Secretary for the Department of Veteran’s Affairs, Robert Wilkie was in Dayton on Friday to tour the Dayton VA Medical Center, which is the future site of the National VA History Center. WYSO’s Jerry Kenney spoke with Wilkie during his visit to the VA about the issues facing today’s veterans and active duty service members.
Jerry Kenney (JK): Secretary Wilkie, thanks for speaking with us today. Let's start with your visit to Dayton and I believe you were in Cincinnati yesterday. Tell us what's taking place on your trip?
VA Sec. Robert Wilke (RW): I will tell you in my now, 11 months at VA, I've been all over Ohio. Ohio is sort of the epicenter for us in that, one it's a place where I don't have to explain military service to anyone, and two even as the population of America changes and tangential to that, the placement of veterans across the country changes as they move into the south and the southwest, Ohio remains a constant. It's always going to be in the top 10, regionally around five or six. And, because of that I've spent a lot of time here in Ohio in the last 11 months.
I came to Dayton to do two things, one, see the facility, the simulation center but also get an update on the new VA History Center that we're going to put here. I think it's fitting, uh, there's no more historic property than the Dayton VA facility and it's important that we continue to honor veterans. I cut the ribbon in Columbus on the VA museum along with General Powell. I think this is a fitting adjunct to that by saying that we are going to provide America a place where Americans can come and study the history of those who have served.
JK: That's great, and I'm sure it would be a wonderful addition to, to this area where veterans and issues surrounding veterans are so important. And so let's get to some of those issues. Can you talk more about the mission act that I believe was passed and what progress has made since its implementation?
RW: It came into effect on June 6, D-Day, the seventy-fifth anniversary of D-Day but also the seventy-fifth anniversary of the G.I. Bill. And I think next to G.I. Bill, Mission's probably the most important piece of legislation VA has ever received. What it does is it opens the aperture for our veterans in the event that we cannot provide a veteran with something that she needs right away or during a certain amount of time. We then work with the veteran to provide that service in the private sector with our partners. I think the more important part though is we put veterans on a level playing field with their fellow citizens by giving them access to urgent care.
So what does that mean? It means we are working diligently to keep veterans out of the emergency rooms. With things like flu and colds and sprained ankles, and to get them where they see their fellow citizens going into urgent care. We had about 44,000 calls on the first day. Most of those were about urgent care. But with these new standards, particularly relevant out west where the distances are so great, and I always say the loneliest sign in America is Interstate 10 in Houston when it says El Paso 910 Miles. We don't want veterans having to go round trip 700 miles when they're passing universities and community hospitals if they have to get to us. So this allows them the option. But what I've been saying, and I said this to the president on Tuesday, we're seeing veterans vote with their feet. They're saying in greater numbers than they have in the past that they want to come to VA because we understand the culture and speak the language.
JK: During a Senate Veterans Affairs Committee hearing held in the last week or so U.S. Senator Sherrod Brown says he pushed your office for more transparency on how the VA was addressing issues surrounding veteran, veteran's suicide rates. Can you talk a little bit about that and what your response was?
RW: Sure, my response is that I am now the head of the federal task force on suicide prevention. My goal is to create, not only a whole-health approach to suicide but a whole of government approach where we can bring in NIH, can bring an HHS, Indian Health and, and take a look, not at that last tragic act in a veteran's life, but the causes leading up to that. Because if we don't look at mental health, homelessness and addiction this is just going to be another federal report that no one will read.
I think the president chose VA to be the lead because most Americans understand at some level what it means to wear a uniform and we are the most visible manifestation of this great tragedy. But I will also say, as I said to Senator Brown in that hearing that we are experiencing this in unprecedented numbers across the country not just for veterans but for teenagers, for young American,. and I hope that we will be able to provide a way for the entire country not only to have a conversation particularly about mental health but to have a conversation about where life is in America in 2019 and 2020.
JK: Any concerns on his call for more transparency? How is that relationship?
RW: Well, how I answered that was by talking about the last veteran suicide which took place in Cleveland and I presented that to him as an indication as to how this crisis hits at all levels. That particular veteran, in his late 60s, was looking at life altering surgery - he was going to lose an eye, jaw bone, and his vocal cords. He came to VA, he took his life but he left us a note saying please take care of my mother. We're never going to be able to stop all of that. But we can do is continue to provide new ways of addressing it here at VA, same day mental health services for transitioning soldiers, the ability to be educated, throughout their military career about the signs of mental health distress.
In my father's day, my father -gravely wounded combat soldier from Vietnam - they would have never talked about this that would have been contrary to the ethos. We have to get people talking, not being afraid to talk, and accepting that when they do talk there is no consequence in their military careers. It really has to start the day they walk into basic training.
JK: We spoke to the Veteran and Military Center at Wright State University which has become a tremendous resource for veterans here as well as the VA, they listed two issues where they believe progress has been made but still more needs to be done. The first being wait times at VA health centers. They say that those are still an issue. Can you talk about that?
RW: Well I don't know that it is an issue when you look at how well VA does in relation to the private sector. The wait times here in Dayton, for primary care for first time appointments are 8 days or less. You won't find that in the private sector. And what I've said in congressional testimony people tend to want to hold us up to a standard that's impossible for anyone to meet. I settle right now for veterans being comfortable and for the VA being fathoms and fathoms ahead - I'll say furlongs not fathoms - furlongs ahead of the private sector. Give you an example - I had one senator criticize us for our wait times for specialty care and one of the largest metropolitan areas in the country. What he didn't say was that the wait times at our VA is 12 days. And in his metropolitan area, in the private sector, it was 78 days. So, the Journal of the American Medical Association has said that we are, our wait times are as good or better than any in the country. I stand on that particularly here in Ohio. When you see those low numbers.
JK: They also say that there has been movement in terms of treating women veterans but it can be an issue that they can often still feel a little isolated when it comes to health care and the VA system.
RW: Well, the culture has changing - give you an example. My father was commissioned 2 months before Kennedy was inaugurated. Less than one half of 1 percent of the force was female. As the Undersecretary of Defense under General Mattis, I was responsible for a force that is seventeen percent female and will hit twenty (percent) by 2025. That means the culture has changed. In my childhood, I would have never expected to see a female wearing the red beret of my father's division, the 82nd Airborne Division. That's commonplace now.
For VA here at Dayton, we have a specific women's clinic with private entrances so that women are where they need to be, where they want to be. Our budget this year for women's health care our women will have about nine and a half billion of 89 billion dollar health budget and that represents their percentage of our VA population, so the culture that they're talking about, yeah there's always going to be somebody who says something inappropriate. What I am concerned about and what you see here is that women are welcome, they have their own space within the VA and they have people who are dedicated to their care.
JK: The final concern that they raised, that they're hearing from the veterans that they work with, that veterans are very concerned about the amount of medications they're being prescribed. And, in light of the fact that Dayton has been pretty hard hit by the opioid epidemic, which has affected much of the nation, but we're wondering, is that something, as you travel around to VA centers around the country, is that something that you have had conversations with the VA doctors about?
RW: Absolutely, as well as the president and members of Congress, particularly Senator Brown and Senator Portman. VA is the leader in reducing the percentage of prescriptions - opioid prescriptions that we have. We are now setting the standard for the rest of the country by substituting opioids with combinations of acetaminophen and aspirin, ibuprofen and aspirin. On top of that, alternative therapies - acupuncture, tai-chi, yoga, aqua therapy.
My father - terribly wounded in the invasion of Cambodia, 30 years of jumping out of airplanes, left service needing two new knees, two new hips, had bad back and had lead in his body that they couldn't take out - a lifetime ahead of pain. If I had told him we're going to treat that with acupuncture or yoga he would probably flattened my nose against my face, but we are changing the culture and the approach. Our mission is to treat pain and not what opioids specifically do, which is to treat the brain and I think we are making advances that the rest of the country can take cognizance of, and we continue to make sure that those levels of prescriptions go down.
We're not going to turn away someone who, for whom the doctors say, there is only one thing to do, but we are making sure that in response to this terrible crisis, we don't contribute to that crisis that has been made manifest across most of Ohio into West Virginia, Indiana, and northern Kentucky.
JK: Can you, outside of the issues that we've talked about here, can you list any other challenges, top priorities that you're working on in your service?
RW: Well, I will take take us back to suicide prevention. Of the twenty veterans who take their lives every day, a couple of those are on active duty, a couple are in the Guard, we don't have contact with those. And then another group, which adds up to about fourteen out of the twenty. We have no contact with. My goal is to offer the country a program whereby - it's [Jill] Dietrich (Medical Center Director) here at. Dayton - will be able, will have the resources to go out into the community and [tell] the community - "We need help in finding these veterans who are not part of our system."
I think that's the key. Working with NGOs, working with charities. It's working as a model with homelessness. Ohio and several other cities in Ohio were amongst the first Dayton Cincinnati first in the country to effectively eliminate homelessness because they entered into a dynamic daily partnership with the states and localities. I think that's actually the key for suicide. There are some states, like Alaska, where more than half of the veterans in that state have no contact with us and that's where we need to focus. But I will come back to what I hope we are able to do and that is to lead a national conversation about mental health. About addiction, about homelessness, and get the country focused on those terrible problems.
JK: Two more things for you. We mentioned it briefly, can you speak more specifically about what your office is doing to help, or how the VA is helping veterans or military personnel transition into civilian life? It's a pretty big issue.
RW: It's a big issue, but it actually starts with the Department of Defense. The Department of Defense is responsible for that handoff. They certainly work with us. Transition assistance is a lot more robust than it was for me watching it growing up. I'm still a reservist so I do still see it at the colonels level, but, what we are now doing with the Department of Defense is that we are educating those transitioning on what services they will be eligible for. We have expanded that to other than honorable discharges. That is something that we never approached in the past because there were legal barriers to us serving that population. Some of that population we dismissed for crimes or bad behavior but we know there's a large chunk who suffered brain trauma that we didn't know about, and that could have been the reason for erratic performance in the military. So, we've reached out to about half a million Americans who fall under that category - we've served several thousand -we want to get deeper into that population, but a more robust transition on the part of DOD is essential so that when veterans are eligible to come to us they have a foundation before we even start.
JK: Finally, I know you just finished a tour of the VA Medical Center. Just summarize your, what you've found here and other centers on your trip.
RW: Well the beauty of Dayton is that it's it's a hub for not only academics but also the military. I walk around this facility and there are Air Force officers everywhere, which is good for an Air Force reservist, as the VA Secretary to see.
The simulation center here is second to none, is cutting edge training on everything from those who process the instruments in the operating room, to our police who are trained in de-escalation, to those who have to deal with the onset of a heart attack, a diabetic attack. The stimulation here is cutting edge and it's part of a pattern at VA that the rest of the country doesn't know a lot about. I'll give you an example. I have a closer relationship with the National Hockey League than my Canadian counterpart because the NHL is working with us on the effects of trauma on the brain. In hockey games, as well as the National Football League, all of that research that you hear about is seen in the Will Smith movie, that's being done at VA in Boston. Here, it's the simulation that leads the country in terms of its application.
The other thing is that this is just one of the most historic spots in the country. There's a reason we're putting the Historic Center here. I mean this is, this would be Abraham Lincoln's dream, you know when he created the Veterans Bureau, a few days before he passed away, before he died, this is what he would have been thinking about and we need to preserve that. Not just for veterans but for the whole country.
JK: VA Secretary Robert Wilkie, thanks for your time.
RW: Thank you. Thank you for having me.
