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Article Date01-01-2008
Record TYPEPeriodical
Article TOPIC 
Article TitlePeriodical Jan 2008
Article ContentPERIODICAL - Jan 2008
Issue No: 200819

Table of Contents
What is
Veterans Affairs Canada: Well-oiled machine or department in crisis?
Chief Editor VVi - View of Sainte Anne
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Veterans Affairs Canada: Well-oiled machine or department in crisis?
Sean Bruyea is a retired captain and disabled soldier who served as an intelligence officer in the Canadian Forces for 14 years. He is now an advocate for other disabled veterans. Robert Smol served for 20 years in the Canadian Forces. He is currently a teacher and freelance journalist in Toronto. The Hill Times 
THE HILL TIMES, MONDAY, JANUARY 21, 2008Veterans Affairs Canada has a lot on its plate: an unexpectedly large number of wounded soldiers returning from Afghanistan, 2,000 or more Second World War veterans dying each month, the appointment of the first-ever ombudsman and introducing the single largest change in veterans benefits in 60 years. While the department paints a rosy picture of effectiveness and client satisfaction, many observers and veterans point to a department in crisis, with top-heavy over centralization, insensitivity to clients and overworked frontline staff.
“The bureaucrats are afraid to pop their head out into the real world for fear of becoming a ‘whack-a-mole’ and getting hit on the head,” said retired sergeant Ron Cundell, a physically disabled veteran living near Barrie, Ont. “They don’t look beyond the tables that are in front of them. They have no proper medical training so how can they truly understand a medical report.” Veterans Affairs is the only government department with its head office located outside Ottawa. Not counting their only hospital, Sainte-Anne-de-Bellevue in Montreal, Veterans Affairs has just over 2,700 full-time equivalents working in veterans programs, benefits, and health care. More than 66 per cent of those positions are located in various headquarters, leaving only 33 per cent of the workforce or less than 900 personnel to care for the 220,000 clients of Veterans Affairs. 
The labyrinthine bureaucracy did not escape the eye of the Senate Subcommittee on Veterans Affairs last month. Liberal Senator Colin Kenny (Rideau, Ont.) commented to the current Deputy Minister Suzanne Tining that the departmental organization chart reminded him “of the organization chart of Homeland Security in the United States,” subsequently qualifying his reference with “I was not being complimentary.” “You are thrown into miles and miles of red tape,” said Mr. Cundell. “What sort of quality of life is that? That consumed me for the first three years of my illness-having to go through all the levels of Veteran Affairs then go to the Supreme Court of Canada for a Federal Court judge to say in one day, ‘he deserves his pension, give it to him.’ ” Only 10 years ago it was the Canadian Forces which found itself being criticized for many of the same reasons Veterans Affairs Canada is now under the gun. However, National Defence has since undergone a ‘revolution’ of sorts. The path to many welcome changes in the CF started in large part as a result of Parliamentary hearings wrapped up in 1998 by the Standing Committee on National Defence and Veterans Affairs. These hearings toured the country’s bases taking input directly from soldiers and their families.“DND seems to be doing a lot of introspective analysis,” said retired army intelligence officer captain Perry Gray a disabled veteran suffering from PTSD. “But on the other end there doesn’t seem to be anything done by VAC. When a person leaves DND there isn’t the same level of treatment provided by Veterans Affairs—I think it’s worse.” It is a point that is disputed by Ken Miller, director of program policy for Veterans Affairs, who claims that under the New Veterans Charter passed in April 2006 disabled veterans will encounter a “seamless transition.”  “The New Veterans Charter created an access point right at the time of release where there is interaction between the veteran and us, and between us and National Defence to ensure that there is continuity as the veteran transitions from life in the military and support of their disability during the last period of time that they were in the military to support under Veterans Affairs,” he said. “It is not an entitlement eligibility type of system it is a needs-based system; that is really what is quite critical now.” If current trends continue, Veterans Affairs will be confronted with a growing queue of younger disabled vets, seeking assistance especially in the area of psychological injuries such as Post Traumatic Stress Disorder. 
In its 2006-07 performance report submitted to the Treasury Board, Veterans Affairs states that “over the past five years the number of clients with PTSD has more than tripled, increasing to 6,504.” Janice Summerby of Veterans Affairs explains, “there are currently a total of 10,882 veterans receiving disability benefits for psychological conditions, including PTSD.” Yet Veterans Affairs’ only hospital, Sainte- Anne-de-Bellevue in Montreal provides mostly geriatric care to aging veterans. There are five clinics across Canada which offer limited outpatient care for psychological injuries such as PTSD. One of those clinics is located at Sainte-Anne’s. In spite of the growing numbers of Canadian Forces veterans suffering from PTSD, Sainte-Anne’s hospital provides only four beds to treat psychological injuries of military service. “I was basically shocked by the whole thing,” said Mr. Gray who was once temporarily admitted to Sainte-Anne’s but was subsequently discharged against his wishes and under heavy medication. “It was a case of take two aspirins and call me in the morning.” Added to this is the additional stress and frustration that a soldier suffering from PTSD has to go through attempting to jump through the bureaucratic hoops in order to receive assistance.
“Some of the forms they have to fill out, especially those going through PTSD, that in itself can give you PTSD,” said NDP MP Peter Stoffer (Sackville-Eastern Shore, N.S.), his party’s veteran affairs critic. “The minister should have honoured what he said he was going to do in the first place which is that the benefit of the doubt will always fall upon the veteran. There must be a tremendous amount of people who just said I give up.” South of the border, the United States Department of Veterans Affairs has more than 150 hospitals, almost 900 clinics and more than 200 veteran support centres dedicated to the care of veterans. Each of these facilities offers mental health care and all veterans’ hospitals have dedicated beds for veterans suffering psychological injuries.In Canada a primary concern remains the management of the limited funds dedicated to veterans’ care. It was during last month’s hearing that Sen. Kenny challenged Deputy Minister Tining, “if you could eliminate various positions and hearings, the business case might even turn out that you would save money and in fact increase benefits.” While the deputy minister testified she “could not agree more” with Sen. Kenny, Ms. Tining declined to answer the question regarding “overhead versus payout.” The Associate Deputy Minister Verna Bruce responded that it was “about $250-million.”The department’s annual report signed by Ms. Tining tells a different story. Veterans Affairs spends 30 cents of every dollar or $1-billion of its $3-billion budget on funding “overhead.” But on the health care side, the inefficiency is even more pronounced with 71 cents of every dollar covering overhead and only 29 cents making it to the veterans’ care. Of more than $1-billion budgeted to the healthcare division, only $266-million is paid out for veterans’ treatment.By contrast, the U.S. Department of Veterans Affairs spends only 10 cents of every dollar on operating costs with approximately 90 cents going directly to the veteran in the form of benefits or medical care. The U.S. has 100 times more employees in their healthcare division than Canada but its budget at $37-billion is only 37 times as large as the healthcare budget of Veterans Affairs Canada. 
Comparison with the oft-criticized Ontario Health Insurance Program (OHIP) paints a picture at Veterans Affairs of a productivity- challenged organization. OHIP is projected to spend approximately $280-million to administer $12.9-billion in payments for health care this year. This equates to an operating cost of 2.1 cents for every dollar paid out for the healthcare of Ontario’s residents. Veterans Affairs spends $2.70 to manage every dollar that it pays out for healthcare, almost 130 times more than the 2.1-cent cost incurred by OHIP to manage each of Ontario’s healthcare dollars.“I’m disgusted by it all,” said Mr. Gray. “If the department truly cared about its clientele, it would spend more time and effort on providing services and benefits rather than publicizing the results of their stilted client surveys.” On the front lines the area counsellors who deal directly with veterans on health care issues, have a reported case load of 1,200 or more clients, reportedly limiting them to contact clients only once every three years. Furthermore, VAC workers especially those in the front line have been quickly trying to add the details of the benefits under the New Veterans Charter to a repertoire of programs and benefits developed over the past sixty years.
“It is pure insanity; they are pulling their hair out,” said Mr. Cundell who also sits on a panel advising the office which serves Toronto and the surrounding area. “We need more Indians not more chiefs. It’s time to change the culture in Veterans Affairs.” Mr. Miller, though, is quick to point out that the number of cases that a counsellor handles should not on its own be taken as an indication of the amount of work or the actual time they may have to deal with the needs of their clients.
“It is not really a case management number, it is the number of clients in a particular area recognizing that not all necessarily need to be case managed, and not all are case managed at the same level of intensity,” he said. Veterans Affairs has yet to face the anticipated wave of wounded military to be covered by the New Veterans Charter. The Canadian Forces have made a concerted effort to retain even severely wounded soldiers from the Afghan conflict protecting them from what they might encounter should they be released. 
“I am aware that DND and the chief of the defence staff have made a commitment to not release currently serving members who have been impacted or injured,” said Ms. Tining to the Senate subcommittee meeting. “As a result, we have not yet seen as clients any who have been released from the Afghanistan conflict.” “In terms of providing services, they are really not doing enough for the modern veteran,” emphasizes chief editor of ‘veteranvoice. info’, Capt. Gray. He does not hold much hope for the wounded returning from Afghanistan when they are passed off to Veterans Affairs, “Nothing in my personal experience has shown me that [Veterans Affairs] is going to provide the level and quality of service required to ensure the necessary quality of life…[Veterans Affairs] is part of the problem, not part of the solution.” 

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 Chief Editor VVi - View of Sainte Anne

As mentioned in the article in the Hill Times, I was hospitalized at Ste Anne's Hospital for a one week period from 28 June to 02 July 2004. I met the doctor and nurse assigned to clients with Operational Stress Injuries (OSI) on the first day and was given a tour of the hospital to familiarise me with where I would be attending therapy sessions. The doctor started me on new medications, which caused me to experience extreme drowsiness. This is a common side effect of some medications prescribed for depression, PTSD and associated conditions.

On the second and third day, I had my first therapy sessions with the social worker and psychologist. It was difficult for me to respond to their questions because of the drowsiness and I became increasingly uncomfortable in each session and left before they would normally end. 

The fourth day was a national holiday so no therapy was scheduled.

I was informed that I was to be discharged on the fifth day after lunch.

I complained to the Ottawa district director of VAC about my unexpected discharge. My area counsellor stated that the hospital usually admitted clients for a minimum of three weeks.

This is what the hospital staff wrote in their reply:

" The hospitalization treatment at St Anne's involves the active participation of the client in the therapeutic process. Unfortunately, at the time of Mr Gray's hospitalization, the latter appeared unable to fully engage and commit himself to the treatment plan in a receptive manner."

It is difficult to participate when one is drowsy as a result of medication, a condition that I told about the doctor on the second day. There was no explanation for why I was prescribed medication on the first day without first conducting a thorough examination to assess my condition.

The adverse effects of the medication did not seem to concern the staff, which seems contrary to normal procedures by which doctors monitor patients to ensure that treatment is effective and safe.

This experience just further compounded my distrust of VAC and its treatment of clients.

Perry Grey
Chief Editor VVi

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Periodical Issue01-01-2008
Periodical No200819
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