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Obituary

VON GLAHN, Walter Edward, 47, of Dover, crossed over Jordan, August 3, 2006. Born November 11, 1958 in Waterbury, Conn., he grew up and lived most of his life in Tampa. He proudly served his country as a medic in the U.S. Army from 1976-1983. After his honorable discharge, he worked at the U.S. Postal Service until his illness forced him to take an early medical retirement in 2000. For a period, during this time, he also served as the vice-president of the local American Postal Worker's Union. Even as his illness took it's toll on his health, Walt reached out to other veteran's suffering from Hepatitis C through internet support chat sites and assisted them with their Veteran Affairs Claims as well as offering them encouragement and support.
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Testimonies and Reports

Testimony of Gary A. Roselle , M. D  Program Director for Infectious Diseases Veterans Health Administration Department of Veterans Affairs 

How the VA spends treatment money
Source: GAO analysis of VHA data. January 2003

The Veterans Administration spent $14 million for Hepatitis C screening- one- third less than the amount budgeted for fiscal year 2000. The VA's budget said almost 985,000 veterans would be screened for Hepatitis C exposure at an average cost of $21 per veteran.

However, according to the General Accounting Office report, the Veterans Health Administration estimates that only 478,000 veterans were screened at a cost of $30 per veteran- a shortfall of over 50 percent.

Congress allocated up to $40,000 for treatment of each HCV patient. But the money was not allocated to the clinics for treatment. The money went to 22 Directors of the Veterans Integrated Services Networks (VISNs)  The money was then distributed to area VAMCs.  

The way the money was distributed caused some VA clinics to receive less funds despite many more patients. So the Clinics didn't treat the vets. If they did treat them, they used medicines that cut the chance in half to rid the virus. The old drugs were cheaper to use than the new ones also. 

Because of this report, the VA instructed the VISN's to give the most money to the clinics with the most positive veterans.

VISN's have been under fire for some time now because of the management of Hepatitis C.  

The testimony in 2000 oversight suggest money earmarked for HCV is being used to save a failing health care system. And it's the same story this time. They didn't care then and they don't care now.   

The sad part is they still don't know the actual number of veterans, tested or treated for HCV. Many have died and sickened as a result of this.

If individual States don't stand up, passing legislation that makes the Veterans Administration accountable to the States for Veterans care, our people will continue to be denied proper care and treatment. The VA answers to no one.
Read the Report

 The Veterans Administration has gone before the Government Accounting Office four times since 2000 on HCV Vets issues.
 

General Accounting Office June 2001
`If you were tested, you need to be tested again
VETERANS' HEALTH CARE United States General Accounting Office Testimony Before the Subcommittee on National Security, Veterans Affairs, and International Relations, Committee on Government Reform, House of Representatives. This is the Statement of Cynthia A. Bascetta Director, Health Care-Veterans' Health and Benefits Issues Thursday, June 14, 2001.

Flawed Screening Procedures
Also, screening procedures used at the sites we visited could result in some veterans with hepatitis C not being identified as at risk.  For example, providers at some sites frequently required veterans to identify their specific risk behavior rather than allowing them to generally acknowledge that at least one risk factor applied to them.  Such a procedure could embarrass veterans, which could result in some not identifying that they had a risk factor.  For example, several staff members responsible for screening at facilities we visited noted that veterans were hesitant to discuss stigmatizing risk behaviors associated with hepatitis C—especially when they were asked to admit their history of sexual behavior and substance abuse—such as alcohol, intranasal cocaine, or intravenous drug use.
 
In some locations, screening was conducted in areas that lacked sufficient privacy, adding another barrier to obtaining accurate information.  For instance, a staff member at one clinic told us that interviews were conducted near the general patient waiting area.  She believed this to be problematic when screening veterans, especially those elderly veterans who might be reluctant to answer questions regarding intemperate alcohol use and sexual conduct.

Flawed Testing Procedures 
Testing procedures at the sites we visited resulted in many at-risk veterans not being tested despite their being screened.  Sometimes tests were not ordered and other times ordered tests were not completed.  As a result, any of these veterans with hepatitis C infections would remain undiagnosed.
 
At four of the seven facilities we visited, we reviewed a random sample of 375 medical records for veterans identified as having at least one risk factor.  On average, we found that about 50 percent of those patients were not tested.  The percentage of sampled veterans who were not tested at the four facilities ranged between 38 and 84 percent.
 
Tests were not ordered for a variety of reasons.  For example, at one facility, providers thought that veterans would not be eligible for antiviral hepatitis C treatment because of age, psychiatric illness, or substance abuse.  At another facility, tests were not ordered for some at-risk veterans who were seen at outlying clinics where providers had not been able to attend training sessions about hepatitis C screening.  Also, some screeners were unsure of their authority to order tests.  Nursing staff, who were charged with screening veterans at yet another facility, did not order blood tests because they did not think they had the authority to order tests, when in fact they did.
 
Also, we found that about 7 percent of ordered tests were not completed at the facilities.  Staff at those facilities told us that sometimes veterans do not show up at the laboratory to have their blood tested and providers often do not follow up with these veterans during their next visit to reschedule the blood test.  These facilities lacked a mechanism for tracking at-risk veterans to ensure that they were tested.  Read Document

Past and Pending CONGRESS HCV Veterans and Civilians Federal Legislation 

• Veterans' Hepatitis C Act of 1998

• PRESUMPTION OF SERVICE CONNECTION FOR CERTAIN VETERANS WITH HEPATITIS C 1998
   

• Veterans' Hepatitis C Benefits Act of 1999
   

• Veterans Comprehensive Hepatitis C Health Care Act 2000
   

• Veterans Comprehensive Hepatitis C Health Care Act 2001

• PRESUMPTION OF SERVICE-CONNECTION FOR CERTAIN VETERANS WITH HEPATITIS C 2001
   

• Veterans Comprehensive Hepatitis C Health Care Act 2003

• Hepatitis C Epidemic Control and Prevention Act 2003 Kennedy

• Veterans Comprehensive Hepatitis C Health Care Act 2003

• PRESUMPTION OF SERVICE-CONNECTION FOR CERTAIN VETERANS WITH HEPATITIS C 2003 Snow

• PRESUMPTION OF SERVICE-CONNECTION FOR CERTAIN VETERANS WITH HEPATITIS C- Bell

• Hepatitis C Epidemic Control and Prevention Act 2003
   

• Expressing the sense of the House of Representatives 2004
   

• PRESUMPTION OF SERVICE-CONNECTION FOR CERTAIN VETERANS WITH HEPATITIS C 2005

• Hepatitis C Epidemic Control and Prevention Act 2005 Wilson

• Hepatitis C Epidemic Control and Prevention Act 2005

• Liver Research Enhancement Act of 2005 Towns
   

• Liver Research Enhancement Act of 2007

• Hepatitis C Epidemic Control and Prevention Act 2007

• Hepatitis C Epidemic Control and Prevention Act of 2007

Veterans Comprehensive Hepatitis C Health Care Act HR 73
Shelved

H.R. 73, the Comprehensive Hepatitis C Health Care Act was introduced on January 7, 2003. Introduction of legislation is to help veterans who may have Hepatitis C get better care and testing from the Department of Veterans Affairs (VA).

Unfortunately this bill does not include transmission methods military veterans were subjected to. The other bills that failed to pass did and were key arguing points between groups.  What this means is Veterans will fall under the CDC definitions for transmission methods.

The CDC states:
"Most risk factors associated with transmission of HCV in the United States were identified in case-control studies conducted during 1978-1986. These risk factors included blood transfusion, injecting-drug use, employment in patient care or clinical laboratory work, exposure to a sex partner or household member who has had a history of hepatitis, exposure to multiple sex partners, and low socioeconomic level. These studies reported no association with military service or exposures resulting from medical, surgical, or dental procedures, tattooing, acupuncture, ear piercing, or foreign travel. If transmission from such exposures does occur, the frequency might be too low to detect."[7] 

If passed, this bill will allow Health and Human Services to implement the pre approved CDC Hepatitis C Prevention plan. This plan calls for Hepatitis C to go under the Substance Abuse management programs that include, HIV and STDs (Sexually transmitted diseases.)

[7] CDC states no association with military service http://www.cdc.gov/ncidod/diseases/hepatitis/c_training/edu/1/epidem-trans-1.htm

VA's position on HCV and H.R. 1020
Shelved

Statement of Nora E. Egan Deputy Under Secretary for Management Department of Veterans Affairs Before the House Committee on Veterans’ Affairs Subcommittee on Benefits April 13, 2000 H.R. 1020 would add a new section 1119 to title 38, United States Code, providing a presumption of service connection for certain veterans who served during a period of war and who suffer from hepatitis C,  notwithstanding that there is no record of such disease during the period of active military, naval, or air service. The presumption would apply where a veteran experienced one of the following during service: Died 2001 

1) transfusion of blood or blood products before December 31, 1992; 

(2) blood exposure on or through skin or mucous membrane; 

(3) Hemodialysis; 

(4) tattoo or body piercing or acupuncture; 

(5) unexplained liver disease; 

(6) unexplained abnormal liver function tests; or

(7) working in a health care occupation.