More On Walter Reed & The Mistreatment Of Vets

NY Times Editorial: The Wider Shame of Walter Reed

It is impossible not to feel fury at the shameful neglect of wounded soldiers at Walter Reed’s outpatient facilities, just a few miles from an oblivious and neglectful White House. Many have been housed in rooms coated with mold and infested with cockroaches and mice. They have been swamped with confusing paperwork and forced to take responsibility for managing their own medical care. And when they or their family members have complained, their pleas for help have been callously ignored.

In military and VA hospitals there has always been a preference for injured troops and veterans to participate in their own care. But the nature of injuries and disabilities that promoted such an approach were dramatically different than what we are experiencing today. Because of advanced uniform and protective gear technologies, there are less of the traditional injuries caused by small weapons fire and artillery, and more injuries caused by mine-type weapons, including the now infamous IEDs (Improvised Explosive Devices).

IED injuries most commonly include concussion and shrapnel injuries about the head, including what is commonly terms "TBI" (traumatic brain injury) or "ABI" (acquired brain injury). The resulting injuries from this type of weaponry never used to make it to the field hospitals in previous wars. The way we treat, triage and transport injured troops in the field has so dramatically improved that 90% of those hit by IEDs are in a surgical/trauma field hospital within 30-90 minutes from the start of a combat engagement and the occurrence of the injuries. Our ability to treat burns, wounds, amputations (including re-attachments in some cases) and our ability to evacuate injured troops is greatly improved since even the first Gulf War under the senior Bush administration.

But the treatment of our injured troops experiences a drop-off in quality once they arrive here in the States. The treatment in the field, at the field hospital, and in the interim facilities--such as those in Germany, Italy, Spain and onboard ships--has always been rated as excellent. But the treatment here in the States, at Walter Reed Army Medical Center, Brooks Army Medical Center, Bethesda National Naval Medical Center, Balboa Naval Regional Medical Center, and elsewhere is wrought with disappointments. Outside of these major military hospitals, in other military districts--like those at Ft. Leonard Wood in Missouri, Great Lakes Naval Hospital (which used to be a regional medical center) and elsewhere--the care is even less charitable because of the cuts and downsizing that has occurred in the medical areas over the last thirty years. The entire military medical approach has changed to an outsourcing approach that, while effective for peacetime care for active duty and their dependents, is completely unprepared and incapable of meeting the demands that are resulting from the THOUSANDS of injuries and disabilities resulting from combat in Iraq and Afghanistan.

Additionally, the model of care still works on the idea of patient education and self-care, with family support. This is an older model that was in vogue many years ago. It was also effective when the injuries were predominantly different in nature and the military medical centers were better prepared, stocked and staffed. Such is no longer the case. Now, despite the role of social workers in the Army and Air Force, there is a greater need for "after care" and social support for the injuries. But the Navy and Marines do not have active duty military social workers, relying more on Navy Chaplains, their RP assistants, the Navy League, and the Red Cross for such services... all of which are not equipped to deal with the types of support services required. Even the Army and Air Force do not have an adequate number social workers to deal with the issues and problems arising from the after care needs of our injured heroes.

Instead, we hear stories about brain injured troops who are discharged from outpatient care, given a map to direct them to the outpatient barracks, and spend several hours just trying to find the barracks located 300 yards away from the hospital because no one realized that a brain injured person would have difficulty dealing with spatial information, such as a map. Then we hear that troops transferred to outpatient care and housed at the outpatient barracks (those that have been in the news because of infestation, mold, unsanitary conditions, and unsatisfactory facility conditions) for weeks without anyone contacting them in regard to what happens next. Additionally, we hear stories about family members who have to fight for basic services and the types of care that is routine for civilians, but are not being provided to our troops unless someone steps up to the plate and goes to bat for the patient.

Then the care at the VA suffers from almost 40 years of cuts, closing of the only facilities equipped to deal with TBI/ABI patients, closing and/or service cutbacks in less populated areas (especially down south), and a medical staff that is predominantly foreign-born and foreign-trained, not to mention almost impossible to communicate with because of language issues. My own experiences with the VA system reflects exactly the experience being reported in the media: the actual medical procedures done are of the highest quality, but the supportive care, outpatient care and administrative operations screws with the hearts, minds and souls of our vets.

In a desperate scramble to mute public outrage, President Bush yesterday named two political veterans to lead a commission charged with investigating conditions throughout the entire system of military and veterans’ hospitals. The choices seem to be good ones: Bob Dole, a veteran wounded in World War II and a former Republican Party candidate for president, and Donna Shalala, who ran the Health and Human Services Department for President Bill Clinton.

While I appreciate the fact that this commission is being formed and action is at least beginning, I question the selection of these people for the commission. What we need is a commission formed by active duty representatives, service officers from the various veterans' groups (DAV, VFW, American Legion, AmVets, etc.), doctors and nurses with military care experience, social workers and community advocates that are not in the "game" of playing politics, but are truly invested in advocating for our troops. We need regional representatives that can provide inspections of each military and VA medical facility with an eye toward not only identifying problems and issues, but specific ways of dealing with the inadequacies and resolving the problems.

There is plenty of blame to go around. Officials at Walter Reed were egregiously negligent. The Army’s high command, and the Joint Chiefs above them, were too weak-kneed or obtuse to demand adequate resources for medical care — just as they were too fearful for their own careers to demand adequate troops to fight the Iraq war to begin with.

The blame belongs in the White House because the Bush gang has consistently stated that we were fully prepared for the invasion and occupation of Iraq and Afghanistan, fully cognizant of all the ramifications of our efforts over there, and that they fully support our troops. The biggest lie being told is that anyone in this administration actually cares one iota for our troops and our vets. The issue of vehicular and personnel armor has still not been resolved and it has been almost five years since the problem was identified. The issue of providing kit upgrades for the helmets that would aid in preventing a large portion of traumatic brain injuries, as identified by the Operation Helmet web site, still has a significant backlog. Only the Air Force has responded in a major way to the need for such helmets, with the Marine Corps and Navy hesitating, and the Army delaying some kit deliveries.

Several things do not make much sense about the problems delivering these helmet upgrade kits:

1. The Air Force, which is in the process of delivering 122,000 kits does not have the majority of troops on the ground and in harms' way;

2. Each delay increases the cost of care we incur for TBI patients, which is estimated at $1.2 million dollars per troop afflicted with traumatic brain injury;

3. The politicians who control the purse strings, from the White House to the previous GOP-controlled congress, has not been supportive of our troops, nor protective of the way we use our tax dollars to provide not only medical care, but preventive measures.

But the fundamental responsibility rests with the president and his former defense secretary, Donald Rumsfeld, who stubbornly insisted on going to war without sufficient resources — and then sought to hide the costs of their disastrous mistakes from the American public.

AMEN! The statement by former Secretary of Defense, Donald Rumsfeld, regarding the lack of proper supply of preventive armor is evidence of the disregard this administration has had for our troops and their needs:

"As you know, you go to war with the Army you have. They're not the Army you might want or wish to have at a later time." - Donald Rumsfeld, December, 2004

I cannot think of a time in our political or military history when such disregard for our troops and their safety was expressed not only in words, but in a total lack of response to the issues that have been clearly raised and brought to the attention of the Pentagon, the DOD, the Secretary of Defense, the White House, the Vice President and the President.

Is it any surprise that the war’s wounded have been hidden away in the shadows of moldy buildings by an administration that refused to let photographers take pictures of returning coffins? Or a White House that keeps claiming that victory in this failed and ever more costly war is always just a few more months away?

It should not be a surprise because this administration is so entrenched in its views, ideology, religious zeal for its delusional beliefs, and its failed plan for Iraq and Afghanistan/

The Walter Reed revelations once again put the lie to the president’s claim that everything is being done to support America’s troops. Just as the administration has been shockingly slow to provide the necessary body armor for troops in Iraq and notably complacent about rotating exhausted troops back into the war, so, too, has it been reluctant to confront the large casualty toll from Iraq and Afghanistan. Military doctors have been amazingly proficient about saving lives that would have been lost in earlier wars. But as we now know, the injured survivors too often fall through the cracks.

Well, stated! It is a fact that our troops have not been even a latent priority in the Bush Doctrine or the agenda of this administration.

The new commission’s investigation, supplemented by the military’s own inquiries and by oversight hearings in Congress, must explore all aspects of this scandal. The revelations have flushed out disturbing complaints about shoddy treatment throughout the military and the veterans’ medical system and about a hostile process for determining disability benefits. None of this can be tolerated. The soldiers who have sacrificed their health and limbs to a misguided and mismanaged war deserve the best possible care when they return — for a lifetime, if necessary. And the president needs to learn that the horrors of this war can no longer be denied or hidden away.

But we need to change the commission's makeup. While it is true that Bob Dole is a veteran, he is also an ultra-conservative that has supported the entrenched views and agendas of the Reagan, senior Bush and junior Bush administrations. Former HHS Secretary Donna Shalala was incompetent, in my view, in that role during the Clinton administration, so I do not have much confidence in her views either. What we need is troops and vets taking an active interest in the the needs of our troops and vets. To hell with the damn politicians and the way this administration deals with reports from commissions. Has anyone forgotten that Bush all but dismissed the findings of the 9/11 Commission? Has anyone been paying attention to how the "Civil Liberties Commission" has been rubber-stamping the Bush agenda? This administration and this president will not hear anything that does not suit his agenda or fit into his already pre-determined, deeply entrenched world view. Unless we have troops and vets protecting their own, there will not be any justice in regard to medical care for our heroes.