Commissions Aim for Better Care for Wounded Soldiers
American soldiers deserve the best health care their country can provide. To assure this, three government panels were assigned the task l of looking into the care of wounded soldiers and recommending improvements. The President and the secretary of Defense have each put together panels of experts to find solutions to identified health-care problems.
Two of the panels have issued their findings and made recommendations. One is still at work. The Independent Review Group, chaired by former secretaries of the Army Togo D. West Jr. and John O. Marsh Jr., submitted its report on April 11. The Task Force on Returning Global War on Terror Heroes, headed by secretary of the VA R. James Nicholson, submitted its report eight days later. The President's Commission on Care for America's Returning Wounded Warriors, headed by former Sen. Bob Dole and former secretary of Health and Human Services Donna Shalala, is expected to submit its recommendations to President George W. Bush on June 30.
Each panel had a specific task. The Independent Review Group focused on Walter Reed Medical Center in Washington, D.C., and the National Naval Medical Center in Bethesda, Md. The Task Force on Returning Global War on Terror Heroes studied gaps in existing services and proposed solutions within existing budgets. The Commission on Care for America's Returning Wounded Warriors is examining and will make recommendations for all-encompassing care for injured soldiers, from their return from the front lines to their return to either military service or civilian life.
INDEPENDENT REVIEW GROUP
The Independent Review Group collected information from public meetings, one-on-one interviews, site visits, web postings and comments made via a toll-free telephone number.
The group found shortcomings in Walter Reed's continuum of care as well as its leadership, policy and oversight. Specifically, the group found that while wounded soldiers received first-class trauma care from their evacuation from the battlefields to inpatient hospitalization, there was a breakdown of health services and care management once the patient transferred from inpatient to outpatient status.
Specific problems in outpatient care included shortfalls in the following: interdisciplinary collaboration in comprehensive care, treatment and administrative services; standards for outpatient case managers' qualifications and training; early identification techniques, comprehensive clinical practice guidelines, research and training for traumatic brain injuries (TBI) and post-traumatic stress disorder; inadequate compensation for burn patients who have lost a limb function; and the automated interface in clinical and administrative systems within the Department of Defense and the VA.
The group also found that there is a declining number of mental/behavioral health-care staff in military medical facilities; amputees have no access to technologically advanced follow-on care outside of the DoD; the policy and guidance within the Physical Disability Evaluation System vary and are too cumbersome within the military health-care system; and reserve component soldiers have specific difficulties in that same system.
Specific problems related to leadership included constraints on Walter Reed from Base Realignment and Closure (BRAC) and a lack of funding; leaders' lack of awareness of poor living conditions; a lack of smooth transition from Walter Reed to the National Military Medical Center in Bethesda, Md.; and staff fatigue from shortages and inadequate training.
Independent Review Group Recommendations
* Resources should be provided to staff to train case managers, as well as develop Tri-Service policy and regulatory guidelines for case management services.
* Every returning casualty should be assigned a single primary care manager and case manager as his or her basic unit of support.
* Clear standards, qualifications and training requirements, including proper initial and recurring training, should be defined and conducted for case management personnel. …