washingtonpost.com
Commission Calls for Changes to Military Health System

Dana Priest and Anne V. Hull
Thursday, July 26, 2007 11:00 AM

The President's Commission on Care for America's Returning Wounded Warriors called for "fundamental changes" in the management of the military's health care and disability system, according to a draft report released on Wednesday.

Washington Post reporters Dana Priest and Anne V. Hull were online Thursday, July 26, at 11 a.m. ET to discuss the commission's recommendations for overhauling the military health care system.

Over the past few months Priest and Hull have investigated the care and treatment of service members returning from the wars in Iraq and Afghanistan in the Post's series, " Walter Reed and Beyond."

The transcript follows:

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Anne V. Hull: Hello everyone. Thanks for joining us. Let's begin.

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North Bethesda, Md.: The recommendations mostly seem to emphasize supporting the care to veterans and their families, something you would have thought the system already covered. Is this just an example of typical government bureaucracy that led to the failure of not doing this already? Can it be blamed on the Bush administration or does this go back much further?

Anne V. Hull: You would have thunk. The problems have existed forever, certainly during the Vietnam War. We haven't had a sustained combat environment since then, so that's probably why you're hearing about it now. Also, the country wants to support wounded service members now and isn't putting up with all the excuses. Yes, to some extent this is a typical bureaucratic set of problems -- times ten -- and to some extent it is the fault of the country's leadership, who are responsible for making sure the bureaucracy does what is important to do, like care for these people.

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Arlington, Va.: If the proposals are enacted, how long will it take for them to be enforced?

Anne V. Hull: The report gives them 12 months; but of course, it has no inherent power, so that's just a little kick and nothing more. The "how long" question is really a political one. How long can they get away with NOT fixing it.

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Ann Arbor, Mich.: Nicholson has said he's leaving, but I've seen nothing about a successor. What does the commission report imply for what characteristics a new Secretary should have?

Anne V. Hull: Someone who can effectively take on a lot more work; a lot bigger responsibility vis a vis the evaluation of wounded soldiers and the health care of their families.

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Tucson, Ariz.: What are you going to do to be more fair to people whose injury or disability is not so visible and has therefore often been downgraded when in fact it is very disabling on a day to day basis, for example pain?

Anne V. Hull: Well, the commission has a specific recommendation on post traumatic stress disorder. The Army is supposed to be quicker at determining fitness for duty using a uniform exam and the VA, which is better equipped anyway, is supposed to more quickly evaluate a soldier and they historically have been more generous with disability compensation than the services.

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Northeast Washington, D.C.: With all the reporting you have done on this subject, after examining the recommendations do you think, if implemented, they would help those real people you have interviewed and those like them?

Anne V. Hull: Yes. But we're a little skeptical of the Recovery Coordinators. Sounds like another layer of managers on top of a system that doesn't really function right now. After the hearing, Sec. Shalala told us she thought they would need are 24 of them. That was a shocking number. There are 28,000 wounded so far, thousands seriously. 24 seems way low.

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Alexandria, Va.: First of all - thanks again to the Washington Post for holding a flame to the administration's feet. My brother was seriously wounded in Iraq and, though his care at Bethesda and Brooke AMC were excellent, it was apparent that neither facility was up to the same level.

My question, however, is whether this report covered the absurd lack of care given to reservists and guardsmen wounded in Iraq? These men and women are being called up to serve in the same warzone for years on end, but then find their healthcare cut off after 2 years.

Anne V. Hull: The commission says only that service members (including guard and reserve) found unfit because of combat-related injuries should receive lifetime health care coverage for themselves and their dependent through TRICARE. Now, that will be very expensive, and it has to be approved in legislation, so we'll see.

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Charlotte, N.C.: Can you sum up what the recommendations were? T hanks

Anne V. Hull: here's the link. the commission report is not long, 29 pages: Recommendations

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Boston, Mass.: Congratulations on your reporting on soldier care. I do get cynical when I hear Bush "will look at" recommendations from bipartisan study groups and he sets up photo ops with affected people. Which of the recommendations do you think Bush will not implement?

Anne V. Hull: Yes, we were surprised at his tone as well. The report, on the whole, used diplomatic language, in contrast to the report commissioned by Defense Secretary Gates which was quite openly critical of the system. So, the proof, as they say, is in the pudding. We'll have to wait and see how the president follows up.

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Washington, D.C.: Living in DC and reporting on this subject in depth you might be aware of how difficult it is for community members to volunteer their time with Walter Reed. Despite all the talk about 'supporting our troops', when we actually try to do so, the hospital gives us the cold shoulder. Is anything being done to tap into the large and willing pool of local support?

Anne V. Hull: This is a problem. We are deluged with readers who call asking, how can we help? The generosity is overwhelming, from someone in the Midwest wanting to donate a billiards table to a cadre of local mental health counselors who want to provide services to an Army with a severe shortage of counselors and psychologists.

Walter Reed either does not return their phone calls or says it needs no help. Gen. Schoomaker, the CG at WR, is aware of this problem and says he is trying to coordinate efforts better. But we've seen no improvement yet.

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Washington, D.C.: I have 2 points...first off the Commission didn't report on the qualities needed for a new VA secretary. That was not what they were commissioned to do.

Secondly...the coordinators would be for seriously injured patients...they cover the definition in the report...and that number is between 2,000 to 3,000 servicemembers if I remember correctly.

People would be well served to read the report and make their own opinions based on the information that was collected.

Anne V. Hull: Right, the commission made no suggestions about the qualities the new VA secretary should possess. But the proposals are massive, particularly the data sharing aspects between DOD and VA. No small undertaking. So whoever gets the job has to cut out for overhauling some key areas of care.

We gave the total number of seriously wounded from Iraq and Afgahnistan. The current number hovers just under 3,000.

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Raleigh, N.C.: There has been a suggestion of Private Sources for these healthcare initiatives. Is this another effort for privatization? It is my understanding that one underlying cause of the problems at Walter Reed was this movement to privatize sources.

Anne V. Hull: One of the proposals, the Recovery Care Plan that calls for Recovery Care coordinators to give personal and longterm care to each seriously wounded soldier, will draw employees from the U.S. Department of Public Health and the Department of Health and Human Services.

With severe shortages in, for instance, mental health care, the Army will go outside to boost its ranks of providers. It has done this for years but the problem is more critical now.

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Washington, D.C.: So, Walter Reed can't even coordinate volunteers and donations, but we are expected to believe they can adequately treat wounded soldiers?! Sigh.

Anne V. Hull: Walter Reed would argue that it is focused on providing the best medical care it can to the soliders. Docs and nurses are working 24-7 and are often deployed themselves for months at a time. It has been an extremely exhaustive chapter in the lives of the staff.

But things fall the cracks when the soldiers leave the hospital beds.

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Rockville, Md.: My friend's husband is a marine who recently returned from Iraq. He is experiencing symptoms of PTSD and although he is eligible for treatment, the marine culture has inhibited his ability to receive services. Any ideas on if/how these new measures could make it easier for marines returning from combat to receive psychological treatment without facing stigma/backlash from superiors?

Anne V. Hull:"Stigma" was addressed in the report released yesterday. "Both departments (DOD and VA) must work aggressively to reduse the stigma of PTSD." Some say the military culture of "suck it up" and "drive on" are the greatest obstacles to troops asking for and getting help. What's needed are top commanders speaking openly about the need for good mental health care; not those at the Surgeon General's office but those in theater.

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Chesterfield, S.C.: Hey Dana, and Ann:

After listening to the news and reading about the findings by Ms. Shalala and Mr Dole, I have a question. According to Mr Snow, "White House press secretary Tony Snow initially told reporters yesterday that Bush would not act immediately on the panel's advice. 'He's not going to be making recommendations; he's not going to be issuing calls for actions,' Snow said."

If nothing is going to be done, then why do the homework????

These guys need everything now, not years down the road.

When will all this end, and what should the soldiers and their families do in the mean time?

Ms. Shalala made the comment: "It isn't fair for a family member to lose their job to take care of their injured soldier, it is their job to take care of him", but with things the way they were, how do you even think about allowing the Army to take care of a family member????

Thank you Annette McLeod

Anne V. Hull: Annette is the wife of wounded Spc. Wendell McLeod, who was hit in head with a steel door on the Iraq border. They spent more than a year at Walter Reed. Now they are coping with the aftermath of the injury at home in South Carolina.

Holding Pattern at Mologne House

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Arlington, Va.: I've an idea to get Walter Reed to accept help from Americans: EVERYONE who wants to help in whatever way, all need to gather at the gates of Walter Reed, with trucks, cars, mobs of people, and, of course, camera crews from ABC, CBS, NBC, and CNN. Bring along a few congresscritters as well, both R and D, and then let's see the brass at Walter Reed fail to return phone calls from volunteers.

Anne V. Hull: Seems like that is what it might take. Walter Reed has not been good at taking advantage of all the people who want to volunteer.

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Washington, D.C.: I think that earlier reader was a little nasty - yes, we can read the report for ourselves, but, as a layperson who is not immersed in this topic via reporting, it helps to have the perspective of reporters like Anne and Dana.

Also, whether or not the commission was tasked with listing a job description for a new sec'y, I, too, think the new VA sec'y will need to come with a plan for how to overhaul this situation. The reporting has revealed it to the masses and now people want to see change.

Anne V. Hull: just passing on

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More Walter Reed series?: Is that over?

washingtonpost.com: Walter Reed and Beyond

Anne V. Hull: That's classified.

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Baltimore, Md.: Are you planning to do more stories in your Walter Reed series?

Anne V. Hull: Why? Do you have a tip?

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Santa Barbara, Calif.: Just wanted to say "thank you" for breaking this story, and the follow-ups. Your articles made me write, for the first time in my franchised life, to my senators, urging them to action to correct this. Please keep up the excellent work.

Anne V. Hull: What we found is that the public pressure, like yours, has kept the issue alive.

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Still outraged....: OK, what can we do to get this beyond the administration, "taking it under advisement"?

Anne V. Hull: All of the recommendations could be implemented by Congress, although many of them would only take action by the executive (the prez). So, I suppose, if Bush decides not to do a thing (unlikely), Congress could take it upon themselves.

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Washington, D.C.: Are the people working to make this situation better military personnel or contractors? If contractors, what is the company name?

Anne V. Hull: There are more and more contractors being used and you can expect that to continue. The commission asks DOD to partner with the private sector on mental health.

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Washington, D.C.: In my experiences, there are many organizations that help directly at Walter Reed such as the Wounded Warrior Project, DSUSA, and the Yellow Ribbon Foundation. Maybe people can check out these reputable groups which already are connected with the hospital? It is much easier than going in as an individual. People have to remember that Walter Reed is not only a hospital but a military facility as well and is secured that way.

Anne V. Hull: You are right. Go to www.washingtonpost.com/WalterReed and we've listed a few of the organizations that help.

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Anne V. Hull: It's the bewitching hour and we've got to get back to work. Thanks for joining us!

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