Assignment of Traumatic Brain Injury (TBI) to VA Hospital

TA Maxwell

LtCol, USMC

TBI

(Microsoft Word)

Around the entire country, there are four Level 1 TBI Veteran Affairs (VA) Hospitals. In New York alone, there are four.

 

If you are from New York, you might prefer it. It's near home; you can keep your job and still see your word child every day; you will transfer from inpatient to outpatient at the same place, with the same doctors; Tri-Care will pay for it, as they pay for VA hospitals.

 

It sounds good, but you will let him them decide. Surely they know the best decision.

 

You are sent to VA.

 

 


 TBI - VA Hospitals

 

Wounded Warriors identified with Traumatic Brain Injuries (TBI), primarily those in the National Naval Medical Center (NNMC), who are identified as patients required to remain as an in-patient, are moved to one of the four VA Hospitals. Those hospitals include:

 

James A. Haley Veterans' Hospital

Tampa, Florida

 

VA Palo Alto Health Care System

Palo Alto, California

 

Hunter Holmes McGuire VA Medical Center

Richmond, Virginia

 

Minneapolis VA Medical Center

Minneapolis, Minnesota

 

Historically, people have been unhappy with the professionalism and performance of these hospitals. A few issues include; staffing, inconsistencies with timing of medication, treatment plateaus with recommendations for long-term care without consideration of alternative treatment options. This is just a few of them.

 

While many improvements have been made throughout VA, and some people are satisfied with what they receive, there are still families who are dissatisfied. However, this has nothing to do with these issues. If the VA hospitals are identified as the best in the nation, the issues remain.

 

The Issue

 

When the doctor decides to send the patient to a Level 1 Polytrauma Hospital, families do not receive the option of going to a civilian hospital. Some case managers provide the families with the option of choosing one of the VA hospitals, others do not even to that – dictating one VA hospital only.

 

For the last two years, I have traveled to Bethesda Naval Hospitals to meet with families of wounded Marines, sailors, and even soldiers. In every case, I would ask them where they were from, and what hospital they were going to next. And nearly every time, they told me “the case manager told me we were going to ____”.  Did they choose that one? Yes, they would say. They had been given the choice of choosing one of the four.

 

And they were unrelated, unless the family happened to live near the VA hospital.

 

And in every case, I attempted to talk to their case manager. When approached, I would explain to the case managers that the families of combat wounded service members have the right to choose a civilian hospital that accepts Tri-Care. The discussions were having no, to little impact. I approached Doctor _________, the Doctor in charge of coordinating the final decision. Every time we talked, she had a new reason why the patients had to go to the VA hospital that had been chosen. Some examples:  

           

   Togetherness is critical for TBI individuals.

      I am fairly knowledgeable on this issue. I came up with the Wounded Warrior Barracks (Maxwell Hall) in Camp Lejeune, NC. Togetherness is very important. But when it comes to TBI, particularly severe TBI, it is the family that matters the most. Many, if not most, TBI individuals can barely function. They do not hang out with their “new friends”. But the families who are heavily engaged? Every minute of every day. Talking. Touching. Loving. For months at a time.

            And if they are near their families home, they see their uncles, aunts, and grandparemts as well. But if they are from New York, and they are in the Richmond VA Hospital, their “togetherness” will be significantly reduced.

 

   My job is to do what is the best for the injured, not the family.

            I agree. The wounded Marine/sailor is the most important. We should do whatever it takes to make Wounded Warrior better. And the families are critical. They need them to be with them. To hold their hand. To wipe their bottoms. Help them take their pills. They also make sure food is eaten, and water is drunk. Nurses are not in that room all day long. It is impossible. Families are.

 

            With a TBI, you might conduct rehabilitation training 3 or 4 times a day. Most train less. But with your family, you train from dawn to dusk. Every minute, every day. Again, talking, touching, feeding, is training. Bottom line: Family involvement has been shown to elevate the levels of rehabilitation. They need to be there.

        

VA Hospital is the best

            This was incorrect. Back then, every family that I had met that had been sent to this hospital has been unhappy. The best example is the Cooley family. They spent 9 months there, and at the end of the 9th month, the Cpl Cooley’s parents were notified that his improvement was complete, and he was to be moved out. The Cooley parents strongly disagreed, and were finally moved to a hospital in Los Angeles. It was a war of its own, but they won. Within 2 days, Cpl Cooley was talking. Today, he walks. Plays his guitar. Chats with his parents and friends. It's amazing, really. But if they had not fought that battle; if he had gone to that “Care Center”, like Tampa VA had told them, it would not be the same.

            And the case manager told me how great the Tampa VA hospital was.

 

   When you get off active duty, you do not rate Tri-Care.

            Correct. This is why TBI wounded Marines/sailors stay on active duty until they are, at least, an out-patient. When they are an out-patient, they usually move home. Again, if they were in a civilian hospital near their home, the transition would be much, much easier. When not near home, they have to get new doctors, at a minimum. That is what I had to do, four different times.

 

            Also worth mentioning… everyone seriously burned, and sent to BAMC, or who lost limb(s), and are in Walter Reed, remain on active duty until they are completely done. I know warriors who had been in BAMC for over three years. It is great. On active duty, so they can stay in that hospital with no questions. Why should TBI patients be treated differently?

 

            If VA hospitals are the best in the world, unless the family lives near there, they are unable to work their jobs, or pay their bills, but they usually stay. Many of them do not even have a car. They do not rate a rental car. They are not funded for a trip home to get their personal car. Generally, they are not funded to return home for any reason. So, they tend to go bankrupt. But they don't care. They just want to take care of their son.

 

But if they were near home, it sure would be nice.

 

The Solution

 

Every time I talk about this, people say “you're right”. Families in particular agree that it would be, or would have been, much better if they had been there. As time goes by, it is improving. More families are being sent to a civilian hospital near their home. But it is not the standard. Most of them are sent to VA a hospital. Case managers are the key. Some of them offer options; some of them don't; but I have never met one who does the proper research that they need.

 

If the family is from New York, for example, there could be a few options. They could go to any VA Hospital of their choice. If they prefer a warmer winter, they can go to Tampa Florida. Whatever. But if they want to stay near home, so they can see their other kids, drive your own car, have their relatives nearby, etc., they can go to a TBI Hospital there in New York. The case manager should give this information to them. They couldn't even make a recommendation. But they often do not. Even when the family is from New York. Imagine Montana, where TBI hospitals are not known. To find the closest one, someone needs to do some proper research. The family can't do it. It is hard enough to think.

 

Case managers should be required to provide a civilian hospital that is TBI qualified near their home.

 

To truly support our Wounded Warriors with a series TBI, that is what should be done.

   
 

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