I 

116TH CONGRESS 

1ST SESSION H. R. 100 

To direct the Secretary of Veterans Affairs to conduct an independent review 

of the deaths of certain veterans by suicide, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 3, 2019 

Mr. BUCHANAN introduced the following bill; which was referred to the 

Committee on Veterans’ Affairs 

A BILL 

To direct the Secretary of Veterans Affairs to conduct an 

independent review of the deaths of certain veterans by 

suicide, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Veteran Overmedica5 tion and Suicide Prevention Act of 2019’’. 

6 SEC. 2. DEPARTMENT OF VETERANS AFFAIRS INDEPEN7 DENT REVIEW OF CERTAIN DEATHS OF VET8 ERANS BY SUICIDE. 

9 (a) REVIEW REQUIRED.— 


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1 (1) IN GENERAL.—Not later than 90 days after 

2 the date of the enactment of this Act, the Secretary 

3 of Veterans Affairs shall seek to enter into an agree4 ment with the National Academies of Sciences, En5 gineering, and Medicine under which the National 

6 Academies shall conduct a review of the deaths of all 

7 covered veterans who died by suicide during the five8 year period ending on the date of the enactment of 

9 this Act, regardless of whether information relating 

10 to such deaths has been reported by the Centers for 

11 Disease Control and Prevention. 

12 (2) ELEMENTS.—The review required by para13 graph (1) shall include the following: 

14 (A) The total number of covered veterans 

15 who died by suicide during the five-year period 

16 ending on the date of the enactment of this Act. 

17 (B) The total number of covered veterans 

18 who died by a violent death during such five19 year period. 

20 (C) The total number of covered veterans 

21 who died by an accidental death during such 

22 five-year period. 

23 (D) A description of each covered veteran 

24 described in subparagraphs (A) through (C), in25 cluding age, gender, race, and ethnicity. 


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1 (E) A comprehensive list of prescribed 

2 medications and legal or illegal substances as 

3 annotated on toxicology reports of covered vet4 erans described in subparagraphs (A) through 

5 (C), specifically listing any medications that 

6 carried a black box warning, were prescribed for 

7 off-label use, were psychotropic, or carried 

8 warnings that included suicidal ideation. 

9 (F) A summary of medical diagnoses by 

10 physicians of the Department of Veterans Af11 fairs or physicians providing services to covered 

12 veterans through programs of the Department 

13 that led to the prescribing of medications re14 ferred to in subparagraph (E) in cases of post15 traumatic stress disorder, traumatic brain in16 jury, military sexual trauma, and other anxiety 

17 and depressive disorders. 

18 (G) The number of instances in which a 

19 covered veteran described in subparagraph (A), 

20 (B), or (C) was concurrently on multiple medi21 cations prescribed by physicians of the Depart22 ment or physicians providing services to vet23 erans through programs of the Department to 

24 treat post-traumatic stress disorder, traumatic 

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1 iety and depressive disorders, or instances of 

2 comorbidity. 

3 (H) The number of covered veterans de4 scribed in subparagraphs (A) through (C) who 

5 were not taking any medication prescribed by a 

6 physician of the Department or a physician pro7 viding services to veterans through a program 

8 of the Department. 

9 (I) With respect to the treatment of post10 traumatic stress disorder, traumatic brain in11 jury, military sexual trauma, or other anxiety 

12 and depressive disorders, the percentage of cov13 ered veterans described in subparagraphs (A) 

14 through (C) who received a non-medication 

15 first-line treatment compared to the percentage 

16 of such veterans who received medication only. 

17 (J) With respect to the treatment of cov18 ered veterans described in subparagraphs (A) 

19 through (C) for post-traumatic stress disorder, 

20 traumatic brain injury, military sexual trauma, 

21 or other anxiety and depressive disorders, the 

22 number of instances in which a non-medication 

23 first-line treatment (such as cognitive behav24 ioral therapy) was attempted and determined to 

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1 quently led to the prescribing of a medication 

2 referred to in subparagraph (E). 

3 (K) A description and example of how the 

4 Department determines and continually updates 

5 the clinical practice guidelines governing the 

6 prescribing of medications. 

7 (L) An analysis of the use by the Depart8 ment, including protocols or practices at med9 ical facilities of the Department, of systemati10 cally measuring pain scores during clinical en11 counters under the Pain as the 5th Vital Sign 

12 Toolkit of the Department and an evaluation of 

13 the relationship between the use of such meas14 urements and the number of veterans concur15 rently on multiple medications prescribed by 

16 physicians of the Department. 

17 (M) A description of the efforts of the De18 partment to maintain appropriate staffing levels 

19 for mental health professionals, such as mental 

20 health counselors, marriage and family thera21 pists, and other appropriate counselors, includ22 ing— 

23 (i) a description of any impediments 

24 to carry out the education, training, and 

25 hiring of mental health counselors and 


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1 marriage and family therapists under sec2 tion 7302(a) of title 38, United States 

3 Code, and strategies for addressing those 

4 impediments; 

5 (ii) a description of the objectives, 

6 goals, and timing of the Department with 

7 respect to increasing the representation of 

8 such counselors and therapists in the be9 havioral health workforce of the Depart10 ment, including— 

11 (I) a review of eligibility criteria 

12 for such counselors and therapists and 

13 a comparison of such criteria to that 

14 of other behavioral health professions 

15 in the Department; and 

16 (II) an assessment of the partici17 pation of such counselors and thera18 pists in the mental health profes19 sionals trainee program of the De20 partment and any impediments to 

21 such participation; 

22 (iii) an assessment of the development 

23 by the Department of hiring guidelines for 

24 mental health counselors, marriage and 


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1 family therapists, and other appropriate 

2 counselors; 

3 (iv) a description of how the Depart4 ment— 

5 (I) identifies gaps in the supply 

6 of mental health professionals; and 

7 (II) determines successful staff8 ing ratios for mental health profes9 sionals of the Department; 

10 (v) a description of actions taken by 

11 the Secretary, in consultation with the Di12 rector of the Office of Personnel Manage13 ment, to create an occupational series for 

14 mental health counselors and marriage and 

15 family therapists of the Department and a 

16 timeline for the creation of such an occu17 pational series; and 

18 (vi) a description of actions taken by 

19 the Secretary to ensure that the national, 

20 regional, and local professional standards 

21 boards for mental health counselors and 

22 marriage and family therapists are com23 prised of only mental health counselors and 

24 marriage and family therapists and that 

25 the liaison from the Department to such 


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1 boards is a mental health counselor or 

2 marriage and family therapist. 

3 (N) The percentage of covered veterans de4 scribed in subparagraphs (A) through (C) with 

5 combat experience or trauma related to combat 

6 experience (including military sexual trauma, 

7 traumatic brain injury, and post-traumatic 

8 stress). 

9 (O) An identification of the medical facili10 ties of the Department with markedly high pre11 scription rates and suicide rates for veterans re12 ceiving treatment at those facilities. 

13 (P) An analysis, by State, of programs of 

14 the Department that collaborate with State 

15 Medicaid agencies and the Centers for Medicare 

16 and Medicaid Services, including the following: 

17 (i) An analysis of the sharing of pre18 scription and behavioral health data for 

19 veterans. 

20 (ii) An analysis of whether Depart21 ment staff check with State prescription 

22 drug monitoring programs before pre23 scribing medications to veterans. 

24 (iii) A description of the procedures of 

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1 scribers outside of the Department to en2 sure that veterans are not overprescribed. 

3 (iv) A description of actions that the 

4 Department takes when a veteran is deter5 mined to be overprescribed. 

6 (Q) An analysis of the collaboration of 

7 medical centers of the Department with medical 

8 examiners’ offices or local jurisdictions to deter9 mine veteran mortality and cause of death. 

10 (R) An identification and determination of 

11 a best practice model to collect and share vet12 eran death certificate data between the Depart13 ment of Veterans Affairs, the Department of 

14 Defense, States, and tribal entities. 

15 (S) A description of how data relating to 

16 death certificates of veterans is collected, deter17 mined, and reported by the Department of Vet18 erans Affairs. 

19 (T) An assessment of any patterns appar20 ent to the National Academies of Sciences, En21 gineering, and Medicine based on the review 

22 conducted under paragraph (1). 

23 (U) Such recommendations for further ac24 tion that would improve the safety and well25 being of veterans as the National Academies of 


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1 Sciences, Engineering, and Medicine determine 

2 appropriate. 

3 (3) COMPILATION OF DATA.— 

4 (A) FORM OF COMPILATION.—The Sec5 retary of Veterans Affairs shall ensure that 

6 data compiled under paragraph (2) is compiled 

7 in a manner that allows it to be analyzed across 

8 all data fields for purposes of informing and 

9 updating clinical practice guidelines of the De10 partment of Veterans Affairs. 

11 (B) COMPILATION OF DATA REGARDING

12 COVERED VETERANS.—In compiling data under 

13 paragraph (2) regarding covered veterans de14 scribed in subparagraphs (A) through (C) of 

15 such paragraph, data regarding veterans de16 scribed in each such subparagraph shall be 

17 compiled separately and disaggregated by year. 

18 (4) COMPLETION OF REVIEW AND REPORT.— 

19 The agreement entered into under paragraph (1) 

20 shall require that the National Academies of 

21 Sciences, Engineering, and Medicine complete the 

22 review under such paragraph and submit to the Sec23 retary of Veterans Affairs a report containing the 

24 results of the review not later than 180 days after 

25 entering into the agreement. 


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1 (b) REPORT.—Not later than 30 days after the com2 pletion by the National Academies of Sciences, Engineer3 ing, and Medicine of the review required under subsection 

4 (a), the Secretary of Veterans Affairs shall— 

5 (1) submit to the Committee on Veterans’ Af6 fairs of the Senate and the Committee on Veterans’ 

7 Affairs of the House of Representatives a report on 

8 the results of the review; and 

9 (2) make such report publicly available. 

10 (c) DEFINITIONS.—In this section: 

11 (1) The term ‘‘black box warning’’ means a 

12 warning displayed on the label of a prescription drug 

13 that is designed to call attention to the serious or 

14 life-threatening risk of the prescription drug. 

15 (2) The term ‘‘covered veteran’’ means a vet16 eran who received hospital care or medical services 

17 furnished by the Department of Veterans Affairs 

18 during the five-year period preceding the death of 

19 the veteran. 

20 (3) The term ‘‘first-line treatment’’ means a po21 tential intervention that has been evaluated and as22 signed a high score within clinical practice guide23 lines. 

24 (4) The term ‘‘State’’ means each of the States, 

25 territories, and possessions of the United States, the 


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1 District of Columbia, and the Commonwealth of 

2 Puerto Rico. 

Æ 


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