Overhaul in care of vets

WASHINGTON — WASHINGTON -- A presidential commission recommended major steps yesterday to overhaul the treatment of military personnel wounded in Iraq and Afghanistan, saying that a system criticized for shabby treatment and numbing bureaucracy needed "fundamental change."

The U.S. must move beyond "patching the system" and apply "a sense of urgency and strong leadership" to create a system focused on the needs of individual patients, said the President's Commission on Care for America's Returning Wounded Warriors.


President Bush, who met with the panel leaders yesterday, created the commission in March. A series of articles in The Washington Post drew attention to poor conditions and neglect of outpatients at Walter Reed Army Medical Center in Washington, where about 30 percent of the wounded soldiers are treated.

In its 25-page report, the panel called for a "patient-centered recovery plan" for each seriously injured service member, for which "a corps of well-trained, highly-skilled recovery coordinators" needs to be organized. It also proposed what was described as the first major overhaul in the veterans' disability system in 50 years.


Donna E. Shalala, a former secretary of health and human services and a co-chairman of the commission, said the Bush administration could implement 29 of the 35 recommendations without legislation.

"The ball's in their court," said former Sen. Bob Dole, the other co-chairman. He said he told the president: "We're expecting somebody to follow up on it."

Shalala said the recommendations could be implemented for less than $500 million, with a 10-year cost of $1 billion.

The individualized recovery plans would be intended, the report said, "to ensure an efficient, effective, and smooth rehabilitation and transition back to military duty or civilian life," while also creating a single point of contact for patients and families.

One of the chief complaints of those undergoing treatment has been the difficulty they have in getting information and promptly planning a course of recovery in appropriate facilities - whether military, veterans or civilian. Often, they say, they must repeat the same information to multiple doctors and others in the health care chain.

Seriously wounded troops are assigned multiple caseworkers, each concerned with only one aspect of their treatment.

In calling for a complete restructuring of disability provisions, the commission said the Pentagon and Department of Veterans Affairs needed to "eliminate parallel activities; reduce inequities; and provide a solid base for the return of injured veterans to productive lives."

It called for aggressive efforts to prevent and treat post-traumatic stress disorder and traumatic brain injury. More than half of the roughly 1,700 injured troops and former fighters polled reported such problems.


In other recommendations, the panel called for strengthening family support, ensuring the rapid transfer of patient information between the Pentagon and Veterans Affairs and continued support for Walter Reed Army Medical Center through 2011, when the Pentagon says it plans to close the hospital.

Dole, a Republican from Kansas who was seriously wounded in World War II, and Shalala, a Democrat who served in the Clinton administration, brought credibility and bipartisanship to while the Bush administration is being criticized for its conduct of the Iraq war. Reports of failures in the treatment of soldiers last winter complicated administration efforts to hold on to dwindling support for its Iraq policy.

Bush, after running on the White House's South Lawn with two soldiers who had lost legs during current wars, said he instructed Defense Secretary Robert M. Gates and Veterans Affairs Secretary Jim Nicholson "to look at every one of these recommendations, to take them seriously, and to implement them, so that we can say with certainty that any soldier who has been hurt will get the best possible care and treatment that this government can offer."

Rep. Bob Filner, a California Democrat and chairman of the House Veterans Affairs Committee, said the panel came up with "a lot of good stuff" but he had expected "a far more thorough shaking-up of the system."

James Gerstenzang writes for the Los Angeles Times.