At U.S. Military Hospitals, ‘Everybody is Overworked’

USA Today

June 4, 2007 – FORT STEWART, Ga. — Winn Army Community Hospital has a baby boom it cannot handle.

Mothers and children and stroller pack the pediatrics department, another hassle after long waits for hard-to-get appointments. The problems don’t stop there. From gynecology to internal medicine, this hospital on the grounds of Fort Stewart, the biggest Army base in the South, is overwhelmed. Too many patients are demanding too many services from a medical facility with too few doctors and too little space.

Military families complain they can’t get in to see a doctor. The hospital’s top commander points to a lack of money and staff to meet basic needs. And everyone involved agonizes about whether the problems can be fixed any time soon.

The Army’s acting surgeon general says the situation here illustrates the challenge the service faces nationwide in keeping health care promises that were made to soldiers when they enlisted. Months after the problems revealed at Walter Reed Army Medical Center caused a massive shake-up throughout the military’s system of care, the service is struggling to find enough doctors and nurses to care for troops and their families.

“If you’re sending someone off into harm’s way, if you’re asking them to do the nation’s business, you need to take care of them,” says Col. Scott Goodrich, Winn’s commander. “Whenever we can’t provide the care we need to a soldier, that’s very, very painful to me.”

The Army operates 36 medical facilities worldwide. For the past two years, more than half have failed to meet Pentagon standards for providing a doctor within seven days for routine medical care. And the Army has been forced to spend more money sending military families to doctors in nearby communities. Payments for outside referrals have jumped from $200 million in 2000 to nearly $1 billion last year, records show. Outpatient care accounts for 70{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of those costs. Go through for more information.

Here at Fort Stewart, home of the 3rd Infantry Division, Winn Community Hospital is among the worst in terms of access to routine medical care. Other problem facilities, according to Army statistics, include Walter Reed, the Army’s premier hospital; Fort Hood, Texas, the Army’s largest base; Fort Campbell, Ky., home of the 101st Airborne Division; Fort Jackson, S.C., a training facility; and Fort Riley, Kan., home of the 1st Infantry Division.

Maj. Gen. Gale Pollock, the Army’s acting surgeon general, says the Army’s entire health system has trouble providing care quickly enough. Pollock visited Fort Stewart in April and calls the situation at Winn “not acceptable.”

Goodrich and Pollock say the reasons for the problems include: the demand for doctors in Iraq; a shortage of Reserve caregivers, and a cumbersome government process for hiring civilian replacements.

Such challenges are not solved easily.

The Army has 4,170 doctors, about 180 shy of what it says it needs. Pollock says she hopes the Pentagon’s plans to expand the Army to 547,000 members — an increase of 65,000 — will provide the doctors that military families need. Last year, Congress approved paying bonuses up to $400,000 for medical officers with critical wartime specialties if they agree to remain on active duty for four years.

“It takes a while to recruit them, to develop them as professionals,” Pollock says. “(But) now that we are growing the Army I’m optimistic I’m going to be allowed to grow the Army medical department staff so that we can start to address some of these issues.”

Goodrich points to a more immediate problem: the conflicting demands for limited funds. “(The Pentagon) says you’re authorized this many people. It’s not enough,” Goodrich says of his staffing. “There’s only so many dollars. If you’ve got a war, you need equipment, you need soldiers, you need body armor. If I had more money, I’d buy more doctors.”

‘It was good, it really was’

Care at Winn was excellent a few years ago, families say. “It was good, it really was,” says Gloria Smith, 50, wife of retired Master Sgt. Anthony Smith. “Since the deployment started, everybody is overworked.”

Many families share that view:

•Sgt. Joseph Waterman returned from Iraq in October 2005 with ribs and vertebrae broken in a roadside explosion. The hospital did not have enough doctors or therapists to help him.

So each week his wife, Mary, drove him three hours to Augusta, Ga., for therapy at Eisenhower Army Medical Center. That required taking their three children, including two who had to miss school, and paying $69-a-night hotel bills the Army was slow to reimburse.

“It was breaking us,” says Mary Waterman, 31. “He was hurt (in Iraq), so I thought they would go out of their way to take care of him.”

Early last year, Joseph Waterman’s case manager at Winn allowed him to finish his therapy at a private facility in Savannah, Ga., a 45-minute drive from Fort Stewart.

•Warrant Officer Dan Howison and his wife, Kathryn, wanted to have a second child before he went back to war. Kathryn Howison, 29, says the family care doctors at Winn were slow to see her and slow to refer her to the hospital’s gynecology department.

“They’d say, ‘I’m sorry we don’t have any appointments this month, call back next month,’ ” she says. “And you’re like, ‘What? You know I have a limited time here where I can try to have this baby. You guys got to get me in there!’ “

After nearly a year of delays, Kathryn was sent to a private fertility clinic in Savannah, where hormonal treatments led to conception last year. The Howisons’ daughter, Piper, was born last week. Dan Howison will head to Iraq this summer.

•Amy Lambert, 40, a mother of three whose husband is being deployed to Iraq in two to three months, says Winn doesn’t have enough staff members to follow up with patients after office visits.

“You have to be the one who pesters them and calls them,” she says. “If you say, ‘Fine, I’m tired of dealing with this,’ that’s what they’re hoping for.”

Patient complaints rise

Linda King, a hospital patient representative since 1990, says there are more complaints than ever. Complaints filed with the hospital hit a record 616 in March, four times as many as March 2006. Three out of four were about access to care or service delays.

Soldiers and families from closed bases have moved to Fort Stewart, adding to the number of those eligible for care at Winn. The potential patient population has swollen 40{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} to 74,000 since the facility opened in 1983, officials say.

The hospital’s emergency room often has only one doctor on duty and strains to handle the demand, receiving 70 to 110 patients per day. Visits jumped to 36,000 last year, up from 30,000 in 2005.

Hospital data show most of those seeking care should not be there in the first place because they are not emergency cases. Seventy-five percent of ER visits in March were for issues such as flu symptoms, chronic pains or prescription fills — matters the hospital’s family doctors should handle, but are too busy or short-staffed to take on.

“They (patients) say, ‘I’ve been trying to get an appointment for two weeks and I’m tired of waiting, I just need to see somebody,’ ” says Maj. Chad Marley, chief of Winn’s emergency room. “Although it makes our job difficult at times, I take some pride in the fact that I’m the only place in the hospital that doesn’t say, ‘No.’ “

Carol Reynolds, 39, the wife of a deployed lieutenant colonel, says she had to change her doctor four times in four years. Goodrich says continuity of care at Stewart is “non-existent.”

And while out-patient services are strapped for space, in-patient rooms are empty because of the shortage of doctors and nurses. Winn is listed as a 112-bed facility, but it can staff only 91 in a major emergency and 40-45 beds routinely, Goodrich says.

Overall, the hospital’s annual budget has nearly doubled since 2001 to $72 million. That’s still nearly $10 million shy of expenses.

Reconfiguration and expansion of the hospital could help ease overcrowding and improve access to care, Goodrich says.

A 2006 Winn hospital Master Plan calls for seven new expansion projects to add 45,000 square feet and renovate another 74,500 square feet of space. Only one project has been approved by the Pentagon, however, and it is delayed until 2013, budget records show.

“Build me a bigger hospital, I’ll take care of more,” Goodrich says.

Hopes for improvement

The situation adds to the stress for family members of soldiers fighting in Iraq or Afghanistan, says Col. Todd Buchs, the Fort Stewart base commander.

“If you look at the average life of a military spouse, it’s a stressful life,” Buchs says. “You’re raising your children with basically a single-parent family. Throw one more stressor on them — being frustrated with the hospital — it just makes your life more frustrating.”

One solution would be to send more patients to see doctors in nearby communities.

However, fewer private doctors want to accept military patients. Some doctors shun Tricare, the military insurance program, which pays the same modest rates as Medicare.

Other doctors only accept military patients if they can prescribe whatever medical treatments they deem necessary, which often conflicts with Army physicians who may prefer more limited procedures, Goodrich says.

Goodrich says he believes Winn is about to get better. With much of the 3rd Division gone to Iraq and some new doctors hired, Goodrich says he can improve access to care and take the pressure off the ER.

Buchs says he hopes the changes work. Families “don’t expect people to feel sorry for them,” he says. “All they want is to be treated with the appropriate care that we can give them because of the sacrifices they are making.”

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