Skepticism Meets Military Medical Care Proposals

Many veterans groups applauded this week's recommendations by President Bush's special commission for increased focus on the needs of wounded troops. Others remain skeptical that the recommendations will be implemented.

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The Presidential Commission said this week that the U.S. military and Department of Veterans Affairs need to drastically change the way they care for U.S. troops who return from the war with physical or emotional wounds.

President Bush appointed the bipartisan commission early this year after scandals at Walter Reed Army hospital and other facilities.

NPR's Daniel Zwerdling has this reaction to the report.

DANIEL ZWERDLING: Listen to this Bush administration press release, quote, the White House has announced the appointment of 13 people to serve as members of a presidential task force that will focus on initiatives to improve health care for the nation's veterans, unquote.

That was back on September 21, 2001. Well, Harry Walters was on that commission. Walters used to be assistant secretary of the Army during the Reagan administration; he ran the VA. And he and his fellow commissioners came up with all kinds of recommendations, which, he says, basically went nowhere.

Mr. HARRY WALTERS (Former Administrator, Department of Veterans Affairs): Commission reports are dead on arrival. But the moment they're published and sent out, someone has found some reason not to take them seriously.

ZWERDLING: Do I detect a note of cynicism in your voice?

Mr. WALTERS: No, no, it's just actually true. I mean, it's not really a complaint. It's just a statement of fact.

ZWERDLING: The new commission was co-chaired by Bob Dole and Donna Shalala. He is the former senator. She used to be secretary of health and human services. They said the military and VA do a great job in lots of ways, treating injured troops, but there are deep-rooted problems.

For instance, some troops could bounce around from one part of the medical system to another. And they fall through the cracks. So the commission said every service member should have a permanent recovery coordinator, sort of like an ombudsman. And that caseworker will shepherd the patient through the whole process.

Some troops come home with crippling injuries, but they have to fight for months or years to get disability payments. So the commission suggested ways to make the process simpler and faster.

Dr. LAYTON McCURDY (Dean Emeritus, College of Medicine, University of South Carolina): I think the recommendations are thorough, much of them are pragmatic, very sensible.

ZWERDLING: That's Dr. Layton McCurdy. He's run all kinds of national medical associations. And he also says that's going to be much harder to carry out Dole and Shalala's recommendations than their report suggests.

For example, their commission warned that there's a serious shortage of mental health specialists in the military and that's one reason why troops, who come home with traumatic injury or post-traumatic stress disorder, often can't get the help they need.

Layton McCurdy served on yet another government panel recently who has came up with the very same findings - that one was formed by the Pentagon.

Dr. McCURDY: The mental health workforce problem is an impending train wreck, in my opinion.

ZWERDLING: McCurdy's task force warned that the shortage will get much worse before it gets better. So even if everybody agreed to start fixing the problem tomorrow…

Dr. McCURDY: We're probably talking about five years to catch up.

ZWERDLING: So what does that mean for the tens of thousands of troops who've already been coming home and will continue to come home in the next couple of years who urgently need mental health care?

Dr. McCURDY: It's very troubling, Mr. Zwerdling. It's very troubling.

ZWERDLING: The Dole-Shalala Commission and other panels agree that there's another reason why troops with serious emotional problems sometimes can't get the help they need. Their officers have contempt for them and they punish them.

So the commissions have all agreed that the military needs to launch aggressive training programs to change the military's mindset. But a former captain in the Marines says that's going to be incredibly difficult to do.

Ms. MELISSA EPSTEIN MILLS(ph) (Former Lawyer, Marine Corps): It's not a situation where somebody can snap their fingers and make it happen.

ZWERDLING: Melissa Epstein Mills was a lawyer in the Marine Corps until last year. Now she's in private practice. Mills says she's seen many tragic cases -tragic is her word - where our Marines served bravely in Iraq or Afghanistan, everybody held(ph) them, they never got into trouble.

Then they came home and got PTSD, they fell apart and couldn't get treatment. They did drugs or something else illegal. And the Marine Corps court-martialed them and kicked them out of the service with few or no benefits. Even other mental health disorders were triggered by their service. Mills says a bunch of training classes isn't going to change the system.

Ms. MILLS: I don't know that anything changes very quickly within the military. It is a big bureaucratic organization like anything else and things do happen very slowly.

ZWERDLING: Mills says she was disappointed when President Bush called the Dole-Shalala report interesting. She says she's not sure exactly what she did want him to say, but more than interesting.

Daniel Zwerdling, NPR News.

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