Hotline

The Army has put up a hotline for soldiers and family members to call with concerns about the MEB/PEB process.
The number is 1-800-984-8523
Overseas DSN: 312-328-0002
Stateside DSN: 328-0002

email: wsfsupport@conus.army.mil

Link to [Flyer]

Flyer Text:
The purpose of the hotline is two-fold:
    -To offer wounded, injured, or ill Soldiers and their family members a way to share concerns on the quality of patient care.
    - To provide senioer Army leaders with visibility on medically-related issues so they can properly allocate resources to better serve Soldiers and families.

The hotline is an avenue to gather information about medical care as well as suggest ways we can improve our medical support systems.

The hotline has not been established to circumvent the chain of command, but rather to give Soldiers and family members an additional means to resolve medical-related issues.  Any type of retribution directed towards those who use the hotline will not be tolerated.

-End flyer text

I wonder how flooded this phone line has been.
I'll be calling soon . . .

matters of time

GonzoGate has eclipsed the WRAMC problems in the news.  The media only has the attention span that Nielsen Families provide.  Fortunately there are still many Veteran Advocacy groups working very hard to make sure the military medical mess can keep the attention it needs in order to create positive change for troopsvets/patients.  I have a list of links posted on the sidebar of this blog, but here they are again:  [LINKS]

what's it take

http://www.thenation.com/doc/20070409/kors
Is America in denial?
I hope not.  In fact, I don't think it is.  I think some politicians are in denial, or they're just good liars - that's a tough one.
I've said before that I probably wouldn't believe the stories I tell if I hadn't lived them - the medical treatment of troops in the military is literally unbelievable.  This story makes me very sad.
I won't do it much justice trying to describe it, but it illustrates how medical conditions are used by MEB officials to kick troops to the curb and leave them behind.
If I hadn't seen this happen I might not believe it myself - but now I encourage all troops to tape record conversations with their providers - it's perfectly legal - just watch out - THEY might say you're paranoid or something . . .

a bitter taste

If the administration was going to address problems "quickly" they would have done so when the first casualties returned from the war back in 2001. For almost SIX (6) years this problem has been brewing. It's past brewing, it's rotten. Ever forget that the coffee pot was on? After a few hours of baking, the coffee gets bitter, acidic and dry - it doesn't taste so good anymore - but it'll sure deliver a good WAKE-UP!!!! on the taste buds.

It's gonna take a lot of cream and sugar to sweeten that coffee. And the coffee was hot - it burnt a lot of people, all the way to the heart.

In a perfect world the system would really only need some minor correcting. But we live in an invented world - one corrupted by some serious political BS.

My prediction: Few, if any, individuals will be held accountable for their wrong-doings and failures as leaders/humans being; more systematic procedures (read: additional bureaucracy) will be created to ensure better treatment for troops/vets; a few featured troops/vets will be treated wonderfully and be seen on TV; the long-term outcomes will be very slow and painful for the majority of troops and vets.

Why so bitter? Not bitter, I'm an idealist at heart, really, but I've seen how money flows and how policies get muddled by politics. Sad.

More money will be spent on investigating and creating additional "checks" (bureaucracy) for the system than will be spent within the system - where it would benefit the individuals in need.

But I remain hopeful that eventually troops and vets will get the care they need.

playing doctor

Sometimes I feel like I'm watching an episode of Whose Line is it, Anyway when I'm looking at the standard procedures of evaluating the medical fitness of soldiers in the Army. Total confusion, total "cover my ass," total ad-hoc, and inconsistent application of Army Regulations.
First of all GAO has already called this an "overly complex system" but still the system remains in place, unchanged.
So who determines the actual disability ratings for a soldier? WOW, that's a loaded question.
The Physical Evaluation Board (PEB) is made up of three people, only ONE of the three needs to be a doctor, and they are the final authority for determining the disability rating a soldiers will receive upon exiting the Army. That's according to Army Regulation 635-40 Section IV, Chapter 4-17 paragraph b. Check it out
But where do they get the information to make such an important decision?
Referral to the PEB comes from determinations made by the MEB after a long, often ugly process that soldiers must endure. The system really isn't all that bad - once understood. The problem is that the administrators are corrupt as all hell.
The PEBLOS will tell soldiers things like "the VA will take care of you," or any other of a series of lies that will encourage soldiers to hurry-up and leave the military, even if the soldier will lose benefits in the process.
One PEBLO had the audacity to tell me that my wife "didn't deserve a second opinion," and that she just needed to "learn to deal with her disability."
So who are these PEBLOS who "play doctor" or try to "play god" with patients' medical care, future benefits, and their lives - they are AGENTS OF A GOVERNMENT SYSTEM. They don't represent anyone's interest accept the Army's - and that means saving money - even at soldiers' expense.
And to make matters worse, severely injured soldiers at Army Community Hospitals, like at Fort Benning (Martin ACH), Ft. Campbell (Blanchfield) and many others, are seen by Primary Care Providers (PCMs) who are General Family Practicioners, Physician Assistants, or Nurse Practicioners. These PCMs write the MEB - the document used by the PEB to determine the disability rating a soldier will receive. These PCMs are NOTORIOUS for falsely recording patients' conditions. These PCMs lack the specialized training often required to properly describe and document the ACTUAL condition that a soldier suffers - yet the PCM can over-rule the opinion of any specialist, and the PEBLO will send the botched MEB forward. Sure a soldier can appeal - but why put a soldier through the extra work of appealing, why not just properly document the condition in the first place.
My opinion, and I share this with many others, is that the "agents of the system" (PCMs, PEBLOS, etc.) hope that soldiers will quit asking for help, will get worn down by the system, accept defeat, maybe even believe that the VA will help. They want the soldier to sign away their benefits and leave the Army.
One quality control mechanism I propose is instead of rating a hospital's performance on how fast soldiers get booted, rate that hospital NEGATIVELY for every appeal it generates. Army Medical Command Officials should want to know why certain hospitals have left more soldiers dissatisfied than other hospitals. HOLD THE LEADERSHIP ACCOUNTABLE!!

equivocation

Back when I was at School equivocation was as bad as lying.
How times have changed.
This morning I read in the Leaf Chronicle about Med Hold at BACH and yesterday about BACH's eagerness to hear suggestions for change.

Sugestions for change need go no further that the Complaint Box at the Patient Representative's office. Or even the notes from past Town Hall meetings with patients in Medical Hold.

The majority of providers at BACH are WONDERFUL - I personally had great experiences with my providers.

The providers who accept roles as administrators become a problem. As an administrator priorities CAN shift from patient care to systematic MANAGEMENT - and all too often the two clash.

Case managers may not be overworked - but their loyalties are to the process before the patient and that is a major systematic problem that must change.

And while BACH will, only with threat of exposure, allow patients to seek treatment outside the walls of BACH, BACH providers are known to prevent follow-through of this outside care. BACH's non-specialized general practitioners often over-rule the recommendations for treatment made by Vanderbilt or other MEDCEN specialty-trained doctors.

Most disturbing has been BACH's management of complaints made by patients. The leadership's actions have made no changes to quality of care concerns brought by patients.

Instead of closing Open Investigations, BACH allows the providers in question to deploy. Deploying the problem only drags the investigation. Worse yet, if that provider is under investigation they are now exposing deployed soldiers to known and unnecessary risk.

But none of that is in the articles in the Leaf Chronicle. The BACH leadership carefully crafted their talking points to avoid more in-depth questioning.

After major lawsuits BACH built a new "Mother-Baby Unit." Spouses can sue for malpractice, service members can't.

So, applying the backward logic so prevalent in the Military, especially the Military Medical System, it would appear that all "questionable providers" see the most vulnerable and voiceless soldiers while all the reputable providers see the other patients.

Like I said, I had an awesome experience at the hospital. I was fortunate to not have an administrator operating on me.

monetary and staff problems at WRAMC

But these problems only came to this point because of leadership failures. Somewhere in the chain of command or concern a leader failed to provide accurate reports and another failed to inspect within their sphere.
The Army probably doesn't need more money - but there needs to be accounting of Total Military spending to ensure proper spending priorities. I'm one of those guys that worries about contractors over-charging for services and lining the pockets of corporate execs at the expense of Military Readiness Spending. I would rather have had more bullets, even toilet paper for that matter, than to have Internet and satellite TV available.
But the Military spends the money congress sends (or the prez pushes) on "stuff," I'd really like to know what "stuff" is. Half of the "wazzuu" expensive toys we take to the sandbox suck. They break or just don't work with other systems already in place. Computer programs don't share the same platforms - but what difference does it make when the sand ruins the electronics.
I'm sure Walter Reed could have found money SOMEWHERE to make sure soldiers were well cared-for. The Army CAN authorize TLA - Temporary Lodging Allowances - to house soldiers in adequate living conditions. But in order to save money the administrators (they don't deserve to be called leaders anymore) tucked the troops away and hoped that no one would look.

ARMY MEDICINE EXPLAINED?

This links to a page that helps explain the Army Medical Separation Process.
It can only HELP explain the system - the system is so confusing that even the administrators make mistakes sometimes. Actually I think they "make mistakes" on purpose, but that's my cynical nature, I guess.
What is the difference between the MEB, PEB, and MMRB?

PUBLIC AWARENSS

Hey, don't get confused yet. I still haven't SCRATCHED THE SURFACE of the VA stuff yet.
AND REMEMBER, THE VA IS A TOTALLY DIFFERENT SYSTEM, AND COMPLETELY SEPARATED FROM THE ARMY SYSTEM.
BUT YES, ABSOLUTELY, BOTH NEED TO BE FIXED!!!!

Plan? What Plan?

When I was in Ranger School I can remember one of the best lessons I ever learned. I was the Platoon Sergeant for a mission and had to write paragraph 4 of the OPORD (Operations Order – this is the tool used by the Army in planning any mission). I barely did anything with the OPORD, that was up to the Platoon Leader to write, I was just going to make sure everyone was awake (food and sleep deprivation at Ranger School made us all want to catch some zz's whenever we could). One of the Ranger Instructors approached me wanting to know what I was doing. I told him I was making sure everyone was awake. He told me to get to work on the OPORD paragraph 4 – that was my job for now. Without skipping a beat he began to explain the importance of the P4 tasks. To that point we had really only focused on Paragraphs 1-3, the actual operation itself. Paragraph 4 was for all the behind the scenes, non-flashy stuff. But Paragraph 4 is probably, as I now know, the most essential Paragraph to the OPORD. This paragraph includes the Medical Evacuation Plan (MEDEVAC). What this RI explained to me was that this Paragraph fueled a soldiers motivation to fight hard and not cower behind his rucksack when the bullets start flying. If a soldier knows that they will be cared for if shot, or worse, the will fight harder knowing that. The Ranger Creed obligates us to “Never leave a fallen comrade,” and the details of the MEDEVAC plan enhance soldiers’ faith that leaders will not only not abandon them, but have a plan to take care of them, especially in the “golden hour,” where life hangs in the balance.

The shittily planned Iraq war had no Paragraph 4. The only large scale logistics have been pocket padding to high-paying politicos. The only MEDEVAC plan is failing. Look only as far as any Army hospital to see the sad state of affairs for wounded soldiers. They are the forgotten ones. Those who live on impaired are forgotten and further punished with he burdens of their injuries and the sketchy medical care they receive. And once the VA takes over – shit, where do I start.

How long will it be before soldiers realize that there is no MEDEVAC plan and they lose the will to fight at all?

Too little too late

Where does the buck stop??
So Weightman was only in Command for 6 months -- who was there 6 months ago and what did they do about this? Those kinds of structural problems don't happen in a few months - we're talking years of abandonment.
What next? What happens after this knee-jerk reaction settles? Will there be follow-up but the administration? Walter Reed is supposed to be the Flag Ship of Army medicine.
Actually the problems at Reed are fairly simple when considering the problems at other hospitals - the ones out of range of national reporting - like here at Ft. Campbell.

These failures are directly linked to the administrations failures in the preparation for war.

WRAMC ain't the first

In September, 2004 I left the 101st Airborne Division and became a MEDDAC soldier in the Medical Hold Company. I was awaiting separation from the Army because of injuries I received while deployed. My wife was also having serious medical problems (BUT THAT'S AN ENTIRELY DIFFERENT STORY).
When I came over to the Ft. Campbell Hospital, Blanchfield Army Community Hospital (BACH) I was offered a company command. The Troop Commander, a Major, was an energetic and compassionate leader - I had a great deal of respect for her and wanted to accept the job. Especially after she discussed what my duties and responsibilities would entail:
The Medical Hold barracks were horrible. Much like the ones at WRAMC now featured all over the news they were full of mold, mildew, asbestos, and deteriorating construction - holes in walls, broken window frames - these were not suitable for soldiers. There was no handicap access and no elevators - and, like at WRAMC, these soldiers were severely disabled I walked through these barracks and wanted to help get them fixed.

The Troop Commander had been working on getting these fixed since they had taken command but to no avail.
I did not accept the company command - my wife's health had deteriorated too much. If I took command I would either abandon her, or be in a position where I could let soldiers down - I was not willing to accept either of these outcomes. I helped with the company in a limited capacity and took care of my wife.
The soldier's barracks situation improved before my wife was granted access to the care she needed in order to heal.

When we requested work orders on these dilapidated buildings the housing office would explain that because the barracks were so old, and marked for destruction, funding could not be approved to renovate or otherwise fix the problems. New construction on-post had priority over old construction - understandable - but it didn't address the current housing problems.

Eventually, after many false starts, the Troop Commander found ways to correct the problem as much as possible. She found ways to get repair work done. Some soldiers moved to a hotel off-post. The soldiers got moved to a better building almost a year later. But better than what? What is considered acceptable? They just moved to a somewhat better building. It's still old and falling apart and won't get renovated, either.

AND I KNOW SHE BROUGHT THESES PROBLEMS HIGH UP THE CHAIN OF COMMAND.
She did her job but found little support from above.

But Ft. Campbell is getting a new command center - it looks nice, IT's HUGE!! Lot's of money going into that development.

The Army is about people, soldiers, not about machinery or equipment. What good will that equipment be if there are no more soldiers left to use it?

accountability

Walter Reed's Commander just got canned, NOW WHAT?
In the reports yesterday soldiers at WRAMC were being punished for their leaders' failures. The First Sergeant was fired, and now the 2-star General got fired, too.
I wonder about the people in-between . . .
There is quite a large gap in rank-structure and accountability between the Company 1SG and Hospital Commander.
BUT - the burden of Command is great and a new commander may be the right start. I trust that the investigators will discover many systematic failures as well as human failures in this whole mess - after all, someone has to design, implement, and oversee this broken system.
The President was at WRAMC a few months ago. Having prepared for VIP guests at various-level functions I can assume that the preparations made prior to the President's visit included making sure all the "bad things" were covered over.
So, while I believe our President is failing in many ways, in this instance I would not be surprised if the military shielded themselves from looking bad.
And that just goes back to integrity and the lack there-of at high levels of the military chain of command. The really good leaders, the ones who put their troops before themselves, usually get passed-over and forgotten. But that's another rant for another day.
Instead I am left to ponder what will become of military medicine - this shit storm may be the catalyst of change so desperately needed.
The Army Times is doing a great job tracking the problems with disability ratings and other issues surrounding the Medical Evaluation Board (MEB) process.
Hopefully the new governmental leadership will start doing what they were selected to do - fix the broken shit the current administration won't admit is broken.

Military Med system FUBAR -- part 3 (5? 67?)

But it also should not have taken newspaper articles to bring change to outpatient conditions at Walter Reed. And while filthy conditions at Building 18 are a temporary problem for these veterans, lowball settlements may leave soldiers and their families impoverished for life.

-- Washington Post Editorial, "Rotten Homecoming" -- 21 FEB 07

I find it nearly impossible to explain how this stuff can happen, when family or friends ask. If I'm bitching about how frustrated I am with being denied treatment or only getting it after a 3-year fight, it's understandably bizarre. I got tired of trying, because it always ends up in, "Well why don't you just...(..)?"

Which would work in any OTHER HMO.
And which wouldn't be necessary if more of the leadership were more interested in patient care and troops' well-being, than number-crunching and avoiding conflict with unethical practitioners.

Here's the systematic issue:

The biggest problem is: most of us wounded, maimed or disabled get
stuck at our shitty little "Army Community Hospitals" (ABHs) on our
own posts--away from the specialty clinics, support programs &
publicity of Walter Reed. Honestly, I'm horrified things got so bad
at Walter Reed, thank god for WaPo--but those articles exposed maybe
5% of the systematic failure to do right by injured troops.

It kills me how the Pentagon makes it sound like all "severely
injured" troops are getting care at Walter Reed. Or its sister-Army
Medical Centers (AMCs).
Bullshit--it's where a severely injured troop goes ONLY if he/she's
wicked lucky, Knows Someone or has a dramatic external injury. The
rest of us "severely injured" hospital-bunnies would all but pull out
a buddy's IV to get to Walter Reed. It's like Xanadu, heaven, a place
of wonder.
The difference? At Medical Centers like WallyWorld you get, you
know, medical treatment along with your
moldy/infested/condemned barracks... Rumor has it: the troops are
sometimes even treated like patients instead of weaklings or shitbags.
WOW!

The majority of us-- shrapneled digestive systems, organ failures,
traumatic brain injuries, spinal cord issues, single-arm amputations,
or whatever (even cancer) get scattered around the country, out of the
public eye (i.e., in little army towns with no investigative
reporters). At these ACHs, hospital administrators can deny
treatment, falsify records, or otherwise screw us with no
repercussions that I've seen, ever.

To be fair: most of the people at these Army Community Hospitals on
tactical/"grunt" posts are AWESOME. Many are army wives or formerly
troops themselves. 90%+ are professional, sweet, and busting their
ass to keep things going. They're so exhausted from dealing with
overcrowded clinics and increasingly pissed off patients, I truly
don't know how they stay sane. I submit "Good Job!" reports on them
whenever possible.

The problem, as usual in a bureaucracy, lies with:
A. Pentagon bean-counters (generals or senior civilians)
shortchanging the outlying hospitals to fund whatever rusty-ass
Artillery system got porked in again this year
B. Hospital admin types (senior officers) who pretend everything's
SUPER instead of grabbing their sack and addressing , or
C. A few unithical & power-trippy doctor or nurse (usually one in
charge of a clinic) too senile, incompetent, ambitious or psychotic
for the whole "medical care" thing

Of course, they're the "authority" or "professionals" so they're the
ones who get to give all the official input. We start thinking we're
just crazy, til we figure out the odds of simultaneous, identical mass
hallucinations are slim. Even on wacky pain meds.

I just don't know how to get help for all of us at outlying hospitals.
I've tried. Others here have worn themselves out trying. How do you
raise hell in Pudunk, Kentucky/Tennessee border for Peter's sake. ANY
suggestions would be genuinely appreciated. Congressionals get shot
down as fast as...quail-hunting partners. We're not allowed to sue
for malpractice (not that most of us would...but the threat might help
quality control)

Recovery Ops

I'm glad the lid finally got blown off the military covering-up the failures of the administration. These problems so recently brought to light about WRAMC (Walter Reed Army Medical Center) are only superficial. Taco Bell has rats and roaches. The real problem is the leadership's failure to take corrective action. These problems have been known for a long time.
Good leaders are not just the lucky people who have no problems during their periods of responsibility. (Though many generals and high-power politicians have either been so lucky, or have done a hell-of-a-job covering things up) The best leaders are the ones who can take horrific problems and conditions and make the situation better. It will take leadership beyond the capability of those currently in charge to fix this problem.
This should be investigated - letting conditions get this bad is dereliction of duty. But to say that leadership knew nothing of the problems adds insult to injury - quite literally in this case.
Either the high-up leaders didn't care enough to inspect all facilities, facility managers lied to higher-up leaders, or the higher-up leaders knew, and did nothing to fix matters. Each of these possibilities demonstrate the dire circumstances within the DoD's management of military medical practices.

What is more - Walter Reed is hallowed ground for injured troops - it's a MEDCEN (Medical Center), in the middle of Washington D.C.!!! The outlying community hospitals in the Army don't have nearly what WRAMC can provide. Soldiers in outlying hospitals live in worse conditions (yeah, I've seen them and smelled the puke left in the asbestos filled hallways by cancer patients returning from chemo and radiation treatment, and I've seen the moldy showers where burn-victims and amputees have to bathe) and there is no spotlight to fix them!!

These troops have returned home from war with life-changing wounds and injuries and the administration continues their "fight the war on the cheap" mentality by cutting corners on health care.

And why can't soldiers make a cause for this themselves? Why is it that these men and women fought a faceless, far-off enemy and can't stick-up for themselves? Easy - they have no weapon, and no support. The majority of seriously injured troops returning to these piss-poor conditions are low-ranking and have little-to-no family or financial support. Battling the physical injuries and psychological trauma of their injuries and the PTSD most likely linked to that injury leaves our combat-trained service members in an unsupported position. They have no recourse against shitty medical care and have no one to guide them through the red-tape involved in transitioning from active duty to the civilian world. Sure there are benefits and programs linked to service - but what good are these services when they are not made accessible to vets and families who would most benefit from them. Besides, most of these vets-to-be just want to get on with their lives - they aren't the type to wallow in misery.

Hopefully this WRAMC shitstorm won't stop in DC - so many more military hospitals need the spotlight turned on. Hospital leaders need to be held accountable for their neglect of troop health.


So if it takes the press corps to motivate the leadership of "this great Nation" so be it - our troops deserve better treatment and their leadership lacks the character, the moral courage and the intestinal fortitude to find a way to provide it.

Washington Post Article

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/17/AR2007021701172.html

Here is the beginning:

Soldiers Face Neglect, Frustration At Army's Top Medical Facility

By Dana Priest and Anne Hull

Washington Post Staff Writers
Sunday, February 18, 2007; Page A01

Behind the door of Army Spec. Jeremy Duncan's room, part of the wall is torn and hangs in the air, weighted down with black mold. When the wounded combat engineer stands in his shower and looks up, he can see the bathtub on the floor above through a rotted hole. The entire building, constructed between the world wars, often smells like greasy carry-out. Signs of neglect are everywhere: mouse droppings, belly-up cockroaches, stained carpets, cheap mattresses.

This is the world of Building 18, not the kind of place where Duncan expected to recover when he was evacuated to Walter Reed Army Medical Center from Iraq last February with a broken neck and a shredded left ear, nearly dead from blood loss. But the old lodge, just outside the gates of the hospital and five miles up the road from the White House, has housed hundreds of maimed soldiers recuperating from injuries suffered in the wars in Iraq and Afghanistan.