Category Archives: FOIA/FOIL

Evidence for Use of Electroshock on Veterans

A FOIA request that I submitted to the United States Department of Veterans Affairs for various types of information on the use of electroshock on Veterans was referred to and responded to by the Veteran’s Health Administration.

Specifically, the FOIA request produced data from Fiscal Year 2009 in a 16 page “draft/pre-decisional” document entitled, “National and Regional Resource Report” and addresses “programs not mandated by the Uniform Services Handbook” (p. 1).

Included in these programs, were programs for women’s PTSD care and Military Sexual Trauma programs. Listed in Appendix 3 was “ECT Services”, in a table (clearly in draft) with two columns, one representing “ECT in FY09” and “pts with 2 or more visits”. This is then broken into three columns. The first was headed as “Parent facility” and consisted of 75 Veterans Affairs Medical Centers (VAMC). The second and third columns represent, “# of visits” and “# of patients” (p. 13) which repeats as headers on the next page (p. 14). By my computations, the numbers in Appendix 3 do not match the description of the data given on p. 4 of the document, “5009 ECT treatments were provided to 743 unique VHA patients ” (p. 4). Therefore, it is unclear whether the data provided in Appendix 3 (pp. 13-14) is additional usage of electroshock or if there was some mistake in the written description provided by the report.  I have added a jpg of Appendix 3 for you to come to your own conclusions. Here is the full excerpt on the “ECT below in its full context under the heading, “ECT Use in the Veterans Health Administration” (p. 4):

All VISN mental health liaisons were surveyed regarding the presence of Electro-Convulsive (ECT) programs in their VISNs. Responses were received from 15 of the 21 VISNs, and all 15 of these VISNs reported ECT programs within their VISNs. Three VISNs reported limited contracts for ECT services and most ECT services are provided to patients coming from within VISN boundaries.
In addition, we examined administrative data regarding ECT use in fiscal year 2009. This was based on current procedural terminology (CPT) codes in the outpatient records (90870 and 90871) and ICD-9 codes from surgery and procedure records (94.26 and 94.27). This method has been found to have reasonable sensitivity and specificity for detecting ECT when compared to chart reviews. This method does not capture ECT provided to VA patients through contracting with a non-VA facility.
In FY09, a total of 5009 ECT treatments were provided to 743 unique VHA patients for an average 6.7 treatments per patient. All 21 VISNs provided some ECT in accordance with Uniform Mental Health Services provisions outlined in VHA HANDBOOK 1160.01. The mean number of patients treated in each VISN was 35.4 (SD 23.3). VISNs 4, 5, and 19 fell one standard deviation below the mean, whereas VISNs 1, 8, 12, and 23 were more than one standard deviation above the mean. ECT was provided in 75 VA Medical Centers for an average of 9.9 (SD 11.3) patients treated per VAMC that provided ECT, although 7 of these facilities had only one recorded treatment, which suggests that ECT may have been recorded in error at these facilities. The VAMCs with the most ECT treatments (≥ 30 patients treated) were San Juan, Omaha, North Chicago, Kansas City, and San Antonio.

(Office of Mental Health Services, Veteran’s Health Administration, May 28, 2010. Draft/Pre-decisional. National and Regional Resource Report  p. 4 )

In the other document I was sent, VHA Handbook 1004-01 — Informed Consent, electroshock is specifed in Appendix A “Treatments and Procedures Requiring Signature Consent” (pp. A1 – A2) and specifies prior to #9 “Electroconvulsive therapy” (p. A2), this note:

NOTE: It is not necessary to obtain a separate signature consent for sedation, anesthesia, or blood product transfusion if the combined consent form for the procedure already contains consent for sedation, anesthesia, or blood product transfusion . . . (p. A2).

Finally, the Information Officer responded affirmatively to a request I had in response to criteria mentioned in the Informed Consent handbook, namely, VHA Handbook 1160.01 (September 11, 2008)  which in relation to ECT states:

(4) Veterans must have access to electroconvulsive therapy (ECT) in the VISN in which they receive care.

(a) ECT must be provided when it is clinically indicated consistent with VA clinical practice guidelines found at:
http://vaww.oqp.med.va.gov/CPGintra/cpg/MDD/MDD_Base.htm, as well as those of the American Psychiatric Association.
NOTE: VA guidelines are located on an internal VA site that is not available to the public.
1. Staff needs to be knowledgeable about the current scientific literature.
2. Electroconvulsive therapy needs to be coordinated with other psychosocial, psychological, psychopharmacological, and medical care that patients may be receiving.
(b) Patients who respond to ECT require some form of continuation or maintenance treatment to prevent relapses or recurrences. (pp. 31-32)

It is time to talk about the evidence of the use of electroshock on Veterans. According to the data I have been given electroshock was routinely used on Veterans in the United States of America in 2009 and was widely available in the VAMC network. I am sure one can spend the rest of one’s life going through all of this information. This is but a step toward finding out what is happening to all Veterans in the United States of America in 2015 and beyond. I have been in communication with the VHA FOIA Officer concerning new questions this information has created including seeking clarification of informed consent procedures and forms used.

On July 24, 2015, I sent a follow-up FOIA request to the Veteran’s Health Administration.

I will continue to follow this information. Please feel free to make suggestions for analysis and other information I ought to put in FOIA requests to the Veterans Health Administration.

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1762