II 

114TH CONGRESS 

2D SESSION S. 3410 

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 SENATE OF THE UNITED STATES 

SEPTEMBER 28, 2016 

Mr. MCCAIN introduced the following bill; which was read twice and 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 Prevention Act of 2016’’. 

6 SEC. 2. DEPARTMENT OF VETERANS AFFAIRS INDE7 PENDENT REVIEW OF CERTAIN DEATHS OF 

8 VETERANS 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. 

10 (2) ALTERNATE ORGANIZATION.— 

11 (A) IN GENERAL.—If the Secretary is un12 able to enter into an agreement described in 

13 paragraph (1) with the National Academies of 

14 Sciences, Engineering, and Medicine on terms 

15 acceptable to the Secretary, the Secretary shall 

16 seek to enter into such an agreement with an17 other appropriate organization that— 

18 (i) is not part of the Federal Govern19 ment; 

20 (ii) operates as a not-for-profit entity; 

21 and 

22 (iii) has expertise and objectivity com23 parable to that of the National Academies 

24 of Sciences, Engineering, and Medicine. 


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1 (B) TREATMENT.—If the Secretary enters 

2 into an agreement with another organization as 

3 described in paragraph (1), any reference in 

4 this section to the National Academies of 

5 Sciences, Engineering, and Medicine shall be 

6 treated as a reference to the other organization. 

7 (3) ELEMENTS.—The review required by para8 graph (1) shall include the following: 

9 (A) The total number of covered veterans 

10 who died by suicide during the five-year period 

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

12 (B) The total number of covered veterans 

13 who died by a violent death during such five14 year period. 

15 (C) The total number of covered veterans 

16 who died by an accidental death during such 

17 five-year period. 

18 (D) A description of each covered veteran 

19 described in subparagraphs (A) through (C), in20 cluding age, gender, race, and ethnicity. 

21 (E) A comprehensive list of prescribed 

22 medications and legal or illegal substances as 

23 annotated on toxicology reports of covered vet24 erans described in subparagraphs (A) through 

25 (C), specifically listing any medications that 


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1 carried a black box warning, were prescribed for 

2 off-label use, were psychotropic, or carried 

3 warnings that included suicidal ideation. 

4 (F) A summary of medical diagnoses by 

5 physicians of the Department of Veterans Af6 fairs or physicians providing services to covered 

7 veterans through programs of the Department 

8 that led to the prescribing of medications re9 ferred to in subparagraph (E) in cases of post10 traumatic stress disorder, traumatic brain in11 jury, military sexual trauma, and other anxiety 

12 and depressive disorders. 

13 (G) The number of instances in which a 

14 covered veteran described in subparagraph (A), 

15 (B), or (C) was concurrently on multiple medi16 cations prescribed by physicians of the Depart17 ment or physicians providing services to vet18 erans through programs of the Department to 

19 treat post-traumatic stress disorder, traumatic 

20 brain injury, military sexual trauma, other anx21 iety and depressive disorders, or instances of 

22 comorbidity. 

23 (H) The number of covered veterans de24 scribed in subparagraphs (A) through (C) who 

25 were not taking any medication prescribed by a 


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1 physician of the Department or a physician pro2 viding services to veterans through a program 

3 of the Department. 

4 (I) With respect to the treatment of post5 traumatic stress disorder, traumatic brain in6 jury, military sexual trauma, or other anxiety 

7 and depressive disorders, the percentage of cov8 ered veterans described in subparagraphs (A) 

9 through (C) who received a non-medication 

10 first-line treatment compared to the percentage 

11 of such veterans who received medication only. 

12 (J) With respect to the treatment of cov13 ered veterans described in subparagraphs (A) 

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

15 traumatic brain injury, military sexual trauma, 

16 or other anxiety and depressive disorders, the 

17 number of instances in which a non-medication 

18 first-line treatment (such as cognitive behav19 ioral therapy) was attempted and determined to 

20 be ineffective for such a veteran, which subse21 quently led to the prescribing of a medication 

22 referred to in subparagraph (E). 

23 (K) A description and example of how the 

24 Department determines and continually updates 


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1 the clinical practice guidelines governing the 

2 prescribing of medications. 

3 (L) A description of the efforts of the De4 partment to maintain appropriate staffing levels 

5 for mental health professionals, such as mental 

6 health counselors, marriage and family thera7 pists, and other appropriate counselors, includ8 ing— 

9 (i) a description of any impediments 

10 to carry out the education, training, and 

11 hiring of mental health counselors and 

12 marriage and family therapists under sec13 tion 7302(a) of title 38, United States 

14 Code; 

15 (ii) with respect to mental health 

16 counselors, marriage and family therapists, 

17 and other appropriate counselors, an iden18 tification of resolutions for— 

19 (I) any standardized credential20 ing discrepancies; and 

21 (II) any impediments to the de22 velopment of an internship training 

23 program; 

24 (iii) an assessment of the development 

25 by the Department of hiring guidelines for 


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1 mental health counselors, marriage and 

2 family therapists, and other appropriate 

3 counselors; and 

4 (iv) a description of how the Depart5 ment— 

6 (I) identifies gaps in the supply 

7 of mental health professionals; and 

8 (II) determines successful staff9 ing ratios for mental health profes10 sionals of the Department. 

11 (M) The percentage of covered veterans de12 scribed in subparagraphs (A) through (C) with 

13 combat experience or trauma related to combat 

14 experience (including military sexual trauma, 

15 traumatic brain injury, and post-traumatic 

16 stress). 

17 (N) An identification of the medical facili18 ties of the Department with markedly high pre19 scription rates and suicide rates for veterans re20 ceiving treatment at those facilities. 

21 (O) An analysis, by State, of programs of 

22 the Department that collaborate with State 

23 Medicaid agencies and the Centers for Medicare 

24 and Medicaid Services, including the following: 


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1 (i) An analysis of the sharing of pre2 scription and behavioral health data for 

3 veterans. 

4 (ii) An analysis of whether Depart5 ment staff check with State prescription 

6 drug monitoring programs before pre7 scribing medications to veterans. 

8 (iii) A description of the procedures of 

9 the Department for coordinating with pre10 scribers outside of the Department to en11 sure that veterans are not overprescribed. 

12 (iv) A description of actions that the 

13 Department takes when a veteran is deter14 mined to be overprescribed. 

15 (P) An analysis of the collaboration of 

16 medical centers of the Department with medical 

17 examiners’ offices or local jurisdictions to deter18 mine veteran mortality and cause of death. 

19 (Q) An identification and determination of 

20 a best practice model to collect and share vet21 eran death certificate data between the Depart22 ment of Veterans Affairs, the Department of 

23 Defense, States, and tribal entities. 

24 (R) An assessment of any patterns appar25 ent to the National Academies of Sciences, EnVerDate Sep 11 2014 03:09 Oct 01, 2016 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3410.IS S3410

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1 gineering, and Medicine based on the review 

2 conducted under paragraph (1). 

3 (S) Such recommendations for further ac4 tion that would improve the safety and well5 being of veterans as the National Academies of 

6 Sciences, Engineering, and Medicine determine 

7 appropriate. 

8 (4) COMPILATION OF DATA.— 

9 (A) FORM OF COMPILATION.—The Sec10 retary of Veterans Affairs shall ensure that 

11 data compiled under paragraph (3) is compiled 

12 in a manner that allows it to be analyzed across 

13 all data fields for purposes of informing and 

14 updating clinical practice guidelines of the De15 partment of Veterans Affairs. 

16 (B) COMPILATION OF DATA REGARDING

17 COVERED VETERANS.—In compiling data under 

18 paragraph (3) regarding covered veterans de19 scribed in subparagraphs (A) through (C) of 

20 such paragraph, data regarding veterans de21 scribed in each such subparagraph shall be 

22 compiled separately. 

23 (5) COMPLETION OF REVIEW AND REPORT.— 

24 The agreement entered into under paragraph (1) 

25 shall require that the National Academies of 


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1 Sciences, Engineering, and Medicine complete the 

2 review under such paragraph and submit to the Sec3 retary of Veterans Affairs a report containing the 

4 results of the review not later than 180 days after 

5 entering into the agreement. 

6 (b) REPORT.—Not later than 30 days after the com7 pletion by the National Academies of Sciences, Engineer8 ing, and Medicine of the review required under subsection 

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

10 (1) submit to Congress a report on the results 

11 of the review; and 

12 (2) make such report publicly available. 

13 (c) DEFINITIONS.—In this section: 

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

15 warning displayed on the label of a prescription drug 

16 that is designed to call attention to the serious or 

17 life-threatening risk of the prescription drug. 

18 (2) The term ‘‘covered veteran’’ means a vet19 eran who received hospital care or medical services 

20 furnished by the Department of Veterans Affairs 

21 during the five-year period preceding the death of 

22 the veteran. 

23 (3) The term ‘‘first-line treatment’’ means a po24 tential intervention that has been evaluated and asVerDate Sep 11 2014 03:09 Oct 01, 2016 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S3410.IS S3410

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1 signed a high score within clinical practice guide2 lines. 

3 (4) The term ‘‘State’’ means each of the several 

4 States, territories, and possessions of the United 

5 States, the District of Columbia, and the Common6 wealth of Puerto Rico. 

Æ 


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