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Army care swings from neglect to excess

Staff Sgt. Ronald Gullion, who is receiving care for damage to his liver at Blanchfield Army Community Hospital at Fort Campbell, Ky., meets with case manager Linda Anderson.

Associated Press

Staff Sgt. Ronald Gullion, who is receiving care for damage to his liver at Blanchfield Army Community Hospital at Fort Campbell, Ky., meets with case manager Linda Anderson.

FORT CAMPBELL, Ky. — In a rush to correct reports of substandard care for wounded soldiers, the Army flung open the doors of new specialized treatment centers so wide that up to half of the soldiers currently enrolled do not have injuries serious enough to justify being there.

Army leaders are putting in place stricter screening procedures to stem the flood of patients overwhelming the units, a move that eventually will target some for closure.

The number of patients admitted to the 36 Warrior Transition Units and nine other community-based units jumped from about 5,000 in June 2007, when they began, to a peak of nearly 12,500 in June 2008, according to interviews and military data.

The units provide coordinated medical and mental health care, track soldiers' recovery and provide broader legal, financial and other family counseling. They serve Army active duty and reserve soldiers.

Just 12 percent of the soldiers in the units had battlefield injuries while thousands of others had minor problems that did not require the complex new network of case managers, nurses and doctors, according to Brig. Gen. Gary Cheek, director of the Army's warrior care office.

The overcrowding was a "self-inflicted wound," said Cheek, who also is an assistant surgeon general. "We're dedicating this kind of oversight and management where, truthfully, only half of those soldiers really needed this."

Cheek said it is difficult to tell how many patients eventually will be in the units. But he said soldiers currently admitted will not be tossed out if they do not meet the new standards. Instead, the tighter screening will weed out the population over time.

"We're trying to change it back," to serve patients who have more serious or multiple injuries that require about six months or more of coordinated treatment, he said.

By restricting use of the coordinated care units to soldiers with more complex, long-term ailments, the Army hopes in the long run to close or consolidate as many as 10 of the transition units, Cheek said in his office near the Pentagon.

A crisis response

In the past, a soldier with a torn knee ligament would have surgery and then go on light duty, such as answering phones, while getting physical therapy. But last October, the Army began allowing soldiers with less serious injuries such as that bad knee to go to the warrior units.

The expansion came in the wake of reports about poor conditions at Walter Reed Army Medical Center in Washington, D.C., including shoddy housing and bureaucratic delays for outpatients there.

Brigade commanders began shipping to the transition centers anyone in their unit who could not deploy because of an injury or illness. That burdened the system with soldiers who really did not need case managers to set up their appointments, nurses to check their medications and other specialists to provide counseling for issues such as stress disorders.

The Army's goal now, as spelled out in a recent briefing given to Defense Secretary Robert Gates, is to screen out those who do not need the expanded care program, shifting them to regular medical facilities at their military base or near their homes.

Jon Soltz, an Iraq war veteran and chairman of VoteVets.org, said the Pentagon is making a fair argument. He acknowledged that some soldiers with less serious injuries might not need the units' services.

But he said commanders need to be able to move their soldiers who cannot deploy due to an injury to the units because that is the only way they can get a replacement before going to war. Otherwise, the brigade goes to battle without the forces needed.

"The larger concern here is that the problem that is driving this is the manpower problem," said Soltz. "The Army is overextended. We don't have enough guys."

It is vital, he said, that the medical system care for all the soldiers who need help and that any changes not threaten that care.

Raymond DuBois, a former acting undersecretary of the Army and manpower adviser under then-Defense Secretary Donald Rumsfeld, said the units address "a problem that was not made aware at the highest levels" and do it well. But he has worried for months that the units were overstretched.

"Guess what? They did it so well everybody wants in," said DuBois, now an adviser at the Center for Strategic and International Studies.

Patient load eases

Cheek stressed that the new, more stringent screening process will not deny care to soldiers in need or limit the treatment units to those with battle wounds.

"If it's a severe, very acute condition that needs rehabilitation and a lot of management and oversight, regardless of where it comes from, that soldier needs to be in this program," Cheek said.

The latest data shows that it is working. The patient load is starting to inch down, from the peak of 12,478 in June to less than 11,400 in October. Cheek estimates that the screening process will reduce the number to between 8,000 and 10,000.

According to Army data, the key struggle is keeping the transition units fully staffed. In many of the more remote locations, Army leaders have trouble finding enough nurse case managers. As of the end of September, 12 of the units based at military posts were short case managers.

Other locations, such as Fort Drum, N.Y., do not have enough behavioral health specialists.

Closing some of the locations may help ease shortages, Cheek said. "It shouldn't be too surprising," he said. "We're 18 months old here, so now it's time for us to relook at how we're doing this, and where we can gain some efficiencies."

He added that an order coming out in December will further refine the screening criteria for the transition units. In particular, it will call for the Army to identify other ways to provide care for reservists so they can receive the treatment they need closer to their homes, which often are far from large military bases.

The Army chief of staff, Gen. George Casey, has made it clear that any soldier who needs the coordinated care must get it, regardless of how many soldiers end up in the program.

Meanwhile, officials are building permanent care centers at the main bases over the next several years, at a cost of more than $1-billion. Annual operating costs are about $270-million, with the staff of about 3,000 consuming most of that expense.

Nearly 40,000 service members have been wounded in action in the Iraq and Afghanistan wars as of Friday, although more than 18,000 returned to duty within 72 hours of their injuries, according to Defense Department data.

Army care swings from neglect to excess 11/02/08 [Last modified: Monday, November 3, 2008 4:38pm]

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