN INJURY NETWORK
9:08:37 AM
CHAIR ROSES announced that the only order of business would be a
presentation by the Alaska Brain Injury Network, with supporting
testimony from a representative of Elmendorf Air Force Base and
a member of the public.
9:08:42 AM
JILL HODGES, Executive Director, the Alaska Brain Injury Network
[(Network)], informed the committee that the mission of the
Alaska Brain Injury Network is to educate, plan, coordinate, and
advocate for comprehensive service delivery systems to survivors
of traumatic brain injury [(TBI)] and their families. Her
organization feels that the returning military population will
need an increase in advocacy efforts on behalf of veterans with
TBI in the near future. The presentation will include
information on TBI and the steps the military is taking, in
Alaska, to assist returning veterans who have suffered a TBI.
In addition, there will be testimony from the spouse of a
soldier who suffered a TBI during his military service. Ms.
Hodges explained that, with the return of many soldiers from
combat, the military must address the issue of the treatment of
TBI at the base hospital. She opined that the military must
plan the continuing care of the injured veterans for the rest of
their lives. She described the procedures that the National
Guard has taken to assist returning guard members who have
suffered a TBI, such as: family briefings and counselors;
assistance from a transition assistance advisor; and grand round
teams that include representatives from the Department of
Defense Military Health System TRICARE, the medical and
psychiatric community, the Alaska National Guard, and the
Department of Veterans' Affairs (VA). The grand round teams
visit villages and other remote areas regularly to inquire about
the health of the returning soldiers. She emphasized that the
military has recognized the need of continuing care and has
funded positions to support injured soldiers. Turning to the
issue of TBI in the civilian population, Ms. Hodges stated that
TBI is recognized by the state as one of the highest
disabilities for children. The Network has items in the
governor's budget for provider training in the treatment of
brain injuries, and she expressed her hope that the items will
be funded and, thereby, assist the private sector with the
coming increase in TBI cases. Ms. Hodges stressed that case
management is very important for the treatment of TBI because
clients with brain injuries cannot plan appointments and look
for help independently. In addition, most survivors are unable
to work, and are susceptible to substance abuse and other
dangers. She related her personal experience with her brother
who continues to suffer symptoms two years after a TBI. In
Alaska, 10,000 families are affected by TBI and 2,000 have lost
a family member. Ms. Hodges further explained that other states
have TBI service delivery systems that include funding, medical
insurance waivers, rehabilitation, and day housing. Ms. Hodges
concluded by saying the Network has been asked by the Alaska
Mental Health Trust Authority (AMHTA) and the Department of
Health and Social Services (DHSS) to develop a five year plan
for the state and she informed the committee that budget
recommendations and information about priority projects are
forthcoming.
9:18:06 AM
CAPTAIN RICHARD BARKER, Clinical Psychologist, Elmendorf Air
Force Base, informed the committee that Elmendorf Air Force Base
is working closely with Fort Richardson Army Base to address TBI
injuries and other issues. Captain Barker explained that there
are "above ground" and "vehicle borne" improvised explosive
devices (IEDs), and one of the injuries they cause is the
signature injury of the war; traumatic brain injury, or post
concussive syndrome. Although the most severely injured will
remain in the Lower 48 for treatment, Captain Barker stated that
many soldiers with the "milder" injuries will be coming home to
Alaska. It is possible for the symptoms of mild post concussive
syndrome to go away after six months or a year; however, some
symptoms may last a lifetime, and the repeated exposure, common
during a war, makes recovery more difficult. Captain Barker
further explained that the definition of a TBI is an injury to
the brain resulting from a blast, a fall, direct impact, or a
motor vehicle accident, which causes an alteration in mental
status resulting in headache, nausea, vomiting, dizziness,
balance problems, fatigue, sleep disturbance, drowsiness,
sensitivity to light and noise, blurred vision, memory problems,
and or difficulty concentrating. Moreover, the brain in a blast
is injured in a different way by the blast wave, fragmentation,
and the effects of the blast on the body. These injuries are
unlike sports injuries and are more damaging to the axons in the
brain. Captain Barker pointed out that more soldiers are
surviving injuries from the war, but many have long lasting head
injuries that will need to be dealt with by their families and
society.
9:24:15 AM
CAPTAIN BARKER provided the following facts: approximately 1.4
million TBIs occur in the U. S. every year; successive
concussions lead to more significant damage; twenty-two percent
of Operation Iraqi Freedom veterans report a TBI inducing event;
and seven percent report continued symptoms. Overall, the
number of victims has become a major public concern. Military
physicians try to diagnose this condition immediately after the
injury, but often traumas are not reported by soldiers; attempts
to ignore the symptoms increase the chance for re-injury and
slow the recovery rate. Moreover, some soldiers will not report
their symptoms on the post deployment health assessment at the
end of their tour. Regarding diagnosis and treatment, he noted
that neuro-imaging studies are negative with mild TBI, which
often leads to misdiagnosis.
9:29:05 AM
CHAIR ROSES asked what type of neuro-imaging is generally used.
9:29:18 AM
CAPTAIN BARKER stated that computed tomography (CT) scans and
magnetic resonance imaging (MRI) images are used.
9:29:31 AM
CHAIR ROSES asked whether positron emission tomography (PET-CT)
radioactive processing is used.
9:29:43 AM
CAPTAIN BARKER said that he will find out what type of imaging
is now being used and inform the committee. He continued to
explain that TBI is a hidden injury that complicates the
diagnosis of physical and psychological problems. At this time,
the military wants to begin giving the Automated
Neuropsychological Assessment Metric 4 prior to deployment. The
assessment can then be re-administered after the soldier comes
home and the comparison to the baseline will indicate damage to
cognitive functioning.
9:33:03 AM
CAPTAIN BARKER observed that treatment for TBI must also include
treatment of post traumatic stress disorder, depression, medical
disorders, and other disorders. Research support for cognitive
rehabilitation treatment is weak; therefore, education about TBI
must begin prior to deployment and continue through treatment
and recovery. Education must also be available to unit
commanders and family members. For Alaska veterans, the Defense
& Veteran Brain Injury Center (DVBIC) in Palo Alto, California,
will provide research and vestibular rehabilitation. Captain
Barker pointed out that injured soldiers must be treated for
headaches, irritability, memory problems, and sleep problems
first, and that recovery depends on: education and reassurance;
rest, and a gradual return to activity; and instruction in
cognitive and memory coping strategies. Barriers to recovery
are: high stress duty; repeated injury; and comorbid
conditions.
9:35:49 AM
CAPTAIN BARKER concluded by comparing the symptoms of TBI versus
post traumatic stress disorder symptoms. He then advised the
committee that Elmendorf Air Force Base has developed a center
for the treatment of mild to moderate TBI. The center has a
staff of 50, including neuropsychologists, a neurologist,
physical and occupational therapists, audiologists, and
technicians. He cited the lack of a sufficient number of case
managers who are needed to ensure that service members are
participating in their treatment options. So far, 100 patients
from the 425th Brigade have been treated by the TBI center, and
many more are expected.
9:39:02 AM
REPRESENTATIVE KAWASAKI asked what is being done by the
Department of Veterans' Affairs (VA) for veterans, especially
those living in rural areas of Alaska.
9:39:49 AM
CAPTAIN BARKER stated that there are five neuropsychologists in
Anchorage.
9:40:37 AM
MS. HODGES stated that her organization could not speak for the
VA or the National Guard and offered to provide the names of
representatives of the VA and the Alaska National Guard.
9:41:16 AM
REPRESENTATIVE LEDOUX asked whether Captain Barker worked in
partnership with any of the Native medical services in the Bush.
9:41:44 AM
CAPTAIN BARKER said no. In answer to a further question, he
expressed his belief that the VA has done some education in
rural areas, and offered to provide further information.
9:42:13 AM
REPRESENTATIVE BUCH asked for more information about pre-
deployment education.
9:42:39 AM
CAPTAIN BARKER answered that the Air Force will do mass
briefings and talk about the potential exposures. The Army is
working to educate spouses so that they can recognize symptoms
after the return of the soldier. Prior to deployment, other
issues, such as exhaustion and mental health, are also covered.
9:44:14 AM
REPRESENTATIVE BUCH affirmed the value of pre-deployment
education.
9:44:36 AM
CHAIR ROSES asked whether the testifiers feel that the present
facilities, nationally and locally, are inadequate.
9:45:03 AM
CAPTAIN BARKER said no. The facilities are not inadequate;
however, they are not ideal. He pointed out that the service is
integrated and providers from around the state, and other
military branches, are being brought in to staff a separate TBI
clinic for about six months. He opined that short term needs
are being met.
9:46:06 AM
CHAIR ROSES observed that, as more brigades come back, there
will be a significant increase in the need to treat TBI.
9:46:20 AM
CAPTAIN BARKER agreed.
9:46:28 AM
CHAIR ROSES asked what policy makers should do to address this
concern.
9:46:39 AM
CAPTAIN BARKER deferred the question to Ms. Hodges. He added
that his purpose was to inform the committee on the military's
goal to raise public awareness of TBI.
9:47:35 AM
STEPHANIE TANNER, Anchorage, Alaska, informed the committee that
her husband, Sgt. Scott Tanner, was exposed to more than 30 IED
explosions during his service tour in Iraq from 2004 to 2005.
He received little treatment in theatre, and began to suffer
many symptoms after his return. Sgt. Tanner's TBI injury was
finally diagnosed in 2007 and he began receiving medication and
therapy at Providence Medical Center. In addition, he is now
receiving support from the Warrior Transition Unit; however,
there are so many injured returning soldiers, the case managers
are stretched too thin, and Ms. Tanner is functioning as her
husband's case manager. Sgt. Tanner is receiving active duty
pay, but he will be medically retired out at half pay if he does
not recover. Ms. Tanner said that her husband will never
recover to his potential because of the eighteen month delay in
the treatment of his injuries.
9:51:12 AM
REPRESENTATIVE RAMRAS offered his admiration for Ms. Tanner's
courage and her husband's service.
9:52:22 AM
REPRESENTATIVE BUCH stated his appreciation for Ms. Tanner's
testimony and asked her to review the protocol that did not
provide medical care for her husband.
9:53:10 AM
MS. TANNER explained that the main problem was, in 2005, TBI was
not recognized, even though many of the returning brigade had
symptoms. Sgt. Tanner transferred to Alaska and began training
duties, but, without treatment, his symptoms increased. Ms.
Tanner opined that, because of the Warrior Transition Unit,
there is more support available now.
9:55:25 AM
RICHARD WARRINGTON, Ambassador, Alaska Brain Injury Network,
informed the committee that he is a veteran and received a
severe TBI 30 years ago. As an ambassador to the Alaska Brain
Injury Network, he urged the committee to ensure that military
veterans do not fall through the cracks of services that are
needed for TBI. He described TBI injuries and said that he is
still disabled after 30 years.
9:57:04 AM
MS. HODGES related that Alaska is small state and does not have
a system in place for the treatment of its population that
suffers from TBI. This is true of the civilian sector and for
veterans living in rural areas. The Alaska Brain Injury
Network, DHSS, and AMHTA have begun to meet monthly with the VA,
the National Guard, the Third Medical Unit, the Wounded Warrior
Project, and the VA Vocational Rehabilitation and Employment
group. She opined that this dialog will help address the
problem in Alaska. In Illinois, legislation mandates that TBI
screening be available for veterans on a voluntary basis. Ms.
Hodges stressed the need to continue education.
9:59:44 AM
CHAIR ROSES suggested that the Military Family Association
should also be represented at the meetings with the VA and other
entities. He then recalled that a funding request for a
statewide assessment of the needs of veterans and their families
was cut from the budget. Chair Roses expressed his hope for the
restoration of this request.
ADJOURNMENT
10:00:33 AM
There being no further business before the committee, the House
Special Committee on Military and Veterans' Affairs meeting was
adjourned at 10:01 a.m.
| Document Name | Date/Time | Subjects |
|---|