Monday, August 24, 2009

Tammy Duckworth and Chris Wallace (Video)

Tammy Duckworth, Assistant Secretary of Veterans Affairs, was interviewed by Chris Wallace on FOX News Sunday.

They had a disagreement about some of the facts regarding the VA's death book, "Your Life, Your Choices."




Transcript: 'Death Book' Debate on 'FOX News Sunday'

Excerpt

CHRIS WALLACE: For the Obama administration's response, we're joined now by Tammy Duckworth, an assistant secretary at the V.A. who knows all about veterans issues. She lost both legs during a mission as a helicopter pilot in Iraq.

And, Secretary Duckworth, welcome to "FOX News Sunday."

TAMMY DUCKWORTH, ASSISTANT SECRETARY OF VETERANS AFFAIRS: Thanks for having me on, Chris.

WALLACE: I want to ask you about the worksheet, page 21 in the V.A. booklet. You're a hero who, despite severe injuries, lives a full life, but you have to get around some of the time in a wheelchair yourself.

Do you have any problem with the V.A. asking elderly veterans whether life is worth living if they have a disability, if they live in a nursing home, if they're unable to shake the blues?

DUCKWORTH: Well, I have to say, Chris, that this is a really important discussion because when I was in Iraq and I was injured, thank goodness I had an advanced directive, that I had both a living will and a medical power of attorney that my husband was able to use to really execute my wishes.

And I don't think that anybody values life more than somebody such as myself or those of us who work at V.A. who've been in combat, who knows what it's like to be given a second choice.

I think that any worksheet that any veteran wants to use that helps him make those decisions in advance for his family members so that they know what your wishes are, that you do want your life prolonged, that you do want to be resuscitated — those are all important.

And V.A. is very happy for veterans to use any booklet that they would like. This booklet was used throughout the Bush administration under two secretaries. But if veterans want to go out and — and we provide it free of charge. There are many other free-of-charge booklets that are out there.

If they want to go and spend $5 apiece and buy Mr. Towey's book, they are welcome to do that. And that all falls under V.A.'s advanced directive policy which was...

WALLACE: But — but...

DUCKWORTH: ... put in place by President Bush.

WALLACE: ... if — if I — if I may, Ms. Duckworth, because we have limited time here...

DUCKWORTH: Sure.

WALLACE: ... why would a question — I can understand questions about if you're in an irreversible coma, do you want us to pull the plug. But why — as I asked Mr. Towey, why would you even have a question in a — in an end-of-life counseling book about if you're in a wheelchair, if you're living in a nursing home, does that make life worth living?

DUCKWORTH: Well, I know that before I was injured, I certainly let my husband know that, you know, being in a wheelchair was something that I feared and I was afraid for, but that I also wanted my life prolonged.

This is a tool. This is a simple tool that was put into place, as I said, under Secretary Nicholson. It was something that was used throughout.

And let me make a correction. We've not used it since 2007 when, under the Bush administration, we decided to go ahead and revise it.

This checklist is still under revision on a timetable according to a program that was actually decided on under the previous administration, because I know that President Bush and Secretary Nicholson and Secretary Peake all valued life. And that's what we're doing is we're revising it.

WALLACE: But — but ...

DUCKWORTH: It will be out in 2010. It's not yet out. So Mr. Towey was not correct.

WALLACE: That's a — Secretary Duckworth...

DUCKWORTH: Yeah.

WALLACE: ... that's just not true. The VHA put out a directive on July 2nd, 2009, and I want to put up two pages from that directive. The first one, page 8, "Primary care practitioners are responsible for giving patients pertinent educational materials, e.g. refer patients to the 'Your Life, Your Choices' module."

And on page 9 it says, "If they request more information, patients may be directed to the exercises in 'Your Life, Your Choices.'"

So as of July 2nd, 2009, last month, more than a month ago, V.A. health practitioners were told to refer all veterans, not just end-of-life veterans but all 24 million veterans, to this document, "Your Life, Your Choices."

DUCKWORTH: Let me make a correction there, Chris. What our practitioners were told is to refer patients to any type of a tool. They can use Mr. Towey's if they want to spend the $5 apiece.

V.A. simply was not willing to buy his booklet at $5 per veteran at the time. This is a decision that was made...

WALLACE: But — but how do you explain...

DUCKWORTH: ... by the previous administration.

WALLACE: It doesn't — it doesn't say give them — give them access to anything. I mean, in the specific V.A. booklet — it's only 15 pages long — it specifically refers to this booklet twice.

DUCKWORTH: The only directive that is out there is actually left over from — I believe it was the beginning of 2007, which our advanced planning directive put into place, and it is actually very clear in saying that we need to provide veterans with information that they can make on how they want their care.

You know, this ultimately is about the care and health care for veterans, and we're actually expanding benefits for veterans. We're actually trying to get more priority aid veterans to sign up for V.A. benefits. We estimate that there'll be another 500,000 veterans coming in for benefits.

We are expanding V.A. benefits to veterans. It is in our best interest to make sure that every veteran out there receives the care and access to the treatments and everything that he needs, because, after all, these are the men and women who fought for us and fought — and they deserve nothing less than the best care.

WALLACE: Secretary — well, we certainly agree on that. Secretary Duckworth, when you look at the workbook now on your Web site, as you point out, there's a disclaimer there. We're going to put the disclaimer that is now on the Web site if you go to the — to the "Your Life, Your Choices" link.

And it says, "The document is currently undergoing revision for release in V.A. The revised version will be available soon." But when the V.A. first reinstated the document a month ago — six weeks ago...

DUCKWORTH: No.

WALLACE: ... it sent veterans directly there, as you can see in the screen grab. I guess the question I have is why, Secretary Duckworth, did the disclaimer about the book only appear this week after Mr. Towey's article appeared in the Wall Street Journal?

DUCKWORTH: Actually, that disclaimer has been there since 2007 when we pulled...

WALLACE: Well, it wasn't — it wasn't...

DUCKWORTH: ... when we pulled...

WALLACE: ... there before August 20th of — between July 20th — July 2nd and August 20th, the disclaimer was not on the Web site, because we checked. DUCKWORTH: Chris, the disclaimer has been at the beginning of the "Your Life, Your Choice" booklet since 2007 when the Bush administration decided to pull it off and revise it on an — on an established time schedule.

WALLACE: The record doesn't show that.

DUCKWORTH: But it — you can go on the Web site now. We have many things on our Web site. They're up there because they receive federal dollars. They're public research grants. We have to keep them on our Web site.

But I will tell you that this booklet has not been in use. It was pulled off the shelves in 2007. We very clearly told all of our medical practitioners not to use it because it was under revision...

WALLACE: I don't...

DUCKWORTH: ... and this is ultimately — again, let's bring this back to...

WALLACE: Miss Duckworth, that just — Miss Duckworth, I don't want to — I don't want to argue with you, but — but the...

DUCKWORTH: Sure.

WALLACE: ... but the facts are that it wasn't in use from 2007 until July 2nd of 2009 when, in the VHA handbook, you specifically reinstated it and specifically told health care practitioners to refer veterans to it.

DUCKWORTH: Chris, it has not been reinstated. Let me make it clear. The only advanced directive that we have is dated February of 2007. And it actually encourages veterans to use any type of tool or checklist they would like to.

There are many, many good ones out there. This "Your Life, Your Choice" is widely used out there, not just within V.A. There are many others that are out there. And veterans are free to use whatever they would like to use.

WALLACE: I — and let — let me — I mean, I...

DUCKWORTH: We just urge them to use some...

WALLACE: I just — I have a problem here. And too often on these shows we say one person said, and another person said.

Secretary Duckworth, I don't know if we're able in the control room to put up the first — the full screen of the VHA directive, but I'd like you to put up the first full screen, if you can.

In the VHA directive of July 2nd, 2009, it says the following on page 8, "Primary care practitioners are responsible for giving patients pertinent educational materials, e.g. refer patients to the 'Your Life, Your Choices' module." I mean, it's just there in black and white on the VHA directive of July 2nd.

DUCKWORTH: Chris, I — I'm sorry, I can't see that on the monitor in here. I will tell you that I know for a fact that the only directive signed by Secretary Shinseki — I mean, signed by a V.A. secretary was actually signed by Secretary Nicholson, and it's dated February of 2007.

What you're looking at may not actually be a directive, so I — since I can't see it...

WALLACE: Well, we'll...

DUCKWORTH: ... I'd be happy to come back and discuss it with you, but let's talk about what V.A. is trying to do.

We have the largest increase in our budget in over 30 years. We are going to be expanding access to veterans. We are working with the new G.I. bill for the 21st century. We are fighting to end homelessness. And we are doing quite a lot for veterans.

And I don't think that there's anybody that understands better the importance and value of life than those of us who have worn the uniform and faced combat.

WALLACE: I apologize. We're running out of time.

DUCKWORTH: Oh, I'm sorry.

WALLACE: I want to ask you one last question. If you feel so strongly about the value of life, although the disclaimer is on there, this document, "Your Life, Your Choices," is still on the V.A. Web site.

Secretary Duckworth, while it's supposedly being revised, it's still up there. Can you promise us that this will be taken down today?

DUCKWORTH: It is still up there with the disclaimer that it's under revision and do not use it. It cannot...

WALLACE: It doesn't say don't use it.

DUCKWORTH: Let me, Chris...

WALLACE: But why have it up there at all? Why not just say we're going to take it down?

DUCKWORTH: Because we are bound by federal law. It was developed with federal research grant monies, and most of our — all of our programs that were results of federal research grants are online for people to use for research purposes.

But we very clearly tell all of our veterans, "Please use any type of a tool that is most suitable for you and your loved ones," and you can certainly — there are many great ones out there, including Mr. Towey's, if they want to go spend the $5 for it apiece.

V.A. makes ours available for free. The checklist that we're actually using is a completely different checklist from this one, because this one has been taken off for revision.

WALLACE: Well, it hasn't been taken off. It's being revised, but it's still on the Web site.

Secretary Duckworth, we want to thank you. We want to thank you for giving us the V.A.'s response. And we also personally want to thank you for your service to our nation.

DUCKWORTH: It was my pleasure to be here. Thank you.

WALLACE: If you want to read the V.A. book for yourself, you'll find a link at our blog, foxnewssunday.com. And we will stay on this story of end-of-life counseling for our veterans.

Wallace was determined not to let Duckworth's comments about the Death Book stand unchallenged.

Duckworth did her best to dodge Wallace's questions.

Someone here is right and someone here is wrong.

If the document is being revised, as Duckworth claims, then the current inadequate version should not be on the website. A disclaimer is not enough.

2 comments:

Jay Bullock said...

Is it "dodging a question" when the person asking the question is using bad information and cropping quotes from VA documents to call the secretary a liar?

Here's the pdf of the actual document. It says what Duckworth says it says, not what Wallace says it says.

For example, Wallace says page 8 reads, "Primary care practitioners are responsible for giving patients pertinent educational materials, e.g. refer patients to the 'Your Life, Your Choices' module." It actually reads, "Giving patients pertinent educational materials (e.g., Refer patients to the “Your Life, Your Choices” module in MyHealtheVet at the web site http://www.myhealth.va.gov, or provide written material such as Appendix C)." Appendix C, of course, walks through the basics of living wills and power of attorney without any of the "deathbook" questions, and only once mentions the "Your Life" book, instead usually referring questions to state resources or medical personnel. Other parts of the memo Wallace selectively quotes from are more direct about instructing practitioners to use a variety of resources, not restricting them to the one, as Wallace made it sound.

Mary said...

Yeah, I've seen the actual document. I posted a link to the pdf on 8/21/2009, 3:05:00 PM.

Here.

Wallace was questioning Duckworth about the particular document, "Your Life, Your Choices," when it was in use, when it was pulled, when it was reinstated, when the lame disclaimer was added, etc.

That's what the interview addressed. That's what the disagreement was about.

Duckworth agreed there are problems with "Your Life, Your Choices" and, as a result, it's being revised. Wallace wondered why the flawed document was still online.

Wallace said, "If you feel so strongly about the value of life, although the disclaimer is on there, this document, 'Your Life, Your Choices,' is still on the V.A. Web site.

"Secretary Duckworth, while it's supposedly being revised, it's still up there. Can you promise us that this will be taken down today?"

She would not. Obviously, it's still online.

That was the key to the discussion. Duckworth was distancing the VA from the death book while at the same time arguing that the problematic document still had to be available "as is" during its revision.

Bizarre.