Date: 2001-11-08
Speaker: GARY G. MILLER (republican)
Chamber: H
State: California

Mr. Speaker. I rise today in support of the conference report accompanying. H.R. 2620 and to thank Chairman WALSH and Ranking Member MOLLOHAN for their hard work on this bill. The chairman and ranking member have worked on a wide range of issues within this bill and I believe my colleagues in this body owe them a debt of gratitude for the dedication and spirit of bipartisanship they demonstrated while reaching compromise on their differences. There is. however. language in this report which concerns me greatly. The language pertains to the U.S. Department of Veterans Affairs and the treatment of veterans with mental illness. Mr. Speaker. there is still enormous concern among veterans organizations. Members of this body and mental health advocates about the VAs desire to implement treatment guidelines for veterans who suffer from schizophrenia. The language included in the House version of the conference report accompanying the VAHUD appropriations bill would have held the VA accountable by requiring them to wait until a scientific review of newer atypical antipsychotic medications was completed by the National Institute of Mental Healththe premiere Federal scientific research agency. By contrast. the Senate conference report language for the VAHUD bill would have left the VA free to implement their new treatment guidelines with little congressional oversight. The compromise contained in this conference report is not what many of us in this body had hoped for. Specifically. the compromise does not go far enough to ensue the guidelines the VA seeks to promulgate will follow the most uptodate science regarding the treatment of schizophrenia. In fact. it is precisely because there is a dearth of scientific research on the use of different antipsychotic medications that I fought for inclusion for the Housepassed language in the conference report. Without sound scientific research. I am concerned the VA will institute treatment protocols which could jeopardize the health of veterans with schizophrenia. As many Members know. mental illness is no small thing. and its certainly not something we can describe in terms of dollars and cents. Unless you meet some suffering from am illness like schizophrenia. its hard to imagine how it can impact a persons life as well as those who love them. Without proper treatment. victims are often completely unable to function in society. accounting for 1 out of 5 hospital admissions and 4 of 10 beds in longterm care facilitesnot to mention countless encounters with the corrections system. This is why I was disappointed stronger language did not make its way into the conference report. I am heartened. however. to see we are sending a clear message to the VA that it is not to use the total sum cost of drugs which are prescribed at VA facilities as a measure of a pharmacy managers or physicians performance. Rest assured I will continue working with veterans organizations and advocates for veterans with mental illness to ensure the VA and individual VISNs closely follow the guidance the conference report provides for respect to the freedom that doctors in the VA system should have to prescribe clinically appropriate medications for their patients without fear of reprisal. Let me be clear on this. Diagnosis and treatment of mental illness should be based on medical judgment and need. not price. Restrictive formulary policies jeopardize patient care by taking treatment decisions out of the hands of doctors. Because patients differ in their clinical responses to different drugs. in their sensitivity to specific side effects. and in their tolerance for these side effects when they occurand because the atypical antipsychotic agents are different from one another in their clinical effects for a particular patient and in their side effectsI have a difficult time believing that any treatment protocol or formulary can embody the best clinical care. Veterans with schizophrenia60 percent of whom have a serviceconnected disabilityshould never be subject to 2ndrate treatment. Those who wore the uniform and served to protect our freedom should have access to the newest and most effective treatment available. While this conference report still leaves us with work to do in overseeing the VAs schizophrenia treatment guidelines. I am pleased to see that we have made some progress. Rest assured I will continue to work. along with Mr.