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Friday, February 22, 2008

Amidst Warrrior Transition Unit Overdoses, Army Surgeon General Schoomaker Blasts Streamlined Disability Pilot Project as 'Fast Bad Process'

From Kelly Kennedy, Army Times:

A pilot project intended to speed the process of evaluating and rating service members’ disabilities will do little more than turn a bad process into “a fast bad process,” the Army’s top medical official said Friday.

Army Surgeon General Lt. Gen. Eric Schoomaker’s comments came at a hearing at which the services’ surgeons general had their chance to brag about what they have done in the year since the outpatient scandal at Walter Reed broke — standing up units specially designed to take care of wounded troops, asking for and receiving money to house those service members, ombudsmen, internal checks and toll-free numbers for reporting problems – before the House Armed Services Subcommittee.

Schoomaker also spent some time talking about continued problems, including his view that the pilot project designed to streamline the disability system will not prove to be the answer. Under the test, taking place at three military medical facilities and one VA medical center in the Washington, D.C., area, service members will receive a single medical examination and a single disability rating issued by VA, an effort to eliminate duplication in the separate military and VA systems and speed up the process.

But Schoomaker said both the military and VA systems for dealing with service members’ disabilities is based on an “outdated” model from the 1940s, when most of the force consisted of single soldiers with no health care. “When you speed up a bad process, all you have is a fast bad process,” Schoomaker said of the ongoing pilot project.

On other issues, Schoomaker said mental health descriptors used by military medical professionals need to be updated to fit today’s ideas about post-traumatic brain injury and depression.

He also said the Army found a new “trend” as it grouped all of its wounded soldiers into one system where they could be carefully monitored: 11 deaths in that population due to suicide, accidental overdose by prescription medications, and in motor vehicle accidents. Schoomaker said the combination of multiple prescription drugs — usually pain medication — mental health issues, alcohol and no supervision on the weekends are contributing to the problem.

In educational interest, article(s) quoted from extensively.

More on that new trend from an AP report earlier in the month, coming amidst the attention accidental overdoses was given in the wake of actor Heath Ledger's death:

Lt. Gen. Eric B. Schoomaker, the Army’s surgeon general, said there has been “a series, a sequence of deaths” in the new, so-called “warrior transition units.” Those are special units set up last year to give sick, injured and war-wounded troops coordinated medical care, financial advice, legal help and other services as they transition toward either a return to uniform or back into civilian life.

Without giving a number, Schoomaker said the deaths among the convalescing troops were “accidental deaths, we believe, often as a consequence of the use of multiple prescription and nonprescription medicines and alcohol.”

“This isn’t restricted to the military, alone, as we all saw the unfortunate death of one of our leading actors recently,” Schoomaker told Pentagon reporters. ... Schoomaker said he didn’t know whether the number of overdoses among soldiers was on the rise, but would try to provide statistics as soon as possible. The series of deaths was noticed and is getting attention partly because the new units concentrate the Army’s temporarily disabled and ill into special groups, thus making it possible for leaders to track and tabulate their health issues more closely and carefully than ever before.

“We’re dealing now with a group of wounded, ill or injured soldiers that have available to them through the medical system, a constellation of very potent and potentially lethal drugs (when taken) in the wrong combination,” Schoomaker said. Officials are working to try to prevent such deaths and “alert the soldiers themselves about what the medications they have may do to them,” Schoomaker said.

'Safety net' proposed
Officials want to “put a safety net around those folks who might have either psychological problems or other injuries or illnesses which may make it difficult to manage a constellation of drugs,” he said.

“I don’t believe those are suicides in the conventional sense. I think these are truly accidental deaths,” he said.

Schoomaker brought up the subject of overdoses when asked how he assessed recent preliminary figures indicating a possible rise in Army suicides during 2007.

The figures showed that, as of last month, officials had confirmed 89 suicides last year among active duty and activated National Guard and Reserve — and that another 32 deaths were still under investigation. If all are confirmed, the total of 121 would be nearly a 20 percent increase over 2006.

Soldiers who have killed themselves most commonly have used weapons, not drug overdoses, which accounted for less than 10 percent of suicides in recent years, according to Army figures.

Statistics show accidental overdoses have become a national problem, with the deaths from accidental ingestion of multiple prescription drugs now exceeding deaths from illegal drugs, Schoomaker said.

Unfolding throughout February, more details trickled out on these "drug cocktail" overdoses. Last week, the AP reported:

There have been at least three accidental drug overdoses and four suicides among soldiers in special units the Army set up last summer to help war-wounded troops, officials said late Thursday.

A team of pharmacists and other military officials met early this week at the Pentagon to look into the deaths in so-called "warrior transition units" - established to give sick, injured and wounded troops coordinated medical care, financial advice, legal help and other services as they attempt to make the transition toward either a return to uniform or back into civilian life.

The Army said officials had determined that among those troops there have been 11 deaths that were not due to natural causes between June and Feb. 5.

That included four suicides, three accidental overdoses of prescribed medications, three deaths still under investigation and one motor vehicle accident, the Army said.

"Army medical and safety professionals continue to remind soldiers and their families of the importance of prescription-drug safety precautions, including following the printed directions and information for each medicine," the Army said of the overdoses in a statement Thursday. Noting the death of actor Heath Ledger, Army Surgeon General Lt. Gen. Eric B. Schoomaker last week first disclosed the issue of drug overdoses in the 35 special transition units, which care for more than 9,500 soldiers.

This comparison did not sit well with everyone:

Sen. Evan Bayh, D-Ind., [a member of the Senate Armed Services Committee,] told reporters during a conference call Friday that likening Ledger's death to the deaths by overdose of wounded soldiers was not appropriate because Ledger was not injured in combat.

"He didn't have a traumatic brain injury," Bayh said. "He wasn't, as far as I know, under a physician's care or residing in a unit designed to protect him and treat him or given by his own caregivers potentially lethal doses of medication and left to self medicate himself when he had a traumatic brain injury."

Said Bayh, "I just think that analogy is inappropriate and I hope it will stop."

The senator pushed for an investigation following the death of Sgt. Gerald Cassidy, a member of the Indiana National Guard. Cassidy, who was in one of the transition units, was found dead in his room Sept. 21 at Fort Knox, Ky., about 15 months after being wounded by a roadside bomb in Iraq.

An autopsy later determined he had been dead for hours and might have been unconscious for days before he was found alone. The Army Criminal Investigation Command determined the death was accidental and caused by a multidrug toxicity complicated by severe atherosclerotic coronary arterial disease.

Paul Boyce, an Army spokesman, said Friday that Schoomaker's intent by the comments was to educate about the growing health risk of overdoses in the military population and the American population as a whole.

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