It's been 14 months since Sgt. Scott Metcalf of the Minnesota National Guard came to Brooke Army Medical Center in San Antonio. During that time, the Army has changed the way it cares for injured soldiers.
Almost a year ago, following the controversy over shoddy care at Walter Reed Army Medical Center and other facilities, the Army opened new Warrior Transition Units at 35 hospitals — with more staff devoted to helping soldiers. Now, there's one squad leader, a nurse case manager and a doctor assigned to every injured soldier.
But there are still problems at Army hospitals, ranging from accidental overdoses on potent prescription drugs to shortages of staff trained to care for post-traumatic stress disorder and traumatic brain injuries.
A Sign of Change
Metcalf, a gunner, was injured in a Humvee accident in Iraq in December 2006. He was about to be sent to Walter Reed in Washington, but because of the problems there, he got sent to Brooke instead. Now, he's waiting for the Army to discharge him.
Metcalf was a prison guard back in Minnesota. After the terrorist attacks of Sept. 11, 2001, he signed up for the Army National Guard. Sometimes the 49-year-old finds himself giving out fatherly advice to the younger soldiers. He has two sons back home. Another, a Marine, just got back from his third tour in Iraq.
That's why Metcalf keeps a large Marine Corps insignia over the single bed in his small room in the outpatient barracks. "That's just kind of my little reminder for him each day," he says.
A calendar spread across Metcalf's wall gives a sense of what's changed about the Army's care. The calendar lists his appointments and tells him when to renew his medications.
"Yeah, it's very simple. I mean, I guess I'm the old KISS factor: 'Keep It Simple, Stupid.' Or else, like I say, 'Keep It Simple, Scottie,' you know," he laughs.
The reminder system helps Metcalf compensate for the memory he's lost because of a head injury.
On this day, his wife is visiting. Kathy Metcalf has taken another of many unpaid leaves from her job as a nurse in Minnesota to spend several days with her husband. She says when he first came to the Texas hospital, she would call him at least once every day, just to remind him of things.
"His short-term memory is not as good as it used to be," she says. "I mean, initially then, I would call every day so he didn't miss his appointments and didn't forget."
Now, Scott Metcalf gets lots of reminders from the extra case workers who have been hired. He writes them all on his calendar.
Problems with Prescription Drugs
In another change since Metcalf came to the hospital, each injured soldier is now assigned one doctor who coordinates all of his or her care — especially prescriptions.
"You might see 10 different doctors with all your different care, and at one point, 10 different doctors were giving you medications," Metcalf says. "And I've seen guys, before a few months ago, I mean, I've seen guys that had tons of bags full of medicines that either they were taking or they didn't know what they were. And now they're down to the drugs they actually need."
Still, there have been numerous prescription drug overdoses in these new Warrior Transition Units. Since last June, at least six soldiers have died from interactions of the drugs they had been given by Army doctors.
One of those deaths happened at Brooke: In January, Sgt. Robert Nichols died from an accidental drug intoxication. He was on 11 different medications, including powerful painkillers and sleeping pills.
In some cases, soldiers overdosed when they mixed drugs with drinking. So in March, the Army banned alcohol in outpatient barracks and ordered some soldiers — depending on their risk — not to drink even off post.
Some Problems Persist
Still, the drug overdoses have continued.
"The mission of the Warrior Transition Unit is to help soldiers heal," says Brig. Gen. James Gilman, who runs medical operations at Brooke. "And giving them directive not to drink at all is one of the steps that's been taken to try to cut down on these deaths and also to help soldiers heal quicker."
Gilman points to other changes: New buildings are going up. Services for injured soldiers that were spread in multiple locations across San Antonio a year ago are now all available on one floor of the hospital.
A year ago, Gilman says, he had a staff of about 30 to serve the 600 injured soldiers at the hospital. Now he has 200.
Still, a recent report from the Government Accountability Office noted shortages of staff trained to care for PTSD and traumatic brain injuries. That's a problem because another recent study, by the independent Rand Corp., found that about one-third of soldiers come back from Iraq with PTSD, a head injury or both.
"First of all, I don't think we've ever had this — I know we've never had, in my 30 years in the Army — this much demand for behavioral health services," Gilman says. "And secondly, I think there is a bit of a shortage in the country of, at least, psychiatrists and psychologists."
Difficulty Getting Discharged
Another problem that came out of the scandal at Walter Reed has been harder to change: the slow and confusing way the Army determines disability benefits and lifetime access to health care.
Metcalf came to Brooke to get treatment for his neck, shoulder and brain injuries. But his wife, Kathy, puts her hand softly on his shoulder and says there was one injury that took her husband a long time to admit — his PTSD.
"I'm proud of my husband for taking that step," Kathy Metcalf says. "Because it was hard. And he has to work on it every day."
Her husband adds, "I want soldiers to know, too, is that it doesn't make you any less of a soldier, no matter who you are, from a private to a sergeant major or from a lieutenant to a colonel or whatever. PTSD is — it's an illness or disease or whatever you want to call it, but what you need to do is accept it, and don't be afraid of the stigma because it is a problem and you can deal with it, and there are people out there to help you with it."
Now, Metcalf sees psychiatrists and takes several medications to ease his anger, his nightmares and his inability to sleep.
Metcalf never thought he would be at the Texas hospital for 14 months. He says he can finish his treatment back home in Minnesota. But it has taken months for the Army to determine his level of disability so he can be discharged.
Although his Army doctors and Army psychiatrists say he has severe PTSD, the Army officially says he doesn't. Its rating board says he has a less serious mental health problem: an anxiety disorder.
"What I need people to realize is that the Army needs to take responsibility for PTSD," he says. "I do have PTSD, but the Army's putting me out with anxiety disorder. And it gives the Army an excuse ... that, you know, 'We don't have a problem with PTSD.'"
Suspicions of Cost-Cutting
Veterans' advocacy groups suspect that the Army tries to save money by giving soldiers disability ratings for less serious conditions. The Army says that's not so. Overall, it says, disability ratings have been higher in the last year — and that costs the Army money.
Indeed, Metcalf appealed and got a rating high enough to ensure that he will always get Army health care, even though the board still says he doesn't have PTSD.
So Metcalf has decided to quit challenging the Army. He's waiting for a discharge date so he can go home to Minnesota.
Because of his physical disabilities, he can't return to his old job as a prison guard. Metcalf says he'd like to go back to school and maybe become an elementary school teacher.
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