Docs Show 'Wounded Warrior' Care Shortfalls

WASHINGTON -- The Army's special medical units should be healing more than 9,300 Soldiers entrusted to their care.

But a nine-month probe by the Tribune-Review found America's sick and injured Soldiers must struggle to mend inside 38 Warrior Transition units the Army has turned into dumping grounds for criminals, malingerers and dope addicts.

Originally designed to treat the wounded from twin wars in Iraq and Afghanistan, after nearly a decade of battle these barracks snag Soldiers in red tape. Despite an epidemic of post-traumatic stress disorder, depression, brain injuries and substance abuse linked to repeated combat deployments, Soldiers sometimes spend years desperately seeking psychological care.

Overlooked, over-medicated and overseen by a stressed staff, the hardest hit often are in the Army National Guard and Reserves.

Picked by President Obama's administration in early 2009 to alleviate suffering in the units, former Deputy Undersecretary of Defense Noel Koch said his tenure ended abruptly in April when he and his investigators at the Pentagon's Office of Wounded Warrior Care and Transition Policy were in the midst of a nationwide investigation similar to the Trib probe.

After compiling reams of audits, reports and interviews with commanders, hospital personnel and patients nationwide and in Europe documenting these problems, Koch said he was given the choice of resigning or being fired by his boss, Under Secretary of Defense for Personnel and Readiness Clifford L. Stanley.

Koch says he quit.

"They're trying to fight two wars at the same time, and everything is breaking down," said Koch, a Vietnam veteran and high-ranking official in President Ronald Reagan's administration. "The Secretary of Defense, Robert Gates, is a good man. He has a Pentagon to run and two wars to fight, so he pushed this down to the services to handle. But they need help."

In his 11 months on the job, Koch said he tried to meet with Gates but was rebuffed. He said Stanley, a former Marine Corps. general, also declined weekly briefings until that fateful staff meeting in early 2010.

After delivering his report, Koch said Stanley uttered a single word, "Wow," and then gave him a cryptic warning: "He did not address me by name, but he did look directly at me and said the following: 'It is important to be careful what is put in written reports. These can affect people's careers.' "

Gates, Stanley and other Pentagon leaders declined to comment.

When the Trib filed a request to view these reports under the Freedom of Information Act, Stanley's department heavily redacted the released versions, citing secrecy and security needs typically reserved for classified military plans.

Concerned that the Pentagon was covering up shoddy treatment of Soldiers, insiders then passed unredacted files to the Trib. They soon were joined by Army employees nationwide who exposed problems at their bases.

In a written response, the Army's former commander of the Warrior Transition program said he couldn't "understand Mr. Koch's perseverating" on the program.

"Unfortunately, I'm not sure Mr. Koch has ever fully understood the consequences of 10 years of warfare and the challenges of deploying brigades with a year or less at home station between deployments," wrote Maj. Gen. Gary Cheek in October.

Most of the Army's top medical commanders refused to speak to the Trib for months. On the eve of publishing these articles, the Army's Inspector General released a report echoing the findings both of Koch's investigators and the Trib.

The Office of Wounded Warrior Care and Transition Policy doesn't direct day-to-day operations of the Army's special medical units. Instead, the Pentagon agency identifies problems plaguing them and tries to find policy solutions.

Although ongoing challenges bedevil the Air Force, Marine Corps and Navy, inspectors found the most chronic problems dog the Army, America's largest service and the one that's doing the most fighting overseas.

The top concern: The Army seems unable to trim the ranks of patients filling the Warrior Transition units a never-ending flood of broken Soldiers that too often buried the special medical units, demoralizing patients and military staffers, according to the files.

These problems aren't new. In early 2007, stories by The Washington Post and other news outlets alleged shoddy treatment of the wounded at the Army's Walter Reed hospital in Washington. Reeling from the scandal, the Army invoked a new mantra "No more Walter Reeds." The "medical holds" housing most of the sick and injured were scrapped and merged with special segregated units for the wounded that had been carved out of the system in 2004, according to Koch and Army studies.

An Army order to send all ailing Soldiers to the new Warrior Transition units un-leashed a flood of 10,000 patients who previously hadn't been identified as "nondeployable," a wave that overwhelmed the medical barracks and from which they're still recovering, according to the Pentagon reports and unit commanders.

At Kentucky's Fort Campbell, home of the 101st Airborne Division, the 67 Soldiers in the "medhold" in 2007 soon were joined by nearly 400 patients, according to Army Col. Mike Heimall, a commander who has drawn praise for compassionate care there and at Fort Riley in Kansas.

The Army brass issued "Frago 3" in 2008 to dam the flood of broken Soldiers by erecting barriers to entering the new Warrior Transition units. Individualized medical diagnoses called "profiles" limiting their military duties for more than six months are now required. The underlying conditions must be "complex" and require extensive clinical case management by trained nurses, who are supposed to oversee the care of about 25 Soldiers each, according to the Pentagon reports and Army files.

The Army credits Frago 3 with finally halving the number of Warrior Transition patients since the unexpected deluge. But it never fully blocked the tide of ailing personnel, according to internal reports. Despite dwindling combat in Iraq, the nationwide Warrior Transition population stays at more than 9,000 Soldiers. An equal number who might qualify for the special program are in their original units, according to Army leaders.

"There are a lot of things wrong with the (units). We have our concerns with the growth of them and how we manage them because they're kind of taking on a life of themselves. I think it's going to require a more direct supervisory approach," said Thomas R. Lamont, a retired Illinois National Guard colonel who serves as the Army's assistant secretary for Manpower and Reserve Affairs.

By mid-2010, the reports estimated 10,000 Soldiers had sought Temporary Disability Retirement for catastrophic ailments a rising trend that was going to make the population "the most ever." The reason the Army is reeling instead of healing is because of the Army's own policies, according to Koch's fact-finders. The Pentagon files indicate that commanders circumvent Frago 3's regulations and hurt the health of all Warrior Transition patients by dumping on the medical units Soldiers they don't want to take overseas everyone from cancer cases and GIs hurt in accidents to trouble makers, dope addicts, potential suicides and malingerers.

While often presented to America as special wards for the wounded, only 11 percent of the Soldiers in the medical units have Purple Hearts or fell ill in a war zone, according to the Pentagon files. They're outnumbered by the estimated 16 percent of the patient population that never deployed to combat and never will, but this tally varies by base.

A February 2010 report estimated that one-third of the 450 Soldiers assigned to the Warrior Transition barracks at Washington state's Joint Base Lewis-McChord had never seen combat. They were "high risk Soldiers who are not ready to deploy and may display high risk tendencies" such as drug addiction, suicide and criminal conduct, the report said.

Georgia's Fort Benning medical barracks also were "burdened with Soldiers placed in there by commanders as an expedient means by which to rid their units of their 'undesirables' " an ongoing problem investigators concluded was occurring nationwide and that "deflected or defeated" other patients trying to heal.

The reports allege commanders nationwide knowingly turn the special units into convenient pre-deployment "dumping grounds." And the Pentagon team wasn't the only one uncovering the problem: The Department of Veterans Affairs in 2009 discovered brigades doing the same thing at Georgia's Fort Stewart, home of the Army's Third Infantry Division.

Koch's investigators feared that packing too many Soldiers into the Warrior Transition units would destroy what the Army calls its "Triad of Care" a "cadre" of staffers who oversee patients in the barracks; nurse case managers who coordinate treatment; and primary care providers, who usually are nurse practitioners and physicians assistants.

The post-Walter Reed reforms in 2007 raised the cadre by quickly drawing often involuntarily hundreds of staffers from all the Army's branches, even combat units. These Soldiers often lacked experience in medicine, especially caring for Soldiers showing signs of substance abuse, brain injury, suicidal thoughts and other problems increasingly prevalent in the service, according to the Pentagon reports and medical commanders interviewed by the Trib.

Koch and his investigators say they are worried that high caseloads from the 2007 flood, along with ongoing "surges" of Soldiers shed as units near deployment dates, continue to overwhelm nurses, primary caregivers and an overworked and undertrained cadre nationwide.

Fort Benning returns about half of its Warrior Transition Soldiers to active duty. Nationwide, however, less than one in three patients remains in uniform. The rest re-enter civilian life too often unhealed after about a year, according to the Pentagon files.

The reports starkly lay out the crux of the problem: The Pentagon is letting the Army turn the Warrior Transition barracks into "dumping grounds" that are "set up to handle everybody," a policy that creates an "exponential misbalance" between veterans who should be there and personnel that commanders don't want on combat deployments. Army policies make it too "difficult to determine a reasonable line of demarcation when it comes to providing care, and what level of care," the reports contend.

To Koch, the growth of the Army's Warrior Transition system and the shape it continues to take "actually made 29 Walter Reeds" plus nine off-site units designed for National Guard and Army Reserve troops.

"What bothered me is that they just wanted to keep the profile as low as possible. They didn't want to focus on it at all," Koch said. "There were a lot of bureaucrats at the Pentagon who were just trying to make the services deal with it, to make the services, especially the Army, take the fall on this. That's the bottom line. They weren't interested in fixing it, but in handling it as a PR issue." Medical commanders told the Trib, however, that the distinction between a combat injury and a garrison malady is becoming increasingly blurred after nearly 10 years of war, especially because of rising mental illness diagnoses. More than one out of five patients in the special units suffers from post-traumatic stress disorder (PTSD) caused by combat or sexual trauma, according to the reports. At Fort Riley, home to the First Infantry Division, two out of every three Soldiers in the Warrior Transition barracks have been diagnosed with mental issues such as PTSD or substance abuse ailments often after the Soldiers underwent repeated combat deployments.

"OK, let's say I have a Soldier who has done three tours. He comes home and his wife leaves him. He begins to have financial difficulties. The stress retriggers PTSD symptoms. Now, you tell me: Which came first, the chicken or the egg?" said Lt. Col. Andrew Price, the commander of the Fort Riley unit.

When a Trib reporter directly asked Army Surgeon General Lt. Gen. Eric B. Schoomaker about the problems the Pentagon team uncovered, the three-star general tasked with overseeing the Warrior Transition units walked away. Neither he nor his staff has answered written questions they requested from the Trib in October.

Schoomaker's four-star boss outgoing Chief of Staff of the Army George Casey told the Trib he's glad the Pentagon went out "inspecting and finding things that we can do better" so his commanders could start "moving it to another level." He nevertheless disputes the charge that Warrior Transition units are "dumping grounds" worse than the wards they replaced.

"Believe me, the WTUs are a huge step ahead of the medical hold detachments," said Casey, who believes that the end of war in Iraq and Afghanistan eventually will allow the Army a chance to "reset" and heal.

Troops nationwide interviewed by the Trib, however, said patients who need more time to mend or who want second diagnoses to ensure adequate retirement benefits often are tagged in Casey's Army as "malingerers" or ungrateful "garrison wreckage."

Koch heard their complaints, too.

"I think the time has come for Congress to look harder into what has been going on with our wounded warriors. We've deserted them before," Koch said. "We did this during Vietnam. We don't need to repeat that history."

source: Military.Com