New PTSD report documents known lapses in veteran care

By WESLEY BROWN | The Augusta Chronicle, Ga. | Published: June 21, 2014

AUGUSTA, Ga. — Guy Albert Guyton III can’t shake the harrowing memory that led to more than 35 years of post-traumatic stress from his short-lived service in the Air Force.

The Augusta veteran has had nightmares and flashbacks of a head-on vehicle collision he witnessed outside the Upper Heyford Royal Air Force station in northern England before exiting the military in 1979 after two years as a police officer.

Often, he recalls rescuing and comforting a mother and her two girls after their father and another couple were decapitated in the crash. In his dreams, he sees dead animals along the highway.

Guyton, 57, said the Department of Veterans Affairs originally claimed the visions, which at times have been so violent they’ve led to injuries, were the result of “battle fatigue” or “shellshock.”

In 2000, the agency diagnosed him as having PTSD, but the New York native said the VA didn’t start treatment until March, when he began meeting a psychologist at the Charlie Norwood VA Medical Center weekly to unlock decades of dormant stress.

“I’m doing well with her. I trust her very much,” Guyton said of his psychologist. “She acts as an intermediary between me and the staff.”

Guyton’s difficulty finding collaborative care is not uncommon, particularly those diagnosed with PTSD, according to a new report from the Institute of Medicine.

The report, released Friday, found the VA and Defense Department do not encourage the use of best practices in programs and services for preventing, screening for, diagnosing and treating PTSD. In the DOD, leaders at all levels are not regularly held accountable for implementing policies and plans to manage the disorder, the institute observed in its study, the second of a two-phase assessment of PTSD services.

Further, the review stated the VA has established policies on minimum care requirements and guidance on treatment, but that it is unclear whether leaders adhere to the policies, encourage staff to follow guidance or use the data available from its specialized PTSD programs to improve the way it manages the disorder. As a result, only 53 percent of Iraq and Afghanistan war veterans who had a primary diagnosis of PTSD and sought VA care in 2013 received the recommended eight sessions within 14 weeks.

Similar rates were not provided for the DOD, but the institute described the military’s PTSD treatment programs as seemingly “local, ad hoc, incremental and crisis-driven, with little planning devoted to the development of a long-range approach to desired outcomes.”

The departments’ main problem stems from the lack of a “coordinated and comprehensive strategy” to track treatment outcomes for PTSD patients, said the study’s chairman, Sandro Galea, of the Mailman School of Public Health at Columbia University in New York.

Without a measurement-based management system that documents patient progress, neither department knows if it is providing effective or adequate PTSD care, Galea said.

“Given that the DOD and VA are responsible for serving millions of service members, families and veterans, we found it surprising that no PTSD outcome measures are used consistently to know if these treatments are working or not,” Galea said in a news release. “They could be highly effective, but we won’t know unless outcomes are tracked and evaluated.”

Though both departments have substantially increased mental health staffing, it does not appear to have kept pace with the demand for PTSD services. The report stated staffing shortages can result in clinicians not having time to readily provide evidence-based psychotherapies.

In Guyton’s opinion, substandard care is the result of union employees who are protected from being disciplined or fired when they don’t follow rules and procedures.

Guyton said oversight in his case led him to falling down a flight of stairs in 2005 after having a flashback. Because of the fall, he needed spinal cord surgery and left-knee replacement.

Seven years later, another flashback caused him to fall and break his tibia and fibula at the ankle. Today, he is limited to a wheelchair.

Now, Guyton said the Augusta VA, which admitted the veteran in September for leukemia blood work, is trying to put his belongings in storage and forcibly discharge him on June 27 from the hospital’s Community Living Center. Guyton said he would continue counseling, but worries stopping physical therapy may cause his rehabilitated spine to regress and require additional surgery.

Because of privacy laws, Pete Scovill, spokesman for the Augusta VA, could not comment on Guyton’s care, but after The Chronicle inquired about the case, Guyton said his discharge date was put on hold.

“We offer and coordinate care for veterans discharged from this facility,” Scovill said in an e-mail. “This patient will receive appropriate counseling, care and support.”


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