After In-Patient Care, Troops Face Bureaucracy

As part of NPR's series on the closure of Walter Reed Army Medical Center, we look at what happens to wounded troops once they're done with in-patient care. NPR Pentagon correspondent Tom Bowman talks to Melissa Block about the complicated bureaucracy that must be navigated — and the steps the Army has taken to make things work more smoothly.

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MELISSA BLOCK, host: That's NPR's Tom Bowman.

And, Tom, we noted that there were two goals when the decision was made to close Walter Reed. The first was to save money. We just heard your report about that. The other was to improve care. And let's talk about that issue now.

A few years ago, there was a scandal at Walter Reed that showed just how badly wounded troops were retreated once they became out-patients at the hospital. Now that Walter Reed is closing, how has the system changed?

TOM BOWMAN: Well, Melissa, the Army has put a lot more controls now in these out-patients. It's created a new entity called the Warrior Transition Units. There are 29 of them at major military treatment centers around the country. They serve 10,000 wounded and ill service members; and not all are combat wounded, some are just sick.

BLOCK: And how do the Warrior Transition Units work?

BOWMAN: Well, they have several thousand people caring for these soldiers. And each soldier has a primary care manager, a nursing care manager, a squad leader. In essence, they kind of mirror regular Army units. But the mission here is just for these soldiers to get better. And these three people keep an eye on you, everything from doctors' appointments to paperwork, to taking your medications.

BLOCK: What are you hearing? Has the system in effective the way it's in place now?

BOWMAN: Well, overall, it's been doing a pretty good job. But earlier this year, the Army inspector general found some problems. First of all, they don't have enough psychologists and counselors and other people to help these soldiers, which is important because a lot of these people have posttraumatic stress and traumatic brain injuries.

Here's another problem they found, as well - that as many as one-third of these 10,000 soldiers are dependent on or addicted to drugs. Now, in response, the Army says, listen, we're going to make sure that the soldiers take the minimum quantity of drugs needed. They're also trying to keep an eye on potential high-risk soldiers for drug dependency.

Another thing they're doing is looking at alternative therapies, things like acupuncture and yoga. And the Army is saying that all these are now reducing this overmedication of soldiers.

But, Melissa, in many cases they're in uncharted territory here. That some of these soldiers have very serious wounds they wouldn't even have survived maybe a decade or two ago. And again, in many of these have unseen wounds of PTSD, traumatic brain injuries. It makes care for them at these military hospitals very, very complicated.

BLOCK: And, Tom, we're talking about care for people still in the military. What about those who leave, who become veterans?

BOWMAN: Well, they, of course, go to the care of the Department of Veterans Affairs. And now the VA has received a lot more money, billions of dollars more in money to help these veterans. But they still have problems. For example, caring for veterans in rural areas who don't have access to large urban hospitals. So the VA is coming up with, let's say, medical vans, storefront clinics in these areas; even telemedicine - linking doctors with these patients out in rural areas to help them.

But it's still a huge, huge undertaking. And the VA is now dealing with more than half a million veterans from Iraq and Afghanistan, at a time when Vietnam veterans are aging, and they're dealing with that population as well.

BLOCK: Okay, NPR Pentagon correspondent Tom Bowman. Tom, thanks so much.

BOWMAN: You're welcome.

BLOCK: And tomorrow, we continue our series with a look at the role Walter Reed Medical Center plays in medical research.

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