The March, 2007 issue of Discover Magazine had an in-depth report on the treatment of Traumatic Brain Injury (TBI) provided for American soldiers deployed currently in Iraq and Afghanistan (here). Much of the lengthy article is about the amazing advances in treating severe injuries in the field. But in the middle and end of the article, it begins to contemplate the lack of follow-up for the brain-injured vets.
From Walter Reed, soldiers are then triaged to one of the nation's VA polytrauma centers, where the hard work begins. (There are only 4 polytrauma centers and 21 designated polytrauma rehabilitation sites, a painfully small number to deal with the great many injured troops.) [snip]
"Now the government must make a commitment to help them in their recovery, but where are the resources going to come from? As brain-injury professionals, we know that TBI services aren't available in many places across the country, and we are aware of huge holes in the system," she says. "Frankly, I'm frustrated and angry about the government's refusal to give the TBI population the support it desperately needs." [quoting Dr. Marilyn Price Spivack, a brain injury rehab specialist at Spaulding Rehabilitation Hospital in Boston]
Spivack is not being glib; the giant holes are glaringly apparent. Many states do not have a single brain-injury rehabilitation center, and of the states that do offer some level of TBI treatment, few actually provide enough assistance to acquire even the most basic level of specialized care. At rates that can exceed a thousand dollars a day for postacute TBI rehabilitation, there aren't many American families that can afford a month's worth of treatment, much less the recommended minimum of 90 days.
As recently as mid-July 2006, the VA Office of the Inspector General admitted that patients and families were dealing with major inadequacies. The reality is that a fundamental level of care is simply absent in most states.
The military did not anticipate the magnitude of the problem, and now they are scrambling to add new brain-injury programs and services. Problems experienced by patients and families include inadequate or absent communication with case managers, lack of follow-up care, and being forced to pay out-of-pocket for necessary treatments and medication.
The article then mentions a study by the Institute of Medicine (link) evaluating the small progress made in developing facilities nationwide to deal with Traumatic Brain Injury. Summarizing the report, which can be downloaded in full at the link just given,
In 1989, a federal task force reported to the nation that there were serious gaps in post-acute clinical care and rehabilitation for persons with traumatic brain injury. Eight years later in the Traumatic Brain Injury Act of 1996, Congress directed the Health Resources and Services Administration (HRSA) to take on a share of the responsibility for advancing state-based TBI service systems.
In this report, the IOM Committee on Traumatic Brain Injury assesses the impact of the HRSA TBI Program. Established in 1997, the TBI Program is a modest federal initiative with broad ambitions; a $9 million grants program aimed at motivating states to create systems improvement on behalf of persons with TBI and their families.
The IOM Committee concludes that there has been demonstrable improvement in two essential preconditions for improving TBI service systems--state-level TBI systems infrastructure and the overall visibility of TBI have grown considerably.
Nevertheless, substantial work remains to be done at both national and state levels. HRSA should address the TBI Program’s fundamental need for greater leadership, data systems, additional resources, and improved coordination among federal agencies.
The state TBI Programs are now at a critical stage and will need continue federal support if they are to build an effective, durable service system for meeting the needs of individuals with TBI and their families.
Ironically, the Discover article never even touches on the scandal of conditions at Walter Reed Hospital that blew up in the press and Congress close to publication date (See here for a group of articles that ran on the issue in the Washington Post). The lack of proper facilities and support for wounded veterans is a wider problem than just the Walter Reed Hospital.
Substandard living conditions like those found at Walter Reed Army Medical Center probably exist throughout the military health care system, the head of a House panel investigating the army's flagship veterans hospital in Washington said Monday.From the Internation Herald Tribune, full story here. The article reports on hearing in Congress, which is not yet available in transcript form from GPO Access. When it gets posted, you should be able to find it by browsing here. The Int'l. Herald Tribune article reports that VP Cheney and President Bush both promise improvements and a full report. You can track more about this on the website of the President's ommission on Care for America's Returning Wounded Warriors here. Note that it's co-chaired by Republican Senator Bob Dole (along with Donna Shalala). But perhaps the Commission will actually deliver the goods since Dole himself was a seriously wounded veteran. Follow the "meetings" link for lists of open hearings, and transcripts of completed hearings.
"We need a sustained focus here, and much more needs to be done," Representative John Tierney, Democrat of Massachusetts, said of a scandal enveloping Walter Reed. Charges of bureaucratic delays and poor treatment there have produced calls in Congress for quick reform.
Tierney said he feared that "these problems go well beyond the walls of Walter Reed," adding that "as we send more and more troops into Iraq and Afghanistan, these problems are only going to get worse, not better."