By C. Todd Lopez
WASHINGTON (April 27, 2010) -- The Army surgeon general invited members of the press, politicians and especially parents and families of Soldiers now assigned to the Army's "Warrior Transition Units" to see for themselves what conditions exist there.
"Come and visit. Spend a day, a week, go to formation with them. Go to treatment with them," said Surgeon General of the Army Lt. Gen. Eric B. Schoomaker. "There is nothing being hidden here."
The WTUs are units set up across the Army specifically to help wounded Soldiers transition from injury back into an active Army unit or back into a productive civilian life. Schoomaker said those concerned about conditions in the units, the kind of treatment Soldiers get there, or the way medicine is practiced, should reserve judgment until they have seen it for themselves.
"There should be nobody out there questioning either our motives or how we are executing this that hasn't seen it first-hand," Schoomaker said. "They need to come and see it."
The press conference was held in response to a front-page article in Sunday's New York Times about the WTU at Fort Carson, Colo. The article raised questions about the amount of medication prescribed to WTU Soldiers, misuse of prescription drugs by Soldiers, possible illegal use of street drugs by Soldiers, care for Soldiers, and also levels of discipline meted out by unit cadre to those in their care.
"We are concerned about over-medication," Schoomaker said, noting that pain management is reliant on the use of medication, and not just across Army medical care. "We're very concerned about our under-treating and under-recognizing pain."
To address that concern, the general chartered a pain management task force a year ago to look at the problems involved in pain management and to find alternative ways to treat pain, including such things as yoga, meditation and acupuncture, for instance.
"We are very concerned about that panoply of drugs that are being used and the number of drugs being used," Schoomaker said.
To deal with that issue, prescription records for Soldiers are tracked Department of Defense-wide in electronic databases, he said.
"We have a fairly comprehensive snapshot of all the prescription use across the Army," Schoomaker said. "And we can target that to the 9,000-plus Soldiers that are in WTUs. We know that WTUs in general, Soldiers in there, have a higher prescription drug use than not. Those are patients with complex problems."
About 75 percent of Soldiers in WTUs are on some sort of prescription medication, the general added.
At the WTU at Fort Carson, Colo., about 26 percent of WTU Soldiers have been prescribed a narcotic, said Col. Jimmie O. Keenan, commander, Evans U.S. Army Hospital, Fort Carson, Colo. She also said a clinical pharmacist is assigned to the WTU to monitor the medications that Soldiers are getting there. Soldier prescriptions are reconciled with primary care mangers for each Soldier, and also with behavioral health providers to ensure everybody knows what drugs Soldiers are being prescribed.
"Any illicit drug use -- either illicit use of prescription medications or illegal drugs -- is a huge concern for us," said Brig. Gen. Gary H. Cheek, commander, Warrior Transition Command. "Frankly we would view illegal drug use as absolutely contrary to recovery and the progress of a Soldier moving into their future."
While both Cheek and Schoomaker agree that there is illegal drug use in WTUs, they said it isn't at a rate much higher than that of the rest of the Soldier population, and there doesn't appear to be any particular drug in widespread use.
"I don't sense and have feedback from across our commanders, of an extraordinary reliance on heroin or a rising use of one particular drug over anything else," said Cheek. "And I think that our Soldier drug use in WTUs is probably very closely aligned with the Army's overall average."
At Fort Carson, in the substance abuse program there, about 6.58 percent of Soldiers are enrolled for opiate-related issues -- that includes heroin. At the WTU, there have been about 80 illegal drug incidences since 2008.
Keenan said the units there try to minimize drug use amongst Soldiers though inspections and urinalysis. The WTU there, for instance, conducts a 100-percent urinalysis each month on all Soldiers, including cadre. Each month, four percent of Soldiers are also subject to random inspections. Additionally, the unit there conducts room inspections for contraband drugs and also maintains lists of what drugs Soldiers are prescribed, to compare against what Soldiers have in their possession.
Keenan also said that Soldiers are given mandatory education on the effects of mixing drugs and alcohol.
"Some Soldiers don't understand how alcohol mixes with medication, as well as other medications that they might try to take from other Soldiers," she said.
Soldiers in WTUs aren't just getting treated for bodily damage -- they are getting treated for things such as post traumatic stress disorder as well. Schoomaker said that ratios between Soldiers and staff are set so that every Soldier gets the care they need, and nobody falls between the cracks.
"There is prescribed interaction between squad leaders and those Soldiers for whom they are responsible," Schoomaker said.
Currently, the Army Medical command has a prescribed ratio at WTUs of one squad leader to every 10 Soldiers, and one nurse case manager for every 20 Soldiers. At Fort Carson, however, that ratio is more robust than the standard prescribes. At WTUs at Fort Carson, there is one squad leader for every eight Soldiers, and one nurse case manager for every 15 Soldiers, according to Keenan.
Cheek also said that the WTUs use comprehensive transition plans -- run by a social worker -- to help Soldiers develop goals for their futures. The plans are reviewed weekly, Cheek said, to help Soldiers work through each issue that can stand in the way of their goal. The WTU's goal, Cheek said, is to get Soldiers "excited about their future," and to let them know "you can have an effective and productive future."
Around 9,300 Soldiers are in the Army's Wounded Warrior program now, Schoomaker said, adding that not all of those Soldiers are going to be happy with the programs the Army provides. "We don't always get it right," he said. "We take every criticism and concern seriously and continuously strive to improve our program."
The general also said that Soldier surveys show that satisfaction with Warrior Transition Units is at 81 percent Army-wide. At Fort Carson, that number is at 90 percent.