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VA uses `spiritual assessments' in treating ill vets

BALTIMORE — “I have dreams,” said Vietnam veteran Raymond Ratajczak Jr., his mouth wet and tears on his face. “Dreams of recovery.”

Ratajczak sat up in a cot at the Baltimore VA Medical Center in a room shared with three other patients. Every few minutes, his face wrinkled and he began to cry.

“What did we talk about earlier today, Raymond?” asked hospital chaplain Charles Thomas. Ratajczak looked up from his bed.

“So a man thinketh, so he be,” Ratajczak said, paraphrasing Proverbs.

Thomas smiled. “Think positive!”

Chaplains like Thomas are one of the newest treatment methods used by the Department of Veterans Affairs to treat the nation's veterans. Their job: to assess the spiritual and emotional health of veterans like Ratajczak and report back to nurses and doctors, in hopes of developing a more “holistic” course of treatment.

Ratajczak, 63, has stage-four cancer. He admits his cancer may have been detected years ago with regular check-ups, but “I neglected my health for years,” he said, his eyes welling up with tears.

Ratajczak was crying so hard he could no longer speak. His uncontrollable tears are a “reaction,” Thomas explained, one provoked even when Ratajczak is not exactly sad. “Sometimes he's better,” Thomas said. “But today he's not doing too well.”

Such “spiritual assessments” are now routinely conducted on entering patients, though they are not mandatory. Critics, however, say the program runs afoul of the separation of church and state, and say a patient's “spiritual” health should have no bearing on his or her physical treatment.

“They're asking invasive questions, like how many times a day do you pray, and then they're evaluating them,” said Annie Laurie Gaylor, founder of the Madison, Wis.-based Freedom From Religion Foundation. “If you don't pass the test, the answer is to give you more religion.”

Earlier this summer, Gaylor's foundation lost a case against the VA when an appeals court in Madison rejected a challenge to the VA's use of religion in its health care practices.

The ruling rested on a Supreme Court decision last year that said taxpayers lack standing in challenging the White House's Office of Faith-based and Community Initiatives.

Since the creation of the White House office in 2001, VA hospitals have found ready cash to use for chaplains, spiritual assessments, and spiritually based substance-abuse programs.

Chaplains at the Baltimore VA hospital do not promote any particular religion, said Thomas, a Protestant, but add a “spiritual dimension” that patients — many of whom shy away from psychiatric treatment for fear of being labeled “crazy” — often need.

Still, there are allegations of improper proselytizing in VA hospitals. David Miller, a 47-year-old Navy veteran, alleged that he has been denied treatment for kidney stones at the Iowa City VA Medical Center since 2005 after objecting to the hospital chaplain's aggressive bedside preaching. Miller, an orthodox Jew, alerted hospital staff continuously that he didn't want a chaplain visit, but the Protestant pastor continued to see him, he said, claiming Miller might die soon and would go to hell if he didn't accept Jesus Christ as his savior.

“I didn't have a lot of energy,” Miller said. “I was sedated and hooked up to heart monitors. But the patient advocate said I should have objected more strenuously.”

The hospital refused to treat Miller after he lodged complaints, he said. It has since agreed to pay for his treatment elsewhere, and the VA is investigating Miller's charges. But Miller said he still plans to sue.

Such scenes don't happen in Baltimore, Thomas said. The Baltimore VA hospital employs 12 Jewish, Protestant and Catholic chaplains. Patients like Ratajczak, who lapsed from his faith years ago, say the presence of these religious advisers has changed their lives.

“I've found faith again,” said Ratajczak, who is Catholic. “There has to be something higher than where we are. I have to believe that.”

Military veterans who have killed or seen death often seek religious explanations for what happened. But even those who never see combat may need a level of spiritual attention, said Jonathan Shay, a noted combat trauma psychiatrist in Cambridge, Mass.

“If you look around the world at societies that have been at war a lot, or specifically think of themselves as warrior societies, they have rituals of purification after battle that characteristically involve the whole community,” Shay said. “In essence, that's saying that everyone requires purification even if they've behaved to perfection.”

During Shay's years as an outpatient psychiatrist, he referred veterans struggling with the guilt of committing sin, or leading others into it, to clergy, he said.

But that's different from VA hospital staff who insist that patients pray or observe some religious practice, Gaylor said.

While the VA has acknowledged it believes spirituality can and should be incorporated into care — for instance, in substance abuse programs — it differentiates between spirituality and religion, arguing that patients can decide whether a particular religion should enter into their treatment.

Ratajczak, for example, is attended by a Protestant chaplain. “It's all one God,” he explained. “It's all one Jesus.”

Some secular aid groups, however, say it can be difficult to tap into government funding if they do not incorporate some element of religious counseling.

In 2003, a non-profit shelter for homeless vets that claimed it lost funding to a Catholic Charities group had to prove it emphasized faith-based values to reclaim its money, said John Downing, president of the Leeds, Mass.-based United Veterans of America.

Downing testified before Congress in 2004 and received the money the next year. He now registers the shelter as a faith-based group to increase his chances of getting funding. The White House office's Web site says it will help “eliminate” all barriers to grant money for Downing's group, as it does for all faith-based groups.

At one level, the distinction between faith-based and secular may be irrelevant in the case of health care, said Downing. “When you treat people with dignity, there's not a faith-based benchmark you don't hit,” he said.

And as soldiers and Marines return home from Iraq and Afghanistan, VA hospitals will be focused on doing that, allowing men like Ratajczak access to a chaplain as he struggles with thoughts of death.

“If God wants me to die,” he told Thomas, “that's OK.”

“Think positive,” the chaplain responded.