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VA therapist yanked from clinic in central Arkansas

Left adrift, say vets haunted by war by Debra Hale-Shelton | June 17, 2018 at 4:30 a.m. | Updated June 18, 2018 at 4:30 a.m.

Larry Hay's Army tour in Vietnam was a half century ago, long before he married Margaret, his wife of 34 years.

The war has long ended; the trauma lingers.

"When he goes to bed at night, he goes back to hell. He goes back to Vietnam every night, and so do I," Margaret said. "We neither one get a good night sleep. ... I try to catch his nightmares."

Larry Hay enlisted in the Army in 1969. Three times, his helicopter was shot down in the jungles of Vietnam.

"At one point, he was on the flight lines where they were working on the helicopters, and one of his friends didn't get low enough," and Hay saw his friend decapitated, Margaret said.

Guard duty created more nightmares: "The Vietnamese would booby-trap the kids and tell them Americans have candy," Margaret said. "They [Americans] didn't have any choice. They had to shoot them. That really weighs on him. He absolutely loves children."

Margaret accompanies Larry to weekly support-group meetings and speaks for him when he isn't up to talking about the war.

"He has terrible nightmares ... to the point that he jerks so hard that he literally flops out of bed," Margaret said. "He's injured himself several times doing that."

Along with other Vietnam veterans suffering post-traumatic stress disorder, Hay began getting help after the Central Arkansas Veterans Healthcare System's outpatient clinic in Conway started two therapy support groups in 2013. The Vietnam veterans nicknamed theirs the Jungle Group; the Middle East veterans called theirs the Desert Group.

The groups met weekly with a therapist at the clinic -- until January. That's when the clinic shut down both groups without advance notice to the veterans. In both cases, the clinic cited therapy concerns and unspecified safety issues. Numerous veterans have questioned the veracity of such concerns and said the shutdown has left some of them thinking about suicide.

"We have people on the edge of hurting themselves," said Vietnam veteran Butch Walker, who sometimes wears an "I Support Vets Too" button and a Donald Trump cap.

The Central Arkansas Veterans Healthcare System transferred the groups' therapist, Susan Kilman, to its North Little Rock facilities, and matters that led to the disbandment remain under internal investigation, said Chris Durney, the system's public affairs officer.

The Conway clinic's chief of staff, Dr. Tina McClain, has apologized for the abrupt shutdown but stood by the decision. The clinic also has not allowed the PTSD groups to resume meeting there, even with a different therapist, but has not ruled out restoring the meetings someday, McClain and Durney said.

"Safety was one concern that had risen out of the activities that had taken place at [the] clinic. The other concern was the lack of therapeutic benefit of those groups," McClain said in an interview. "I have been a psychiatrist myself for 20 years, and I have never seen a support group that functioned in the fashion that this activity represented."

U.S. Rep. French Hill, a Republican whose 2nd District includes Conway, said in an email that he believes "the groups should resume eventually, but should do so at a deliberate pace" and "with a therapist that adheres to evidence-based mental-health practices."

Durney said the affected veterans can get individual therapy in Conway and can choose from "some exceptional" individual or group therapy at the system's North Little Rock facilities. Teletherapy also is available individually. But some veterans said that they have found group therapy more helpful than individual sessions, that they don't want to drive to North Little Rock, and that they are uncomfortable with video therapy.

Hill said he "supports local access to care, so that veterans in Arkansas aren't limited to one option: the VA in Little Rock."

Durney said the system is looking into Kilman's "conduct" relating to the support groups. "We're looking at everything before we do anything" and want to "make sure that all her rights are observed," he said.

Kilman did not reply to Arkansas Democrat-Gazette messages sent to her through Facebook.


In late March, dozens of veterans crowded into the Conway clinic's lobby to discuss their frustrations over the groups' shutdown with McClain and another administrator. The meeting followed a request by Hill's office.

Several veterans walked with canes; two had service dogs. A few spouses attended. So did representatives of Hill and Sens. Tom Cotton and John Boozman, both R-Ark.

"Don't start out by lying to us. Tell us the straight truth," one veteran shouted.

The veterans' message soon became clear: They wanted the therapy groups back. They wanted Kilman back. "She's the one good thing about the VA," one man said.

McClain's message also was clear: "Susan will not be back in this [clinic] in the foreseeable future," she said, declining to explain the decision.

Trying to calm the veterans, she said, "I'm sorry ... that this happened so abruptly. I hate the abruptness of the severing of your relationship with your therapist.

"I don't think the wrong decision was made" but wish there had been more time for a transition, she said.

McClain said she realized the veterans have suffered emotional distress but wanted to avoid a tragedy such as the one at a California veterans home where four people, including a gunman, were shot to death in March.

"We have others who have felt unsafe to come in this building due to things they heard in this group," she said.

"Had all things been normal, we would have anticipated that someone was leaving a position and we would have transitioned and have had someone in line to take that spot," she said in the interview later. "Because of the volatility and our concerns for safety, the decision had to be made to do this abruptly."

McClain also told the veterans that a clinic employee who some said has been rude would be reassigned and no longer deal with them by phone. That employee has declined comment.

"I understand your frustration. I understand your anger," McClain said.

"No, you don't!" one man shouted.

One after another, words of anger, frustration followed:

"You pulled the plug on us. You just snuffed us out!"

"There's the fear that someone is going to shoot himself."

"I didn't know I was worth health care" until Kilman came along.

Hay's legs began trembling. His wife quietly walked to his side, then guided him away from the crowd until he was calmer.

Margaret Hay said her husband "had gotten a lot better, but he's regressed so much" since the group therapy ended. "He's not very functional right now," she said.

McClain said later that the meeting's angry tone reinforced her decision.

"I have never encountered anything [comparable] in my [psychiatric] career with the VA or outside the VA," she said. "I will tell you that the dynamics in that meeting removed any reservations about the decision to abruptly halt those groups."

"We have veterans who left that clinic and never went back as a result of their experience with these groups. We had staff dreading going to work on the days these groups met," McClain said.

McClain said she doesn't believe "any of the problems stemmed from the veterans" and doesn't believe Kilman had "ill intent toward any veteran."

Walker, 72, of Conway said he heard that some veterans have reported that Kilman threatened them.

"I never saw her threaten anybody or talk down to anybody," he said. "But she could spot a phony in a New York minute ... somebody trying to get diagnosed with PTSD that's not even close."

Walker said he "questioned some of the guys in the Desert Group and all of the guys in [the Jungle] Group. ... All I get is negatives" on whether they saw Kilman threaten anyone.


Margaret Hay said Kilman "empowered" the veterans.

"I think they [clinic personnel] think she did her job too well, honestly. Before Susan, these Vietnam veterans did not have the tools to band together. They didn't have the self-esteem to band together and get anything done. "

Now, Larry Hay and other Vietnam veterans gather weekly at a senior-citizen center in Conway, but without a therapist. They've chosen a chairman, Walker.

"They [Vietnam veterans] knew at least half of the country didn't like them. So, we didn't get the applause" when returning home from the war. [The shutdown] brought back those memories. We felt shunned," Walker recalled.

Walker's nightmares also have returned.

In some of the nightmares, "everybody was turning against me," he said. "Even my dad has been in the dreams and turning against me. It's ... a feeling of abandonment."

Walker has not forgotten his friend who was killed by a land mine. "Like a lot of guys, you say, 'Why did I come home alive and someone else didn't?'"

A spokesman for Cotton, who also is a combat veteran, said the senator supports the return of the group therapy "as quickly as possible."

"Our office has contacted the Department of Veterans Affairs seeking more information concerning the shutdown of the mental health therapy support groups." Cotton spokesman James Arnold said in an email.

Hill's office has sent a representative to the veterans gatherings at the senior-citizen center.

In an email, Hill's office said it doesn't know "all the reasons" the clinic halted the two therapy groups but said, "We would like to see veterans treated in a manner that is supportive of their therapy, which should have included ready access to [a] properly trained therapist and better communication, e.g., notification to each veteran of why appointments were cancelled."

Veteran Malcolm "TJ" Boultbee, who served in Southeast Asia after the Vietnam War, does not talk much about his service there, though it still haunts him.

"I've had episodes where the television talked to me. Now, you're telling me I'm having to interact with a TV" for therapy, he said.

Boultbee is angry and sounds tough, until he pets his little, gray dog, Pickles, who wears a service-dog vest and an "I Support Vets Too" button. Nearby sits Boultbee's caregiver, who drives him to Conway from his Mountain Home residence when his memories are such that he cannot drive.

The veterans try to help one another, offering aid whenever they fear a buddy is contemplating suicide. One of them whispers that he fears another man who just left a room might take his own life.

When the veterans talk of guns, Margaret Hay said, they're talking of shooting themselves, not someone else.

"They're suicidal, not homicidal," she said.

Like her husband, another Vietnam veteran, also named Larry but who didn't want his last name used, can't forget the war's children.

"They would use kids to walk up to you and with a grenade and blow themselves up," Larry said of the enemies. "That was part of our training to know how dangerous the enemy was and how different they were in thinking.

"There are so many different shades of [war]," he said. "Just being in a situation where you never know when a mortar tract will come flying in on top of you with no warning at all. ... It's 24/7. ... This is the thing that makes it so powerful: The war didn't start up and end at 6 p.m."

Larry was not a sniper but met some who were, and he understands the lingering trauma the job carried.

"Some people got so good at killing, they came back and they didn't want to change," he said. "When you create a batch of killers, you'd best be able to control them."

"You had to have a mindset that everyone out there running [in] the other uniform ... you had to kill him or he was going to kill the guy beside you," Larry said. "The sniper has to be ... able to distance himself from the humanity of it. Thank God I never had to move into that mentality."

But he knew of those who did. He called them "grunt-level snipers" and said, "They'd lay there in diapers two days" waiting for a target.

On why the government's investigation relating to the therapy groups is taking so long, Durney said, "The government moves very slowly at times. We're talking about people's rights, people's futures, people's jobs."

As for Walker, he said, he would give working with another group therapist a try.

"But I don't want to drive to North Little Rock for it," he said.

A Section on 06/17/2018

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