Cheating grim death
Lightning-fast treatment is the key to success
The path from military medicine to the Department of Veterans Affairs, which is charged with providing care to the nation's 24.7 million veterans, is, all too often, no simple stroll down easy street. The Defense Department and the VA have separate medical systems and separate medical boards that determine soldiers' eligibility for benefits. Efforts are underway to remove some of the roadblocks. The VA now has representatives at 136 military installations, including Landstuhl and Bethesda. The Pentagon has a new program, the Disabled Soldier Support System, with 10 counselors around the country. The VA and the Pentagon are working on a two-way electronic medical records system, which VA Secretary Anthony Principi says will be in place next year. Since 1998, the departments also have been trying to establish one-stop medical exams that would work for both military discharge and veterans benefits. Just this month, the Government Accountability Office reported that four of eight single-exam programs touted by the VA didn't exist and that the military often diverted funds for the project to healthcare for active-duty soldiers.
Returnees from Iraq and Afghanistan are guaranteed two years' free healthcare by the VA. Veterans groups give the VA high marks for quality of care; over the past decade it has pioneered patient-safety programs like computerized prescription entry, considered vital for reducing medical errors. But the system faces increased demand. Enrollment has risen from 4.8 million to 7.6 million since 2001. "The VA is not ready for an influx of new veterans," says Rep. Lane Evans, ranking Democrat on the House Veterans Affairs Committee. "It is managing by rationing healthcare services."
Last year, in an effort to stretch the dollars, the VA eliminated healthcare benefits for vets who make more than about $30,000 a year; the agency has also proposed increasing user fees. And although the VA has cut the wait for an initial primary-care visit down to 30 days for most patients, it can take months to see an eye doctor or oncologist. "Often the appointment to see a specialist is 10 months to a year," says Cathy Wiblemo, deputy director for healthcare for the American Legion. Principi says it may take six months to see an orthopedist for a hip replacement, "but I'm not sure that's that much different than the private sector."
When his long convalescence is over, David Coleman isn't sure where he will be headed. But last week he got some great news: The Marine Corps decided he'd be better off recuperating at home in Montana for 30 days before his next surgery. As soon as the paperwork is done, Coleman will be headed for the airport. He says: "I will be home for Thanksgiving."
Battle wounds
Causes of injuries to Army troops wounded in action and evacuated to military hospitals.
Iraq
Improvised explosive devices 31.6 pct.
Shrapnel 18.9 pct.
Gunshot 15.5 pct.
Other 34 pct.
Afghanistan
Gunshot 25.5 pct.
Blast 20.4 pct.
Land mines 14.3 pct.
Other 39.8 pct.
Source: U.S. Army Medical Department
USN&WR
With Elizabeth Querna, Susan Brink, Angie Cannon, Marianne Szegedy-Maszak, Daniel Gilgoff, Carol Susan Hook, Jennifer L. Jack, Nancy L. Bentrup, Allegra Moothart, Ann M. Wakefield, Jill Konieczko and Monica M. Ekman
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