Wednesday, March 07, 2007

The Road to Walter Reed, Paved with Good Intentions - Part II

The Road to Walter Reed, Part I

During the 1990's, the problems facing Gulf War veterans had become a national issue. While no one has yet to medically identify the causality of the numerous illnesses suffered by these vets, it was still clear that the system had allowed the vets to be outprocessed from the military without proper identification and treatment of many illnesses that may have been managed to recovery if treated aggressively in the first few months or weeks of onset. Second, the survey of veterans' health returning from the Gulf was not begun until three years after their return and well after a good pattern and source could be identified clearly. That meant that the military medical corp would be hard pressed to identify the causality and recommend appropriate protections to the DoD. Finally, this had rapidly expanded the roles of disabled vets: those looking for treatment in VA centers and disability benefits.

Some of the issues that contributed to this problem were the rules and regulations that established points of separation from the military. In the case of the Reserve and National Guard components, those laws and regulations that activated the Reserve and Guard for emergent contingencies and then de-activated them again caused many to be seperated or returned to civilan life without appropriate oversight for potential medical issues (e.g. Gulf War Syndrome and other ailments). These points of separation and de-activation, strictly observed, had many servicemen and women stricken from the roles without consideration for other issues. This included medical issues as well as an appropriate transition period that provided for the continued care or time to transition back to civilian life (ie, obtaining a job, insurance, housing, etc).

In 1998, the National Defense Authorization Act (sections 501, 502, 513, and 522 among many) sought to address many of these problems by providing for voluntary extension by the service member. Most of these laws and regulations were set to become effective in the year 2000. These laws and regulations also strengthened the already existing ADME (Active Duty Medical Extension) program.

The ADME is designed to allow Reserve and Guard component servicemen and women to voluntarily extend their term of active duty while continuing to receive medical treatment until they are able to return to civilian life and work after demobilization. Those that do not volunteer for such an extension are REFRAD (removed from active duty) and, by not entering the voluntary program, have accepted responsibility for their own treatment and financial status. It would mean that the usual processes for de-activation or separation could be suspended in order to provide care, pay and benefits for the service men and women as well as their dependents.

In addition to these regulations, the 1998 NDAA also sets forth programs and incentives for attracting medical personnel, particularly doctors, dentists and nurses (section 517 and 534). According to the NDAA, the services were suffering a serious shortage. One of the improved incentives was to reduce the "pay back" scale for payment of education. Before 1998, the military required two years of service for every six months of education that was paid for by the government. The 1998 NDAA reduced this to 1 year per every six months paid. Further, nurses who graduated from civilian nursing programs were to be offered the Nurse Officer Candidate Accension Program. This would allow nurses to have their education paid for at schools that did not have Senior Reserve Officer Training Programs in place, in exchange for four years service.

These sections clearly indicate that another crisis was occuring at the same time the government was creating an additional burden on the Military Medical Corps.

Questions remain: now that the government has made good on its intentions to provide care and services for many more servicemen and women, how were they going to make good on it without the necessary human resources? You don't. The people you do have work longer and harder. The people needing to see those people wait longer and longer.

How do you build a system meant to maintain people longer than the original system intended complete with tracking of status, pay and benefits? You add paper and processes to an already onerous system, call it something else (Medical Retention Process), pretend everything is fine until a story breaks and congress calls you for a hearing, while men and women wait for pieces of paper and treatment in overcrowded facilities that were old, decrepit and never mentioned once in this NDAA or any succeeding NDAA or any other budgetary demands as a part of this entire process.

Just another pothole in the road to Walter Reed paved with good intentions.

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