[Mb-civic] Army Doctors Scrambling

[Michael Butler]

Also see below:     
He Lost an Arm in Iraq; the Army Wants Money    €

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    Army Doctors Scrambling, Report Says
    By Esther Schrader
    Los Angeles Times
 The military medical system has been overwhelmed by the scope and severity
of injuries among troops, a health expert writes.

    Washington - A shortage of surgeons to treat the wounded in Iraq has
left Army medical teams in the country scrambling to handle the largest
number of military casualties since the Vietnam War, the New England Journal
of Medicine reports today.

     The Army has fewer than 50 general surgeons and 15 orthopedic surgeons
in Iraq at any one time to serve more than 138,000 troops. Despite the
numbers, advances in battlefield surgical techniques and care mean a greater
percentage of soldiers wounded in Iraq are surviving than in any previous
American conflict.

     The article describes a military medical system that has undergone
fundamental changes since the 1991 Persian Gulf War, but that nonetheless
has been overwhelmed by the scope and severity of injuries occurring among
troops in Iraq. It was written by Atul Gawande, an assistant professor at
the Harvard School of Public Health and a former senior health advisor to
the Clinton White House.

     Since March 2003, 1,276 U.S. military personnel have died in the Iraq
war, with an additional 9,765 wounded, according to Pentagon figures. The
number of deaths directly related to combat passed 1,000 this week, the
Pentagon said.

     "Just as the rest of the military structure was unprepared for the
length of the war and the evolution in the nature of the war, so has the
military medical establishment been understandably unprepared for that,"
Gawande said in an interview.

     "What is striking is that they have been able to adapt in ways that
allow them to keep a high rate of survival for the soldiers," he said. "But
there are costs, and what you see is a potential problem on the horizon."

     Gawande did not specify the number of surgeons he thought the military
should have in Iraq. He said there were several indications, though, that
the current level was insufficient.

     With just 120 general surgeons on active duty, the Army has been forced
to use urologists, plastic surgeons and cardiothoracic surgeons to perform
general surgery on soldiers in Iraq.

     Many surgeons have been deployed for more than two years in the Iraq
campaign, and military planners are contemplating pressing some to return,
Gawande writes.

     The physicians are working under difficult circumstances. In many
cases, the military has taken over Iraqi hospitals, and the facilities are
flooded with civilian patients whom the Americans are unable to treat. With
no clear directive from the Pentagon on treating civilians, some physicians
refuse to help even pediatric patients out of fear the children could be
booby-trapped with bombs, Gawande writes.

     Dr. Michael Kilpatrick, deputy director of deployment health support
with the Pentagon's Office of Health Affairs, acknowledged that Army
surgeons working in Iraq had had to improvise in some cases and had been
forced to work outside their specialties in others. But he said the
relatively low number of deaths proved the system was working.

     "There are certainly going to be times in any location where the
workload is going to exceed the personnel present," Kilpatrick said. "There
are going to be some extremely long hours at times."

     But, he added, "the fact that they have responded as well as they have
speaks to the fact that they were well prepared. You can't anticipate every
eventuality. I think the training and preparation that people had has stood
them in good stead."

     Detailing the nature of combat injuries and their complications,
Gawande says that blast injuries from suicide bombs and land mines are up
substantially in recent months and have proved particularly difficult to
treat without risking infection. Eye injuries have caused blindness among a
"dismaying" number of soldiers, he says.

     Soldiers who survive the initial blasts and field treatment are
suffering at high rates from later complications, including pulmonary
embolisms (when a blood clot travels to the lungs) and deep venous
thrombosis (blood clots in the legs). Some of those soldiers have died of
the complications.

     Army medical teams are also worried about what Gawande calls an
epidemic of multi-drug resistant bacterial infection in military hospitals.
Among 442 medical evacuees seen at Walter Reed, 8.4% tested positive, a far
higher rate than previously seen among wounded troops.

     Despite the challenges, Gawande credits nurses, anesthetists,
helicopter pilots, other transport staffers and a rethinking of the combat
medicine system for improvements in soldiers' survival rates.

     The system now focuses on damage control, not definitive repair,
Gawande writes. Field doctors carry "mini-hospitals" in Humvees and field
operating kits in backpacks so they can move with troops and undertake
surgery on the spot.

     They limit surgery to two hours or less, often leaving temporary
closures and even plastic bags over wounds, and send soldiers to one of
several combat support hospitals in Iraq.

     The strategy seems to be working, Gawande finds. Although at least as
many U.S. troops have been wounded in combat in the Iraq war as in the first
five years of Vietnam, 90% are surviving, compared with 76% in Vietnam.

     Other experts also have credited superior body armor and equipment for
improving combat injury survival. But the survivors often have injuries so
severe that their future prospects are uncertain, Gawande writes.

     One airman lost both legs, his right hand and part of his face. "How he
and others like him will be able to live and function remains an open
question," Gawande said.

   

    Go to Original 

    He Lost an Arm in Iraq; the Army Wants Money
    By Dianna Cahn 
    Times Herald-Record

     Friday 10 December 2004
 Spc. Robert Loria is stuck at Fort Hood, Texas.

    Middletown - He lost his arm serving his country in Iraq.

     Now this wounded soldier is being discharged from his company in Fort
Hood, Texas, without enough gas money to get home. In fact, the Army says
27-year-old Spc. Robert Loria owes it close to $2,000, and confiscated his
last paycheck.

     "There's people in my unit right now - one of my team leaders [who was]
over in Iraq with me, is doing everything he can to help me .... but it's
looking bleak," Loria said by telephone from Fort Hood yesterday. "It's
coming up on Christmas and I have no way of getting home."

     Loria's expected discharge yesterday came a day after the public got a
rare view of disgruntled soldiers in Kuwait peppering Defense Secretary
Donald Rumsfeld with questions about their lack of adequate armor in Iraq.

     Like many soldiers wounded in Iraq, Loria's injuries were caused by a
roadside bombing. It happened in February when his team from the 588th
Battalion's Bravo Company was going to help evacuate an area in Baqubah, a
town 40 miles north of Baghdad. A bomb had just ripped off another soldier's
arm. Loria's Humvee drove into an ambush.

     When the second bomb exploded, it tore Loria's left hand and forearm
off, split his femur in two and shot shrapnel through the left side of his
body. Months later, he was still recuperating at Walter Reed Army Medical
Center in Washington, D.C., and just beginning to adjust to life without a
hand, when he was released back to Fort Hood.

     After several more months, the Army is releasing Loria. But "clearing
Fort Hood," as the troops say, takes paperwork. Lots of it.

     Loria thought he'd done it all, and was getting ready to collect $4,486
in final Army pay.

     Then he was hit with another bomb. The Army had another tally - of
money it says Loria owed to his government.

     A Separation Pay Worksheet given to Loria showed the numbers: $2,408.33
for 10 months of family separation pay that the Army erroneously paid Loria
after he'd returned stateside, as a patient at Walter Reed; $2,204.25 that
Loria received for travel expenses from Fort Hood back to Walter Reed for a
follow-up visit, after the travel paperwork submitted by Loria never reached
the correct desk. And $310 for missing items on his returned equipment
inventory list.

     "There was stuff lost in transportation, others damaged in the
accident," Loria said of the day he lost his hand. "When it went up the
chain of command, the military denied coverage."

     Including taxes, the amount Loria owed totaled $6,255.50. The last line
on the worksheet subtracted that total from his final Army payout and found
$1,768.81 "due us."

     "It's nerve-racking," Loria said. "After everything I have done, it's
almost like I am being abandoned, like, you did your job for us and now you
are no use. That's how it feels."

     At home in Middletown, yesterday, Loria's wife, Christine, was beside
herself.

     "They want us to sacrifice more," she said, her voice quavering. "My
husband has already sacrificed more than he should have to."

     For weeks now, Christine has been telling her 3-year-old son, Jonathan,
that Robbie, who is not his birth father, will be coming home any day now.

     But the Army has delayed Loria's release at least five times already,
she said, leaving a little boy confused and angry.

     "Rob was supposed to be here on Saturday," she said. "Now [Jonathan] is
mad at me. How do you explain something you yourself don't understand?"

     Christine said the Department of Veterans Affairs has been helpful in
giving Loria guidance about how to get his life back on track, offering
vocation rehabilitation to "teach them to go back out in the world with the
limitations they have."

     But the Army brass has been unreceptive, she said.

     The Lorias also contacted the offices of U.S. Sen. Hillary Clinton,
D-N.Y., and Rep. Maurice Hinchey, D-Saugerties. Hinchey's office responded.

     "There's enough to go on here to call the Army on it and see if it can
get worked out," said Hinchey aide Dan Ahouse. "We are expressing to the
Pentagon that based on what we see here, we don't see that Mr. Loria is
being treated the way we think our veterans returning from Iraq should be
treated."

     Army officials at Fort Hood could not be reached for comment yesterday.

     "I don't want this to happen to another family," Christine Loria said.
"Him being blown up was supposed to be the worst thing, but it wasn't. That
the military doesn't care was the worst."

     The End of Her Rope

    Christine Loria was at the end of her rope earlier this week when she
called her wounded husband's commanders at Fort Hood, Texas, and gave them a
piece of her mind.

     The Army was discharging her husband, Robert, after he lost his arm and
suffered other severe injuries in Iraq, without even gas money to drive his
car home.

     "I am up here and he's there. That's 1,800 miles away," she said. "I
had to call his chain of command and scream at them."

     Their reaction she said, was "very mature."

     If he feels that way, why is his wife talking for him? Why doesn't he
come talk to us himself?" she remembers them asking her.

     "Because on some level, he still respects you," she answered. "I don't
have that problem."

     
     Who to call to Help

    Outraged about Army Spc. Robert Loria's plight? Speak your mind. Below
are contact numbers for federal legislators and defense officials.

     U.S. Senate: Hillary Clinton: 202-224-4451; Charles Schumer:
212-486-4430 
    U.S. House of Representatives: Maurice Hinchey: 845-344-3211; Sue Kelly:
845-897-5200 
    Secretary of Defense: Donald Rumsfeld: 703-692-7100
    Fort Hood: Major General James D. Thurman: 254-288-2255 or Fort Hood
operator at 254-287-1110; Public Information Officer Jim Whitmeyer:
254-287-0103 

 

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