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Panel Calls for Changes to Wounded Veterans’ Care

July 25, 2007 at 6:10 PM EDT
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JUDY WOODRUFF: Some five months after a public outcry over the care being provided to America’s wounded warriors, a presidential commission released its report today on how to improve the system.

DONNA SHALALA, Co-Chair, President’s Commission on Care for America’s Returning Wounded Warriors: We knew that the system had some problems. And we also knew that Band-Aids were not going to cut it.

JUDY WOODRUFF: Former Senator Bob Dole and former Health and Human Services Secretary Donna Shalala were tapped by President Bush in March to head the nine-member panel, this after disclosures in The Washington Post and Salon online of poor conditions and treatment of many wounded soldiers in outpatient care at Walter Reed Army Medical Center in Washington.

One of the commission’s recommendations is to develop integrated care teams for injured service personnel, like the panel member Marc Giammatteo, who was injured in Iraq and underwent more than 30 surgeries to save his right leg.

MARC GIAMMATTEO, President’s Commission on Care for America’s Returning Wounded Warriors: Throughout my recovery, my acute medical care was absolutely fantastic. However, I and some of my fellow wounded service members experienced problems with our outpatient care.

The commission has heard the same thing a number of times during our site visits to VA, DOD, and other facilities around the country. That’s why, in our report, we have created a system that serves by developing a patient and family-centered integrated care model.

JUDY WOODRUFF: The commission also proposes to overhaul and simplify the current disability and compensation system, require comprehensive training programs in post-traumatic stress and traumatic brain injuries for military and VA personnel, create a Web site to allow patients and doctors to share information, as patients move to other facilities, provide more financial support and leave for families of injured service members.

In addition to the president’s commission, at least a half-dozen other panels have been created and numerous congressional hearings have been held to investigate major health care shortcomings throughout the Departments of Defense and Veterans Affairs.

As a result, several top generals and Army officials, including the commander of Walter Reed Hospital, the secretary of the Army, and the Army surgeon general, have resigned or were fired.

Most recently, Veterans Affairs Secretary Jim Nicholson announced he would step down by October.

Earlier today, White House officials said today they would not act immediately on the commission’s proposals. Then, late this afternoon, after a run at the White House with two injured soldiers, President Bush called on both the Congress and his own executive branch to implement the commission’s recommendations.

Fundamental changes proposed

Bob Dole
Co-Chair, Wounded Warriors Commission
[A] lot of well-intentioned people in both parties -- it's not a political thing -- did little Band-Aids. They put one here and one here. And we decided that wasn't going to work. We wanted to go for major reform.

JUDY WOODRUFF: And joining me now are the commission's co-chairs, former Health and Human Services Secretary Donna Shalala and former Senator Bob Dole.

Thank you both for being with us.

BOB DOLE, Co-Chair, President's Commission on Care for America's Returning Wounded Warriors: Thank you.

JUDY WOODRUFF: Secretary Shalala, to you first.

The report talks about a need for fundamental changes in the way service members who are wounded are cared for. Why the need for fundamental changes?

DONNA SHALALA, Co-Chair, President's Commission on Care for America's Returning Wounded Warriors: Health care has changed. And the need for integrated care, from the time in which they're wounded in the field, right through their outpatient care, to the benefits that they get, it needs to be integrated. You need a team of people.

These are injuries that, in another war, would have caused death. So, they're more complex. And we need a different system.

JUDY WOODRUFF: In your eyes, Senator Dole, what -- what was it that's wrong with the system right now?

BOB DOLE: Well, there's been something wrong with the system -- one of the reports we used was a report by General Bradley, Omar Bradley, in 1956. And he was trying to fix the system.

So, there's been, you know, all kinds of commissions since then. But a lot of well-intentioned people in both parties -- it's not a political thing -- did little Band-Aids. They put one here and one here. And we decided that wasn't going to work. We wanted to go for major reform.

And, thanks to the efforts of primarily Secretary, we have done that. We have kept the number limited to six, six very important ones, that will, I think, have a great impact.

JUDY WOODRUFF: Six recommendations.

And, Secretary Shalala, if you had to choose the most important one, is there one?

DONNA SHALALA: The six combined will have a major impact on improving care and opportunities for wounded soldiers and wounded veterans.

JUDY WOODRUFF: You talk about completely restructuring the disability rating system...

BOB DOLE: Yes.

JUDY WOODRUFF: ... the compensation system. Right now, Senator Dole, that is handled largely at the Department of Defense. You're recommending moving it to the Veterans Department.

BOB DOLE: That -- you know, I happen to think -- maybe it's because I have dealt with a lot of people with disability -- that's the most important, but the others are probably equally as important.

What's going to happen now is that you will have a physical at the DOD, but the VA is going to make the rating. And they will work out what the physical should be. So -- and you're going to get credit for -- say your spouse served 15 years in the Army, Navy, whatever. They will get paid for that. They will get a payment for that.

But, in addition to that, they're going to get a disability payment rated by the VA. And included in that, for the first time, will be one -- what we call a quality of life. Let's say you're -- you're badly burned or you're a double amputee. The quality of life deteriorates. And we think that should be compensated for.

Need for a single coordinator

Donna Shalala
Co-Chair, Wounded Warriors Commission
One of our soldiers that was injured who is on the panel said he couldn't remember the names of all the coordinators that he had to deal with.

JUDY WOODRUFF: And how is that different, Secretary Shalala, from the way it's done now?

DONNA SHALALA: Right now, you can get a disability rating both at the Defense Department and at the VA. We have a lot of mission creep here.

In fact, what this does is make it very straightforward. And DOD does what it should do, make a decision about whether someone is fit to continue in the military. And, if they're not, they go over to the VA and get a disability rating and get investment in education, in training, and in other things that they need to move on with their life.

JUDY WOODRUFF: And, yet, we have heard a great deal about how the VA, the Veterans Administration, is overwhelmed and...

BOB DOLE: Oh, it can't be.

JUDY WOODRUFF: ... especially during this war.

BOB DOLE: Yes.

JUDY WOODRUFF: So, how do you -- can you be sure they can handle this additional responsibility?

BOB DOLE: Yes.

Well, my own view is, we have to quantify these things. And we have we have asked for numbers. We're not sure we're exactly right, but they're probably somewhat in excess of 3,000 young men and women who were seriously injured in Iraq and Afghanistan.

Now, if we can't deal with 3,000, you know, in this great country of ours, we have got a problem. So, I don't think it's overwhelmed. We have got what we call trauma centers in four places in the country, and they're not filled. I mean, there are not enough patients.

What we need, as Secretary Shalala has pointed out, we need to find some more health specialists, particularly in the mental health care, but they're very hard to find in the private sector or the Army. But we're not -- I don't think we're over -- we don't need any more new buildings. We just need to make certain that the deserving veterans get everything that's coming to them, everything we can do for their family, for themselves, for the rest of their life.

JUDY WOODRUFF: Are you saying, Senator, that there's -- there's capacity there now that's not being used? Is that what you're saying?

BOB DOLE: Oh, I think -- you could out -- well, I think there's never been a full capacity at Walter Reed, and they get about 30 percent of the patients. They can expand and expand. But, you know, they're -- they're not at capacity now at Walter Reed.

JUDY WOODRUFF: Well, then, what was the problem, Secretary Shalala?

DONNA SHALALA: Well, some of it was just coordinating what needed to be done.

We have recommended a recovery plan, a single coordinator, so that the family and the individual has someone to talk to. One of our soldiers that was injured who is on the panel said he couldn't remember the names of all the coordinators that he had to deal with. There has to be a single person and a plan, the plan put together by all the health care professionals and educational professionals.

And then implementing that plan with the wounded soldier is what the coordinator does, so that you know one person is in charge, and that person is not going to be deployed to Iraq or to Afghanistan. They're going to stick with the patient right through until they're back either in the military or until they're back into civilian life.

BOB DOLE: And another point, Judy, just to make quickly, you know, the health care is so much better now, that there are more people survive. I think, in World War II, for everyone killed, there was one survivor. Now it's -- what is it? For everyone killed, there were 14 or 15 survivors.

So, you can -- and we have had nothing but good words about acute care. It's when you get in the outpatient status, you know, when you're trying to make appointments and get your benefits, that's where these problems have occurred. And that's the ones we have tried to address.

JUDY WOODRUFF: And that's what most of your focus is on.

BOB DOLE: Yes.

DONNA SHALALA: Exactly. The system is too fragmented. We have to make it seamless, make it work as effectively and as quickly. More importantly, we don't want a lot of young people sitting around. The worst thing...

BOB DOLE: Patient-oriented is a word you coined.

DONNA SHALALA: Exactly.

BOB DOLE: So...

DONNA SHALALA: A patient-centered system.

What we did was, we thought about, what does the wounded warrior need to get them well?

Emphasis on traumatic injuries

Bob Dole
Co-Chair, Wounded Warriors Commission
We don't need to build more hospitals in every state. We need to spend the money to get these young men and women to the best possible doctor they can find near their home.

JUDY WOODRUFF: You -- you do put emphasis, as Senator Dole just said, on -- on treating post-traumatic stress disorder and on traumatic brain injury.

And, yet, one of your panel members who heads up the National Rehabilitation Hospital here in Washington, said today there's a 20-25 percent vacancy in jobs, the kinds of jobs, the therapists who treat that. Where do you find the people to do the work?

BOB DOLE: Yes, well, he's having the same problem. Ed Eckenhoff, a great guy who runs the National Rehabilitation Hospital in D.C. -- and he's on the commission -- as he said just today, they're very hard to find. We're going to have to find them, and not only in the DOD and VA, but in the private sector, too, and train them.

JUDY WOODRUFF: So, where do you find them?

BOB DOLE: Yes. Well...

DONNA SHALALA: Well, I mean, there are young people in colleges today that would love to go into these professions. You have to make it economically competitive.

BOB DOLE: Yes.

DONNA SHALALA: They have to be good jobs. They have to be seen as an opportunity to serve in the public service. I think that we can build a cadre of talented people, but we're going to have to pay for it.

The other thing we're going to have to do is do a lot more prevention. We need to reduce the number people that get these injuries. Some of it is equipment, and some of it early training and early intervention often in the field.

The military is just starting to do some of this, getting their mental health specialists actually in Iraq and Afghanistan. You're a young person. You just graduated from high school. You join the military. And these are traumatic experiences. And working with the young people earlier on will make a difference.

BOB DOLE: But it also will put emphasis on, if you can't get the best possible care at a DOD facility or VA, you're authorized to go to a private facility.

JUDY WOODRUFF: Well, that's what I wanted to ask you about, because I notice that you do make a note in here of saying there needs to be more blending, when appropriate, of the military, the veterans and private hospitals.

DONNA SHALALA: Right.

JUDY WOODRUFF: That's not a simple thing to do.

DONNA SHALALA: Well, the fact is, what you want is the right care at the right time in the right place.

And, for many soldiers, it's going home.

BOB DOLE: Yes.

DONNA SHALALA: Going home might mean there's not a military or a VA facility, but a first-class private facility. The support system is at home. They ought to have the opportunity to get first-class care at home.

BOB DOLE: We don't need to build more hospitals in every state. We need to spend the money to get these young men and women to the best possible doctor they can find near their home.

JUDY WOODRUFF: I noticed earlier today at the White House, where you were -- you met with the president this morning.

BOB DOLE: Yes.

JUDY WOODRUFF: Tony Snow, the president's spokesman, came out afterwards. And he was asked, is the president going to do something immediately? And he said, no, this is going to be integrated into the other things that we're working on.

BOB DOLE: Yes.

JUDY WOODRUFF: And, then, late this afternoon, the president himself came out and said that he has instructed...

BOB DOLE: Well, I talked to the White House. I was a little upset by that. And they said, well, we wanted to give you -- you hadn't voted yet. You hadn't had an official vote yet. And they were just waiting until they had that. And that was sort of a -- you know, but the president said it very well. In fact, he said, we're going to implement these.

JUDY WOODRUFF: So -- so, you were the instigator behind the president coming out this afternoon?

BOB DOLE: I don't think I was the instigator. I was disappointed with what I had read earlier.

But we were promised -- I think we can say promised -- when we took -- we don't need this job.

BOB DOLE: You know, we did this because we thought it would help some young men and women. And the president said, if we found people in need, you know, we would take care of it. And it -- if it doesn't happen, you will probably hear from us again.

JUDY WOODRUFF: So, just to be clear, after Tony Snow said his -- said what he said this morning, you contacted the White House?

BOB DOLE: No, I think it was Laurie McQue, our press person, just called and said, there's a report, didn't quote Tony, but it -- the point is, the president made it clear.

DONNA SHALALA: Yes.

Let's be clear. Every time we have met with the president, he has said he's ready to go. Give me the recommendations.

What happened this morning, I think, is a little carefulness, waiting until we voted officially before they made their comment. But there's no question that the president was clear in the segment that I saw.

BOB DOLE: We thought, when we were down there this morning, that he didn't have anything else to do today. We were in that Oval Office how long, getting pictures, visiting.

DONNA SHALALA: Neither one of us are going to let anyone off the hook, whether it's the secretary of defense or the secretary of veterans affairs.

We have given them recommendations that are doable. Everything we have recommended can be done within six months to a year, most of it quicker than that. Most of our recommendations can be done by the administration.

JUDY WOODRUFF: Well, who...

DONNA SHALALA: A few need to be done by Congress.

BOB DOLE: And we're going to report to Congress tomorrow, I might add.

JUDY WOODRUFF: But your commission...

DONNA SHALALA: Yes. We're going up to brief Congress and to talk specifically about what they need to do.

JUDY WOODRUFF: But your commission goes out of existence after this.

DONNA SHALALA: Yes. But Senator Dole and I don't.

BOB DOLE: We're still alive, yes.

Pushing for implementation

Donna Shalala
Co-Chair, Wounded Warriors Commission
We did something no other commission has ever done. We gave them a short, targeted report with a small number of recommendations that are very powerful that will make a big difference.


JUDY WOODRUFF: So, I was going to say, who is there to hold the administration's feet to the fire?

DONNA SHALALA: We will.

BOB DOLE: We will.

We can write op-ed pieces and make statements.

BOB DOLE: But we don't want that to happen. We want everybody to just sort of -- they told us, if we had a good product, there would be -- it would be implemented. We think we have a good product.

DONNA SHALALA: We did something no other commission has ever done. We gave them a short, targeted report with a small number of recommendations that are very powerful that will make a big difference.

JUDY WOODRUFF: Very quickly, when all this came out in February and March, Walter Reed and the terrible stories that came out, people felt there was a serious problem here. You today are making it sound like it was not that awful, that it was something, that it was bad, but it's very manageable.

BOB DOLE: Yes.

JUDY WOODRUFF: So, put it in perspective.

BOB DOLE: I think that was -- this is my own view -- that was more facility-related, although it did affect outpatient care.

And I applaud The Washington Post, because it was a wakeup call. Everybody got involved, seven or eight committees in Congress, the White House, you know, everybody. And that's why we ended up on a commission.

But we think now that we have recommendations that will correct most of the abuses.

DONNA SHALALA: There is no excuse for not giving a wounded soldier the best possible care.

So, if there was one problem, it's too many.

BOB DOLE: Yes.

DONNA SHALALA: That's the way I react as an American. That's the way Senator Dole reacts. That's the way everyone in this country reacts.

And, when the president asked us to do it, we said we would do it, but we were going to be very focused and tell him exactly what needed to be done to make certain this doesn't happen again.

JUDY WOODRUFF: Secretary Shalala, Senator Dole, thank you very much...

BOB DOLE: Thank you.

JUDY WOODRUFF: ... co-chairs of this commission.

BOB DOLE: We appreciate your being with us.

DONNA SHALALA: Thank you.