Care at Warrior Transition Units: work in progress
May 13, 2010
WASHINGTON (Army News Service, May 13, 2010) -- Top Army leaders say finding the correct equation to caring for wounded Soldiers is an evolving concept -- one that will continue to change as treatment methods are examined.
In a visit to the Fort Carson, Colo., Warrior Transition Battalion Monday, Gen. Peter W. Chiarelli, vice chief of staff of the Army, said he is proud of what Warrior Transition Units have accomplished so far.
"Will the Warrior Transition Unit model change over time' There's no doubt about it," said Chiarelli. "But," he continued, "I think we're doing better than we've ever done before ... and it is such a vast improvement."
Chiarelli's visit to Fort Carson was largely in response to a New York Times article that was published last month which berated the WTU process with claims of incompetent care, over-medicating, drug addiction, and harsh treatment by cadre. The article also alleged that the Army was "warehousing" wounded Soldiers.
While Chiarelli admitted he was hurt by some of the accusations, he said most of the issues addressed were already known concerns, and any shortcomings will be examined.
"My biggest concern is that this same story could have been told at any of the other 28 WTUs," said Chiarelli. "But every time an article like that is written, we learn something."
Chiarelli defended the units saying that most Soldiers transitioning out of WTUs are happy with the care they received, and that only a small percentage of discontented Soldiers were represented in the story.
"Our own studies that we do monthly show Fort Carson as one of our best WTUs, with over a 90-percent rate of satisfaction with the care that Soldiers are getting there," Chiarelli explained.
Current Soldiers at the Fort Carson WTB got the chance to voice their opinions.
"I was surprised by the article," said 1st Lt. Jason Mazzella, a field artillery officer who was injured in Afghanistan. "I didn't experience any of the negative points that were brought up; I've had a good experience going through the entire process."
Spc. Manuel Rodriguez agreed and said that he thought the criticisms exacerbated the situation.
"In my opinion, I thought it was completely blown out of proportion, and it addressed issues that the command has been aware of over a long period of time," said Rodriguez. "I think it's ridiculous to expect so much from a brand new unit ... if you were to go out and start a corporation, would it be impeccable after two years' Of course not."
Launched in 2007, WTUs were formed in response to an influx of Soldiers with physical and psychological injuries and illnesses. At the time, Soldiers needing on-going outpatient medical care were put on medical hold and largely left to navigate appointments and schedules on their own. After hearing complaints, the Army realized something needed to change.
As part of the Warrior Transition Command, more than 9,000 Soldiers in 29 WTUs throughout the country now receive individualized care based on a personally-tailored comprehensive transition plan. Soldiers meeting the criteria of needing six or more months of supervised, continuous medical attention are entered into the program, where the focus is on the future -- either transitioning back to their units, or out of the Army. A team of physicians, case managers, behavioral health specialists and cadre assist the Soldiers in their recovery.
"We're doing things differently than the way we did in past wars," said Brig. Gen. Gary Cheek, commander of the Warrior Transition Command, but he confessed, "We have no illusions that this is a perfect program."
A top challenge that WTU staff face is the treatment of Soldiers with post-traumatic stress and traumatic brain injury. Sixty percent of the 483 Soldiers at the Fort Carson WTB suffer from some kind of behavioral health issue.
While the Army has become proficient in "fixing" physical injuries, Chiarelli explained that when dealing with psychological wounds, the arena is completely different.
"When it comes to injuries of the mind, we can't just lob it off and replace it with another one," he said. "There's so much we don't know about the brain."
He added that many of the Soldiers returning from deployments in Iraq and Afghanistan have some degree of post-traumatic stress, but the stigma attached with asking for help and recognizing that help is needed is often an obstacle. Chiarelli said he thinks the Army is catching the worst cases of Soldiers with PTS and TBI, but the challenge is getting care for those who have less traumatic cases.
"It is hard for someone to believe that something you can't see is a no-kidding, real injury," Chiarelli said of PTS. "It's really complicated. Seemingly there's nothing wrong with the person from the outside ... these are invisible wounds. And that's why it's so hard for us to change the culture of the Army."
Addressing the allegations of drug addiction and over-medication, Chiarelli explained that drug use is not just a problem in the Army; it's a problem in society. He added that WTUs are alcohol-free zones, chiefly because most prescription medications become dangerous when combined with alcohol.
Even though alcohol isn't allowed, Chiarelli said mixing prescription drugs with alcohol is the leading cause of overdoses in WTUs. He also outlined the electronic medication management system used for high-risk cases which dispenses pills only at prescribed times and doses, used to cut down on any chance for overdose.
One Fort Carson WTB Soldier and his wife know firsthand the challenges of working toward recovery.
"We've had our share of problems, but I do see improvement in the WTU," said Teresa Mischke, who has been the primary care-giver for her husband, Sgt. Darren Mischke, a TBI patient.
"I think the Army has been delivered a huge problem, because TBI and PTS are such a horrible combination," she said. "But WTUs were created to help find solutions."
Teresa said that at times she worried about speaking up on Darren's behalf, wondering if anyone would listen, and admitted that she stepped on some toes in the process.
"I think at times we've all felt overwhelmed, not knowing where to go in the system," Teresa said. "I've had to advocate for him when he couldn't."
Teresa said it is important for all Soldiers in the WTU program to speak up when they believe something isn't right in their treatment, because it helps to fix inconsistencies.
Sgt. Jerrald Jensen, who recently returned to his active-duty unit from the WTB agreed, but said it's key to remember that the concept of the WTU is a pilot.
"I have a lot of better things to do than sit around and write lists of complaints," he said. Jensen suffered injuries in an IED attack in Iraq, now has a reconstructed jaw, and much of his face is damaged. He is currently helping Soldiers in his unit train for another deployment.
"Nobody can make someone else get better mentally," Jensen said.
Sgt. Brandon Daggs, who is being treated for a rare form of cancer, said that as Soldiers, they are being taken care of in more ways that people can imagine.
"I laid on my back going through cancer treatments for two years, and it was dark, but I get out here [Fort Carson] and I'm up, doing physical training, rock climbing, hanging out with new friends ... I'm here healing," said Daggs.
He also touched on the allegations of drug addictions within WTUs. Daggs gave the example of a 20-year-old Soldier who has gone through something traumatic in a war zone, and is sent back home without properly adjusting.
"It's hard to get a 20-year-old kid to really look down inside and put a flashlight on his deep-dark demons and want to put a band-aid on that," he said.
Daggs said that often young Soldiers come back from combat physically in one piece, but are suffering inside.
"If you aren't willing to fix the problem, then you are just going to look for ways to cover it up," he said, referring to drug use.
Against the claims of harsh treatment by the unit noncommissioned officers, Chiarelli explained that cadre are specially screened for the job and put thorough a specific training program on how to look after WTU Soldiers.
He said there may be some noncommissioned officers who have a hard time making the transition from running a platoon in combat to leading people who are all suffering from issues that require special care.
"No one came into the Army to do this job," explained Chiarelli. But he maintained that any NCOs found not right for the task are reassigned.
"I know in my heart of hearts that we are doing the best we can," he said.
Chiarelli stressed that every case in each WTU is unique and comes with its own challenges, so it is impossible to assign a broad treatment, leadership or transition method to all Soldiers.
"In a lot of units, things are black and white. That's not the case here."