Veterans For America

Laura Ungar, the Courier-Journal (Louisville, KY)

Injured in a roadside blast in Iraq, Sgt. Gerald Cassidy was assigned to a new medical unit at Fort Knox, Ky., devoted to healing the wounds of war.

But instead of getting better, the brain-injured soldier from Westfield, Ind., was found dead in his barracks Sept. 21. Preliminary reports show he may have been unconscious for days and dead for hours before someone checked on him.

Sen. Evan Bayh, D-Ind., linked his death in part to inadequate staffing at the unit. Only about half of the positions there were filled at the time. The Army is still investigating the death and its cause, and three people in Cassidy’s chain of command have lost their jobs.

“By all indications, the enemy could not kill him, but our own government did,” Bayh told the Senate Armed Services Committee recently. “Not intentionally, to be sure, but the end result apparently was the same.”

As more wounded soldiers return home from war, critics say staff shortages and turnover have affected the quality of health care at Army posts across the nation.

Overall, the Army’s Medical Corps has downsized significantly since the 1991 Persian Gulf War, dropping from 5,400 to 4,300 physicians and from 4,600 to 3,400 nurses. According to the Defense Department, more than 29,000 service members have been wounded in action in Iraq or Afghanistan over the past six years, compared with fewer than 500 in Operation Desert Storm.

Warrior Transition Units, created after substandard outpatient care was revealed at Walter Reed Army Medical Center, have struggled to find enough doctors, nurses and squad leaders to serve a growing number of patients. The Defense Department allocated about $1.4 billion in operations, maintenance and construction funds for unit facilities and projects.

Military doctors and nurses at Fort Knox move every three to five years, and some are deployed overseas. For patients, that turnover often results in them being treated by doctors and nurses unfamiliar with their cases.

Late last year, Congress passed legislation requiring the Defense Department and Veterans Affairs to develop a policy on improving care for the wounded. And Army officials say they are already doing better, noting that Warrior Transition Units are approaching or meeting staffing goals across the nation.

“We’ve progressed quite well” on those units, said Brig. Gen. Michael S. Tucker, assistant surgeon general for Warrior Care and Transition. “We’ve done it while we’re at war and really strapped.”

But some positions have been filled with workers temporarily borrowed from other areas of the military, and critics say that as the number of returning soldiers grows, the need for more doctors and nurses will grow, too.

Meanwhile, officials said, Army hospitals need more staff now. Fort Knox’s Ireland Army Medical Center is struggling to fill more than 100 vacancies. It also lacks certain specialists, including neurologists who treat traumatic brain injury, considered the signature injury of the Iraq war.

“It would be very generous to say we’re at the proper staff,” said Constance Shaffery, public affairs officer at Fort Knox. “We are not at the staffing levels we want.”

Bayh pointed to a September report from the Government Accountability Office showing that more than half of the Warrior Transition Units nationwide had shortages in key positions at the time. Of 2,410 positions, 1,127 — or 47 percent — had not been filled.

Jonathan Swain, Bayh’s press secretary, said Cassidy’s family is not talking to the press as the military continues to investigate his death.

In response to a reporter’s questions about the case, Shaffery said: “There’s been nothing to indicate staffing had anything to do with it.”

Nationally, Tucker said, the 35 transition units have reached 80 percent to 85 percent staffing and were on target to reach at least 90 percent by Jan. 1.

Although the numbers are encouraging, officials acknowledge that needs are always changing. For instance, Fort Campbell’s staffing goals were developed based on an estimate of 403 patients, and there are 459. Nationwide, 8,700 soldiers are assigned to the units.

Sgt. Dwight Blackman, a 38-year-old Iraq veteran who suffered a heart attack, is one of 277 in the Fort Knox unit. In the past few months, he said, staffing “has improved a lot” and he has no problem getting the care he needs.

Staff shortages at Army hospitals have existed for years.

Nationally, the number of doctors has remained the same since 1999, Army officials said, while the number of nurses has fluctuated from a high of 4,615 in 1992 to a low of 3,381 in 2000.

Army officials said they must compensate for the higher-than-usual level of turnover that has resulted from deployments.

“We have a core group of civilian physicians who never deploy. Some have been here for 20 years,” said Lt. Col. Carolyn Tiffany, deputy commander for clinical services at Fort Knox. “They keep our clinics and services running the same way, providing the continuity of care that our patients deserve and expect.”

Still, officials said they’d like to have a more ideal staffing level in line with the demand for care.

“It’s sort of like winning the lottery,” Shaffery said. “It’s something we dream about.”