In a rush to correct reports of substandard care for wounded soldiers, the Army flung open the doors of new specialized treatment centers so wide that up to half the soldiers currently enrolled do not have injuries serious enough to justify being there, The Associated Press has learned.
Army leaders are putting in place stricter screening procedures to stem the flood of patients overwhelming the units - a move that eventually will target some for closure.
According to interviews and data provided to the AP, the number of patients admitted to the 36 Warrior Transition Units and nine other community-based units jumped from about 5,000 in June 2007, when they began, to a peak of nearly 12,500 in June 2008.
The units provide coordinated medical and mental health care, track soldiers' recovery and provide broader legal, financial and other family counseling. They serve Army active duty and reserve soldiers.
Just 12 percent of the soldiers in the units had battlefield injuries while thousands of others had minor problems that did not require the complex new network of case managers, nurses and doctors, according to Brig. Gen. Gary H. Cheek, the director of the Army's warrior care office.
The overcrowding was a "self-inflicted wound," said Cheek, who also is an assistant surgeon general. "We're dedicating this kind of oversight and management where, truthfully, only half of those soldiers really needed this."
Cheek said it is difficult to tell how many patients eventually will be in the units. But he said soldiers currently admitted will not be tossed out if they do not meet the new standards. Instead, the tighter screening will weed out the population over time.
"We're trying change it back," to serve patients who have more serious or multiple injuries that require about six months or more of coordinated treatment, he said.
By restricting use of the coordinated care units to soldiers with more complex, long-term ailments, the Army hopes in the long run to close or consolidate as many as 10 of the transition units, Cheek said during an interview in his Virginia office near the Pentagon.
In the past, a soldier with a torn knee ligament would have surgery and then go on light duty, such as answering phones, while getting physical therapy. But last October, the Army began allowing soldiers with less serious injuries such as that bad knee to go to the warrior units.
The expansion came in the wake of reports about poor conditions at Walter Reed Army Medical Center in Washington, D.C., including shoddy housing and bureaucratic delays for outpatients there.
Brigade commanders began shipping to the transition centers anyone in their unit who could not deploy because of an injury or illness. That burdened the system with soldiers who really did not need case managers to set up their appointments, nurses to check their medications and other specialists to provide counseling for issues such as stress disorders.
The Army's goal now, as spelled out in a recent briefing given to Defense Secretary Robert Gates, is to screen out those who do not need the expanded care program, shifting them to regular medical facilities at their military base or near their homes.
Jon Soltz, an Iraq war veteran and chairman of VoteVets.org, said the Pentagon is making a fair argument. He acknowledged that some soldiers with less serious injuries might not need the units' services.
But he said commanders need to be able to move their soldiers who cannot deploy due to an injury to the units because that is the only way they can get a replacement before going to war. Otherwise, the brigade goes to battle without the forces needed.
"The larger concern here is that the problem that is driving this is the manpower problem," said Soltz. "The Army is overextended. We don't have enough guys."
It is vital, he said, that the medical system care for all the solders who need help and that any changes should not threaten that care.
Raymond F. DuBois, a former acting undersecretary of the Army and manpower adviser under then-Defense Secretary Donald H. Rumsfeld, said the units address "a problem that was not made aware at the highest levels" and do it well. But he has worried for months that the units were overstretched.
"Guess what? They did it so well everybody wants in," said DuBois, now an adviser at the Center for Strategic and International Studies.
Cheek stressed that the new more stringent screening process will not deny care to soldiers in need or limit the treatment units to those with battle wounds.
"We don't really care about the source of the wound, illness or injury. We really care about the severity of the wound, illness or injury," said Cheek. "So if it's a severe, very acute condition that needs rehabilitation and a lot of management and oversight, regardless of where it comes form, that soldier needs to be in this program."
The latest data shows that it is working: The patient load is starting to inch down, from the peak of 12,478 in June to less than 11,400 in October.
Cheek estimates that the screening process will reduce the number to between 8,000 and 10,000.
As those numbers come down, the Army is also reviewing which units get more use. The list of potential closings include warrior transition units at Fort Rucker and Redstone Arsenal, in Alabama; Fort Leavenworth in Kansas; Fort Dix in New Jersey; and Fort Irwin in California. According to Army data, many of them either have only a dozen or so patients now, or can be combined with another nearby facility.
At Fort Campbell in Kentucky, however, more than 600 soldiers are in the treatment program. Staff there are bracing for a surge of patients when the three 101st Airborne Division brigades start returning home in the coming months.
Gen. Peter Chiarelli, Army vice chief of staff, toured the unit in late October. He gathered more than two dozen staff around a long table to hear their concerns about how the program is operating. Afterward he marveled that they talked not about their own administrative complaints, but about specific problems they were trying to solve for their patients.
In a small office down the hall, Lisa Gaines was blunt about what the unit meant to her.
"It's done wonders for our family," said the mother of five.
Seated next to her, Spc. Sean Gaines nodded quietly as his wife talked about the strains his injury had on the family and how the staff worked to heal all wounds - physical and emotional.
Deployed to Iraq in 2004 with the 2nd Brigade, 101st Airborne Division, cavalry scout Gaines was shaken but not bloodied by the blasts of several car bombs and a house explosion. Yet when he returned home, he began having pain and his body went numb. The medical diagnosis was a crushed cervical disc - an injury he got either in Iraq or in training, only to surface later.
After surgery in October 2007, he came to Fort Campbell's warrior transition unit - but he needed more than physical therapy. He had been told he could no longer serve as a scout.
"He loves the Army, he loves the military. For them to tell him he could no longer be a scout, it was difficult. It was a strain," recounted Lisa Gaines. He was agitated, angry and withdrawn, she said.
In response, the warrior unit gave him underwater training as therapy for his injury, coupled with family counseling, budget management and career help.
"I realized I had options, I could continue to serve," said Sean Gaines, who soon will leave the transition unit and take on a new Army job doing transportation management.
The counseling gave him time to figure out his options, come to terms with the change, and understand that he could either "drive on or prepare to exit," he said.
He decided to go on, saying, "I am not going to be a scout, but I will still be part of a team."
According to Army data, the key struggle is keeping the transition units fully staffed. In many of the more remote locations, Army leaders have trouble finding enough nurse case managers. As of the end of September, 12 of the units based at military posts were short those case managers.
Other locations, such as Fort Drum, N.Y., do not have enough behavioral health specialists.
Closing some of the locations may help ease those shortages, Cheek said.
"It shouldn't be too surprising," he said. "We're 18 months old here, so now it's time for us to relook at how we're doing this, and where we can gain some efficiencies."
He added that an order coming out in December will further refine the screening criteria for the transition units. In particular, it will call for the Army to identify other ways to provide care for reservists so they can receive the treatment they need closer to their homes, which often are far from large military bases.
The Army chief of staff, Gen. George Casey, has made it clear that any soldier who needs the coordinated care must get it, regardless of how many soldiers end up in the program.
Meanwhile, officials are building permanent care centers at the main bases over the next several years, at a cost of more than $1 billion. Annual operating costs are about $270 million, with the staff of about 3,000 consuming most of that expense.
Nearly 40,000 service members have been wounded in action in the Iraq and Afghanistan wars as of Friday, although more than 18,000 returned to duty within 72 hours of their injuries, according to Defense Department data.