Recovery Coordinator Urged for Injured Soldiers

A presidential commission urged broad changes to veterans' care that would boost benefits for family members helping the wounded, an easy-to-use Web site for medical records, and overhaul disability pay. Panel co-chair Donna Shalala spoke with Renee Montagne.

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STEVE INSKEEP, host:

It's MORNING EDITION from NPR News. Good morning. I'm Steve Inskeep.

RENEE MONTAGNE, host:

And I'm Renee Montagne.

The panel that investigated the care given to wounded soldiers and veterans gave its recommendations yesterday to President Bush.

President GEORGE W. BUSH: The spirit of that report is, any time we have somebody hurt, they deserve the best possible care and their family needs strong support. We've provided that in many cases but the extent we've had we're going to adjust.

MONTAGNE: President Bush responding to the recommendations, which followed news reports earlier this year that returning servicemen and women face squalid conditions at some military hospitals and layers of bureaucracy as they tried to get care. The panel that produced the recommendations was co-chaired by Donna Shalala, who served in the Clinton administration, and she joins us on the line.

Good morning.

Ms. DONNA SHALALA (Co-chair, Veterans Care Commission): Good morning.

MONTAGNE: Your report urges broad changes to veterans care. What do you consider the most critical, the most urgent reforms?

Ms. SHALALA: Well, actually, we picked six, which is unusual for a commission because usually you have 302. So I don't want to pick any one of them out. It begins by saying that seriously wounded veterans really need someone to coordinate their care. We've called it a recovery coordinator. We've said teams of doctors have to agree on a recovery plan and make it very clear that one person is in charge of coordinating it and advocating it for the patient.

MONTAGNE: Let's go back to the precise things that you would like to see changed. Just - if you can quickly rattle them off and give us a sense of what it is you're telling the president.

Ms. SHALALA: Well, first, we're talking about coordination of care. Second, a major overhaul of a very confusing disability system. We believe that the DOD ought to only make the decision about whether you're fit or unfit for duty. And after that, if there's a disability decision to be made, it should only be done by the VA, not the DOD.

Now, you've got two sets of disability decisions, appeals. Very confusing to a young soldier that wants to get on with their life. Third, we believe there ought to be more family support. This is a different generation. Women are working. Moms are working. They can't give up their jobs and go rushing off to a hospital thousands of miles away to coordinate the care of a loved one. And we have to take responsibility to makes sure they have the support they need when someone is severely injured

Ms. SHALALA: After that, we talk about a series of recommendations that would actually clean up the Walter Reed situation. One of our concerns is it's going to close in 2011. We have to make sure it continues to have first rate care. A third of all the patients that come out of Iraq that are seriously injured end up going there, and it's very important.

Finally, we make a recommendation on post-traumatic stress disorder and traumatic brain injury. We have to make sure our equipment is first class. But more important, soldiers are prepared for the kind of trauma of battle, and, once injured, that they get treated immediately and intensively.

MONTAGNE: You say your recommendations required strong leadership, but this issue has been on the table in some form since the U.S. invaded Iraq. Why do you think it will be deal with now?

Ms. SHALALA: Well, I think the attention that was brought by the Washington Post to the Walter Reed facilities situation, the fact that Americans as a group, no matter what their position is on the war, believe that injured soldiers ought to be taken care of with the highest quality care. This is not something for a Washington insider. Every American I've met over the last year has said we've got to do something; it's shameful that anyone who was injured in this war would not get the highest quality care.

MONTAGNE: Thanks very much for joining us.

Ms. SHALALA: You're welcome.

MONTAGNE: Donna Shalala co-chaired the presidential panel on military and veterans' health care. She was the secretary of health and human services in the Clinton administration.

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Panel Calls for Changes in Military Medical Care

Pfc. Christopher Williams holds a certificate during a June Purple Heart ceremony in Washington.

Pfc. Christopher Williams holds a certificate during a June Purple Heart ceremony in Washington, D.C. PVT Williams was injured while serving in Iraq. Brendan Smialowski/Getty Images hide caption

itoggle caption Brendan Smialowski/Getty Images

A presidential panel examining medical care for wounded U.S. service members on Wednesday called for changes that would boost benefits for care givers, establish a Web site for medical records and overhaul the way disability pay is awarded.

The nine-member panel — led by former Sen. Bob Dole (R-KS) and former Health and Human Services Secretary Donna Shalala — also recommended stronger partnerships between the Pentagon and the private sector to boost treatment for traumatic brain injury and post-traumatic stress disorder.

A 29-page draft report was presented to President Bush, after the Senate on Wednesday addressed some of the issues by passing sweeping legislation to expand brain screenings, reduce red tape and boost military pay.

The commission formally approved the recommendations later in the day.

"Gone will be the days of injured soldiers telling the same information to doctors over and over again," said Shalala, who said the proposals seek to provide more customized, personalized care to injured Iraq war veterans.

She called the report a set of recommendations that could be implemented right away. About six of the 35 proposals require legislation, while the rest call for action primarily by the Pentagon and Department of Veterans Affairs.

Among the recommendations was an indirect rebuke of the VA — a call for Congress to "enable all veterans who have been deployed in Afghanistan and Iraq who need post-traumatic stress disorder care to receive it from the VA."

Only recently, the VA has taken steps to add mental health counselors and 24-hour suicide prevention services at all facilities, following high-profile incidents of suicides involving veterans.

In the past, the VA had failed to use all the money for mental health that was allotted to it.

"The experiences of these young men and women have highlighted the need for fundamental changes in care management and the disability system," the report read.

"Making the significant improvements we recommend requires a sense of urgency and strong leadership," it said. Bush said his hand-picked investigative panel had interesting suggestions on improving health care for those wounded in battle.

But the White House said not to expect action right away.

The report does not seek to directly criticize or lay blame for shoddy outpatient treatment at Walter Reed Army Medical Center, which resulted in a public outcry for change and creation of the commission. It cited a need to move forward, explaining there was no need to "reiterate" the findings of news reports that uncovered substandard care from the Defense Department and VA.

Among the proposals:

— Boost staff and money for Walter Reed until it closes in the coming years. Also, urges Pentagon to work with the VA to create "integrated care teams" of doctors and nurses to see injured troops through their recovery.

— Restructure the disability pay systems to give the VA more responsibility for awarding benefits.

— Require comprehensive training programs in post-traumatic stress and traumatic brain injuries for military leaders, VA and Pentagon personnel.

— Create a "My eBenefits" Web site — developed jointly by the VA and Pentagon — that would allow service members and doctors to access private medical information as the injured move from facility to facility to receive treatment.

— Provide better family support, because one-third of injured Iraq war veterans reported that a family member or close friend had to relocate to care for them. It calls for training and counseling for families of service members who require long-term care and improved family leave and insurance benefits for family members.

President Bush created the panel in March to investigate problems in the treatment of wounded veterans following disclosures of roach-infested conditions and shoddy outpatient care at Walter Reed.

The White House event followed the Senate's vote by unanimous consent on legislation that seeks to end inconsistencies in disability pay by providing for a special review of cases in which service members received low ratings of their level of disability. The aim is to determine if they were shortchanged.

The bill also would boost severance pay and provide $50 million for improved diagnosis of veterans with traumatic brain injury or post-traumatic stress disorder. The House was considering similar measures.

"It has been hurry up and wait for the results of this commission report and now the White House is telling our vets to wait even longer," said Sen. Patty Murray (D-WA). "That's why the Senate has moved ahead with our Wounded Warriors Act. The public is waiting, our veterans are waiting."

Paul Rieckhoff, executive director of Iraq & Afghanistan Veterans of America, agreed.

"It is important for the American public to understand that the Walter Reed fiasco is not over," he said. "Everything is not fixed. The follow-through will be the most important part."

White House press secretary Tony Snow said that Bush would not be acting immediately on any of the recommendations. Rather, he said that the panel's ideas would likely be integrated with other ongoing efforts to improve health care and overall treatment of returning soldiers.

From Associated Press reports

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