November 3, 2008

Army Reexamines Warrior Transition Units

A media firestorm accused the U.S. Army of substandard care for wounded soldiers, but ironically, in an effort to fix the problem the government is actually taking care of more troops than necessary at specialized treatment centers.

The Associated Press conducted the research that found the number of patients admitted to the thirty six 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.

Army leaders are now implementing stricter screening procedures to cut back the flood of patients overwhelming the units.
The units serve both Army active duty and reserve soldiers. They give coordinated medical and mental health care, track soldiers' recovery and provide broader legal, financial and other family counseling.

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 H. Cheek, the director of the Army's warrior care office.

Just 12 percent of the soldiers in the units had battlefield injuries.

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 improved tighter screening would weed out the population over time.

"We're trying 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.

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 that changed in October when the Army directed 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.

The Army's new goal, 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 said 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 or 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."

Raymond F. DuBois, a former acting undersecretary of the Army and manpower adviser under then-Defense Secretary Donald H. Rumsfeld, said the units address "a problem that was not made aware at the highest levels" and do it well.

However, he's been worried for months 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.

Cheek said the new screening process would not deny care to soldiers in need or limit the treatment units to those with battle wounds.

"We don't really care about the source of the wound, illness or injury. We really care about the severity of the wound, illness or injury," said Cheek. "So if it's a severe, very acute condition that needs rehabilitation and a lot of management and oversight, regardless of where it comes form, that soldier needs to be in this program."

The patient load is starting to decrease, 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.

The Army is also reviewing which units get more use. The list of potential closings include warrior transition units at Fort Rucker and Redstone Arsenal, in Alabama; Fort Leavenworth in Kansas; Fort Dix in New Jersey; and Fort Irwin in California. According to Army data, many of them either have only a dozen or so patients now, or can be combined with another nearby facility.

According to Army data, the biggest obstacle is keeping the transition units fully staffed. Many times, 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 those case managers.

Cheek said closing some of the locations could help ease those shortages.

"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."

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

The army is 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.

The Department of Defense said nearly 40,000 service members have been wounded in action in the Iraq and Afghanistan wars. However, more than 18,000 returned to duty within 72 hours of their injuries.


Image Caption: A wounded Soldier attends the dedication of the Center for the Intrepid at the Brooke Army Medical Center in Fort Sam Houston, Texas. New Warrior Transition Unit policies will help Soldiers receive the best possible care by providing cadre and allowing Soldiers who need less care to leave packed WTUs.  Photo by Air Force Staff Sgt. D. Myles Cullen