Fort Sill WTU case managers make the healing happen
November 13, 2008
Caring for wounded Soldiers at Fort Sill is a team effort the post takes very seriously.
Wounded Soldiers have a network of care providers at Reynolds Army Community Hospital who work together with Warrior Transition Unit leaders.
Care for WTU Soldiers is organized through the six nurse case managers at RACH. Case managers are like the hub of care; they act as a liaison between the Soldiers and the doctors who provide them care.
Being a case manager is no easy task. Though the preferred ratio of Soldiers to case managers is 20 to 1, many times Reynolds case managers have more than 20 Soldiers they take care of, and even 20 can be hard to juggle.
Becky Wallace, a WTU case manager, has weekly appointments scheduled with her WTU Soldiers. They must meet with her at least once a week, but she also takes walk-ins and deals with telephone calls as well. She has a work phone and a government cell phone that she answers calls on.
"Sometimes they're both ringing at once and you've got a Soldiers in here too," said Wallace, who's been a case manager for more than four years. So, multi-tasking is an essential skill.
In addition to taking calls, Wallace said case managers direct WTU Soldiers' care, schedule their appointments, listen to their issues and guide them to the appropriate resources, to include issues like finance or housing available, even if that's finance or housing.
Wallace said the case managers main focus is helping WTU Soldiers get better and get them home or back to their units. She said she also tries to get them closer to home for their care once the Soldiers have a treatment plan. They then become members of the Community-Based WTU near their hometowns.
Case workers are Soldiers' biggest advocates for anything and everything, Wallace said. "When they come in here and close the door they can address all their issues," she said.
During the Soldiers' weekly visits, case managers review the Soldiers' appointments, review the medications they're on and the side affect, and council the Soldiers not to drink alcohol while using the medications, Wallace said. "We are always watching these guys for any signs of suicide ideation. If they're getting depressed, if they're acting out of character, we have to be alert for that too."
Wallace also tracks her Soldiers who are going through the Medical Evaluation Board.
She said her job is to make sure their paperwork is moving and not just sitting on someone's desk. She tries to make sure someone is addressing the paperwork.
"It's been a pleasure and an honor for me to works with these Soldiers," Wallace said.
Spc. Richard Johnson, a WTU Soldier, has been at the WTU here since January of this year. He injured his back while taking fire at Baghdad International Airport in early 2007. He served out the rest of his deployment, but continued to experience pain after returning home. He came to Fort Sill as a member of the Michigan National Guard in September of 2007 to be a trainer with Operation Warrior Trainer at the 479th Field Artillery Brigade, and was assigned to the WTU after he continued having problems with his back.
"There is nothing negative I could say about the WTU," Johnson said. "From that point on I met my primary care physician; I got assigned a case manager, and then it just, for me, pretty much went like clockwork."
Johnson said nurse case managers are kind of the "do-all, know-all." His case manager manages all his medical care. he compared to a logistics officer she handles all communications, makes sure that the medical appointments are coordinated correctly, makes sure he has all documentation he needs for appointments outside Reynolds, makes sure all notes from outside physicians get to Reynolds in a timely manner so that the primary care physician can have all the information he needs to make medical diagnoses and create treatment plans, and coordinates leaves and passes.
Case managers are not the only people looking out for the welfare of WTU Soldiers.
Their care is managed by the "triad," which includes the case manager, the primary care physician and the squad leader. The Soldiers have three people looking at their plan of care weekly and making sure they're progressing. If there are any issues, it's something the Triad discusses.
"We try to meet every other week for the Triad, and then on the opposite week the group meets with the deputy commander for clinical service," Wallace said.
The meeting with the DCCS includes the physical evaluation board liaison officer, platoon sergeants, the ombudsman, case managers, the primary care physician, the medical evaluation board doctor and the representative from mental health.
Another key player in WTU Soldiers' care is the primary care physician.
The WTU has one doctor, Dr. (Maj.) John Whittingham, who takes care of the WTU Soldiers, so it's about 120 patients to a doctor as opposed to typically 1,000 to one. So they have very good access to primary care, said John Schaefer, deputy commander for clinical operations at Reynolds.
Whittingham is the key to directing WTU Soldiers' care and forms the Soldiers' treatment plan. He is the only sees WTU Soldiers. He tries to optimize the Soldiers medical care to get them as healthy as possible. That can include physical therapy, pain management and surgical intervention, Wallace said.
Whittingham is Johnson's primary care physician.
"He's like the HMO guy. He's the physician that sees you and keeps up with your medical records and documentation, and then he's the guy who refers you to specialists," Johnson said.
When WTU Soldiers require care that is not offered at the hospital here, Reynolds coordinates for them to receive that care at other major military medical centers.
Those Soldiers are transported on temporary duty to the areas that have resource capabilities," said Dr. Thomas Dykes, chief of surgery at Reynolds. "If we had someone with an amputation that needed to be in the amputee center at (Brooks Army Medical Center), then they would not be forced to stay here. We have the ability to get them to the resources that they need."
When WTU Soldiers need care Reynolds can provide, they are given priority.
For many of the surgical clinics, WTU consultation is next day; in orthopedics, they have a walk-in slot for WTU Soldiers so they can be seen the next day after referral, said Dykes. For all the specialists at Reynolds, the hospital is able to exceed the WTU standard for all access, to include surgery access. The only time there are difficulties is when WTU Soldiers must be refered outside of Reynolds, and those civilian providers aren't obligated to respond to the access standards that the Army sets for itself, Dykes said.
Another key player in WTU Soldiers well being is their advocate at Community Mental Health, Kevin Bell, a licensed clinical social worker.
"Lots of those Soldiers have issues adjusting to the environment," Bell said. They're dealing with sleep difficulties, deployment-related issues. Some have post-trauma issues; some may have marital issues or concerns. Some have mood problems and depression."
Bell said his job is to provide treatment or therapy and to set up a treatment plan, which is something the Soldiers agree upon that outlines what they would like to address, where they would like to see themselves and how to get there.
He said therapy is "usually quite focused. "
Once an individual identifies to you what they want and you agree upon a treatment goal, the things that they want to accomplish, it's about helping them meet their goals," he said.
And mental health affects physical health and pain tolerance.
"When the mind is either anxious or depressed, it usually tends to experience things like pain, dramatic swings, stomach problems, bladder/bowel problems, headaches, muscle tension and for some people the pain receptors seem to be a little wound up, which means they're experiencing the pain at a greater severity," said Bell. "So you find that if you deal with the mental part of that, you can pretty much take enough of the edge off that the pain is tolerable."
CMH offers WTU Soldiers a wide range of therapy, to include progressive muscle relaxation, psycho-educational group therapy where they can work on coping skills and learn coping strategies, support groups, a women's warrior group, and anger management groups that teach techniques and strategies for managing anger.
"Mental health is important because it deals with Soldiers' emotional and psychological health, and for people who are used to having a certain level of functioning, losing that level of functioning almost always has an emotional response," Bell explained. "Sometimes folks are prepared for it, sometimes they're not. A lot of times folks think my job as a WTU social worker is just to address, 'Hey, am I crazy or am I no'.' That's not it.
"People have different issues, and it's helping them adjust to the condition they have to deal with, helping them to being able to focus on their strengths, and work towards recovery."
Johnson also sees personnel at Community Mental Health for post traumatic stress disorder.
"Mr. Bell is kind of like my voice of reason," Johnson said. "When things become so chaotic with me, when it's hard for me to put things where they need to be, that's where he's probably my godsend, because he helps me kind of put things in perspective, and sometimes that hard for me where before that was never an issue."
"The care that I've gotten has been outstanding," Johnson said. He said all the members of his healthcare team have proven to him that they are committed to wounded Soldiers.
Johnson has had surgery on his back and has been treated at Community Mental Health. He said he feels he is close to coming to the end of his medical care. He feels his medical care has been optimized, and he anticipates going through a medical evaluation board sometime soon and returning home.