Veteran Issues Digest Number 1717

[admin]

1.
Shortages, turnover afflict military health care

Posted by: "Colonel Dan" colonel-dan@sbcglobal.net coloneldan1

Thu Jan 3, 2008 9:25 am (PST)

http://www.courier- journal.com/ apps/pbcs. dll/article? AID=/20071223/ NEWS01/71
2230488

Sunday, December 23, 2007, WOUNDS OF WAR
Shortages, turnover afflict military health care
Fort Knox among army posts affected

By Laura Ungar
<mailto:lungar@courier- journal.com> lungar@courier- journal.com
The Courier-Journal

also see Video at:
http://www.courier- journal.com/ apps/pbcs. dll/article? AID=/20071223/ VIDEO01/7
1223002

Injured in a roadside blast in Iraq, Sgt. Gerald Cassidy was assigned to a
new medical unit at Fort Knox devoted to healing the wounds of war.

But instead of getting better, the brain-injured soldier from Westfield,
Ind., was found dead in his barracks Sept. 21. Preliminary reports show he
may have been unconscious for days and dead for hours before someone checked
on him.

U.S. Sen. Evan Bayh, an Indiana Democrat, linked his death in part to
inadequate staffing at the unit. Only about half of the positions there were
filled at the time. The Army is still investigating the death and its cause,
and three people in Cassidy's chain of command have lost their jobs.

"By all indications, the enemy could not kill him, but our own government
did," Bayh told the Senate Armed Services Committee last month. "Not
intentionally, to be sure, but the end result apparently was the same."

As more wounded soldiers return home from war, critics say staff shortages
and turnover have affected the quality of health care at Army posts across
the nation.

Overall, the Army's Medical Corps has downsized significantly since Desert
Storm, dropping from 5,400 to 4,300 physicians and from 4,600 to 3,400
nurses. According to the U.S. Department of Defense, more than 29,000
service members have been wounded in action in Iraq or Afghanistan over the
past six years, compared with fewer than 500 in Operation Desert Storm.

Warrior Transition Units, created after The Washington Post revealed
substandard outpatient care at Walter Reed Army Medical Center, have
struggled to find enough doctors, nurses and squad leaders to serve a
growing number of patients. The Defense Department allocated about $1.4
billion in operations, maintenance and construction funds for unit
facilities and projects.

Military doctors and nurses at Fort Knox move every three to five years, and
some are deployed overseas. For patients, that turnover often results in
them being treated by doctors and nurses unfamiliar with their cases.

Earlier this month, Congress passed legislation pushed by Bayh requiring the
Defense Department and Veterans Affairs to develop a policy on improving
care for the wounded. And Army officials say they are already doing better,
noting that Warrior Transition Units are approaching or meeting staffing
goals across the nation.

"We've progressed quite well" on those units, said Brig. Gen. Michael S.
Tucker, assistant surgeon general for Warrior Care and Transition. "We've
done it while we're at war and really strapped."

But some positions have been filled with workers temporarily borrowed from
other areas of the military, and critics say that as the number of returning
soldiers grows, the need for more doctors and nurses will grow, too.

Meanwhile, officials said, Army hospitals need more staff now. Fort Knox's
Ireland Army Medical Center is struggling to fill more than 100 vacancies.
It also lacks certain specialists, including neurologists who treat
traumatic brain injury, considered the signature injury of the Iraq War.

"It would be very generous to say we're at the proper staff," said Constance
Shaffery, public affairs officer at Fort Knox. "We are not at the staffing
levels we want."

Positions unfilled

Cassidy, 32, came to Fort Knox in April, and was eventually assigned to the
Warrior Transition Unit, which opened in June to handle outpatients who need
at least six months of care.

The injured or ill soldiers live in barracks one or two to a room, have
medical appointments in a special clinic at the hospital, and are supposed
to get three visits a day from squad leaders, Army personnel usually at the
rank of staff sergeant. They are told, in posters and by staff, that their
mission is to heal.

In Cassidy's case, something went awry.

Bayh said the soldier tried unsuccessfully for five months to get
transferred to a specialized private facility in Indianapolis "after
receiving substandard care at Fort Knox."

Bayh pointed to a September report from the Government Accountability Office
showing that more than half of the Warrior Transition Units nationwide,
including those at Fort Knox and Fort Campbell, had shortages in key
positions at the time. Of 2,410 positions, 1,127 -- or 47 percent -- had not
been filled.

Jonathan Swain, Bayh's press secretary, said Cassidy's family is not talking
to the press as the military continues to investigate his death. Calls to
his wife and mother were not returned.

In response to a reporter's questions about the case, Shaffery said:
"There's been nothing to indicate staffing had anything to do with it."

But Bayh disagreed, and Swain said the senator wants to know if problems
because of low staffing are occurring in units elsewhere.

At the Senate committee hearing where the case was discussed, Army Secretary
Pete Geren pledged that officials would "rectify the situation." Other
high-ranking Army officials say they have been filling vacancies among
physicians, nurse case managers and squad leaders.

Nationally, Tucker said, the 35 transition units have reached 80 percent to
85 percent staffing and are on target to reach at least 90 percent by Jan.
1.

Lt. Col. Chip Pierce, deputy director of the Warrior Transition Office, said
all key positions at the Fort Knox Warrior Transition Unit had been filled
as of mid-December and Fort Campbell has met its goals for doctors and squad
leaders but still lacks two of 11 nurse managers.

Although the numbers are encouraging, officials acknowledge that needs are
always changing. For instance, Fort Campbell's staffing goals were developed
based on an estimate of 403 patients, and there are 459. Nationwide, 8,700
soldiers are assigned to the units.

Sgt. Dwight Blackman, a 38-year-old Iraq veteran who suffered a heart
attack, is one of 277 in the Fort Knox unit. In the past few months, he
said, staffing "has improved a lot" and he has no problem getting the care
he needs.

"We've still got a little ways to go," said Unit Commander Lt. Col. Lanier
Ward. "It's a work in progress."

Residents asked to apply

Staff shortages at Army hospitals have existed for years.

Nationally, the number of doctors has remained the same since 1999, Army
officials said, while the number of nurses has fluctuated from a high of
4,615 in 1992 to a low of 3,381 in 2000.

Some patients at Ireland Medical Center say staff shortages have led to long
waits, overworked doctors and visits to private physicians.

Army Staff Sgt. Linda Brashears, who suffered a brain injury in Iraq, sees a
private practice neurologist off post, paid for by the military health
system, and said that until a couple of months ago she faced three-hour
waits as a walk-in patient at Ireland.

Although a new appointment policy has meant shorter waits, "We still need
more people," she said. ".There's more patients."

Overall, about 210,000 people are eligible for care at Ireland, officials
said, and total hospital staff stands at about 1,100.

Lt. Col. Dawn Erckenbrack, hospital administrator, appealed to
Louisville-area residents to apply for their vacancies for doctors, nurses,
social workers and others. She said Kentucky's doctor shortage and
competition from the civilian world make these vacancies especially
difficult to fill.

Despite shortages, Erckenbrack and Col. Rhonda Earls, the hospital
commander, said they do all they can to ensure patients see doctors in a
timely fashion -- using contracted physicians and referring patients to
private-sector providers.

Pvt. Ike Staple, a 39-year-old with high blood pressure assigned to the
Warrior Transition Unit, said he goes off the post for procedures such as
EKGs.

Keeping records

Army officials said they also must compensate for the higher-than- usual
level of turnover that has resulted from deployments.

Jessica Torres, who just moved from Louisville to Colorado and whose husband
serves in Iraq, said turnover affects the care she and her two children have
gotten at military hospitals because new doctors aren't as familiar with
their medical histories.

Ireland officials -- who wouldn't say how many staff members have been
deployed, citing security concerns -- acknowledged that turnover can hurt
patient care. But they said they try to minimize problems with detailed
electronic records, good communication between incoming and outgoing doctors
and the use of civilian workers.

"We have a core group of civilian physicians who never deploy. Some have
been here for 20 years," said Lt. Col. Carolyn Tiffany, deputy commander for
clinical services at Fort Knox. "They keep our clinics and services running
the same way, providing the continuity of care that our patients deserve and
expect."

Still, officials said they'd like to have a more ideal staffing level in
line with the demand for care.

"It's sort of like winning the lottery," Shaffery said. "It's something we
dream about."

Reporter Laura Ungar can be reached at (502) 582-7190.


2.

War effort disruption possible with base shift, Pentagon says

Posted by: "Colonel Dan" colonel-dan@sbcglobal.net coloneldan1

Thu Jan 3, 2008 9:37 am (PST)

Somebody needs to tell the Pentagon and the Whitehouse.. .we are at War

www.baltimoresun. com/news/ local/bal- md.brac03xjan03, 0,7735514. story

baltimoresun. com

War effort disruption possible with base shift, Pentagon says

By Timothy B. Wheeler

Sun reporter

January 3, 2008

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Shifting sensitive defense work being done at Fort Monmouth in New Jersey to
Aberdeen Proving Ground could disrupt the war effort if the Army fails to
replace the many workers who are likely to quit or retire rather than move,
the Pentagon acknowledges.

In a report to Congress, Deputy Defense Secretary Gordon England writes that
officials plan to minimize the upheaval from the base move by relocating its
5,200 workers gradually over the next three years and recruiting military
retirees locally to fill the many vacancies expected.

The 15-page report, required by Congress when it approved the nationwide
military base realignment in 2005, was submitted last week. It provides a
broad outline but few details of how the Defense Department plans to close
the 90-year-old New Jersey post and move its work force to Maryland without
a drop-off in its work.

With as many as 70 percent of the Monmouth workers indicating that they will
not move to Maryland when their jobs transfer, the report says the Army
faces a "significant challenge" in replacing them, in part by training new
people for highly technical, often classified work.

The Army plans to hire up to 2,500 employees over the next few years. If it
can't get enough to cover the gap, it will look to recruit military retirees
- an estimated 14,000 live around Aberdeen - or contract out some of the
work.

The Army also has stepped up efforts to hire graduates of colleges in the
region, offering them temporary, low-cost housing on base at Monmouth until
their jobs are transferred to Maryland.

The report also proposes to offer unspecified retention, recruitment and
relocation bonuses to cut down on turnover.

The Army's plans for the move to Aberdeen call for completion of new and
renovated laboratories and offices by the 2011 deadline. But the report
acknowledges that "some areas of concern still exist" about the likelihood
of finishing work in time.

Efforts will be made to line up suitable backup space at other government
installations nearby or in private facilities, the report says.

New Jersey officials have complained that the Pentagon understated the costs
and disruption of moving Monmouth's work to Aberdeen. Congress has never
reversed a base closing once it has been approved.

<mailto:tim.wheeler@ baltsun.com> tim.wheeler@ baltsun.com

Copyright C 2008, <http://www.baltimor esun.com/> The Baltimore Sun