Wallace claims document directs VA doctors “to refer all veterans” to “Your Life, Your Choices”

From the August 23 edition of Fox Broadcasting Co.'s Fox News Sunday:

WALLACE: Secretary Duckworth, that's just not true. The VHA put out a directive on July 2, 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 2, 2009 -- last month, more than a month ago -- VA 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. [Jim] Towey's [director of faith-based initiatives in the Bush administration] if they want to spend the $5 apiece. VA simply was not willing to buy his booklet at $5 per veteran at the time.

WALLACE: But how do you explain --

DUCKWORTH: This is a decision that was made by the previous administration.

WALLACE: It doesn't say, “Give them access to anything.” I mean, in the specific VA booklet -- it's only about 15 pages long -- it specifically refers to this booklet twice.

Wallace and Fox crop doc: actually directs patients to " 'Your Life, Your Choices' ... or other published resources"

Fox's Page 8: Practitioners must give “patients pertinent educational materials (e.g., Refer patients to the 'Your Life, Your Choices' module...)”:

Actual Page 8: “Refer patients to the 'Your Life, Your Choices' module ... or provide written material such as” VA's advance directives doc. Page 8 of the July 2 release of a VHA Handbook titled “Advance Care Planning and Management of Advance Directives,” and signed by Acting Under Secretary for Heath Gerald M. Cross, states [emphasis added]:

Primary care practitioners are responsible for:

[...]

b. 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 directs practitioners to a PDF of the VA's “What You Should Know About Advance Directives” document, dated December 2006.

Fox's Page 9: “Patients may be directed to the exercises in 'Your Life, Your Choices'”:

Actual Page 9: “Patients may be directed to the exercises in 'Your Life, Your Choices' ... or other published resources.” From the document [emphasis added]:

VA must provide additional information about advance directives and/or assistance in completing forms for all patients who request this service. This assistance may be provided by social workers, or others who are appropriately trained, and must be available to patients in all clinical settings.

a. Content. Designated practitioners need to ensure that the patient understands the meaning of advance care planning and advance directives, including the information listed in subparagraphs 8b to 8f. For patients who already have an advance directive, practitioners also need to cover points in paragraph 8g and 8h. Possible clinical scenarios and treatment options need to be discussed with attention and sensitivity to the patient's individual circumstances, needs, and culture. Patients may be directed to the exercises in “Your Life, Your Choices” (available on My HealtheVet at the web site http://www.myhealth.va.gov), or other published resources.

After Duckworth corrects Wallace, he again airs graphic, falsely suggests she is lying

From the August 23 edition of Fox News Sunday:

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” [sic] is widely used out there, not just within VA. There are many others that are out there. And veterans are free to use whatever they would like to use. We just urge them to use them.

WALLACE: Let me -- I mean, I just -- I have a problem here. And often -- too often on these shows, we just 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 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 2, 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 2.

But VHA doc supports her statement that VHA “encourages veterans to use any type of tool or checklist they would like to.” From Pages 9 and 10 of the document, under the heading “Patient-Requested Additional Information About Advance Directives or Assistance in Completing Advance Directive Forms” [emphasis added]:

b. Forms. If requested, appropriately trained staff must assist the patient in completing:

(1) VA Form 10-0137. VA Form 10-0137 (revised December 2006) is a combined DPAHC (Part II) and living will (Part III). A Veteran who does not want to specify treatment preferences may still designate an HCA to make treatment decisions on their behalf. Additionally, a Veteran may specify treatment preferences without designating an HCA. VA Form 10-0137 is available electronically on the VA internet Forms website at http://www.va.gov/vaforms, the VA intranet Forms website at http://vaww.va.gov/vaforms, in iMedConsent™ (“Shared” category), and with a link on the National Center for Ethics in Health Care web site at http://vaww.ethics.va.gov, (This is an internal web site not available to the public.) and My HealtheVet at http://www.myhealth.va.gov. NOTE: VA recognizes State-authorized forms and DOD advance directives to the extent they are consistent with VA policy.

(a) To provide further information about their treatment goals, specific treatment preferences, etc., patients may attach one or more additional page(s), each of which must be initialed and dated, to VA Form 10-0137. This may consist of blank sheets on which patients write what they wish or pages from existing documents (e.g., worksheets from “Your Life, Your Choices” or other available sources. To ensure that the document filed in the patient's record is complete, VA Form 10-0137and any supplemental pages must be scanned (or filed) together, to create a single document.

Transcript

From the August 23 edition of Fox Broadcasting Co.'s Fox News Sunday:

WALLACE: 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 an end-of-life plan-- 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 [Jim] 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 [James] Peake all valued life. And that's what we're doing, is we're revising it. It will be out in 2010. It's not yet out. So Mr. Towey was not correct by saying --

WALLACE: Secretary Duckworth, that's just not true. The VHA put out a directive on July 2, 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 2, 2009 -- last month, more than a month ago -- VA 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. VA simply was not willing to buy his booklet at $5 per veteran at the time.

WALLACE: But how do you explain --

DUCKWORTH: This is a decision that was made by the previous administration.

WALLACE: It doesn't say, “Give them access to anything.” I mean, in the specific VA booklet -- it's only about 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 beginning of 2007, 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 VA benefits. We estimate it will be another 500,000 veterans coming in for benefits. We are expanding VA 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.

[...]

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” [sic] is widely used out there, not just within VA. There are many others that are out there. And veterans are free to use whatever they would like to use. We just urge them to use them.

WALLACE: Let me -- I mean, I just -- I have a problem here. And often -- too often on these shows, we just 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 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 2, 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 2.

DUCKWORTH: Chris, I'm sorry. I can't see that on a monitor in here. I will tell you that I know for a fact that the only directive signed by Secretary [Eric] Shinseki -- I mean, signed by a VA 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 -- I'd be happy to come back and discuss it with you.