Hearing: VA OUTREACH TO VETERANS AT RISK FOR HEPATITIS C INFECTION
Bernie Sander is late. No matter. He asks important questions which the VA doctors respond to with some candor.
Mr. Sanders.
Having come–just one question and again I
apologize if this issue has been gone into before. The rate of
infection for veterans of hepatitis C is much higher than in
the general population. Can somebody explain briefly why that
is the case? Is that because veterans in general being young
males primarily are more at risk or what is the connection?Dr. Garthwaite.
We believe right now we can say that when we tested veterans who showed up for care and were getting blood treated, it was at the 8 to 10 percent level. What we can’t tell you exactly is whether that is a true representation of the entire veteran population since smaller number–only a portion of the total number of veterans use the VA health care system. I think our population is skewed in that we take people who are disabled, often combat disabled, which implies that
they were wounded in service or had transfusions in relation to
their disabilities perhaps or we have patients–one of the
other selection criteria is the highest priority for veterans
is that they are poor. Often in America people are poor because
they are ill to begin with or in some cases because they suffer
from mental illness or disability, including drug and alcohol
use, and we know that drug use is highly correlated as well. So
we think that at least the population that we have tested so
far has some significant risk factors, combat wounds,
transfusions, multiple surgeries with transfusions prior to
1990 when testing was available. Certainly the theaters of
Vietnam in particular where we see the highest prevalence
certainly had risk factors associated with them. These are
areas in which medics were often called upon to treat people
who were bleeding so there was a fair amount of mixture and
potential cross infection out in the field.Mr. Sanders.
You think that service in Vietnam is a significant cause for–perhaps for the disparity of incidence?
Dr. Garthwaite.
I am not sure—-
Dr. Holohan.
There is an increased risk for patients with hepatitis C who have been in country in Vietnam, yes. They have a higher ratio of being positive than veterans who were not.
Mr. Sanders.
On top of the fact that they may be low income
and may use drugs, just presence in Vietnam, everything being
equal, will give you a higher risk factor?
Dr. Holohan.
Yes.
Mr. Sanders.Thank you.
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My notes: HCV & blood exposure, transfusions, wounds. All acknowledgedby the VA. Vietnam = highly correlated. Skewed veteran patient population = skewed studies. Poverty: the stress of living in poverty does effect the immune system.
This line of questioning was a good start in 1999. Then the whole thing fell off a cliff. Why?
After HIV/AIDS, the blood transfusion elephant in the room was exposed. Changes were made in the blood product business. Changes were also made regarding the other big elephant in the room: decades of un-sterile mass vaccinations. But the vaccinations are still not discussed publicly. Pathogen transmission was an unintended result. Even today, some may think that the benefits of past mass vaccinations outweighed the risks of infection from blood-born pathogens. That position is tenable when you look at pictures of smallpox victims, a virus that has been eradicated because of global mass vaccinations.
Today, infections from unsafe medical procedures in healthcare settings are being discussed; there is more accountability in that area but we have a long way to go.
asknod
brewerkelli
cspencer02
jamesaurora
kcraveiro
Laura
Veterans Claims Help 
Squidly, you are so right about the utter lack of outreach! Government HCV outreach has been close to zero. To veterans in private care, it was zero. (There was minimal outreach with AO.).
These hearings were taking place in 1999. My DH was diagnosed with HCV in the fall of 2003 but his liver function wasn’t normal at a previous 6-month check-up. When he was told me that he had HCV, we were both incredulous. Neither of us had ever heard of it. He was advised to tell his employer that he was going into treatment for liver cancer,not HCV because of the stigma. They slowly eased him out as his healthcare bills mounted anyway. It was a company-owned and funded plan. My teenaged son and I tested negative–which was fortunate because we all shared family razors.
But here we are, 14 long years later, and people still don’t know what HCV is and the stigma is still very real.
Nod spiced up my frustrated post about the way HCV is portrayed last August. :
https://asknod.wordpress.com/2012/08/22/npr-blogger-great-news-boomers-you-beat-your-iv-drug-addiction/
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I didn’t know that Sanders was going to replace Murray. That bodes well actually. Bernie is in power because of the loyal Vermont veteran and senior vote. He courts them and I believe he will
try to do a good job of representing their (our) interests.
Of course nothing is for sure in DC! It happens if it happens. 🙂
Bernie Sanders knows what the vA failed to do and why they failed to do it. The excuse is always the budget. Congress did not do the right thing for HCVETS. We had the right to know. Countless families have been destroyed over HCV because of our government’s lack of accountability. They knew most infected Vets have private health insurance and would never be tested for HCV until it was too late. The sad truth is most Vets will die with this disease. When it comes to a liver transplant at $500K, will the Vet have to go to the back of the line? Congress hasn’t given me any reason to think otherwise at this point.
Obviously, the “presumptive” horse never got up again after this hearing. The VA DID NOT reach out to Vietnam or post Vietnam vets. It has been more Like: “oh, look mom! My liver is ready to fall out of my chest!” The VA has touted for years that they have more risk factors for HCV than the CDC.
What difference does that make if Veterans aren’t being tested because they don’t make the VA’s list of risk factors to begin with?
Now Sen. Sanders will replace Sen. Patty Murray as Chairman of the Senate Veterans Affairs Committee. Maybe it’s time that a multitude of Veterans remind him of his part in this HCV game. Congress turned their heads and the VA scooted out of the back door with all of the loot. Seems as though some members of Congress should be savvy enough to understand that VA is good at making money disappear for reasons that Congress never intended. The outreach
was a VA scam because it would lead to Presumptive Service connection. The VA
constantly proclaims that they spend money on researching the etiology of HCV
but where are all of these results?
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Why ask the already burdened VA health system to take a
lead in a national public health effort? Because recent studies
confirm 8 to 10 percent of all veterans suffer from HCV, four
to five times the rate of infection in the general population.
At one recent VA screening, more than a third of the veterans
tested positive for HCV antibodies, with almost two-thirds of
those having served in the Vietnam war era.
According to testimony we heard last year from former U.S.
Surgeon General Dr. C. Everett Koop, the VA has a 5-year window
to “head off very high rates of liver disease and liver
transplants in VA facilities over the next decade” when those
exposed to infected blood and blood products 20 to 30 years ago
will seek care for acute symptoms, cirrhosis and liver cancer.
Mr. Sanders. I would just add to what Mr. Weidman says, and
correct me if I’m wrong, if the VA does the right thing and
they reach out to all of the veterans, the 10 percent who are
infected are treated, you must be talking about astronomical
numbers that there is no way on God’s green Earth you can deal
with within the budget.
Mr. Brownstein or Dr. DiBisceglie, is that correct?
Dr. DiBisceglie. That is correct.
Mr. Sanders. In other words, you are going to have to take
from Peter to pay Paul? And Peter is really hard pressed today.
Dr. Garthwaite. In the ideal circumstance, we will find
efficiencies that don’t affect patient care, obviously.
Mr. Sanders. I know that you share that concern.
Mr. Shays. The bottom line is that there is a line item in
the budget but no money in essence for it.
Dr. Garthwaite. Right. There is no additional money because
the President’s budget did conform to the previously agreed
upon balanced budget agreement.
Mr. Shays. It is important for that to be part of the
record for me because I want to stay within the budget
agreement if we can, but you would do a disservice if we don’t
acknowledge it up front. The ball is in our court now how we
deal with it.
Mr. Sanders. I don’t agree that we should stay within the
caps.
Mr. Shays. But we both agree that this is going to cost a
plenty sum, and the money has to be there. I can’t say that it
has to come from within the budget.
Mr. Sanders. I don’t think there is any great secret that
VA hospitals all over this country are hurting and to take
money away from already underfunded areas to deal with this
tragedy, people are going to be worse off.
Mr. Shays. In Connecticut, we combined some hospitals and
made some tough decisions. We didn’t see that same success in
Boston. So we have some disputes within our own district which
says there are some savings to be made but frankly those
savings are needed in a whole host of areas besides this.
Mr. Sanders. But we don’t want to see VA health care
undermined, and we are at that point. Now we have to vote.
Mr. Shays. The testimony so far is that some say 10 percent
can be treated, some 20 and potentially up to 40 percent
successfully, and we still haven’t defined success. We would
all agree I am assuming that everyone has a right to know that
they have hepatitis C, not knowing that it would be a tragedy
for them not to know how and to begin to find ways to deal with
it, and certainly not to spread the disease and so on. My first
question is even if we didn’t think that we could successfully
treat someone with hepatitis C, we do feel that it is important
that they know that they have it; is that correct?
Dr. Mitchell. That is correct.
Dr. Garthwaite. One of the criteria is patient requests for
screening.
Mr. Shays. Any patient who requests will be tested?
Dr. Garthwaite. Yes.
Mr. Shays. But you don’t test everyone. Everyone who comes
in is not tested for hepatitis C?
Dr. Mitchell. As I said, with the information letter the
point was if they have absolutely no risk factors, we would not
test them unless they requested to be tested because, as Dr.
Holohan described earlier, the risk of a false positive is
fairly high. So if they have no risk factors we do not test. We
say you have none of the known risk factors and we have been
more inclusive than the CDC in that by adding the Vietnam
veteran as one and—-