Sexually abused veteran raises new questions about VA caregiver program

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A Johnson City woman’s experience with Mountain Home VA raises more questions about a Veterans Affairs program already under scrutiny.

The VA’s caregiver program pays family members to care for post-9/11 veterans with catastrophic injuries. Kim Coble is one of those veterans. She is a victim of military sexual trauma, according to medical records.

As a result, her husband is paid by the VA to take care of the Army veteran, but both say her mental illness only worsened once they entered the program at Mountain Home last year.

“I was really devastated emotionally,” Coble said when we interviewed her on March 9. “I just wanted to end my life.”

Those words would haunt her in the coming months.

Lawmakers created the VA caregiver program years ago without clear guidelines in Congressman Phil Roe’s view. The House Veterans Affairs Committee Chairman (R), TN-District 1, said Congress gave each VA facility too much leeway initially.

“It’s being looked at,” Rep. Roe said of the increased oversight the program is now receiving. “We need to paint the white lines on the road for it, so this is how you do this.”

Coble is adamant the VA, both nationally and locally, is not following the law as it administers the program.

“I want it fixed for all veterans and all caregivers,” she said.

Coble said not only did a VA social worker affiliated with the caregiver program access what she considers private psychotherapy notes, the social worker then shared them with others, including her husband.

“I was very hurt and angry,” she said. “It’s hard enough talking to your mental health counselor about what’s going on with you and then you find out that someone accessed your psychotherapy notes and read them and not only did the caregiver support coordinator read them, she shared them with several other social workers. It’s very devastating.”

In addition to what she considers a privacy violation, her husband said he never received significant caregiver training as required by law.

“The problems that we’ve had with the VA here have been extremely detrimental to Kim’s health and her psychological well-being,” Scott Martin said.

Coble filed formal complaints, questioning, among other things, why her VA primary care team failed to play a significant role in the caregiver program.

“All three of my primary care providers were unaware of the program, unaware that they had clinical responsibilities to this program,” Coble said.

Coble’s crusade also took her to a House Veterans Affairs Committee hearing earlier this year. At the beginning of the hearing, the minority leader acknowledged Coble’s experience.

“One such veteran family I’d like to recognize here today is Kimberly Coble and her husband Scott who depend on the caregiver program,” Congressman Julia Brownley (D), California said. “After facing inconsistencies and roadblocks with the program and the difficulty of recognizing mental health trauma, Ms. Coble has come here to offer her perspective.”

According to the federal regulation associated with the caregiver program, a veteran’s primary care team, which is required to include a primary care provider who coordinates care, is tasked with making a clinical determination that authorizes a veteran and his or her caregivers to participate in the program.

Our review of VA records nationwide shows the majority of all caregiver support coordinators are licensed social workers. All four of Mountain Home’s coordinators are social workers. Nationwide, very few coordinators are registered nurses, nurse practitioners or doctors, according to our review of federal records.

Despite the inconsistencies between the regulation and the actual way the program’s administered, Mountain Home, citing a directive, maintains the facility is administering the program properly. In fact, the facility reports licensed social workers determined eligibility for most of the 348 caregivers in the program locally.

“A licensed clinical social worker determines administrative eligibility for most applications,” the facility said in response to a Freedom of Information Act request related to the program. “…Based on the current directive, the assessment to determine clinical eligibility is completed by a primary care provider, a primary mental health provider, or multidisciplinary team of licensed professionals, which, in most cases, includes a social worker.”

In Coble’s case, Mountain Home disputes the veteran’s assertion that her doctors were not aware of her husband’s involvement in the program.

“That is false,” the facility said in a statement. “The veteran’s medical record, which can be seen by all of her providers, shows ample documentation regarding her involvement in the VA Program of Comprehensive Assistance for Family Caregivers. Her primary care team was aware of her and her caregiver’s involvement with the Caregiver program due to ordering necessary consults during the evaluation process.”

While Mountain Home officials declined an on-camera interview, the facility also maintained it is appropriate and necessary for staff to review a patient’s health records.

“Our facility privacy officer has explained, and the Veterans Healthcare Administration’s Privacy Office has concurred, with their letter dated November 30, 2017:  ‘The VISN and VHACO leadership of the Caregiver Support Program state that the access to the electronic health record is warranted for the caregiver support coordinator position,'” Mountain Home Director Dean Borsos said in a letter to Congressman Roe last year. “The facility privacy officer explained in a letter to you dated September 18, 2017, that staff perform ‘clinical interventions’ and that access to the Electronic Health Record is appropriate and necessary. All VHA clinical coordinators regularly review electronic health records in accordance with their job duties.”

Congressman Roe is in agreement a caregiver support coordinator should be able to access a veteran’s medical records “to give the most complete care possible,” according to a letter he sent Coble in February.

Despite those words, the Department of Health and Human Services promised Coble the agency would address her privacy complaint.

“We have carefully reviewed your complaint against Mountain Home VAMC and have determined to resolve this matter informally through the provision of technical assistance to Mountain Home VAMC,” HHS said in a March letter.

Coble and her husband met with top Mountain Home administrators earlier this month, prompted by our questions, they said. During the veteran’s meeting, administrators told her any problems she has with the program on the national level need to be addressed in Washington, DC. At the local level, they continually asked if there was a way to help provide the treatment she wants. Coble told us none of those options are good enough because they don’t follow the law. She and her husband said they walked away still in despair.

“It makes us feel like we can’t make a difference,” Martin said. “Nobody’s going to listen. Nobody cares.”

“That makes me feel very hopeless and helpless,” Coble said.

In the days after that meeting, the veteran said she attempted suicide.

“I just went very numb and I tried to kill myself,” she said. “I took almost a whole bottle of pills.”

Doctors have since treated and released Coble following her suicide attempt.

Just Wednesday, the Senate passed Congressman Roe’s bill that, among other things, expands the caregiver program to pre-9/11 caregivers. The legislation now heads to President Donald Trump for his signature.

“The caregiver expansion is phased in over time, so the congressman plans to continue oversight that will address guidance and infrastructure issues during that phase-in period,” Rep. Roe Communications Director Tiffany Haverly said. “Additionally, there are some provisions to address IT issues with the program. The data that will be made available once the IT system is operational will allow for a greater ability to assess the effectiveness of the program as well as monitor the workflow and management of the various elements.”

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