Justice and Support for Veterans with Substance Use Disorders  

Episode Notes

Transcript

Judge Taryn Heath:

Basically what honor court is, it is an alternative to jail or prison. And by this success we save taxpayers money while also rehabilitating and providing our participants with a new foundation for the rest of their life.

Announcer:

Equal access to justice is a core American value. In each episode of Talk Justice, an An LSC Podcast, we’ll explore ways to expand access to justice and illustrate why it is important to the legal community, business government, and the general public. Talk Justice is sponsored by the Leaders Council of the Legal Services Corporation.

Will Gunn:

Hello and welcome to Talk Justice. I’m Will Gunn, vice President for Legal Affairs of the Legal Services Corporation and your host for this episode. I’m also a retired US Air Force colonel and I served as general counsel for the US Department of Veterans Affairs. So this topic is near and dear to my heart. Today we’re highlighting a conversation between veterans and legal experts about wraparound services To address the needs of veterans with substance use disorder, many veterans live with mental or behavioral health challenges as a consequence of their service including traumatic brain injury post-traumatic stress disorder or PTSD and substance use disorder. Approximately one in 10 veterans returning from Iraq and Afghanistan suffers from a form of substance abuse and according to the US Department of Veterans Affairs, the rate of opioid use disorder among veterans is almost double that of the general population. Today you’ll hear how civil legal aid, the Department of Justice and Veterans Treatment Courts provide vital assistance for veterans who are facing these issues. This panel discussion originally took place at LSCs November 19th event called “Honoring Justice Supporting America’s Veterans.” Our guests are assistant US attorney for Rhode Island, Amy Romero, managing attorney for Colorado Legal Services, Pueblo office, Bob Keating, Judge Taryn Heath of Ohio Stark County Court of Common Pleas and former undersecretary of the US Army and Co-founder of the software company WorkMerk, Patrick Murphy.

Host:

So panelists welcome and I appreciate your joining our conversation today. Patrick, I know you have some limitations on your time, so I’d really like to start with you to give us a bit of a foundation. You come to this discussion with someone with multiple perspectives. You are the former number two civilian official with the Department of the Army, and you are also a former army officer. Can you share with us the greatest challenges that you’ve seen people encounter in terms of reintegrating into civilian life?

Patrick Murphy:

We know our and sister veterans most are civic assets. They do phenomenal work, they’re great Americans, but there are far too many that drowned in the sea of goodwill and especially during that transition period where every year we have over 200,000 active troops who become veterans and we got to make sure we’re doing all we can to reach out to them. Part of that leadership philosophy will, as you mentioned, is meeting them where they are. For me, it’s personal. When I joined the Army 19, it changed my life, allowed me to go become a commissioned officer, allowed me to go to law school and even when I was in law school, working at a civil law clinic as a student leader there and meeting people where they are, including clients, and we used to go to a soup kitchen and I’ll never forget, one of my first clients was a Vietnam veteran who happened to be homeless and he still wore his cargo jacket and he came in because he knew we had set up this weekly clinic and he came and said, Hey Patrick, can you help me fill out this job application?

Not really legal services work, but it was being there for him. He was so proud that he had now a lawyer helping him to check his work. But we all know there are just far too many that fall through the cracks. And again, I’m very quick to say how our veterans are civic assets and they start businesses. I invest in those businesses, but that ethic will that you and I and Danielle and so many on this call and all of us know is that we leave no one behind. When you see one veteran being homeless is one too many, they cut it this year, 7%. It’s the lowest it’s ever been. That is phenomenal. We have served about 6.7 million veterans through the VA through Veterans Health Administration more than ever in history. That’s phenomenal. But we also know that too many are taking our own life.

We know too many are wrapped up in substance abuse, and so that’s why the work with Legal Services Corporation and all of us in this call is so critically important. So the number one challenge that I see is figuring out how we can meet these brother and sister veterans where they are and we meet them to our clinics across this country that we help fund. We meet them through social media, we meet them wherever they are and whenever we can get in front of ’em to make sure we take care of ’em. So there you go. Will

Host:

Appreciate it. Thank you very, very much. Bob, I want to turn to you as someone who manages and leads a legal services operation there in Colorado. Over the years I’ve encountered a lot of lawyers and a lot of different people who have a perception that the biggest legal challenge that veterans face is accessing VA benefits such as healthcare and disability compensation in your work and legal aid. Are those the only types of legal issues you see that come up for veterans? What’s your experience been like?

Bob Keating:

Well, we’d like to get accredited, each of the attorneys in here to work with the va, but so many of our cases don’t involve VA benefits per se. We had 50 cases in the last year in the Pueblo office and across our organization there were over 500 cases involving veterans. And although there might be some substance use disorder issues or alcohol issues, oftentimes it’s delirium associated with illness or dementia that brings the client in. We recently had a client with delirium who made an Improvident real estate agreement and we’re working to get him out of that. We had to bring a declaratory judgment act to have the court declare his rights and other party’s rights under the various contracts. So it’s important to do each area of the law as they come in. We had a gentleman many years ago who came in and unfortunately he was discharged less than honorable discharge, but it was related to his military service.

He was stringing communications wire during the Vietnam era in Alaska and he fell out of a tree and suffered a head injury due to the head injury. He ended up having some criminal problems and he was discharged. He came to us with fairly rapidly advancing dementia and he needed a conservatorship to help him out to handle his finances, but he also, we got him into the PACE program, which is the program for all inclusive care of the elderly. It’s a Medicaid program, and he was able to get medical treatment outside of the VA but in the community and he ended up in a nursing facility and unfortunately, his dementia advanced so quickly that he wasn’t able to communicate in short order and subsequently died, but he needed our assistance to get the healthcare that he needed even outside of the va. We also have cases were helping the spouses of veterans. When the veteran may be in a nursing home under the Medicare Catastrophic Coverage Act, the spouse doesn’t lose their home or their income. They are allowed to access the institutionalized spouse’s income. And I think that’s very important and those are examples of what we’re able to do outside of the scope of the VA work.

Host:

Appreciate you sharing your perspectives, judge you in the veterans treatment court field, having founded the honor court there in Stark County, can you share with our audience what differentiates an honor court from other types of courts and what representation looks like in the cases that come before you?

Judge Taryn Heath:

Honor court is a veterans treatment court that is a certified specialized docket by the Ohio Supreme Court and our court deals with felons. We were the first felony veterans treatment court in the state of Ohio. And what particularly works in this veteran’s treatment court, and the reason I named it honor court is really stressing de-stigmatization. Our mission statement is reclaiming honor, dignity and lives, and we really focus on helping as many people as we can. There are some people that are in our program that have low level nonviolent offenses that qualify for a diversion program where if they successfully complete our program, their charges are dismissed and their record expunged. There’s others that are in our general probation track, which the carrot is in completing the program, they can successfully get off probation in less time than a normal probation track because we’re asking more of them during the time period.

They participate in the court in terms of accountability and give back to the community. And then we also have a judicial release track for people who may have been sentenced to prison and brought back and put in honor court so that they can complete their obligations under their sentence in the community rather in terms of a prison sentence. And basically what honor court is, it is an alternative to jail or prison. And by this success we save taxpayers money while also rehabilitating and providing our participants with a new foundation for the rest of their life. Our secret sauce is our mentor program, which is volunteer veterans from the community who volunteer to mentor our participants and keep in contact with them in between regular court sessions. It’s extremely helpful. Veterans relate to veterans. My dad was in the army, my husband was in the Air Force.

I did not serve, but I know and have embraced the military culture. You have to do that in your veterans treatment court and they relate when they are partnered up with a veteran that really, really helps encourage them to succeed through the program. We also focus on everybody has to have a mental health assessment and a substance abuse assessment. I don’t care if your crime suggests that it was related to that or not. I need to know what the whole picture is so that we can develop a treatment plan that works for each of our participants. I have a multidisciplinary team that staffs our participants, that includes a representative from our local community legal aid organization here, a representative of the Veteran Service Commission. There’s a variety of other people too, but those services, the combination of legal aid services and Veteran Service Commission services are key to securing for my participants the benefits that they are entitled to and we strive to make sure that they get those benefits because they are supportive to what they are trying to accomplish.

I’ll just give you a couple of examples. One of my favorites is Rusty. He was a gunner in Vietnam and was credited with saving about 20 men in a really hot situation. He, despite having been out of the service all this time, never got his medals of recognition and we were not only able to secure an upgrade in his service, also obtained all of his medals for him and at his graduation from honor court gave him those. He said that that was the first time he ever truly felt like a veteran. So it was emotional. I’m getting goosebumps just talking about it right now. Also, medical services and dental services, so important. A recent graduate of ours, and this is interesting because he actually came to us from an adjacent county that runs a veterans treatment court, but he lived in Stark County. So Judge Dapto said, if you do the Veterans Treatment Court in Stark County, that’s good enough for me.

He graduated there the Friday before Veterans Day with me, and he’s actually graduating today in Mahoning County. But we got him, he was a meth addict, so the teeth, things like that all gone. He got brand new dentures smiles. He secured a job from somebody that he did community surface work with who was so impressed. They were working on a veteran’s home and the individual offered him a job, asked him what he wanted to make. I think he told him something like eight $9 an hour. He goes, I’m going to pay you $25 an hour. So because I incentivized community service that benefits veterans organizations or veterans, he was able to connect with a veteran organization and ended up securing employment with them. And finally, securing benefits for our participants is literally lifesaving. Someone who had not been to VA and didn’t even know he was VA eligible, I have everybody if they haven’t been to the doctor in a while ago, he was diagnosed with cancer, didn’t even know he had it, and was able to secure the medical benefits and services that he was entitled to and was able to survive. So I’d offer that up as an example of how connecting people with services is lifesaving.

Host:

Thanks very much, judge. I just want to say I love the name honor court and I’ve spoken to someone I know that Judge Robert Russell who was giant and he talks about the power of the mentoring component. And so what you’re saying, what both of you say with respect to that is just so powerful. Veterans helping veterans. So thank you. Amy, I know that you serve on the Department of Justices service members and Veterans Initiative. Can you share with us a bit about the initiative and any trends that DOJ has seen regarding veteran civil legal needs?

Amy Romero:

Absolutely. So I know Judge Heat just spoke about veteran treatment courts and the amazing court that’s taking place and her jurisdiction. So veteran treatment courts mainly exist at the state and local levels, and they received funding by DOJs Office of Justice programs. We do have several federal level veteran treatment programs run through US attorney’s offices, and I believe there’s going to be a link in the chat box so you can check to see if there’s a federal level veteran treatment program in your jurisdiction. As Will mentioned, we do have a service member and veterans initiative, which is housed in DOJs civil Rights Division. Through this initiative, we offer outreach and training to support service members, veterans, their families, and we enforce civil rights laws that impact veterans and service members, including SCRA, which is the service member Civil Relief Act, which provides financial protections er, which is Uniform Services Employment and Reemployment Rights Act, which provides employment protections to service members who are returning from their service to their civilian jobs.

Now, judge Heath talked about the secret sauce for her court. For me, when it comes to veterans with substance use, my secret sauce is the Americans with Disabilities Act, the A DA, and I want to talk about that because I know a lot of you, when I was a legal aid attorney, which is where I started my career, I did use the A DA. I often used it in my eviction defense cases in my employment cases. And so there is a private right of action, but DOJ enforces it as well. So the A, as many of you know, is a federal law that gives protections to individuals with disabilities in many areas of life. Employment, healthcare, courts, prisons, schools, homeless shelters, restaurants, hotels. When you think of the, A lot of people think of ramps or elevators or service animals, sign language interpreters, but I want to talk about the A DA as it relates to veterans with substance use disorder and specifically with opioid use disorder.

So substance use disorder and opioid use disorder are disabilities under the A DA, and as I’m sure you all know, opioid use disorder is life-threatening and debilitating each year. In Rhode Island where I live, opioid related overdoses continues to be a leading cause of death, and I wouldn’t be surprised if that’s the case where you all live as well. The good news is that opioid use disorder is treatable. There are three life-saving medications approved by the FDA Methadone, buprenorphine or otherwise, often known as Suboxone and Naltrexone, which is often known as Vivitrol. But the problem is, is people who are prescribed this medication often face barriers due to stigma around the medications. So we’ve seen prisons refuse to allow inmates to have access to their medication, sober housing, where a condition of living there is that the individual not take their medication. Primary care doctors that refuse to see patients that are taking this medication, employers who refuse to hire someone if a drug test shows one of these medications and the list goes on and on.

So the A protects individuals who are taking legally prescribed medication. So just as the A DA would ensure that someone with diabetes is able to receive the insulin they need the a A ensures that someone with opioid use disorder is able to receive the medication they need, whether it be methadone or Suboxone or Vivitrol. And so we have used the A DA to help ensure that people who are prescribed this medication don’t have to choose either take my medication or comply with probation or take my medication or get access. And so I’m going to give you a quick example from one of my cases. So I am at a US attorney’s office. I’m in a USA, and I received a referral from a doctor at the va. This veteran had come to the VA for a medical issue and while hospitalized, the doctor had started him on a prescription for suboxone because they discovered he had opioid use disorder.

He was in withdrawal when he was in the hospital, so he was ready to be medically discharged and he needed to go to a skilled nursing facility for rehab and he wanted to go to this specific facility where his friends and family could visit him. It was in a good location for him. And so at first, the skilled nursing facility said, sure, yep, we have room. And then when they found out that he was on suboxone, they said, no, sorry. And so the complaint came to me. I opened an investigation and sure enough they did have a policy that they would not take individuals who are prescribed methadone or suboxone for opioid use disorder. Interestingly, they did allow patients who were prescribed suboxone for pain but not for opioid use disorder, which kind of highlights the stigma around opioid use disorder and around kind of medication.

There’s a stigma that you don’t want to give drugs to drug addicts. It’s essentially what the people don’t say anymore, but often unfortunately what’s guiding these decisions. And so we were able to enter into a settlement agreement with this skilled nursing facility where they no longer do that. And so this is one of many cases that we’ve brought. So if you have a client who’s facing a barrier who has told you can’t receive this service, or you can’t have this job, or you can’t have this housing because you’re prescribed this medication, then please feel free to reach out to us.

Host:

Patrick, I want to turn back to you. I know that you have a hard stop coming up, but your perspective is really unique having been both a soldier and someone who rose to be the number two official in the US Army. I tell you real quick, about a week ago, well, right before Veteran’s Day, I was at a prison down in Florida and I met a veteran there and he told me about his substance abuse that started while he was in the military. And this was during the eighties and nineties and during a time, time when of course the military started really cracking down on drug use and they nodded to rehabilitation, but from my perspective, did very little with respect to that. Now we hear about what VA’s integration into the veteran streaming course and the other efforts efforts. Do you think the VA and the military and the legal community has done enough? Do you have any suggestions?

Patrick Murphy:

Well, thanks. Well, I appreciate it. There’s no doubt we all could do more. And it’s not necessarily a whole government approach. It’s a whole nation approach that we need to take. And so that’s why I appreciate Amy saying what she did, right? It’s people view US attorneys and prosecutors like I used to be in southeastern New York as you’re just trying to prosecute crimes. No, you’re fighting for justice and do what’s right. And especially when you talk about veterans courts or in a judge’s cases, you mentioned in Ohio, they call ’em honor courts there, right? We have about 80 veterans courts across the country. They were established, it was mentioned by Judge Russell back in 2008. His clerk was a former 82nd airborne guy like myself. And they do phenomenal work. Why? Because as the judge said, it’s the wraparound services, it’s hey, if they have substance abuse issues, if they have mental health issues, they get those wraparound services if they’re homeless.

And that’s why these specialty courts are so incredibly important. They’re incredibly effective with about 90% effective rate. And why is that? That’s because, as you mentioned, Will, one in five of our Iraq Afghanis, a veteran of our generation of veterans, will suffer the two satory injuries of our war, PTSD, post-traumatic Stress disorder, or TBI traumatic brain injury. And so when you have that to make sure that if they fall through the cracks, if they go down the wrong path, that it’s not just prosecuting and put ’em in jail. That’s how it was in the past. Well, as you mentioned right now in America, there’s over 181,000 American veterans in jail, 181,000. That’s why, as we say, when I was in the Pentagon, what we say, go left of boom, be proactive. And so that’s why these veterans courts or Ohio Honor courts are so incredibly infected and especially how we’re working with it through Legal Services Corporation.

And I’ll say one last thing. I think it’s important. Amy mentioned about one in six of our veterans, Iraq cancer veterans suffer from substance abuse. And so we need to make sure that we have this holistic treatment, gives ’em the care, the treatments they need. Yes, there’s somewhat of a no tolerance policy in the military. It’s why we do mandatory drug test because we can’t have them high on drugs when they’re firing assault weapons, et cetera. But if they occurred these injuries or these mental health issues, or is this substance abuse while they were in service, we just can’t discard ’em and treat ’em like a bad habit. We got to make sure we take care of ’em, provide those wraparound services, give them the support through Legal Services Corporation and our allies across this country, and really better effectively use these 80 treatment veterans treatment courts across the country because they’re so damn effective.

And that’s why it’s an honor to be here with the judge, with Amy, with all of us on this call will with Bob Keating and really Chairman John Levy, who really, as he became the chairman over eight years ago, really made this an initiative and really expanded the board and said, we’re going to get great markets like Will Gunn and Daniel Brooks and all these great folks to be part of his day-to-day team, but getting allies like the folks in this call to do all we can to make sure we’re pushing the effort and over 200 folks that are joining us in the Zoom today that not just preach and the choir, but expand our congregation out there to help our brothers to veterans by living that ethos that we leave no veteran behind. So thank you for having me, will and everybody, I hope to see you all soon.

Host:

Appreciate the remarks. Bob, over to you. I’m just wondering if you could just briefly comment, we’ve heard this service, we’ve heard this term of wraparound services. As you close out your thoughts, can you just mention a bit about how wraparound services fit in the context of civil legal aid?

Bob Keating:

Yes. Our community has, and I think across the state, a legal resources day and folks come in for guidance with attorneys and a gentleman who is a veteran, he was a contractor. He came in for some contract advice, but he had told me that he just got out of treatment a short time before at the VA treatment center in Sheridan, Wyoming. And he was singing their praises. He said they did a great job to help him get straight. He was back in business. I think that’s wonderful. I’ve had the occasion to be involved with the VA on several issues recently, and the VA’s doing a great job, including the switchboard if you’re trying to get in. But for wraparound services, we have homeless agencies working with us, DV organizations, the community, and I think every community needs to be involved to provide assistance, including legal services, organizations, the treatment courts, everything. There’s an opportunity for veterans to get voluntary treatment for substance use and alcohol. Sometimes there’s a need for an emergency commitment or an involuntary commitment outside of Veterans Court, but it’s best if they get in there before they get in any type of trouble. But of course, the veterans courts have a great success rate.

Host:

Thank you very, very much, Bob.

Bob Keating:

Thank you.

Host:

You’ve worn these various hats, legal aid and also assistant US attorney. Any closing thoughts that you’d like to share?

Amy Romero:

Yeah, absolutely. So when I was an LSC attorney, I would represent individual clients and through that individual representation, you get relief for your client, but often the bad practice doesn’t stop, right? The landlords still discriminating against just different tenants. Your future clients essentially, or the employer is still kind of a bad employer or the hospital is still kind of turning away patients. Whatever the problem is isn’t necessarily addressed. Sometimes it can be addressed through individual representation, but not always. And so that’s where I think DOJ comes in and the civil rights work we do and why it’s so exciting. So we enforce many of the same laws that you all do or the LSC attorneys do, but we’re focused on pattern of practice. I think our jurisdiction is pattern of practice, an issue against a group of persons that raises an issue of general importance.

So first of all, we take the position that veterans and service members that they are, that is an elevated public importance that we are committed to that these people served our country and we’re committed to serving them. But if I think the link was put in the chat about the complaint, but if you have a client and they’re facing an issue that maybe there’s a blanket policy, right? You have reason to believe other people are also going to be impacted by this policy, we encourage you to bring it to us. I gave up the example earlier of the veteran with the skilled nursing facility. Well, actually, that skilled nursing facility was owned by this big corporation that runs skilled nursing facilities throughout the country. And so through that one complaint, we changed the policy for all the skilled nursing facilities. We had a complaint in Pennsylvania, my colleagues, where it started with it was three people, and they were told as a condition of probation that they couldn’t be on their medication for opioid use disorder.

Well, DOJ based on those three people opened a lawsuit and reached a settlement with the entire state court system of Pennsylvania. So sometimes the individual work that you do can really have an impact, and we encourage you to file those complaints. And if you’re not sure, to reach out to your local US attorney’s office, what I do, civil rights coordinator, there’s one of me in every single US attorney’s office in the country. So if you don’t know who that person is, feel free to email me directly and I can connect you to the person who is geographically located where you are.

Host:

Thank you so very much. Thank you. Judge Heath, I’ll give you the last word.

Judge Taryn Heath:

I think it’s really important to be a constantly evolving court in veterans treatment courts. I really stress that I want my team members to make suggestions on how we can do things better, more efficiently. I don’t subscribe to, oh, we always did it this way, so we’re going to do it this way because I always like to get better at what we do. That’s number one. And number two is hope and don’t give up. As long as somebody wants sobriety, wants mental health, and is willing to continue to work at it, even though they may slip or fall, don’t give up on them and give them hope and they will succeed.

Will Gunn:

In closing, I’d like to thank our fantastic guests for sharing their perspectives and inspiring us with their dedication to serving veterans. And thanks to our listeners for tuning into this episode of Talk Justice. Please subscribe so you don’t miss an episode.

Announcer:

Podcast guest speakers views, thoughts and opinions are solely their own and do not necessarily represent the legal services corporation’s views, thoughts, or opinions. The information and guidance discussed in this podcast are provided for informational purposes only, and should not be construed as legal advice. You should not make decision based on this podcast content without seeking legal or other professional advice.