Major Gaps Found In Care Of Traumatic Brain Injuries

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Traumatic Brain Injuries

There are "majorgaps" in identifying and treating traumatic brain injuries inservicemembers, according to an Army task force report released onThursday, USA Today reports. According to the report,which was completed in May 2007, the gaps "were created by a lack ofcoordination and policy-driven approaches." The task force found gaps inthe identification and treatment of soldiers who have mild traumatic braininjuries often resulting from exposure to roadside bomb blasts, despite thefact that researchers at the Defense andVeterans Brain Injury Center in 2004 developed ways of identifying the injuries.

According to the Army, 10% to 20% of Marines and soldiers returning from Afghanistan and Iraq might have experienced braininjuries, which often have no outward signs of injury. According to USAToday, at least 20,000 servicemembers from the wars in Iraq and Afghanistanhave been diagnosed with or have shown signs of brain injury (Zoroya, USAToday, 1/18). More than 80% of servicemembers who have mild braininjuries and receive proper treatment completely recover, the task force said.According to Col. Robert Labutta, a neurosurgeon with the Army surgeongeneral's office, less than half of servicemembers who have experienced a mildtraumatic brain injury in combat have persistent symptoms associated with it(Hefling, AP/Contra Costa Times, 1/18).

The task force in May made 48 recommendations to improve the diagnosis,treatment and research into brain injury. Nine of those recommendations havebeen implemented, and 31 are being addressed. Recommendations that have notbeen addressed include establishing better ways of tracking the incidents ofbrain injury and identifying former soldiers who may have experienced a braininjury, but left the service; expanding baseline testing of a soldier's brainfunctions; and standardizing care and treatment for soldiers with braininjuries at all Army hospitals.

Judith Ruiz, a task force member and program manager for traumatic braininjury, said, "Since the release of the report (in May), we've beenworking arduously to put these recommendations into action." Brig. Gen.Donald Bradshaw, the task force's chair, said, "This is a very complexprocess and so the fact that we've made headway on all of these recommendationsis really very, I think, laudatory" (USA Today, 1/18). Headded that, although the Army has a handle on treating more severe braininjuries, it is "challenged to understand, diagnose and treat militarypersonnel who suffer with mild" traumatic brain injuries (AP/ContraCosta Times, 1/18).


Mandatory Spending

The Commission on the Future for America's Veterans this summer is planning to releasea report that will call for a "government-chartered entity" funded bymandatory spending to provide health care for U.S. veterans, members said at a New America Foundation forum on Wednesday, CQ HealthBeat reports. Commission member KennethKizer, a former undersecretary of health at the Department of Veterans Affairs, said the new organization, which was giventhe working title of the Veterans' Healthcare Service, would have abureaucratic structure similar to that of the U.S. Postal Service. The commission is recommending that veterans' health care switch fromfunding by discretionary spending to mandatory spending to provide the neworganization with a predictable stream of revenue and more control over how tospend funds. Commission members also expressed concerns about the possibilityof cuts to veterans' health care as mandatory spending for long-termentitlements, such as Medicare and Social Security, require more federalfunding (Yoest, CQ HealthBeat, 1/17).


Gerald Cross, principaldeputy undersecretary of Veterans' Health, on Thursday during a hearing of theHouse Veterans' Affairs Subcommittee onHealth said hesupports several veterans' health bills, but he criticized some of the measuresbecause they duplicate, overlap with or do less than established programs, CQHealthBeat reports.

Cross said that he "strongly supports" a bill (HR 3819) backed byveterans' groups that would prevent veterans from paying high out-of-pocketcosts for emergency care not received at VA facilities. However, he said thathe opposes a bill (HR 3458) to improve traumatic brain injury treatment inrural areas by establishing pilot programs in five states. He said, traumaticbrain injuries "cannot be treated in a vacuum." Cross also said VAopposes a bill (HR 4231) that would establish a pilot program to test the useof vouchers for mental health care services in areas at least 30 miles from aVA facility.

According to Cross, VA opposes legislation (HR 4053) that would requirecomprehensive treatment for substance abuse disorders and the designation of atleast six "centers of excellence" nationally for treatingpost-traumatic stress disorder and substance abuse disorders. He said, "Wecannot support its prescriptive approach of mandating forms of treatment,treatment settings and composition of treatment teams," adding, "VAhas previously expressed its difficulties with the concept of centers ofexcellence as opposed to the achievement of an overall standard of delivery ofexcellent care on a national basis" (Reichard, CQ HealthBeat,1/17).

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