Legislature(2015 - 2016)GRUENBERG 120
03/15/2016 01:00 PM MILITARY & VETERANS' AFFAIRS
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HCR 25-POST-TRAUMATIC STRESS INJURY DAY HJR 30-POST-TRAUMATIC STRESS INJURY 1:36:29 PM CHAIR HERRON announced that the only order of business would be HOUSE CONCURRENT RESOLUTION NO. 25, Designating June 27, 2016, as Post-Traumatic Stress Injury Awareness Day; and HOUSE JOINT RESOLUTION NO. 30, Urging the American Psychiatric Association to change the term "post-traumatic stress disorder" or "PTSD" to "post-traumatic stress injury" or "PTSI"; and urging the governor to support usage of the term "post-traumatic stress injury." 1:37:14 PM KENDRA KLOSTER, Staff, Representative Chris Tuck, Alaska State Legislature, presented HCR 25 on behalf of Representative Tuck, prime sponsor. She stated that HCR 25 would establish June 27, 2016, as Post-Traumatic Stress Injury (PTSI) Awareness Day. She added that HCR 25 would also encourage the terminology change from "post-traumatic stress disorder (PTSD)" to "post-traumatic stress injury." Ms. Kloster said that she has been working with the nonprofit organization, Honor for ALL, whose goal is for similar legislation to be passed in all 50 states. She maintained that already eight states have passed legislation promoting PTSI awareness, as well as, the U.S. House of Representatives and the U.S. Senate. MS. KLOSTER explained that the word "disorder" frequently portrays a negative image with associated stigma, and that the word "injury" is a better descriptor. Ms. Kloster stated that 260 million people suffer from PTSI worldwide and, in the United States, about 3.5 percent of adults are being diagnosed with PTSI in any given year. She added that the incidence of military related PTSI is on the rise, but conceded that the increase may be due partly to increased awareness and better detection. She noted a Veterans Administration (VA) assessment reported that the VA was only reaching about 20 percent of people with military related PTSI. Ms. Kloster attested that establishing a day for PTSI would increase awareness of PTSI and educate the public about detecting the signs of PTSI and connecting with services. 1:39:59 PM REPRESENTATIVE CHRIS TUCK, Alaska State Legislature, presented HCR 25, as prime sponsor. He said that most families have been affected by PTSI. He related his personal experience with his brother, who served in the U.S. Navy, and now suffers from PTSI. He contended that his brother was born a normal child and raised normally, and he expressed his belief that calling PTSI a disorder does a disservice to great men and women who served their country and to others suffering from PTSI. REPRESENTATIVE TUCK reiterated that an awareness day for PTSI is a first step in educating the public on the issue and connecting people with services. He noted recent information asserting that children with adverse childhood experiences can suffer from PTSI. 1:41:52 PM REPRESENTATIVE HUGHES asked if there is anything significant about the designated date in the proposed concurrent resolution, and if the designation would be for just one year. MS. KLOSTER responded that June 27 was chosen for Alaska because it is the day named in legislation passed by the eight states, the U.S. House of Representatives, and the U.S. Senate. She added that this year the day would be named by concurrent resolution, and the sponsor would decide later whether to introduce legislation making it an annual recognition. 1:43:15 PM REPRESENTATIVE HUGHES asked if the sponsor envisioned any special activities associated with the day besides a press release. MS. KLOSTER responded that retired Colonel Bob Doehl, Deputy Commissioner of the Department of Military & Veterans' Affairs (DMVA), is online to testify and can better answer that question. She also mentioned a letter of support from the commissioner of DMVA, retired Colonel Laurel Hummel, included in the committee packet. 1:44:24 PM REPRESENTATIVE LEDOUX asked how many Alaskans currently suffer from PTSI. MS. KLOSTER also deferred that question to Colonel Doehl. REPRESENTATIVE LEDOUX asked if Ms. Kloster knew what type of services are currently provided to those suffering from PTSI. MS. KLOSTER responded that service members are tested for PTSI during debriefing and that there are a number of services, including therapeutic, that can be accessed through the [Federal] Veterans Health Administration (VHA). She added that DMVA also helps people with PTSI to connect with services. 1:46:49 PM CHAIR HERRON advised that Rob Earl will present HJR 30, and both resolutions will be in front of the committee when asking for testimony. 1:47:09 PM ROB EARL, Staff, Representative Bob Herron, Alaska State Legislature, presented HJR 30 on behalf of Representative Herron, prime sponsor. He suggested that given the large number of veterans and the high rates of child abuse and domestic and sexual violence in Alaska, the number of people suffering from post-traumatic stress injury (PTSI) is easily in the thousands. Mr. Earl echoed the remark made previously by Ms. Kloster that the word "disorder" carries a stigma and is considered degrading by many who suffer from PTSI. He added that referring to the condition as a disorder suggests that it is untreatable but, in fact, it is a treatable injury. He also stated that historically the condition has been viewed as a mental illness caused by a pre-existing flaw. He added that replacing "disorder" with "injury" would make it clear that this is not the case. Mr. Earl said that the stigma of the word "disorder" discourages some sufferers from seeking treatment. He added that timely treatment is critical, especially considering the high rate of suicide associated with PTSI. MR. EARL paraphrased the last paragraph of the sponsor statement for HJR 30, which read as follows [original punctuation provided]: HJR 30 specifically resolves that the Alaska State Legislature: · Believes that the term "post-traumatic stress disorder" be universally changed to "post- traumatic stress injury" · Urges the American Psychiatric Association to consider changing the term "post-traumatic stress disorder" to "post-traumatic stress injury" for the next revision of the Diagnostic and Statistical Manual of Mental Disorders · Urges the Governor to support the usage of the term "post-traumatic stress injury" MR. EARL mentioned the letter of support from the nonprofit organization, Honor for ALL, the letter of support from DVMA, and the two zero fiscal notes, included in the committee packet. 1:50:05 PM REPRESENTATIVE HERRON stated that he introduced the joint resolution due to his personal experience with people having post-traumatic stress. He referred to the double murder at Bethel High School in 1997 causing post-traumatic stress in people who had witnessed the incident. He opined that although they were not harmed physically, they were still harmed. Representative Herron referred to Socrates and the Shakespeare play, Macbeth, to make the point that post-traumatic stress has been in existence all through history. He reiterated Mr. Earl's claim that "disorder" connotes weakness and Representative Tuck's claim that continued use of the word "disorder" is a disservice to the individual, the family, the community, and society as a whole. Representative Herron conceded that the effort to change the label may be difficult and take time, but expressed his belief that the awareness promoted under HCR 25 and HJR 30 would be very important. 1:52:50 PM REPRESENTATIVE HUGHES asked if other states have passed resolutions similar to HJR 30. CHAIR HERRON responded in the affirmative. REPRESENTATIVE HUGHES asked if PTSD is referred to in Alaska statutes and, if the joint resolution passed, would require amending. CHAIR HERRON responded that change would take a long time. He noted that currently the word "disorder" is referenced throughout the Department of Health and Social Services (DHSS) regulations and information. He reiterated that "this will be a long journey" and expressed his hope that society would recognize post-traumatic stress as an injury and not a condition from birth. REPRESENTATIVE HUGHES offered her support for the proposed joint resolution and agreed that the term "disorder" does not imply an event as the cause as does the term "injury." 1:54:56 PM REPRESENTATIVE LEDOUX stated that she does not see a pejorative associated with the term "disorder." She did express, however, that she supports using the terminology preferred by those who are affected. She asked if anyone from the psychiatric profession could testify as to the difference between the two terms. CHAIR HERRON responded that it is his intention to have such testimony put into the record. He conceded that there are those on either side of the issue. 1:57:16 PM REPRESENTATIVE SPOHNHOLZ said that she supports the proposed joint resolution and related that she adopted a child who suffers from PTSI. She added that this resolution would be important for military service members with PTSI who express concern for the term "disorder." She stated that she agrees with the suggestion of securing a psychiatric opinion. She offered that brain science indicates that the brain is a growing, changing organ, and injury to the brain is treatable and recoverable. 1:59:11 PM REPRESENTATIVE TUCK stated that the dictionary definition of disorder is "an abnormal physical or mental condition." He maintained that the definition implies a condition from birth and that "injury" implies an event that happens to someone. He further claimed that a label does have an impact and the proposed resolution would stimulate discussion about PTSI. 2:01:04 PM CHAIR HERRON relayed that at the Chris Kyle Patriots Hospital's grand opening in Anchorage, he learned that Alaskans who have gone to that hospital have experienced remarkable success. He stated that changing the label is about striving for awareness. REPRESENTATIVE HUGHES stated that she wanted to know from a psychiatrist's perspective if a disorder is considered to be an ongoing condition to be managed rather than something from which one could recover. She added that if that were true, then terminology would impact the treatment approach to PTSI. 2:03:45 PM REPRESENTATIVE LEDOUX asked whether there were implications for medical insurance or workers' compensation insurance associated with treating PTSI as a recoverable injury. REPRESENTATIVE TUCK reminded the committee that not all injuries are recoverable but that timely services are important. KENT HALL, Vice President, Honor for ALL, relayed that he is a Vietnam combat veteran who has been diagnosed by the Veterans Administration (VA) as having post-traumatic stress disorder (PTSD). He said that in 2010 he saw a video by a renowned psychiatrist, Dr. Frank Ochberg, describing PTSD as a wound, not a weakness. Mr. Hall emphasized the importance of that recognition for him in that he stopped blaming himself and started looking for a solution to his problem. He said that since then he has become involved in Honor for ALL, a national, nonprofit organization based in Michigan. He went on to say that he speaks publically on the issue and travels widely to events and rallies. He added that Michigan became the first state to pass a PTSI Awareness Day. He claimed that last year eight states passed resolutions recognizing PTSI, and this year seven more states did the same. MR. HALL referred to his own experience with PTSD and PTSI and affirmed the positive changes in his life since receiving help from the VA. He expressed significant benefits from his participation in Vietnam veteran group therapy sessions sponsored by the VA and lead by a psychologist. He claimed that a strong, proud soldier does not want to have a mental disorder, yet knows that it is alright to seek help for an injury. He relayed that Dr. Ochberg participated in the team that defined PTSD [in the third edition of Diagnostic and Statistical Manual of Mental Disorders (DSM)] in 1980, but now laments the use of the word "disorder," understanding that it has contributed to the stigma that prevents veterans from reaching out for help. Mr. Hall stated that there is no difference between PTSD and PTSI as far as diagnosis or benefits, but said he believes the use of the term PTSI makes a difference to veterans faced with issues and needing help. MR. HALL explained that the date for the awareness day, June 27, was inspired by the birthday of North Dakota National Guard Staff Sergeant Joe Biel, who suffered from PTSD after two tours in Iraq and took his own life on April 26, 2007. He added that former U.S. Senator Kent Conrad of North Dakota initiated PTSD awareness day. 2:12:04 PM CHAIR HERRON asked Mr. Hall about the resistance to the change in terminology from PTSD to PTSI. MR. HALL responded by saying that even renowned psychiatrists disagree regarding the change. CHAIR HERRON stated his intent to have Dr. Ochberg testify at the second hearing on HJR 30. 2:14:51 PM ROBERT DOEHL, Deputy Commissioner, Office of the Commissioner/Adjutant General, Department of Military & Veterans' Affairs (DMVA), Joint Base Elmendorf-Richardson (JBER), testified that DMVA strongly supports both HCR 25 and HJR 30 to better address a condition that affects at least 30 percent of Alaska's 57,000 combat service veterans and those still serving. He stated that about 18,000 veterans in Alaska suffer from PTSD. He claimed that PTSD does not always affect just an individual, but often takes its toll on family, friends, and co-workers. He attested that he has had experience with people suffering from PTSD his whole career - in the military, with the Department of Justice, and with the Office of the Attorney General. He described the many consequences of PTSD, including loss of job, loss of family, and suicide. He claimed that the term "disorder" exacerbates a stigma that discourages treatment among those who struggle with the condition. He maintained that PTSD is not a disorder in an individual but the natural response to an unnatural situation or event that has been externally imposed upon that individual. 2:19:12 PM COLONEL DOEHL stated that after meeting with partner agencies, he believes that together they would be able to plan awareness day activities that would attract media attention. He also said that he sees the awareness day as a springboard for connecting PTSD sufferers with treatment and services. He maintained that any contact with the Veterans Health Administration (VHA) or Veterans Benefit Administration (VBA) provides a veteran with information on PTSI and available services. Colonel Doehl relayed that assistance is also available through DMVA and through vet centers located in some of the larger cities in Alaska. He claimed that peer groups are phenomenal assistance devices for veterans. He related a VA claim that for a veteran who requests assistance for an acute PTSD related concern, the response time for contact with a qualified provider is less than twenty-four hours. COLONEL DOEHL relayed that he is not aware of any changes that would be needed in DMVA statutes or regulations due to the change in terminology proposed by HJR 30 but surmised that statutes in other state departments may require changes. 2:21:42 PM REPRESENTATIVE LEDOUX asked if family, friends, and co-workers can be impacted by someone with PTSI to the extent that they in turn suffer from PTSI as a result. COLONEL DOEHL answered that in order to have PTSI, one must have suffered an injury-causing event. He stated his belief that if the PTSI manifested itself by violence, then there could be a second direct effect of PTSI on someone else. He added that from his experience reviewing several hundred depositions, there are other diagnoses appropriate for spouses living with someone with PTSI. CHAIR HERRON mentioned an incident in which the National Veterans of Foreign Wars (VFW) commander, speaking at a congressional hearing, reacted very negatively to the idea of replacing "PTSD" with "PTSI." Chair Herron said that after the hearing, many veterans came up to congressmen to offer their support for the change. Representative Herron asked Colonel Doehl how this controversy can be addressed. 2:25:07 PM COLONEL DOEHL opined that mental health injuries have been difficult to recognize as not being a weakness or fault. He suggested that more education is needed to understand the injury component, not just for those suffering from PTSI, but for the broader population. He claimed that one source of confusion is related to the fact that only 30 percent of combat veterans report PTSD, but 100 percent of people who are shot report a bleeding wound, which results in being awarded with a Purple Heart. He reiterated that defining post-traumatic stress as an injury and designating the awareness day would greatly advance the knowledge and discussion needed. 2:26:38 PM REPRESENTATIVE LEDOUX said that she was curious about the controversy, and she asked what the rationale was for resisting the change in terminology. COLONEL DOEHL deferred to the American Psychiatric Association (APA) for its position regarding "disorder" versus "injury." He stated his belief that the broader population has difficulty adjusting to change and struggles with recognition of something they can't see. He reminded the committee of the great strides made in recognizing and understanding PTSI since 1970 and opined that with greater awareness and education, the public's ability to visualize and accept PTSI will increase. 2:29:00 PM REPRESENTATIVE HUGHES asked Colonel Doehl to review again the number of veterans and active duty military personnel estimated to have PTSI. COLONEL DOEHL stated that the Alaska VA Healthcare System reports 57,000 combat veterans in Alaska, and 30 percent of them are being treated for PTSD. He said that there are about 30,000 active duty military personnel, but not all of them have been in combat. He gave an estimate of about 8,000 active duty military personnel in Alaska suffering from PTSI, based on an estimated 20,000 who have been in combat. 2:30:43 PM REPRESENTATIVE HUGHES asked what activities Colonel Doehl envisioned besides a media campaign for the PTSI Awareness Day under the proposed concurrent resolution. She questioned if there would be events making services more available or any plans to coordinate with the U.S. Army or U.S. Air Force located in Alaska. COLONEL DOEHL stated that the DMVA envisions creating events by heavily leveraging federal resources through the VA and the vet centers with a focus on providing services. He said that the active duty military personnel would be invited to participate. 2:33:11 PM FORREST POWELL, Program Coordinator I, Office of Veteran Affairs (OVA), Department of Military & Veterans' Affairs (DMVA), said that he represents the interests of the Office of Veteran Affairs in regard to the PTSI Awareness Day proposed under HCR 25 and agreed with Colonel Doehl's answers to the questions. He stated that he is a veteran with PTSD. CHAIR HERRON asked Mr. Powell for his thoughts regarding the change in terminology, from PTSD to PTSI. MR. POWELL replied that his concern was for his own behavior and controlling it, and added that he did not feel that the awareness activities and terminology change would make a difference for him. JEFF SLAIKEU, Office Manager, Office of Veteran Affairs (OVA), Department of Military & Veterans' Affairs (DMVA), offered his agreement with Mr. Powell's testimony. 2:37:03 PM CHAIR HERRON said he would invite Dr. Ochberg and retired U.S. General Peter Chiarelli to testify at the next hearing on the proposed joint resolution. REPRESENTATIVE LEDOUX requested that a representative from either the American Psychiatric Association or the Alaska Psychiatric Association be invited to the next hearing to testify on the rationale for not making the terminology change. CHAIR HERRON responded that he would locate a representative who could speak to Representative LeDoux's concern. [HCR 25 and HJR 30 were held over.]