Team Infidel
Forum Spin Doctor
New York Times
March 12, 2007
Pg. 1
By Deborah Sontag and Lizette Alvarez
When Staff Sgt. Jarod Behee was asked to select a paint color for the customized wheelchair that was going to be his future, his young wife seethed. The government, Marissa Behee believed, was giving up on her husband just five months after he took a sniper’s bullet to the head during his second tour of duty in Iraq.
Ms. Behee, a sunny Californian who was just completing a degree in interior design, possessed a keen faith in her husband’s potential to be rehabilitated from a severe brain injury. She refused to accept what she perceived to be the more limited expectations of the Veterans Affairs hospital in Palo Alto, Calif.
“The hospital continually told me that Jarod was not making adequate progress and that the next step was a nursing home,” Ms. Behee said. “I just felt that it was unfair for them to throw in the towel on him. I said, ‘We’re out of here.’ ”
Because Ms. Behee had successfully resisted the Army’s efforts to retire her husband into the V.A. health care system, his military insurance policy, it turned out, covered private care. So she moved him to a community rehabilitation center, Casa Colina, near her parents’ home in Southern California in late 2005.
Three months later, Sergeant Behee was walking unassisted and abandoned his government-provided wheelchair. Now 28, he works as a volunteer in the center’s outpatient gym, wiping down equipment and handing out towels. It is not the police job that he aspired to; his cognitive impairments are serious. But it is not a nursing home, either.
Like the spouses of many other soldiers with severe brain injury, Ms. Behee, also 28, transformed herself into a kind of warrior wife to get her husband the care she thought he deserved. By now, there is a veritable battery of brain-injured-soldiers’ relatives who have quit their jobs and, for some extended time, moved away from their homes to advocate for and care for these very wounded soldiers during long hospitalizations.
In the eyes of five such relatives interviewed, the military health care system, which is so advanced in its treatment of lost limbs, has been scrambling to deal with an unanticipated volume of traumatic brain-injury cases that it was ill equipped to handle. Largely because of the improvised explosive devices used by insurgents in Iraq, traumatic brain injury has become a signature wound of this war, with 1,882 cases treated to date, according to the Defense and Veterans Brain Injury Center.
In general, these caregivers said that their grievously wounded soldiers had either been written off prematurely or not given aggressive rehabilitation or options for care. From the beginning, they said, the government should have joined forces with civilian rehabilitation centers instead of trying to ramp up its limited brain-injury treatment program alone during a time of war. That way, soldiers would have had access to top-quality care at civilian institutions that were already operating at full throttle and might be closer to home.
In fact, many soldiers do have that access. But unlike Ms. Behee, many caregivers only belatedly come to understand how to negotiate the daunting military health care system.
Generally, after severely brain-injured soldiers are medically evacuated to the United States, they are treated first at Walter Reed Army Hospital or Bethesda Naval Hospital. Relatively quickly, the military, depending on the branch, initiates a medical retirement process that turns the soldiers’ health care over to the V.A. If soldiers succeed in deferring retirement, they remain covered by a military insurance policy that, if pressed, pays for private care.
Still, the military hospitals tend to discharge seriously brain-injured soldiers to V.A. hospitals, regardless of their active or retired status. It is how the system works, and challenging it requires constant haggling, which often leaves the families of the severely wounded soldiers feeling abused, resentful and anxious for those soldiers without an advocate.
“We have been let down by a system that is so bungling and bureaucratic that it doesn’t know what it can and cannot do and just says ‘No’ as a matter of course,” said Debra Schulz of Friendswood, Tex., whose son, Lance Cpl. Steven Schulz of the Marines, 22, suffered a severe brain injury during his second tour in Iraq.
Offers of Help
Early on, at least two top-ranked nonprofit civilian centers, the Rehabilitation Institute of Chicago and the Kessler Institute for Rehabilitation in New Jersey, made overtures to the government. Since the Vietnam War, their leaders said, while the V.A. has focused primarily on the chronic care of aging veterans, the civilian acute rehabilitation system has been dealing daily with brain-injured patients, fine-tuning their care.
Dr. Bruce M. Gans, chief medical officer of the Kessler Institute, contacted senior military and V.A. physicians. “I said, ‘Please let us help. Please let us be used as a resource,’ ” Dr. Gans said. “Especially in the early days, they had no capacity to take care of these kids. There was either no response or a negative response. We just didn’t understand.”
Last week, Dr. Joanne C. Smith, chief executive officer of the Rehabilitation Institute of Chicago, met in Washington with senior Pentagon officials and found far keener receptivity to the idea of extending civilian sector treatment to more soldiers, she said. After revelations by The Washington Post of problems with outpatient care at Walter Reed and Bob Woodruff’s reporting on ABC about traumatic brain injury, the tenor of the conversations was “action-oriented,” Dr. Smith said.
“There was a high degree of acceptance that there is a gap in the military system’s current ability to take care of particularly the profoundly injured,” she said.
V.A. officials, however, do not believe there is a problem or any need for rescue by the private sector.
The V.A. has centralized the care for severe traumatic brain injury at four hospitals that specialized in brain injury before the war. Those four, converted into “polytrauma centers” by Congress in 2005, have been gradually beefed up and the level of care has improved since Sergeant Behee arrived at Palo Alto in the summer of 2005, advocates for veterans say. But they still have a total of only 48 beds.
Some 425 soldiers have been treated for moderate and severe traumatic brain injury at the polytrauma centers in the past four years, according to the Defense and Veterans Brain Injury Center.
“At the moment we are handling the numbers,” said Dr. Barbara Sigford, the V.A.’s national director for physical medicine and rehabilitation. “The trauma centers are running close to capacity, but there are always beds available.”
Harriet Zeiner, the lead clinical neuropsychologist at the V.A.’s polytrauma center in Palo Alto, said care at the polytrauma centers was “tremendous.” She and Dr. Sigford said the great majority of soldiers and their families had been satisfied. A few disgruntled families, they said, grew frustrated with the slow recovery process and directed their anger at the V.A.; many went “through the system early on while we were still building the blocks,” Dr. Sigford said.
Susan H. Connors, president of the Brain Injury Association of America, said she was more concerned about follow-up care once soldiers returned to their communities, a concern of all advocates for these soldiers. The polytrauma centers, Ms. Connors said, are “pretty good.”
Dr. Sigford of the V.A. said, “We really are able to take care of a high-acuity group.”
But Dr. Smith of the Rehabilitation Institute of Chicago disagreed in the strongest terms.
“The V.A. has not been doing this for the last 35 years, and there is no way, with the complexity of this injury, that the V.A. system is prepared to get to parity with the civilian acute rehabilitation system overnight,” she said. “They’re dabbling in brain injury, and you can’t dabble in brain injury.”
A Growing Group
The severely brain-injured are among the most catastrophically wounded soldiers, and recovery can be painfully slow or, in some cases, entirely elusive. “There is no prosthetic for the brain,” said Jeremy Chwat, vice president for program services at the Wounded Warrior Project, an advocacy organization.
The Wounded Warrior Project organized a meeting on traumatic brain injury in Washington attended by about three dozen caregivers last fall. One raised “a huge, sad ethical question,” Mr. Chwat said, related to the advances in military trauma care that have saved so many lives: “Are we doing these young men and women a service by bringing them home alive?”
March 12, 2007
Pg. 1
By Deborah Sontag and Lizette Alvarez
When Staff Sgt. Jarod Behee was asked to select a paint color for the customized wheelchair that was going to be his future, his young wife seethed. The government, Marissa Behee believed, was giving up on her husband just five months after he took a sniper’s bullet to the head during his second tour of duty in Iraq.
Ms. Behee, a sunny Californian who was just completing a degree in interior design, possessed a keen faith in her husband’s potential to be rehabilitated from a severe brain injury. She refused to accept what she perceived to be the more limited expectations of the Veterans Affairs hospital in Palo Alto, Calif.
“The hospital continually told me that Jarod was not making adequate progress and that the next step was a nursing home,” Ms. Behee said. “I just felt that it was unfair for them to throw in the towel on him. I said, ‘We’re out of here.’ ”
Because Ms. Behee had successfully resisted the Army’s efforts to retire her husband into the V.A. health care system, his military insurance policy, it turned out, covered private care. So she moved him to a community rehabilitation center, Casa Colina, near her parents’ home in Southern California in late 2005.
Three months later, Sergeant Behee was walking unassisted and abandoned his government-provided wheelchair. Now 28, he works as a volunteer in the center’s outpatient gym, wiping down equipment and handing out towels. It is not the police job that he aspired to; his cognitive impairments are serious. But it is not a nursing home, either.
Like the spouses of many other soldiers with severe brain injury, Ms. Behee, also 28, transformed herself into a kind of warrior wife to get her husband the care she thought he deserved. By now, there is a veritable battery of brain-injured-soldiers’ relatives who have quit their jobs and, for some extended time, moved away from their homes to advocate for and care for these very wounded soldiers during long hospitalizations.
In the eyes of five such relatives interviewed, the military health care system, which is so advanced in its treatment of lost limbs, has been scrambling to deal with an unanticipated volume of traumatic brain-injury cases that it was ill equipped to handle. Largely because of the improvised explosive devices used by insurgents in Iraq, traumatic brain injury has become a signature wound of this war, with 1,882 cases treated to date, according to the Defense and Veterans Brain Injury Center.
In general, these caregivers said that their grievously wounded soldiers had either been written off prematurely or not given aggressive rehabilitation or options for care. From the beginning, they said, the government should have joined forces with civilian rehabilitation centers instead of trying to ramp up its limited brain-injury treatment program alone during a time of war. That way, soldiers would have had access to top-quality care at civilian institutions that were already operating at full throttle and might be closer to home.
In fact, many soldiers do have that access. But unlike Ms. Behee, many caregivers only belatedly come to understand how to negotiate the daunting military health care system.
Generally, after severely brain-injured soldiers are medically evacuated to the United States, they are treated first at Walter Reed Army Hospital or Bethesda Naval Hospital. Relatively quickly, the military, depending on the branch, initiates a medical retirement process that turns the soldiers’ health care over to the V.A. If soldiers succeed in deferring retirement, they remain covered by a military insurance policy that, if pressed, pays for private care.
Still, the military hospitals tend to discharge seriously brain-injured soldiers to V.A. hospitals, regardless of their active or retired status. It is how the system works, and challenging it requires constant haggling, which often leaves the families of the severely wounded soldiers feeling abused, resentful and anxious for those soldiers without an advocate.
“We have been let down by a system that is so bungling and bureaucratic that it doesn’t know what it can and cannot do and just says ‘No’ as a matter of course,” said Debra Schulz of Friendswood, Tex., whose son, Lance Cpl. Steven Schulz of the Marines, 22, suffered a severe brain injury during his second tour in Iraq.
Offers of Help
Early on, at least two top-ranked nonprofit civilian centers, the Rehabilitation Institute of Chicago and the Kessler Institute for Rehabilitation in New Jersey, made overtures to the government. Since the Vietnam War, their leaders said, while the V.A. has focused primarily on the chronic care of aging veterans, the civilian acute rehabilitation system has been dealing daily with brain-injured patients, fine-tuning their care.
Dr. Bruce M. Gans, chief medical officer of the Kessler Institute, contacted senior military and V.A. physicians. “I said, ‘Please let us help. Please let us be used as a resource,’ ” Dr. Gans said. “Especially in the early days, they had no capacity to take care of these kids. There was either no response or a negative response. We just didn’t understand.”
Last week, Dr. Joanne C. Smith, chief executive officer of the Rehabilitation Institute of Chicago, met in Washington with senior Pentagon officials and found far keener receptivity to the idea of extending civilian sector treatment to more soldiers, she said. After revelations by The Washington Post of problems with outpatient care at Walter Reed and Bob Woodruff’s reporting on ABC about traumatic brain injury, the tenor of the conversations was “action-oriented,” Dr. Smith said.
“There was a high degree of acceptance that there is a gap in the military system’s current ability to take care of particularly the profoundly injured,” she said.
V.A. officials, however, do not believe there is a problem or any need for rescue by the private sector.
The V.A. has centralized the care for severe traumatic brain injury at four hospitals that specialized in brain injury before the war. Those four, converted into “polytrauma centers” by Congress in 2005, have been gradually beefed up and the level of care has improved since Sergeant Behee arrived at Palo Alto in the summer of 2005, advocates for veterans say. But they still have a total of only 48 beds.
Some 425 soldiers have been treated for moderate and severe traumatic brain injury at the polytrauma centers in the past four years, according to the Defense and Veterans Brain Injury Center.
“At the moment we are handling the numbers,” said Dr. Barbara Sigford, the V.A.’s national director for physical medicine and rehabilitation. “The trauma centers are running close to capacity, but there are always beds available.”
Harriet Zeiner, the lead clinical neuropsychologist at the V.A.’s polytrauma center in Palo Alto, said care at the polytrauma centers was “tremendous.” She and Dr. Sigford said the great majority of soldiers and their families had been satisfied. A few disgruntled families, they said, grew frustrated with the slow recovery process and directed their anger at the V.A.; many went “through the system early on while we were still building the blocks,” Dr. Sigford said.
Susan H. Connors, president of the Brain Injury Association of America, said she was more concerned about follow-up care once soldiers returned to their communities, a concern of all advocates for these soldiers. The polytrauma centers, Ms. Connors said, are “pretty good.”
Dr. Sigford of the V.A. said, “We really are able to take care of a high-acuity group.”
But Dr. Smith of the Rehabilitation Institute of Chicago disagreed in the strongest terms.
“The V.A. has not been doing this for the last 35 years, and there is no way, with the complexity of this injury, that the V.A. system is prepared to get to parity with the civilian acute rehabilitation system overnight,” she said. “They’re dabbling in brain injury, and you can’t dabble in brain injury.”
A Growing Group
The severely brain-injured are among the most catastrophically wounded soldiers, and recovery can be painfully slow or, in some cases, entirely elusive. “There is no prosthetic for the brain,” said Jeremy Chwat, vice president for program services at the Wounded Warrior Project, an advocacy organization.
The Wounded Warrior Project organized a meeting on traumatic brain injury in Washington attended by about three dozen caregivers last fall. One raised “a huge, sad ethical question,” Mr. Chwat said, related to the advances in military trauma care that have saved so many lives: “Are we doing these young men and women a service by bringing them home alive?”