STEVE INSKEEP, host:
It's MORNING EDITION from NPR News. I'm Steve Inskeep.
It is not easy to take care of soldiers returning from Iraq and Afghanistan, and even after recent scandals it's not clear if the U.S. Army is getting it right.
Yesterday, we told you about an alarming number of soldiers who have overdosed on potent prescription drugs they were given by Army doctors. Today, we're going to hear about one Army hospital in Texas that is trying to improve the care it gives soldiers. But it's hard to get everything right for patients with post-traumatic stress disorder and head injuries.
NPR's Joe Shapiro reports.
JOE SHAPIRO: If you want to see what's changed at Army hospitals just spend some time with Sergeant Scott Metcalf of the Minnesota National Guard. Metcalf was a gunner injured in a Humvee accident in Iraq. He was about to be sent to Walter Reed, but because of the problems at that hospital in Washington he got sent instead to Brooke Army Medical Center in San Antonio. Now he's waiting for the Army to discharge him. He's been here for 14 months.
Sergeant SCOTT METCALF (Minnesota National Guard): This is home. This is my room.
SHAPIRO: Metcalf shows his small room with a single bed in the outpatient barracks. He was a prison guard back in Minnesota. After 9/11, he signed up for the Army National Guard. He's 49 now. Sometimes he finds himself giving out fatherly advice to the younger soldiers here.
He's got two sons of his own back home. Another, a Marine, just got back from his third tour in Iraq. That's why Metcalf keeps a large Marine Corps insignia over his bed.
Sergeant METCALF: That's just kind of my little reminder for him each day.
SHAPIRO: In the 14 months Metcalf has lived here, the Army has changed the way it cares for injured soldiers. Almost a year ago, the Army opened new Warrior Transition Units at 35 hospitals — with more staff devoted to helping soldiers. Now, there's one squad leader, a nurse case manager and a doctor assigned to every injured soldier. You get a sense of what's changed just by looking at the calendar spread across Scott Metcalf's wall. It lists his appointments and tells him when to renew his medications.
Sergeant METCALF: Yeah, it's very simple. I mean, I guess I'm the old KISS factor: Keep It Simple, Stupid. Or else, like I say, Keep It Simple, Scottie, you know.
(Soundbite of laughter)
SHAPIRO: This reminder system helps Scott Metcalf compensate for the memory he's lost because of a head injury.
On this day, his wife is visiting. Kathy Metcalf has taken another of many unpaid leaves from her job as a nurse back in Minnesota to spend several days with her husband. She says when he first came to this Texas hospital she'd call him at least once every day just to remind him of things.
Ms. KATHY METCALF (Husband in Army military hospital): His short-term memory is not as good as it used to be. I mean, initially then I would call every day so he didn't miss his appointments and didn't forget.
SHAPIRO: Now, he gets lots of reminders from the extra case workers that have been hired here. He writes them all on his calendar.
Another thing that's changed since he's been here, now each injured soldier is assigned one doctor who coordinates all their care, especially prescriptions.
Sergeant METCALF: You might see 10 different doctors with all your different care, and at one point, 10 different doctors were giving you medications. And I've seen guys, before a few months ago, I mean, I've seen guys that had tons of bags full of medicines that either they were taking or they didn't know what they were. And now they're down to the drugs they actually need.
SHAPIRO: Still, there've been numerous prescription drug overdoses in these new Warrior Transition Units. Since last June, at least six soldiers have died from an interaction of the drugs they've been given by Army doctors.
One of those deaths was here at Brooke. In January, Sgt. Robert Nichols died from an accidental drug intoxication. He was on 11 different medications, including powerful painkillers and sleeping pills.
In some cases, soldiers overdosed when they mixed drugs with drinking. So in March, the Army banned alcohol in outpatient barracks and ordered some soldiers — depending on their risk — not even to drink off post. Still, there've continued to be drug overdoses.
Brigadier General James Gilman runs medical operations here.
Brigadier General JAMES GILMAN (Runs medical operations, Brooke Army Medical Center): The mission of the Warrior Transition Unit is to help soldiers heal. And giving them a directive not to drink at all is one of the steps that have been taken to try to cut down on these deaths and also to help soldiers heal quicker.
SHAPIRO: Gilman points to other changes. There are new buildings going up and services for injured soldiers that a year ago were spread in multiple locations across San Antonio. They're now all available on one floor of the hospital. There are 600 injured soldiers here. A year ago, Gilman says, he had a staff of about 30 for them. Now he's got 200.
Still, a recent report from the Government Accountability Office noted shortages of staff trained to care for PTSD and traumatic brain injuries. It's a problem because another recent study, by the independent Rand Corporation, found about one-third of soldiers come back from Iraq with PTSD, a head injury or both.
General GILMAN: First of all, I don't think we've ever had this — I know we've never had, in my 30 years in the Army — this much demand for behavioral health services. And secondly, I think there is a bit of a shortage in the country of, at least, psychiatrists and psychologists.
SHAPIRO: There's another problem that came out of the scandal at Walter Reed, and it's been harder to change: the slow and confusing way the Army determines disability benefits and lifetime access to health care.
Scott Metcalf came here to get treatment for his neck, shoulder and brain injuries. But his wife, Kathy, puts her hand softly on his shoulder and says there was one injury that took her husband a long time to admit — his PTSD.
Ms. METCALF: I'm proud of my husband for taking that step, because it was hard. And he has to work on it every day.
Sergeant METCALF: I want soldiers to know, too, is that it doesn't make you any less of a soldier, no matter who you are, from a private to a sergeant major or from a lieutenant to a colonel or whatever. PTSD is — it's an illness or disease or whatever you want to call it, but what you need to do is accept it, and don't be afraid of the stigma because it is a problem and you can deal with it, and there are people out there to help you with it.
SHAPIRO: Now, Metcalf sees psychiatrists and he's on several medications to ease his anger, his nightmares and inability to sleep.
He never thought he'd be here for 14 months. He says he can finish his treatment back home in Minnesota. But it's taken months for the Army to determine his level of disability so he can be discharged. Although his Army doctors and Army psychiatrists say he has severe PTSD, the Army officially says he doesn't. Its rating board says he has a less serious mental health problem, an anxiety disorder.
Sergeant METCALF: What I need people to realize is that the Army needs to take responsibility for PTSD. I do have PTSD, but the Army's putting me out with anxiety disorder. And it gives the Army an excuse is that, you know, We don't have a problem with PTSD.
SHAPIRO: Veterans' advocacy groups suspect the Army tries to save money by giving soldiers disability ratings for less serious conditions than, say, PTSD. The Army says that's not so. Overall, it says, disability ratings have been higher in the last year — and that costs the Army money.
Indeed, Metcalf appealed his rating and got a new one high enough so he'll always get Army health care, even though the board still says he doesn't have PTSD. So Metcalf has decided to quit challenging the Army. He's waiting for a discharge date so he can go home to Minnesota. Because of his physical disabilities, he can't do his old job as a prison guard. Scott Metcalf says he'd like to go back to school and maybe become an elementary school teacher.
Joseph Shapiro, NPR News.
INSKEEP: This is the second of two reports from Joe Shapiro, who covers this subject as deeply as anyone. And you can hear his previous report about a rash of accidental prescription drug overdoses at Army hospitals by going to npr.org.