Veteran Overmedication and Suicide Prevention Act of 2023
This bill requires the Department of Veterans Affairs (VA) to contract with the National Academies of Sciences, Engineering, and Medicine to report on the deaths of covered veterans who died by suicide during the last five years, regardless of whether information relating to such deaths has been reported by the Centers for Disease Control and Prevention. A covered veteran is any veteran who received VA hospital care or medical services during the five-year period preceding the veteran's death.
Among other elements, the report shall include the total number of covered veterans who died by suicide, violent death, or accidental death, as well as certain demographic information.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4400 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 4400
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
June 30, 2023
Mr. Buchanan (for himself and Mr. Connolly) 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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veteran Overmedication and Suicide
Prevention Act of 2023''.
SEC. 2. DEPARTMENT OF VETERANS AFFAIRS INDEPENDENT REVIEW OF CERTAIN
DEATHS OF VETERANS BY SUICIDE.
(a) Review Required.--
(1) In general.--Not later than 90 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall seek to enter into an agreement with the National
Academies of Sciences, Engineering, and Medicine under which
the National Academies shall conduct a review of the deaths of
all covered veterans who died by suicide during the five-year
period ending on the date of the enactment of this Act,
regardless of whether information relating to such deaths has
been reported by the Centers for Disease Control and
Prevention.
(2) Elements.--The review required by paragraph (1) shall
include the following:
(A) The total number of covered veterans who died
by suicide during the five-year period ending on the
date of the enactment of this Act.
(B) The total number of covered veterans who died
by a violent death during such five-year period.
(C) The total number of covered veterans who died
by an accidental death during such five-year period.
(D) A description of each covered veteran described
in subparagraphs (A) through (C), including age,
gender, race, and ethnicity.
(E) A comprehensive list of prescribed medications
and legal or illegal substances as annotated on
toxicology reports of covered veterans described in
subparagraphs (A) through (C), specifically listing any
medications that carried a black box warning, were
prescribed for off-label use, were psychotropic, or
carried warnings that included suicidal ideation.
(F) A summary of medical diagnoses by physicians of
the Department of Veterans Affairs or physicians
providing services to covered veterans through programs
of the Department that led to the prescribing of
medications referred to in subparagraph (E) in cases of
post-traumatic stress disorder, traumatic brain injury,
military sexual trauma, and other anxiety and
depressive disorders.
(G) The number of instances in which a covered
veteran described in subparagraph (A), (B), or (C) was
concurrently on multiple medications prescribed by
physicians of the Department or physicians providing
services to veterans through programs of the Department
to treat post-traumatic stress disorder, traumatic
brain injury, military sexual trauma, other anxiety and
depressive disorders, or instances of comorbidity.
(H) The number of covered veterans described in
subparagraphs (A) through (C) who were not taking any
medication prescribed by a physician of the Department
or a physician providing services to veterans through a
program of the Department.
(I) With respect to the treatment of post-traumatic
stress disorder, traumatic brain injury, military
sexual trauma, or other anxiety and depressive
disorders, the percentage of covered veterans described
in subparagraphs (A) through (C) who received a non-
medication first-line treatment compared to the
percentage of such veterans who received medication
only.
(J) With respect to the treatment of covered
veterans described in subparagraphs (A) through (C) for
post-traumatic stress disorder, traumatic brain injury,
military sexual trauma, or other anxiety and depressive
disorders, the number of instances in which a non-
medication first-line treatment (such as cognitive
behavioral therapy) was attempted and determined to be
ineffective for such a veteran, which subsequently led
to the prescribing of a medication referred to in
subparagraph (E).
(K) A description and example of how the Department
determines and continually updates the clinical
practice guidelines governing the prescribing of
medications.
(L) An analysis of the use by the Department,
including protocols or practices at medical facilities
of the Department, of systematically measuring pain
scores during clinical encounters under the Pain as the
5th Vital Sign Toolkit of the Department and an
evaluation of the relationship between the use of such
measurements and the number of veterans concurrently on
multiple medications prescribed by physicians of the
Department.
(M) A description of the efforts of the Department
to maintain appropriate staffing levels for mental
health professionals, such as mental health counselors,
marriage and family therapists, and other appropriate
counselors, including--
(i) a description of any impediments to
carry out the education, training, and hiring
of mental health counselors and marriage and
family therapists under section 7302(a) of
title 38, United States Code, and strategies
for addressing those impediments;
(ii) a description of the objectives,
goals, and timing of the Department with
respect to increasing the representation of
such counselors and therapists in the
behavioral health workforce of the Department,
including--
(I) a review of eligibility
criteria for such counselors and
therapists and a comparison of such
criteria to that of other behavioral
health professions in the Department;
and
(II) an assessment of the
participation of such counselors and
therapists in the mental health
professionals trainee program of the
Department and any impediments to such
participation;
(iii) an assessment of the development by
the Department of hiring guidelines for mental
health counselors, marriage and family
therapists, and other appropriate counselors;
(iv) a description of how the Department--
(I) identifies gaps in the supply
of mental health professionals; and
(II) determines successful staffing
ratios for mental health professionals
of the Department;
(v) a description of actions taken by the
Secretary, in consultation with the Director of
the Office of Personnel Management, to create
an occupational series for mental health
counselors and marriage and family therapists
of the Department and a timeline for the
creation of such an occupational series; and
(vi) a description of actions taken by the
Secretary to ensure that the national,
regional, and local professional standards
boards for mental health counselors and
marriage and family therapists are comprised of
only mental health counselors and marriage and
family therapists and that the liaison from the
Department to such boards is a mental health
counselor or marriage and family therapist.
(N) The percentage of covered veterans described in
subparagraphs (A) through (C) with combat experience or
trauma related to combat experience (including military
sexual trauma, traumatic brain injury, and post-
traumatic stress).
(O) An identification of the medical facilities of
the Department with markedly high prescription rates
and suicide rates for veterans receiving treatment at
those facilities.
(P) An analysis, by State, of programs of the
Department that collaborate with State Medicaid
agencies and the Centers for Medicare and Medicaid
Services, including the following:
(i) An analysis of the sharing of
prescription and behavioral health data for
veterans.
(ii) An analysis of whether Department
staff check with State prescription drug
monitoring programs before prescribing
medications to veterans.
(iii) A description of the procedures of
the Department for coordinating with
prescribers outside of the Department to ensure
that veterans are not overprescribed.
(iv) A description of actions that the
Department takes when a veteran is determined
to be overprescribed.
(Q) An analysis of the collaboration of medical
centers of the Department with medical examiners'
offices or local jurisdictions to determine veteran
mortality and cause of death.
(R) An identification and determination of a best
practice model to collect and share veteran death
certificate data between the Department of Veterans
Affairs, the Department of Defense, States, and tribal
entities.
(S) A description of how data relating to death
certificates of veterans is collected, determined, and
reported by the Department of Veterans Affairs.
(T) An assessment of any patterns apparent to the
National Academies of Sciences, Engineering, and
Medicine based on the review conducted under paragraph
(1).
(U) Such recommendations for further action that
would improve the safety and well-being of veterans as
the National Academies of Sciences, Engineering, and
Medicine determine appropriate.
(3) Compilation of data.--
(A) Form of compilation.--The Secretary of Veterans
Affairs shall ensure that data compiled under paragraph
(2) is compiled in a manner that allows it to be
analyzed across all data fields for purposes of
informing and updating clinical practice guidelines of
the Department of Veterans Affairs.
(B) Compilation of data regarding covered
veterans.--In compiling data under paragraph (2)
regarding covered veterans described in subparagraphs
(A) through (C) of such paragraph, data regarding
veterans described in each such subparagraph shall be
compiled separately and disaggregated by year.
(4) Completion of review and report.--The agreement entered
into under paragraph (1) shall require that the National
Academies of Sciences, Engineering, and Medicine complete the
review under such paragraph and submit to the Secretary of
Veterans Affairs a report containing the results of the review
not later than 180 days after entering into the agreement.
(b) Report.--Not later than 30 days after the completion by the
National Academies of Sciences, Engineering, and Medicine of the review
required under subsection (a), the Secretary of Veterans Affairs
shall--
(1) submit to the Committee on Veterans' Affairs of the
Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the results of the review; and
(2) make such report publicly available.
(c) Definitions.--In this section:
(1) The term ``black box warning'' means a warning
displayed on the label of a prescription drug that is designed
to call attention to the serious or life-threatening risk of
the prescription drug.
(2) The term ``covered veteran'' means a veteran who
received hospital care or medical services furnished by the
Department of Veterans Affairs during the five-year period
preceding the death of the veteran.
(3) The term ``first-line treatment'' means a potential
intervention that has been evaluated and assigned a high score
within clinical practice guidelines.
(4) The term ``State'' means each of the States,
territories, and possessions of the United States, the District
of Columbia, and the Commonwealth of Puerto Rico.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Veterans' Affairs.
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