Arizona Military Affairs: Combat Veterans Care

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We’ll show you how the Carl T. Hayden VA Hospital in Phoenix is caring for injured veterans returning home from Afghanistan and Iraq.
Phoenix VA Hospital – Care for Returning Veterans
Veterans returning home from the Operation Iraqi Freedom/Operation Enduring Freedom campaigns can get the health care they need by contacting the OIF/OEF Clinic at:
602-277-5551 ext. 7685 or online at

Larry Lemmons: Tonight on Horizon, find out what's being done to make sure our war wounded don't fall through the cracks. And the house majority leader joins proved house budget. Those stories are next on horizon.

Announcer: Horizon is made possible by contributions from the friends of eight, members of your Arizona PBS station. Thank you.

Larry Lemmons: Good evening. I'm Larry Lemmons and welcome to horizon. One week ago the Arizona House of Representatives came up four votes shy of the 31 needed to pass a key budget bill. Yesterday lawmakers gave it another try, and they got the job done. Passing a key part of the house's $10.6 billion budget. Joining me to talk about the budget plan is House Majority Leader Tom Boone of Peoria. Representative Boone, thank you so much for coming down at such an integral time. You guys just passed all the bills for this budget, is that correct, tonight?

Tom Boone: Just finished on the floor and came down and walked in here.

Larry Lemmons: Thank you so much. Let's jump into it. Obviously the big difference between the house budget and senate budget, the tax cut. They only had 7 million, you guys have 60 million?

Tom Boone: Yes, we do. That is a big difference between the senate proposal and the house proposal at this time. Of course, I guess as a starting point I might just say we believe the budget we passed through the house, actually yesterday and today combined with all the bills is, good for Arizona. It focuses on education, transportation, public safety, and also some economic development. Which gets into the tax package.

Larry Lemmons: Corporate income tax primarily, isn't it?

Tom Boone: Actually that's part of it. It's a $60 million package in total. We had a lot of discussion on that bill on the floor today, as you well might imagine. And a lot of it misdirected, in my opinion. And just some of the comments that were made I found astounding on those but actually did not support the $60 million package. There were statements on the floor particularly from the democrats saying that it only addressed or I should say affected special groups. It was a slash and burn tax policy. I took notes on it. And only the elite benefit.

Larry Lemmons: They do support the senate budget, then.

Tom Boone: I understand. But just a few differences. In light of those comments, there's some key things we believe that are real important in our tax package if I could go just a few.

Larry Lemmons: Talk about the, what, the education investment act?

Tom Boone: Correct. Educational investment act and economic stimulus act is what it's referred to. Just a few points, the college safing plan deductions for state income tax purposes allows families to deduct up to $5,000 on their state income tax return for state income tax purposes to make contributions to 529 plans to fund their kids' college education. Could be used at community colleges, state colleges, private schools, what not. There's an extension of the time from January 1 through April 15 to allow for those tax credits for contributions to public schools, extracurricular fees, I should say, and also the private school tuition.

Larry Lemmons: And that is something that the senate budget does not have, is that correct?

Tom Boone: Correct.

Larry Lemmons: And something probably that governor is not going to appreciate, either.

Tom Boone: Perhaps not. She seems to not like that for some reason. Although the general public likes it a lot. All the polls show over 60% of the folks in Arizona think that's a great thing that we've got. It allows school choice for parents. So that's a part of the budget. We've also got a tax credit simplification actually for the charitable contributions made to charities. It actually would allow for a lot more to be donated to charities because it reduces all the paperwork, the base years supported by all the major charity organizations in the state. We think that's a good thing. The other thing that it does it has an additional exclusion for all state retirees and military retirees both state and federal employees in the state of Arizona. There's an exclusion of their retirement income currently of $2,500. We increased that to 3500 for all, a 40% increase. It's been since 1989 they've had any work done on that exclusion. Now, on those four issue us alone, families, retiree, et cetera, to call them special groups, to call that slash and burn tax policy, to call that it's only for the elite that would benefit makes no sense.

Larry Lemmons: That's politics, maybe.

Tom Boone: Well, if that's the case I feel good I'm voting for that if that's the case.

Larry Lemmons: If you wouldn't mind, let's move on to health and welfare also.

Tom Boone: Sure.

Larry Lemmons: I know the senate has put in about $8 million more than the house did on that budget. 8 million, however, was done on both to cover the deficit in the healthcare group of Arizona. Which you guys put up an accountability thing in there also.

Tom Boone: The accountability we're requiring now budget for the healthcare group which we feel is absolutely necessary, is much more than what the senate is doing in terms of accountability. Healthcare group is a disastrous situation for those who are involved. There are about 25,000 people that are involved in that group that have insurance provided to them through the healthcare group. It's managed by access currently. This is the third year in a row it's had a deficit. We tried to pass a bill early in the session. It went to the senate and died in the senate as a result primarily of testimony from the folks from access, saying they had a plan to bail it out. They only needed the time, et cetera. Nobody believed them. We didn't. A week after the bill died, based upon that testimony, a letter was sent out by the access groups saying that, by the way, the plan we don't believe will work now and we need at least $8 million to bail us out this year. We found that to be very disingenuous to say the left. We have a lot of accountability features we built into the budget on healthcare group.

Larry Lemmons: Run short on time. So education. $46 million for teacher pay raises. Also in the senate. But you guys have half of that based on performance.

Tom Boone: Absolutely. Both the senate proposal and house proposal call for $46 million for teaches. The difference is we split ours in two parts. The first $23 million is basically distributed like the senate does, but the second $23 million is based upon performance. So it links the pay for teachers based upon student achievement. We feel that's important. That's the big difference. Now, overall in K-12 I just might make the point that overall for the entire K-12 budget, the house version is actually $16 million more than the senate version. That's one component.

Larry Lemmons: I think the house had $80 million in discretionary funding. But that 80 million was also slotted specifically for kindergarten in the senate.

Tom Boone: It's actually the same in both the house and senate. So both of those are identical. Both provide for $80 million.

Larry Lemmons: Transportation extends the state's bonds from 20 to 30 years to free up $500 million in highway construction. Of course we need. That even the governor was talking about the time tag.

Tom Boone: Absolutely. That was part of the governor's proposal in her budget extending those bonds from 20 to 30 years. The senate has that in their proposal and so does the house. We actually match it.

Larry Lemmons: $100 million for public safety.

Tom Boone: Correct.

Larry Lemmons: How does that break down?

Tom Boone: Mainly for correctional, our correctional system to add --

Larry Lemmons: 6,000 new beds?

Tom Boone: Actually we have 8,000 total in both. The only difference between the house and senate version is we require 3,000 private, 3,000 public, and the senate is 4,000 public, 2,000 private. That's the only difference.

Larry Lemmons: And higher education, 35 mill to pay for university research building, 30 to all the universities.

Tom Boone: That's identical in terms of money between the senate and house versions.

Larry Lemmons: So you've passed these bills in the house. When do you expect negotiations?

Tom Boone: Actually when I leave here, I'll be going back to the capitol and I'll be finding out whether we start tonight or first thing in the morning.

Larry Lemmons: What do you anticipate in terms of the battle between the governor and the senate? In those terms she certainly supports the senate budget. How do you anticipate how that will turn out?

Tom Boone: Well, I anticipate that now we'll have serious negotiations, I believe. And I think my opinion is they'll go fairly quickly. I think everybody in the governor's office, the senate and house leadership would like this thing to be finished fairly soon, as soon as possible. And I think we'll all get down to it and very diligent in getting it done.

Larry Lemmons: Thank you so much, representative Boone, for take the time to come down here. Now you can get back to work on negotiations.

Larry Lemmons: Tonight we continue our series on Arizona's military affairs, looking at what's being done for injured veterans. Producer David Majure takes us to the veterans home in Phoenix.

Brent Phillips: Pretty much the reason I joined was I felt that it's part of my duty. If I want to enjoy the freedoms I have I should sign up to earn them.

David Majure: 25-year-old Brent Phillips enlisted with the marines before 9/11, before joining up meant joining the war.

Brent Phillips: We were in peacetime at the time. There was nothing serious going on. I ended up going to h.m.x. 1 which is a non-deployable unit. The presidential helicopter squadron. Which was fun. I was there for almost a year. And then when I realized that we were actually going to go to war, that's when I requested a transfer back to first marine division. Because in my opinion, what's the point of being a marine in a non-deployable unit. I wanted to be in with the guys overseas in the fight. And that's when after I got my transfer two months later I ended up in the desert of Kuwait waiting to deploy to Iraq.

Interview: I want to start with the ears.

David Majure: At the Coral T. Hayden veterans home in phoenix this man gets a checkup. For the past two years his health and life have been anything but routine.

Brent Phillips: Once things started set thing down after the major conflict, that's when we started getting into the different type of warfare. It wasn't an uniformed enemy that we were fighting. We were fighting ambushes. That's what I was attached to after that was task force scorpion, which actually went out, sought out and destroyed ambushes. And we found one.

David Majure: Two rocket-propelled grenades ripped through the windshield of Phillip's humvee. Two more exploded right beside it.

Brent Phillips: I got a messed up back and neck. My eye obviously was pretty much destroyed over there. I've still got over 400 pieces of metal in me about the size of a grain of sand. 10 pieces of glass in my left eye. Nerve damage in the back of my hand to where I can't feel things at certain points on the back of my hand. I'm progressing pretty well. I'm working with the back, working with the neck. My eyesight, after a couple of surgeries to repair it, they did an experimental surgery which is a Boston [indiscernible] prosthesis. What that is is an artificial lens, cornea, iris and optic fluid. That brought my vision when I had it done to 20/30. So it was pretty incredible. I'm the first one in the military to have it done. I figured I can't see that good, anyway, so why not try it and see what it can do and open the door up for any other veterans that get this type of injury. And it worked for two-years. But right now something completely off the wall is happening in the back of it where the arteries are about to pop in the back of my eye. And when that happens I'll lose the vision in it. So I'm going to lose the sight in it. But at least they learned something from my incident that can help other veterans.

Pat Tuli: He's kind of typical in that there are a lot of eye injuries. There are a lot of facial injuries. Because the helmets protect the head, but they don't protect the face.

David Majure: Pat Tuli is case manager for the operation freedom enduring clinic -- she and her counterparts at other V.A. hospitals are responsible for making sure combat veterans get the healthcare they need, the care they entitled to.

Pat Tuli: Any vet that has a problem with the V.A., if they call me I will move mountains for them. This is what I do. I believe that this is the very least that we can do is to take care of them. They put their life on the line for this country. And that's our job. This is why they have the V.A. This is what we are supposed to do. And anybody that has a problem here needs -- if they call me, I will fix it. I will fix it. And they know. That my vets know that. I have a long history of moving mountains for them. Because they deserve it.

Brent Phillips: But I think you might think it's weird, but I never leave home without my purple heart. I wear it around my neck. And I do that mainly because that reminds me I don't have bad days anymore. Because nothing can compare to a bad day that I had there. And then I also wear a cross. This is the same cross I had on me the day that I was ambushed. And it's only by him that I survived. So I wear them together. And I don't leave home without them.

Larry Lemmons: Joining me to talk about veterans healthcare are Dr. Caroline Deegan who works at the Carl T. Hayden V.A. medical center in Phoenix and Pat Tuli yes, the V.A. hospital case manager who works directly with injured soldiers who have come home from Afghanistan and Iraq. Welcome. Thanks for coming down and talking with us.

Larry Lemmons: You know, we were using these acronyms. They might be useful to try to describe what O.I.F., O.E.F. is. Operation Iraqi freedom, operation enduring freedom and why the separation of those two. Anyone. Pat?

Pat Tuli: Okay. O.A.F. stands for operation Iraqi freedom and O.E.F. for Iraqi enduring freedom. The difference is that there's a difference in the terrain, in the landscaping, actually in the type of war that they're fighting. So we take care of both of those sets. And we do -- and our acronym is O.I.F. /O.E.F. It's a lot easier than saying all the words.

Larry Lemmons: So why are things so different today? We were talking about how Vietnam was such a different kind of conflict and how the vets were treated. Is this why the change in treatment? Dr. Deegan.

Caroline Deegan: Well, I think in terms of how they're welcomed in the v.a., we've learned a lot in those what, 30, 40-years since Vietnam. We've learned that patients expect certain rights. You know, the Vietnam vets came back one at a time. They didn't have the kind of unit cohesion that we have now. And they came back to a country that perhaps didn't welcome them the way we are welcoming them now. So I think the society has changed a lot with regard to how do we deliver healthcare. And the v.a. not only wants to keep up with the changes, we'd like to be in the front of them.

Larry Lemmons: Well, so much is different with these conflicts, too. Because as we talked about on the battlefield now, the way medicine is, they can actually survive things that might have killed people in the past. So they come back with much more severe injuries many times but you're able to treat it. I was wondering, in those terms, what do you do to help prevent these veterans from falling through the cracks that used to exist?

Pat Tuli: We have actually -- we've come a long way in developing how we take care of them. And we have partnered with the military and we have partnered with the military treatment facilities like Walter Reed and Bethesda. And we have established what's called the seamless transition. Which means that there is a liaison in every sing of one of them, multiple liaisons in these treatment facility. Where if an Arizona vet is coming home, I usually will get a call from the liaison in Walter reed, for example, which I'll get his medical information and actually talk directly to them. The minute that I know that we're having the vet come home I'm right there and I call and I talk to the families and I talk to the veterans. And then I establish a care plan for them. Which most of the severely injured I will give to Dr. Deegan because she's really our flagship doc. She's the first one that steps forward in our V.A. and says, I want to take care of these veterans. So she takes care of the severely injured. And we set up appointments; we set up a medical appointment. And then Dr. Deegan as the primary care, for example, I'll use her as my example. And she is my example. She is my inspiration to greatness. She is the caretaker or the gate keeper on these vets. She will do the preliminary exams on them. And then the referrals to the specialty clinics if there's back injuries or eye injuries or if there's traumatic brain injury. All of those have a protocol that we will filter them to the specialty clinics that they need. And then we piggyback that primary care appointment to a mental health screening appointment where we take a military history, take a look at how they're doing with readjustment, whether there's any anxiety or p.t.s.e. or any other psych issues we need to be aware of. If there is we fast track them to the care they need for that also.

Larry Lemmons: How is this different from the way it was in the past?

Caroline Deegan: One of the way it's different is that just as there needs to be a seamless transition between a military treatment facility like Walter reed or Bethesda or brook army burn center and let's say our V.A., within our v.a. we really need to have a seamless transition between the case manager, whose pat, and the primary care provider or physician, and then the various specialties that are treating the patient. What we realize right away is, it's quite possible for people to come easily from the military treatment facility to our hospital and then get lost getting from where I am to the orthopedic clinic. That's when pat had the idea for the virtual clinic, which we have since implemented. We don't have spatial arrangements right now to put all of us together who are working on these vets in the same place, although we hope to do that in the future. So what we did is make sure there are really good lines of communication. So that if I see the veteran and realize they need to see an orthopedist within let's say two days, we set up a system whereby there's somebody identified in the orthopedic clinic who will see that patient in two or three days. And we have them flagged as an O.I.F.O.E.F. vet in their medical electronic records. And we're able to put in a consult. Even though all our clinics is very busy as is every clinic in the valley inside and outside the v.a., these vets are able to get the kind of special care that they need because we've made it seamless inside the Carol T. Hayden V.A. We're trying to keep it seamless.

Larry Lemmons: Dr. Deegan, one thing, call it a signature injury or something or head injuries for this particular conflict. We are seeing more of those because they're surviving. That must be a very difficult thing to treat and to spot. Could you talk a little bit about what you treated?

Caroline Deegan: It's a challenge. And I think every war has a signature injury. And for us it's going to be, number one, the mechanism of injury which is blast injuries. My husband figures about 69% of the wounded that seeing coming out of Iraq and increasingly now out of Afghanistan as they start using I.E.D.'s in that theater as well, 69% of these wounded are caused by blasts or explosion injuries. And then 62% of those blast injuries result in a traumatic brain injury. And 80% of all the traumatic brain injuries we see are not those we might have seen in prior wars say in "Private Ryan," for example, where there was a bullet that went through an iron helmet. But these are blast waves that can penetrate anywhere. Kevlar can't stop a blast although it stops a lot of sniper bullets. The resultant trauma actually affects the whole brain. So we're seeing patients who are coming to us particularly having lost part of the frontal lobe of the brain which has to do with the things that make us make good adult decisions. That's clearly having an impact on be avenue for. Some of the sides of brain affect speech and movement so we're seeing our veterans coming back with those kinds of injuries. And we have to be now prepared for a whole new kind of veteran just as we have now a whole new kind of war.

Larry Lemmons: And there was a -- what's the term you used -- closed head injury?

Pat Tuli: Closed head injury.

Larry Lemmons: Because sometimes those aren't even spotted until sometime down the line.

Pat Tuli: That's correct. And what we did, actually it's been done nationally now, but what we did over a year ago was to develop a template so that we are asking the questions. When they come in, all of our o.e.a. providers. I think it's important to tell you the O.I.F. virtual clinic is made up of primarily voluntary people. They step forward and said they wanted to take care of these vets. This is what we're here for, this is what the V.A. is forks and these are our latest combat vets and we need to help them and make sure they get the very best of care. So in addition to their regular panels, we've done this without impacting the care of our other veterans because they're also important and we would never ever kick them to the curb kind of thing. So in addition to their regular panels they have taken on and become the experts. When they developed this template, all the o.i.f. providers then use the template to screen so we don't miss anything. Were you exposed to a blast? Were you around an explosion? If yes, then it goes. And actually you've got assets attached to it. And really Dr. Deegan really developed that and got it going a long time before our national leadership did.

Larry Lemmons: We want to put up that phone number before we run out of time also. Anyone who has served in Iraq or Afghanistan. Because some of these head injuries, like we said, they may not know they have them. So they should be screened. Is that correct? And the number is up there at the moment.

Pat Tuli: Oh, good. The other thing, too, is we have a lot of vets that when they came back they thought that some of these problems, especially the readjustments issues and anxiety and p.t.s.d. issues would go away.

Larry Lemmons: Post traumatic stress disorder.

Pat Tuli: That's correct. Would go away. They're finding now after several years it's not going away. And they are now coming to the v. A. We want them to know to come in and to call -- call me. I will get you in. I will help you. That's my job.

Larry Lemmons: How important, Dr. Deegan as someone treating that, is that for them to get that treated?

Caroline Deegan: Not only is it important to get it treated, but we're learning so much because we have the first opportunity now to treat P.T.S.D. early. The P.T.S.D., post traumatic stress disorder was first described in the V.A. in the 1980's. And those are our Vietnam vets who had already been back 10, 15 years from Vietnam. We were able to see people very soon afterward. And we really believe we're going to get better results, whether it's traumatic brain injury or post traumatic stress disorder the sooner we get to see those patient. So we want them to come in and we want to see them. We promise we'll take great care of them.

Larry Lemmons: Dr. Deegan, Pat Tuli, thank you very much for the work you're doing for our nation's veterans.

Pat Tuli: Thank you for letting us come and also for getting the word out for us.

Larry Lemmons: No problem.

Mike Sauceda: The Arizona veteran home came under fire for problems in caring for elderly veterans, but progress has been made. We'll give you an update. Plus it's been 15 years fence the fort McDowell, Yavapai tribe fought and won the right to Indian gaming. Learn more about the event Thursday at 7:00 on horizon.

Larry Lemmons: Don't forget to join us Friday for the journalists' roundtable. Thanks for joining us tonight on this Wednesday evening. I'm Larry Lemmons. Good night.

Tom Boone:House Majority Leader;Dr. Caroline Deegan:Carl T. Hayden V.A. Medical Center;

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