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Old 05-16-2008, 11:20 AM
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Default Email From Va Employee Suggests Avoiding Ptsd Diagnosis

Check out the two reports listed below............Seems the VA is just as unscrupulous and deceptive as we always thought they were!

---START---

E-mail from VA worker says to avoid PTSD diagnosis

By KIMBERLY HEFLING


WASHINGTON (AP)
— An internal e-mail written by a Veterans Affairs Department employee suggested avoiding a diagnosis of post-traumatic stress disorder for veterans and instead considering a diagnosis that might result in a lower disability payment.


A copy of the e-mail was distributed Thursday by the groups Citizens for Responsibility and Ethics in Washington, a congressional watchdog group, and VoteVets.org. The e-mail dated March 20 had been forwarded to VoteVets.org, an Iraq and Afghanistan war veterans lobbying group opposed to the Bush administration's handling of the war and veterans issues.


The name of the sender and the recipients were blacked out by the groups. The e-mail has the subject title "Suggestion."


"Given that we are having more and more compensation seeking veterans, I'd like to suggest that we refrain from giving a diagnosis of PTSD straight out. Consider a diagnosis of Adjustment Disorder, R/O PTSD," the e-mail said.


It also said, "Additionally, we really don't or have time to do the extensive testing that should be done to determine PTSD."


VA Secretary James Peake issued a statement calling the e-mail sender's suggestions "inappropriate" and said the employee had been repudiated and was apologetic. The VA did not release the name of the employee.


Just last week, Peake was called to Capitol Hill to answer questions about internal e-mails that surfaced during a trial that seemed to suggest VA officials were hiding the number of veterans trying to kill themselves. One e-mail started with "Shh!" Some lawmakers have said the official who wrote it should be fired, but Peake has said he has no plans to do so. Peake promised to make the agency more open.


Post-traumatic stress disorder is an anxiety disorder that can occur after a traumatic event such as war. Nightmares, flashbacks, and substance abuse can be among the symptoms.


A recent study by the Rand Corp., found that that about one in five troops who found in Iraq or Afghanistan have symptoms of major depression or post-traumatic stress disorder.


Jon Soltz, an Iraq War Veteran who is chairman of VoteVets.org, said some veterans have suspected they received a diagnosis of an adjustment disorder instead of the correct diagnosis of PTSD because the payout to them would be less.


"Many veterans believe that the government just doesn't want to pay out the disability that comes along with a PTSD diagnosis," Soltz said in a statement, "and this revelation will not allay their concerns."


-------------------------


VA Staffer Discourages PTSD Diagnoses

TEMPLE, Texas (CBS)
A Department of Veterans Affairs team leader in Texas suggested mental health professionals should diagnose patients with “adjustment disorderrather than post traumatic stress disorder in order to save time and money treating veterans, according to an internal VA e-mail.


VA Secretary James Peake immediately called the e-mail “inappropriate” and a violation of VA policy.


On March 20, Norma J. Perez, a PTSD program coordinator and psychologist at the Olin E. Teague Veterans’ Center in Temple, Texas sent an e-mail with the subject line “Suggestion” to several staffers including psychologists, social workers, and a psychiatrist.


In the e-mail, Perez wrote, “given that we are having more and more compensation seeking veterans, I’d like to suggest that you refrain from giving a diagnosis of PTSD straight out.” She then went on to say, “consider a diagnosis of Adjustment Disorder…”

"This means the veterans will not get disability benefits and health care for PTSD,” Paul Sullivan, the executive director of the advocate group Veterans for Common Sense, told CBS News.


Andrew Pogany, an investigator with the National Veterans Legal Services Program, said he thinks “purposely misdiagnosing someone is a serious ethical issue that [could] fall under malpractice.”


"VA staff across the country are working their hearts out to get our veterans the care they need and deserve," said U.S. Senator Patty Murray (D-Wash), a key member of the Senate Veterans Affairs Committee. "But e-mails like these make their jobs far more difficult."


In her e-mail, Perez also told staffers, “we really don’t... have time to do the extensive testing that should be done to determine PTSD.”


Sullivan, whose group has a pending lawsuit against the VA to force the agency to improve the treatment of veterans, said this “shows our suit has merit and that the VA lacks the capacity to provide proper care.”


In a statement, however, Secretary Peake said, “a single staff member, out of VA's 230,000 employees, in a single medical facility sent a single e-mail with suggestions that are inappropriate and have been repudiated at the highest level of our health care organization.” He added, “the employee has been counseled and is extremely apologetic.”


Peake promised that the VA is “committed to absolute accuracy in a diagnosis and unwavering in providing any and all earned benefits. PTSD and the mental health arena is no exception.”

-------------------------

Yeah right, sure they are!

Gimp
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  #2  
Old 05-16-2008, 11:28 AM
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Default My apologies

To Larry (Mortardude)............Evidently I was posting this as he was posting his thread on the same subject.

Please take a look at his thread on this issue as well because it contains information on how to contact the idiot piss ant VA employee who committed this atrocity!


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Old 05-16-2008, 03:14 PM
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Default UPDATE...Democratic Senator requests info & investigation of this!

FOR IMMEDIATE RELEASE Contact: Kawika Riley (Veterans’ Affairs)


May 16, 2008 (202) 224-9126

AKAKA REQUESTS DOCUMENTS AND INVESTIGATION OF VETERANS AFFAIRS PTSD DIAGNOSIS FOLLOWING DISTURBING EMAIL


WASHINGTON, D.C.
– U.S. Senator Daniel K. Akaka (D-HI), Chairman of the Veterans’ Affairs Committee, sent a letter to Veterans Affairs Secretary James Peake today, in response to a recently disclosed email from a VA mental health professional which suggested that time and money could be saved if VA stopped diagnosing veterans with post-traumatic stress disorder. Akaka also made a statement on this matter earlier today, calling the email “disturbing and disappointing.”



May 16, 2008
The Honorable James B. Peake, MD


Secretary of Veterans Affairs
810 Vermont Avenue
Washington, DC 20420

Dear Secretary Peake:



I am writing regarding recent events at the Temple , Texas , VA Medical Center. The suggestion that diagnoses of PTSD should be avoided due to cost and time considerations is deeply troubling, and merits close investigation.

VA has a responsibility to take seriously the effects of combat trauma, yet there are some who fail to appreciate the significance of this responsibility. The sentiment expressed in an email by the Program Coordinator for the PTSD Clinical Care Team at the Temple VAMC is clearly inappropriate, and I applaud your strong statement reiterating VA’s commitment to proper screening and diagnosis. Further, I share your hope that this is indeed isolated to a single facility and practitioner.

I have asked the Office of the Inspector General to undertake an immediate review of the diagnosis patterns at Temple , and the role that Department guidelines for the diagnosis and treatment of PTSD may have played in those patterns. I have also asked the IG to examine the Compensation and Pension decisions based on Compensation and Pension exams performed at the Temple VAMC for any irregularity.

I know you understand how imperative it is that VA conducts Compensation and Pension exams and decisions according to evidence based clinical guidelines. Without a thorough exam, an appropriate decision is impossible. The report from the Institute of Medicine (IOM) entitled Post Traumatic Stress Disorder: Diagnosis and Assessment (2006) stated that “An optimal assessment of a patient consists of a face-to-face interview in a confidential setting with a health professional experienced in the diagnosis of psychiatric disorders…[T]he process of diagnosis and assessment will likely take at least an hour or could take many hours to complete.” VA’s own Best Practice Manual for Posttraumatic Stress Disorder Compensation and Pension Examinations recommends a three hour time allotment for completing an initial PTSD examination, with additional time needed for complex cases.

Unfortunately, Committee oversight indicates widespread inadequate evaluation of veterans claiming service-connection for PTSD due to combat exposure and military sexual trauma. Recently, two Compensation and Pension examination reports indicated that exams last between 30 and 35 minutes. Veterans often report to the Committee that during exams they were not asked about their military experience and received superficial evaluations. Veterans’ advocates report the reluctance of some VA examiners to provide a diagnosis of PTSD, even for veterans previously diagnosed with PTSD. VHA managers have expressed the view that “the VISN does not get any funding to do Compensation and Pension examinations.”

These reports are deeply unsettling. I know that you agree with me that it is entirely inappropriate to attempt to save time or money by limiting the quality of medical examinations and the support given to Compensation and Pension units at VA medical centers.

To fully address the quality of Compensation and Pension exams and decisions, I suggest that a team of experts from the National Center for PTSD conduct a comprehensive study of the issues at hand. Such a study should review examinations for PTSD from a statistically valid national sample to assess 1) the amount of time taken to conduct PTSD examinations; 2) the adequacy of the examination, including the need for any additional testing of claimants; 3) the number of cases in which a “rule out PTSD” diagnosis was provided; and 4) whether or not another diagnosis was provided to veterans in cases where the evidence suggested that a diagnosis of PTSD is determined to be more appropriate.

Furthermore, as Chairman of the Committee with oversight jurisdiction over these matters, I request that VA provide to the Committee all records from January 1, 2001, to the present relating to any and all guidance given to any VA staff regarding the diagnosis of PTSD in veterans. “Guidance” includes formal and informal guidance, advice, and recommendation, regardless of format or medium.

I also ask, to avoid future problems, and to ensure proper conduct of Compensation and Pension exams and decisions, that you issue guidance to VHA and VBA clinicians, administrators, and support personnel to ensure that sufficient care and time is spent on each Compensation and Pension exam and decision.

I appreciate your strong repudiation of the Temple VAMC psychologist’s email, and your commitment to serving veterans. The trauma of combat can leave veterans with serious and long-term invisible wounds, and VA’s mission is to care for those veterans. VA must err on the side of presuming that those who have been exposed to service in a theater of war may be marked by that service. Our commitment to veterans demands nothing less.

Thank you for your attention to these issues. I look forward to working with you to ensure that veterans are getting the care and benefits they deserve.

Sincerely,
Daniel K. Akaka
Chairman

-END-


Gimp
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Old 05-17-2008, 07:58 AM
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Default Update # 2

More Senators and Congressmen are demanding an investigation. They want to know about the email sent by a VA employee urging mental health workers not to diagnose PTSD.

Sen. Daniel Akaka (D-HI), Chairman of the Senate Committee on Veterans' Affairs, issued two press releases on this situation...Sen. Richard Burr (R-NC), Ranking Member on the Senate Committee on Veterans' Affairs, is also on board. Everyone is using a different approach to get to the bottom of this situation.

But, the most interesting and compelling set of demands comes from presidential candidate...Sen. Barack Obama (D-IL), Member of the Senate Committee on Veterans' Affairs.


Obama wants to know what we all want to know...is this an "incident," or is it a "trend."


Below you will find a copy of his letter to VA Secretary James Peake...........


###START###


Obama Demands VA Investigate Allegations of PTSD Misdiagnoses to Reduce Costs


Friday, May 16, 2008
FOR IMMEDIATE RELEASE
CONTACT: Michael Ortiz, 202 228 5566


WASHINGTON, D.C.
- U.S. Senator Barack Obama today sent the following letter to Secretary of Veterans Affairs James Peake, calling on him to investigate reports that a psychologist at a Texas Veterans Affairs (VA) facility told staff members to refrain from diagnosing veterans with post-traumatic stress disorder (PTSD) in order to reduce costs. According to today's Washington Post, the psychologist, Ms. Norma Perez, apparently emailed Teague Center staff members suggesting the alternative diagnosis to limit the number of tests required to diagnose PTSD. Since the wars in Iraq and Afghanistan began, thousands of service members have returned home suffering from combat-related psychological injuries like PTSD, which require much-needed treatment.


In the letter, Obama calls on Peake to launch an investigation into the incident to evaluate whether Perez was advised to send this e-mail or give this instruction at the urging of her superiors; whether staff members at the Teague Center followed Perez's advice, and if so, how many veterans were affected by incorrect diagnoses; whether officials at other veterans centers have given some similar admonitions to staff members charged with diagnosing PTSD; whether affected veterans have been given immediate re-diagnoses and; whether this is an incident or a trend through the VA system.


Obama also wrote today to Veterans Affairs' Committee Chairman Daniel Akaka requesting a hearing to examine this matter.


The text of the letter is below:


###START###

Dear Secretary Peake:


I am writing to express my serious concerns about reports that a psychologist at a Texas Veterans Affairs (VA) facility told staff members to refrain from diagnosing veterans with post-traumatic stress disorder (PTSD).


According to today's Washington Post, Norma Perez, a psychologist at the Department of Veterans Affairs' Olin E. Teague Veterans' Center in Temple, Texas, sent an email to other staffers saying: "Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out." She then suggested the alternative diagnosis of "Adjustment Disorder," adding that VA staff members "really don't . . . have time to do the extensive testing that should be done to determine PTSD."


Simply put, Ms. Perez's email is outrageous. As you well know, PTSD is the most prevalent mental disorder afflicting our returning Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans. In order to receive their deserved benefits, these brave men and women must endure a long and arduous process. To hear that a VA official is promoting misdiagnoses of soldiers to save money is unacceptable and is tantamount to fraud.


You have said that Ms. Perez's email is "inappropriate," but more must be done. I call on the Department to open an investigation into the following:


1) Whether Ms. Perez was advised to send this e-mail or give this instruction at the urging of her superiors at the Teague Center.

2) Whether staff members at the Teague Center followed Ms. Perez's advice, and if so, how many veterans were affected by incorrect diagnoses.

3) Whether officials at other veterans centers have given some similar admonitions to staff members charged with diagnosing PTSD.

4) Whether this is an incident or a trend. I understand that the VA keeps detailed information on the number of diagnoses of PTSD and adjustment disorder. Your investigation must look at changes in the number of both diagnoses over time, both system-wide and on a facility-by-facility basis.

5) What is being done to ensure that any veterans affected by this instruction do not fall through the cracks. All veterans given an incorrect diagnosis should be given redress both in their diagnoses and their subsequent disability benefits.

6) Whether there are any trends among veterans who have committed suicide recently to determine whether any were wrongly diagnosed with adjustment disorder. Your investigation should include a survey of root cause analyses of recent veteran suicides.

7) Whether there are other instances across the VA bureaucracy of veterans with legitimate cases of PTSD being swept under the rug for budgetary reasons or for expediency. Why, for instance is the number of approved benefits claims for PTSD at the Veterans Benefits Administration decreasing at a time when diagnoses for PTSD at the Veterans Health Administration are increasing?



Too many veterans see the VA as a bureaucracy with the singular goal of denying services and benefits to veterans. This recent incident merely serves to promote that impression. I request that you advise me by no later than Friday, May 23, 2008, as to whether you will open such investigation.

Thank you.


Sincerely,


Barack Obama
United States Senator


---END---


Give'um hell Barack! .............


Where in the hell is John McSame on this issue.....he sure has been very quietly avoiding or ignoring any response to all of this? I thought he was supposed to be soooooooooooooooooo supportive of military veterans and in favor of improvements to their health care and benefits?


In fact----------nothing could be further from the TRUTH!----Just check out HIS voting record in Congress on Veterans issues at the DAV web site, it may just surprise you. His voting record on these issues is DEPLORABLE & DISGRACEFUL!



Gimp
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Old 05-17-2008, 08:58 AM
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Default Gimpy et. al

That is also my question. Is this just one asshole or does this permeate the whole VA. I know for a fact that there are some unbelievabley wonderful people that work for less and do a great job at the VA and CARE. My psychiatrist is one of the finest I've ever met. She has no fear of the VA. I know when I left the VA I ran into some of the adjudication board members in the elevator in Winston-Salem, VA Regional Office. They mentioned me leaving and wished me luck. I said, "bet you guys will be glad to see me go." They responded that just the opposite. With me attending my patients hearing they could question me and get answers, unlike just a written assessment. They stated that they wished everyone from the Vet Centers in NC would come with their patients. At that time, I was the only one. So...is this dork working on his own or is he getting this from up above and passing it down. I've also seen the dark side of the VA, and had a former VA nurse at the Naval Hospital, fat ugly bitch, talk about all the Vets whining about their, "BOO-BOO'S" from Vietnam. Attitudes differ greatly in this world, as so, attitudes differ in the VA. Can't picture this being top down, but a damn EXTENSIVE INVESTIGATION needs to be done. You go Obama, Burr, and the rest.

Pack
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Old 05-18-2008, 02:58 PM
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Default Packo....Good points all

Quote:
Originally Posted by Packo View Post
That is also my question. Is this just one asshole or does this permeate the whole VA. I know for a fact that there are some unbelievabley wonderful people that work for less and do a great job at the VA and CARE. My psychiatrist is one of the finest I've ever met. She has no fear of the VA. I know when I left the VA I ran into some of the adjudication board members in the elevator in Winston-Salem, VA Regional Office. They mentioned me leaving and wished me luck. I said, "bet you guys will be glad to see me go." They responded that just the opposite. With me attending my patients hearing they could question me and get answers, unlike just a written assessment. They stated that they wished everyone from the Vet Centers in NC would come with their patients. At that time, I was the only one. So...is this dork working on his own or is he getting this from up above and passing it down. I've also seen the dark side of the VA, and had a former VA nurse at the Naval Hospital, fat ugly bitch, talk about all the Vets whining about their, "BOO-BOO'S" from Vietnam. Attitudes differ greatly in this world, as so, attitudes differ in the VA. Can't picture this being top down, but a damn EXTENSIVE INVESTIGATION needs to be done. You go Obama, Burr, and the rest.

Pack
And, why is that BITCH stil "employed" at the VA for Gods' sake.


Check THIS out..................


###START###


Norma J. Perez is still employed by the VA, even after writing an email urging subordinates to deliberately misdiagnose PTSD. Her continued employment makes a mockery of the VA’s mental health care system.


by Larry Scott



Looking through the State of Texas web site to document licensed psychologists, you will not find the name Norma J. Perez. Yet Perez, apparently unlicensed, is the post-traumatic stress disorder (PTSD) coordinator for the Department of Veterans’ Affairs (VA) facility in Temple, Texas.


Norma J. Perez is also at the center of a rapidly-growing controversy that raises questions, not only about how the VA diagnoses PTSD but, about who guides, or even controls, the diagnosticians.


On March 20, 2008, Perez wrote an email to her PTSD team, including psychologists, social workers, and a psychiatrist telling them: “…I’d like to suggest that you refrain from giving a diagnosis of PTSD straight out. Consider a diagnosis of Adjustment Disorder, R/O [ruling out] PTSD.”


The subject line on Perez’s email read: “Suggestion.” But, let’s get serious. In a government office when your superior makes a “suggestion,” you can rest assured that it really is an “order,” and it better be followed.
Why did Perez make such a “suggestion?” The email begins: “Given that we are having more and more compensation seeking veterans, I’d like to suggest…” Perez’s first thought was money! Her sole reason for writing this email was to save the VA additional disability compensation payments for PTSD.


She then verifies this money-saving agenda at the end of the email by stating: “Also, there have been some incidence (sic) where the veteran has a C&P [compensation and pension examination], is not given a diagnosis of PTSD, then the veteran comes here and we give the diagnosis, and the veteran appeals his case based on our diagnosis.” What Perez is saying is this: By not diagnosing PTSD, then the VA’s assessment will coincide with the C&P examiner’s assessment and the claim for PTSD is denied, saving the VA the cost of disability compensation.


Now we know why Perez made her “suggestion,” but what does it really mean? Perez has told her subordinates to make a deliberate misdiagnosis. Perez’s actions are unethical, completely void of morality and could fall under the definition of malpractice.


Perez’s email also stated: “Additionally, we really don’t have time to do the extensive testing that should be done to determine PTSD.” This mind-set is a dereliction of duty. The job of Perez and her subordinates is to take the time to make a proper evaluation and diagnosis, whether that is PTSD or not. That is what they are paid to do. To suggest otherwise to her staff tells us Perez has no concept of the requirements of her position.


Norma J. Perez has disgraced her profession. She, perhaps, has put in jeopardy the well being of many veterans. How many vets were misdiagnosed at Perez’s suggestion during the nearly two months between the date the email was written and the time it became public? We may never know.


But, there are those who do want to know. At least three U.S. Senators are calling for investigations into Perez’s email. Sens. Daniel Akaka (D-HI), Chairman of the Senate Committee on Veterans’ Affairs, Richard Burr (R-NC), Ranking Member on the Committee and Barack Obama, Member of the Committee, have all called for immediate probes. Perhaps the most interesting demand for an investigation comes from Obama who wants to know if the Perez email is just an “incident” or if it is a “trend.”


Obama’s question is right on target. Is this an isolated incident? Is Norma J. Perez a loose cannon who has caused the VA more unneeded bad publicity? Or, is Perez’s email indicative of the policies being implemented at VA facilities across the country? Anecdotal evidence suggests that a diagnosis of PTSD is more difficult to obtain as tens of thousands of older veterans, from conflicts going back to World War II, are coming forward to seek help with their mental health issues.


Off with her head? In a professional sense, this would seem a logical punishment for Norma J. Perez. If she does happen to be licensed, (how the HELL can James Peake allow an "unlicensed" individual be the "Head of the Department????...Gimp) the State of Texas should examine this issue. If she is a member of the American Psychological Association, they should consider action. But, more importantly, the VA should act now to make sure veterans are protected from those who would seek to do them harm with a deliberate misdiagnosis.


Norma J. Perez should be fired for cause. Perez’s actions have caused veterans to question the medical integrity of the VA mental health care system. Vets will now be asking the questions: Have I received a correct diagnosis? Or, am I being shuffled aside in an attempt to save the VA money?


VA Secretary James Peake has stated that Perez has been “counseled” and is “apologetic.” This is no consolation to the veterans who may have been misdiagnosed or to the veterans who now fear the very system meant to care for them. Peake said that Perez’s suggestion has been “repudiated at the highest level” of the VA. What does that mean? Very little, because Perez is still employed by the VA.


Secretary Peake’s message to all veterans is very clear. Perez’s suggestion was repudiated by the VA not because it was wrong, but because she got caught.

---END---


No more accurate words were ever written!


Not ONLY should Perez be fired for "cause".........but Head of the Mental Health Division at the VA, Dr. Ira Katz and VA Secretary James Peake should be "fired" by President Bush as well!.........He (Bush) keeps blowing smoke up everyones rear end about how much he "supports the troops", this would sure prove he at LEAST has the balls to make it appear that's true FOR A CHANGE.......wouldn't it???

Gimp
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"We have shared the incommunicable experience of war..........We have felt - we still feel - the passion of life to its top.........In our youth our hearts were touched with fire"

Oliver Wendell Holmes, Jr.
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Old 05-18-2008, 06:35 PM
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If for no other reason she should be fired for imcompetence. Anybody knows what is sent by e-mail is out there for many to see. Now if she had done the advice by word of mouth none of this would have ever come to light. I just wonder what the VA considers to be a firing offense?
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Old 05-19-2008, 02:24 AM
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Default Gimpy and Doc

The Nurse I was referring to was a "former" VA Nurse now working at the Naval Hopsital. She's not well liked at the hospital either. I had her crying on the phone apologizing to me one day.....the whole story is good, I'll tell you both in person.

Of course she should be fired. Getting rid of someone in the Guvment is hard but certainly not impossible. Being unlicensed is not uncommon either. I'm not sure about a Ph.d Psychologist, but I know if you were employed with the VA since 1991, in my field, you did not have to have a license. Now, you have 3 years to get one, but the older employee's are grandfathered in. Believe it or not, in my field, I'm not all that keen on licenses...as they have very little to do with how someone practices. The exam's are silly, just like the National Teachers Exam. In most states you are only required to take the NTE to get a license or be certified to teach. There is no requirement to pass it. There were probably 3 questions about mental health in my exam...none had anything to do with actual practice.

This person MUST be fired but what will probably happen is they will be dumped off on another VA somewhere or asked to resign. Gotta go....could tell you what I know about what happens to bad hospital directors...and they don't get fired. Hopfully with all the congress people involved, the VA will throw her to the wolves. Doubt it though.

Pack
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