Brad Racino, Reporter, I-Newsource
Mark Sauer, Senior Editor, KPBS
Related Story: Pulling Back The Curtain On The Mayor's Race
ALISON ST JOHN: You are listening to Midday Edition. I'm Alison St. John inform Maureen Cavanaugh. It's estimated that 400,000 service members have returned from recent military complex and are living with the invisible wounds of war. Including combat stress, depression and post-traumatic stress disorder. That doesn't even include the number who may have suffered a traumatic brain injury while deployed. That is nationwide, but San Diego is home to the largest number of veterans from the resource of any county in the country. And so it is good news at the University of San Diego is launching a key initiative to serve veterans and specifically those suffering from these invisible wounds. Our guest is Prof. Michael Terry who is clinical associate professor at the Hahn school of nursing and health sciences at USD. Dr. Terry, thanks so much for joining us.
MICHAEL TERRY: Good afternoon.
ALISON ST JOHN: So what is the need that's prompting you to change the way you are training nurses at UCSD.
MICHAEL TERRY: There a couple of things Allison the first thing is that the program, hospital nursing has been affiliated with the military for a number of years and a number of our students seeking Dr. degrees or Masters degrees as our military active duty or retired, and about five years ago the leadership at Balboa Naval medical Center came to us and said we really need nurse practitioners and one of the persons that contention and came to us was John DiNardo, who is actually one of the first Naval nurse practitioners. And he saw the need being a nurse practitioner himself and and the rear admiral and other folks had come to you USD and talk to Dean Sally Hartman said we need a program like this. We are really short on resources and we see this as being a critical problem in the future.
ALISON ST JOHN: Why nurses as opposed to any other doctors for example, why nurses are so critical?
MICHAEL TERRY: Good point, nursing has had a unique relationship with patients or clients from the very beginning because of the type of model the biopsychosocial and communication model that kind of embodies the spirit of nursing, where nursing has been around caring and an unnecessarily caring. So nurses are often the first people that a patient arrest someone seeking help talks to when they call in. They often man the communication lines or the hotlines. There are more nurses than any other health professional in the country. And the psychiatric nurse practitioner has been a more recent add-on to that and brings and a unique set of skills that are different than a psychologist or psychiatrist for example.
ALISON ST JOHN: I think that is one of the big problems is connecting to servicesThat are growing increasingly out there with the people in need them, right? Are you looking at where these nurses would be place so they could actually reach the people who need what they have to offer?
MICHAEL TERRY: Yes that is part of it. You know that I think that one of the things that has been in cringing and at the same time dismaying of the last several years is we've seen a huge development about services for returning service members who have been recently deployed right at the post deployment stages, and now who have left the service and become veterans and yet the services are, I mean they are huge, they are all over the place and you could pick up any journal or go to any website for the military in you could see all the services that are offered, but not at one place.
ALISON ST JOHN: And yet there are 20% of people homeless on the streets in San Diego of the veterans are suffering from PTSD and never access the services. Do you think that the stigma is making it more difficult for these professionals to actually reach the people that need the help?
MICHAEL TERRY: That is actually one of the key things that we can't actually treat someone until they come in the door and increasingly there are technologies such as on-site web-based services that are being made available so that service members can contact essentially a program online that they can download services or links or actually participated some screenings and even have a chat with someone who they remain anonymous with so they can avoid this kind of stigma. Because the stigma that is presenting a lot of services. The services, they are fragmented and everyone is starting up a banner and literally seeing and when they get Amanda qualify because they are limited in terms of the scope they can do, or that location so there's a huge problem with the integration when you actually get it, but getting it is a huge part of the problem and it is because of what Paul Chappelle was talking about in terms of the warrior mentality. It is the warrior mentality and stuff that leads to its own built-in stigma that's really the hardest thing to overcome because the very thing that makes you a key kind of factor in part of the team in the team mentality is that you can depend on the person next to you. You risk your life for the person and the person is always there for you and the bond is insoluble. To think that the person could be a weak link because our country stigmatize mental illness and to think that the person might have an emotional breakdown and not be there for you when you really are depending on your life or that create such a statement that weekend, people cannot come in and say I might have a problem and they go through a huge amount of suffering and stress before they ever get help just out of this absolute denial. It can't be happening to me. And also our whole society and tequila the warrior mentality, the warrior ethic and courage is, you don't deal with it because you cannot deal with that when you are in a combat zone. You can't afford to let it John you just put it aside the problem is reported the site but we don't come back and pick it up again.
ALISON ST JOHN: Is there something in the training of the nurses that you are doing that addresses the issue?
There isn't a lot of it has to do with the type of sensitivity of the way you do an assessment, the way US questions, the ways you pose a problem. This is not a job for a census taker which much of medicine ends up being in terms of just asking a yes or no question. You ask them do you feel like hurting yourself, you know, there's hardly any service member present or past was going to say right away that that is the first thing on their mind is hurting himself that is the last thing you want to do but they feel like they just like to get out of the pain and suffering, whatever it takes.
ALISON ST JOHN: Our training vendors this question. Getting help from the military health establishment?
MICHAEL TERRY: Yes we are the placement sites as you mentioned on your piece and I know we've talked about this before we have two trucks right now the program is very small so we filled the graduated one class of only four people so far. One was a civilian nurse practitioner who was working at Balboa Naval who is now a psychiatric NP, and the other two are, one is retired and what is currently Lieut. Navy commander and once an Air Force major who are working with the military but because of this connection of our history and safety ago and because of the school of nursing's connections we've been able to work through placements so we have placements out the different VA sites in San Diego area, and also with the veteran center and with Kim Pendleton and Balboa Naval.
ALISON ST JOHN: So there won't be any problem with the students getting a job after they finish training?
MICHAEL TERRY: No, in fact Balboa Naval at one time one psychiatric nurse practitioner and now there are seven.
ALISON ST JOHN: That's right so what kind of students are applying are these people who have been in the military themselves or civilians, were the nurses?
MICHAEL TERRY: They are both. For example in our current class we have a retired Army nurse who really feels like she wants to go back and, her heart is there with the servicemembers and she wants to work in the VA having received services herself. And then we have another nurse who is current active-duty military naval, and she's working doing her rotations at Camp Pendleton at the VA. And she intends to continue in her current job as a psychiatric NP. Well she is employed and while she is still in service.
ALISON ST JOHN: I was interested to hear that also you're going to be doing some research, is that right?As part of the initiative into dramatic brain injury and PTSD?
MICHAEL TERRY: We are looking, part of the issue is training people to recognize that this triad exists between TBI, PTSD and chronic pain for example. Because to pick up on what you really have to be looking for the other two, because together they are synergistic in terms of the level of symptomatology that they present with. And because each individual one of those don't present typically with what you would think of when you typically go to a primary care center, civilian center in particular where people are not trained to begin to recognize how these show up
ALISON ST JOHN: Can you give an example of some of the symptoms that might be telltale signs but you might not recognize?
MICHAEL TERRY: For example, someone walks into remember 50% of service members whether veteran or currently in the service end up in civilian primary care sites, often because of the stigma. When they actually do stakeout help, when the present, they will present with trouble sleeping, they will prevent nightmares agitation, frustration, the fact they do not feel like themselves, they feel like the world does not feel like normal anymore to them and literally their brains have changed from this path of cortisol for the stress of being deployed from these periods of time the more you are deployed the more cortisol you bring and the more likely it is to change it. That does not mean that they will develop PTSD but it means that the brain can changed and if there are underlying factors that can, including childhood neglect and abuse, those kinds of things can actually can actually create a susceptibility to this showing up later on. We don't have any good ways of screening for that now but the way the symptoms present is that someone comes in and the same agitated I'm frustrated I'm angry I find myself yelling for no reason. I don't feel like people understand me. The only people I can talk to are my buds, but they are not around. They're all over the country and I feel like I've been dropped off and dumped off and I don't know what to do
ALISON ST JOHN: Then the question arises what (inadible) split the client into a whole series of things that are healing, what kind of treatments are you offering is a drug-based or talk-based?
MICHAEL TERRY: Both there are a number of evidence-based treatments that have been promoted for this. One, there are some that are related directly to treating PTSD. The first thing you have to do is great for them the military is doing a better job screening for this weekend gone to any kind of check about the VA or insulation without asking about suicide these days matter where you are coming in for you will definitely be asked about that and you are doing a good job at right at post employment first when you get back several months later in six months later about screening for PTSD. But not everybody shows up. And it's not always picked up and the screening tools are somewhat superficial. So that screening, if you get a hit on it you get it more of a diagnostic assessment. So first you've got to be picked up on event you've got to agree to come back. You've got if you like the person you talk to or the area where you are getting services going to actually be receptive to you, where they are not going to turn you away and say this is normal, in some cases it is operation or combat stress not helping PTSD yet, everyone's having symptoms for the cortisol in their brain but they are not at full PTSD, and so helping people to access services that they can normalize some of the stress that are there. Some hyper alert, hyper focused always looking for the sniper around the corner, hearing sounds that set off reexperiencing and traumatic flashbacks that might not be fully PTSD but might be on the border of a.
ALISON ST JOHN: So Dr. Terry the nurses are obviously being trained to release but the symptoms, but then are they qualified and authorized Just prescribed drugs.
MICHAEL TERRY: They are. Nurse practitioners prescribed drugs in all 50 states in the district of Columbia psychiatric Nurse practitioners are licensed to do therapy as well as prescribed we do PTSD, progressive exposure therapy we do personal integration therapy and cognitive and behavioral therapy. Those are non-, drugs, but we use them with medication if necessary.
ALISON ST JOHN: Got it ingested the minute we have left there's a lot we don't know about genetic brain injury. Are you also participating in research into what are the best ways of helping people who have symptoms of TBI
MICHAEL TERRY: We are consumers of the research now that's being developed we have a focus called evidence-based practice we take things further developed and proven to be efficacious and we look for ways to best apply it in the current situation and the research that we are looking at doing here in the hospital of nursing is based on the center that we are just getting funding for right now and we are halfway there to developing Institute of nursing research and I expect to have it up and running within the next five years and in that site we are going to be developing more research particularly around these areas and we do have PhD students right now conducting research individually around us but we hope to have a laboratory set up to focus more on this in the future.
ALISON ST JOHN: Do you have a sense of the numbers of people in the San Diego community looking for these kinds of services?
MICHAEL TERRY: I have no idea. I just know that it's huge.
ALISON ST JOHN: That's good thank you so much for sharing. Yet one more resource that people who are coming back from the war zones can turn to. That is on school of nursing and health sciences is treating psychiatric nurse practitioners and Prof. Michael Terry, thank you so much for joining us.
MICHAEL TERRY: Thank you
ALISON ST JOHN: Stay with us. Coming up next, some people may be suffering posttraumatic stress from the San Diego mayor's race. It was a pretty tough political campaign. We will talk about what went on behind the scenes with investigative reporter Brad Racino. You are listening to Midday Edition on KPBS. I am Allison St. John in for Maureen Cavanaugh. The San Diego mayor's race was an epic struggle. If you like we are all veterans of that reason of course we know the winner was Bob Filner. Now that the battle is over Brad Racino of investigative news source decided to take a look at the campaign strategies with the men behind the candidates. Tom Shepherd who managed a winning campaign and Ryan Clumpner who managed Carl DeMaio's campaign. We have Brad in studio with us. Brad, thanks so much for joining us.
BRAD RACINO: Think you for having me here.
ALISON ST JOHN: And also Mark Sauer, KPBS senior editor is going to be helping us with the discussion here.
MARK SAUER: Good to be here.
ALISON ST JOHN: Brad, let's start with you what made you decide to do the story and the back to talk to the strategists?
BRAD RACINO: We talked earlier about voter apathy and the standard before a lot of complaints that no one wanted to vote for either of the candidates I thought that was kind of interesting and going into it we thought that at the end let's get a recap of what happened and what went wrong and what the strategies actually think of the candidates now that it is over especially for the losing team we thought now they would be more candid and open up with their strategies, but regrets and what went wrong so that's where it started from.
ALISON ST JOHN: What was your impression of the two guys?
BRAD RACINO: They're vastly different people. Tom Shepherd is kind of a legend in this town I didn't know much about him going in but he saw numerous people, elected in San Diego for the last 30 years. He's very guarded. He chooses his words very carefully. (Inaudible) on the other hand I've actually seen him speak about the core (SBJ) conference and he's very open, very libertarian, very, and advocate for his candidate, which is a little bit different. So just the juxtaposition of their personalities alone was interesting to me. But their vastly different people.
ALISON ST JOHN: So Tom Shepherd as you say is pretty legendary he has a reputation for successfully getting Republicans into office and he took a big risk by taking on the Filner campaign you brought a clip long let's see what he has to say.
NEW SPEAKER: I was informed by being a close observer of Mike Aguirre's tenure as city attorney and I watched how much damage an unstable personality can have on an institution. And I'd class DeMaio in the same category as Aguirre in terms of a destructive personality. I think he has the potential to do serious damage to the structure of San Diego government and to the bond of trust between city government and its people.
ALISON ST JOHN: So that was Tom Shepherd talking about one of the reasons he decided it was important for him to get in behind Filner. I mean, did not do much damage to his reputation in the city? What was he risking by jumping behind Filner?
BRAD RACINO: It cost a lot of his Republican base. He lost clients or Republicans you a supportive the Republican Party, he damaged not only his professional reputation but also his personal a lot of friends that he I guess have turned his back their back on him so this was a huge hit that he took to do this.
ALISON ST JOHN: But Mark there is some historical precedence?
MARK SAUER: It's interesting it seems like we are talking about is the difference between a hired gun and a true believer with Shepherd certainly going over here and being hired now the Democratic side when he worked with Republicans for so long. Some presidents with the supranational level Dick Morris comes to mind who of course is very far right ideological commentator pundit consultant now for Fox news of course he badly mis-called the national election but he worked for President Clinton and help the Democrat and Republicans throughout. So you have some presidents there but here in San Diego it looks like you've got, as you see the Libertarian hard right ideologue running DiMaio's campaign versus in this case a hired gun following the Democrat.
ALISON ST JOHN: But rather, did he tell you that he struggled much with the decision?
MARK SAUER: No he said he struggled for some time but this gentleman approached him after Nathan Fletcher's campaign he was running until he lost in the primaries and Filner had come and said that after that meeting he took some time and really thought about this decision and what it would do to his reputation.
BRAD RACINO: That is the speculation now, what will he do if Shepherd is so good and has a good track record and of course won this race, does winning the next however, whatever party loyalty you might have figured who knows. I guess that is a decision again for Shepherd to make.
ALISON ST JOHN: Positionally speaking winning is what it is browser looks like to some degree his gamble paid off.On the other hand, Jason Roe, how long and he known to my?
BRAD RACINO: DiMaio back in DC some around 2002, 2003 when DeMaio was running the policy Institute sorry if I have the name wrong, but he used to help get congressmen to go speak at (inaudible) and saw DeMaio speak and he said he knew him but knew of him, and he really liked his style in the things he was singing when he came back to San Diego and started working with him he said that he really respected and liked what he had to say thought he had a different vision for the city, so we really kind of hung onto that.
ALISON ST JOHN: What does he say is the reason DeMaio failed?
BRAD RACINO: A few things they said number one voter turnout they were not expecting the under 30 turnout. 2008 there were a record number of young people voting and they bet on that not happening again. They have different thresholds and all these different projections of of what happened but they never never thought that this many people would turn out. So they said that going forward the Republican basically needs to concentrate on the under 30 crowd. He kept referring to them as the less informed the crowd. Or something along those lines.
ALISON ST JOHN: Underestimated the under 30s.
BRAD RACINO: He said they didn't do enough in social media are doing stuff for the young people inside were they get messages from they did not do a good job on that
ALISON ST JOHN: What do you think Mark in terms of why you didn't think the campaign worked?
MARK SAUER: It's interesting that seems to be a local microcosm for the national field nationally for example isn't pulling and the analysis that we saw several days before the election the strong white male middle-aged and older turnout also tends to be less educated and less college-educated better known for the Republican candidates Romney on the national scale and from what you are saying here, Mr. DeMaio on the locals side, I'm wondering how you come to the conclusion this is the ill-informed crowd. A lot of the demographic shift that is the less educated voter who is still clinging to the Republican core.
ALISON ST JOHN: And then there is the Latino voter too. I don't know if that DeMaio campaign reached out to them.
BRAD RACINO: That didn't even come up, They never talked about that.
MARK SAUER: And women of course internationally for the Democratic vote turned out such numbers that we had famous comments on rape from some of the ill advised comments from some of the Senate candidates on a national level from Republicans.
ALISON ST JOHN: Obviously to a large degree most of the candidates were riding the coattails of what happened nationally but also there were some things that they may be able to, did Tom take credit for any of the win from his campaign, was there anything he said I'm glad I did this?
BRAD RACINO: I mean he's a very humble person. We met with him once but it seemed like he also admitted that he came into this midstream. This was not something he was on from the beginning and this was very different for him he said it was on Mike a lot of campaigns I have ever read because I came into something that was already going on and I think he had to take control at certain different levels so he did not take credit for much she was a very humble person.
ALISON ST JOHN: Post both campaigns to a very negative. There was some horrendously negative ads. Were there places where the candidates regretted attacking their opponents on the other side?
BRAD RACINO: Yes, Jason wrote me mention of the attack against Nathan Fletcher
MARK SAUER: That goes back to the primary
BRAD RACINO: That was here in K bps when it goes back to an ethics campaign the demand campaign was unaware that Mr. Fletcher had already know that this was dismissed there was no longer ongoing. The DiMaio campaign did not know that.
ALISON ST JOHN: That was attacked a pretty good strategic move to attack Nathan Fletcher and primary because he felt that he probably could not have beaten Nathan Fletcher. Do you think he could've beaten Nathan Fletcher in the general? Mark?
MARK SAUER: That's a good question and we were talking before we went on the air it's curious that the infamously late session from the editorial board of the UT by the editor Jeff Light said that we've got to block Filner from going forward here being a Republican backed newspaper. And it seemed a lot of folks said at the time know you're big problem in the election is going to be Nathan Fletcher because he's going to draw Democrats and moderate Republicans and Filner being such a polarized from the left candidate versus the right. It would seem Fletcher has a much better chance we can speculate now but it seems to me Fletcher were in the general election Mr. DeMaio may not have gotten much over of 40% of those.
ALISON ST JOHN: So now what about owners campaign Tom Shepherd, did he regret anything that what they saw and to DeMaio?
BRAD RACINO: They pointed at the infamous Lily Pond accident and he sat back and chose his words carefully again and said yeah that was something he was not happy with. I think he said it was not vetted, he was not based in fact. I got the impression that that was not his direct choice, it was not a choice he made, but someone in his staff and that he was not happy about it.
MARK SAUER: For listeners that are not aware can we explain about the Lily Pond incident?
BRAD RACINO: Should definitely put in the ballpark was trashed there was a water fight and filters campaign made it a point to kind of say that that was a result of DeMaio's partner, his partner is involved in it at some point I don't know the full details of it.
MARK SAUER: Yeah, Bob Filner kind of throwing the holy water on social media said that DeMaio's partner in the point of that was not so much saying all my goodness it is criminal charges which was over the top of the time but the whole point was to note that for DeMaio's conservative backers that he is a gay man and he's in a committed relationship.
ALISON ST JOHN: Do you think that backfired on Filner's campaign?
MARK SAUER: It seems it sounds like he didn't certainly has regrets based on what he said to you
BRAD RACINO: He called it a game bidding campaign about it was despicable he had done this in Mr. Shepherd did not bring it up is something that was intentional, but I don't know.
ALISON ST JOHN: But DeMaio does not regret anything he threw at Filner?
BRAD RACINO: I did not speak to DeMaio personally but as far as the campaign goes I mean, yeah, he did not let too much out about too many regrets just the Fletcher thing, and other regrets were just miss-polling and basic bad numbers.
MARK SAUER: Let's talk about polling for a minute there, did you mention much about the internal polling they were doing because there were some very curious both and Allison and I were talking about this earlier before the campaign you had a survey USA 10 news couple of polls which showed a pretty comfortable lead though there was a great undecided, comfortable lead for Bob Filner at the time about seven points I believe in the most recent one and also just before the election beauty comes out with people where it was 10 point lead for DeMaio and again still some undecideds of the 17 point swing. Did he talk about internal polls or any of the polls?
BRAD RACINO: They said they did a lot of polling on their own and I think babies listings on the national Republican pulling, so they had kind of base their predictions on that and did not talk about any tables or other bowls of the city so I think they were basically one bad numbers.
ALISON ST JOHN: So Shepherd was not disappointed in the way UT took up the cudgels for his opponent?
BRAD RACINO: I guess not
ALISON ST JOHN: DeMaio has said that he is not very confident that Filner can do the job and he is pretty scathing.
NEW SPEAKER: That was going to me is that this guy ran an entire campaign offering a vision for the city other than he would not do what Carl would do, and line at every opportunity and getting away with it. And that is what is scary for me, said bipartisan professional and personal biases aside, this guy is about to be given the keys to the castle in the city of San Diego who is just starting to get out of a financial crisis that has burdened us for more than a decade and this guy has gotten a plan and he doesn't have the temperament to be a chief executive. You know, being one of 435 members of Congress there's only so much damage that Bob Filner can do. I am frightened for the city of San Diego what will happen with Bob Filner has merit.
ALISON ST JOHN: Okay so that is DiMaio's campaign strategist.
MARK SAUER: Don't sugarcoat it
ALISON ST JOHN: What did Tom Shepherd tell you about how Filner has changed the campaign because I mean there have been some concerns he was a congressman is that the skill you need to be a chief executive of the city?
BRAD RACINO: Well, he kind of said he was on two different sites he said that he has changed that he's evolved, matured, that he now knows what it takes to be Mark of the chief executive, the leadership kind of position. But on the other hand, he said that he hadn't really had any success in molding him. He said Bobby is Bob. So it's kind of strange the dichotomy of saying that he's evolved but also sick he has had no hand in it.
ALISON ST JOHN: Did he help them a little bit during the campaign on his positions like about the ports in the convention center or the Plaza de Panama
BRAD RACINO: Right, after Filner's information at the Plaza de Panama showing where he brought in an impersonator and a couple things I guess Shepherd said to him and said what were you thinking and kind of rehashed his points on what it means to be a leader and not that kind of very loud and boisterous personality that is required in Congress when you need to get hurt, but that's not something you may or should be doing.
MARK SAUER: So sanded the rough edges little bit, we've got to shift the role from Congress to know a leadership role in the city which is what his great device was.
ALISON ST JOHN: What about Jason, did he have to do sanding of the edges of DeMaio?
BRAD RACINO: Not really he said that of all the people he's worked with that it was not really hard he said there were a few more things that were stylist versus substance he said Carl knew these issues better than anyone in the city better than CEOs, we did not have to teach them that, it was just the style of certain things. He did take credit for having to my whenever he watched DeMaio is look straight into the camera I said was that you? Little things like that that they did but pretty himself after the third debate he never watched another debate and never had to go again.
ALISON ST JOHN: What did he say about what might happen with DeMaio now?
BRAD RACINO?He said he doesn't know his plans for sure but we've definitely not seen the last Carl DeMaio.
ALISON ST JOHN: Okay well we are going to have to end it there. I'd like to thank you very much, Brad Racino, thanks very much.
BRAD RACINO: Thanks.
ALISON ST JOHN: And of course Mark Sauer KPBS senior editor.
MARK SAUER: You bet.
ALISON ST JOHN: And you are listening to Midday Edition. I am Alison St. John in for Maureen Cavanaugh.