Transition staff for military wounded poorly trained, stigmatized, fatigued
By Carl Prine
Published: Monday, February 7, 2011
FAYETTEVILLE, N.C. -- On May 28, 2007, a bomb planted by an Iraqi insurgent along Route Canal in the village of Zaganiyah tore into Sgt Ken Katter's truck.
Blood dribbling from his ears and regaining consciousness, the Army cavalry scout dusted himself off and never left the front lines of America's Global War on Terror.
The 5-73rd Cavalry hung a Purple Heart on his chest, and Katter kept patrolling Diyalah Province's deadliest acres, despite mounting seizures, debilitating migraines, wrenching neck and back pain, and nerve tremors that quaked his arm, according to medical records provided to the Tribune-Review.
Once back at North Carolina's Fort Bragg, however, Katter's chain of command accused him of shirking his duty. Shuffled off to a Warrior Transition Battalion in the shadow of the base's Womack Army Medical Center, Katter was bedeviled for nearly three years by "cadre" staffers, soldiers without combat experience who were supposed to care for him.
For a man who honorably served in the Marine Corps and left to become a Michigan police officer before joining the Army after the Sept. 11, 2001, terror attacks, it was hard to understand.
"I didn't expect our own people to treat us like that. At least in Iraq, we knew who the enemies were," said Katter, 43, of Saginaw, Mich.
His cadre stole Christmas presents intended for the wounded, threatened him with criminal charges for lying about his fitness -- allegations later proven unfounded by a Fort Bragg investigation -- and tagged him with a crude nickname they scrawled on a duty board, according to Fort Bragg files, as well as interviews with Katter and nearly a dozen former combat veterans and local volunteers assigned to his Warrior Transition unit.
A highly decorated but permanently disabled soldier diagnosed with the signature wounds of the wars in Iraq and Afghanistan -- traumatic brain injury and post-traumatic stress disorder -- Katter was honorably discharged from the Warrior Transition unit in August.
He was given a 100 percent permanent disability rating by the Veterans Administration, according to his medical files.
Fort Bragg commanders insist that what Katter and other combat vets experienced will never happen again, as a result of ongoing changes from the top to fix the Warrior Transition unit there.
"This organization is truly all about leadership. Period," said Army Lt. Col. Tom Schumacher, 43, who took over the unit Nov. 3. "We have 626 warriors in transition. That's 626 missions we need to lead them through. The only way you can manage that is through leadership, with compassion."
The majority of staffers recruited to care for wounded, injured and sick soldiers at the Army's 29 Warrior Transition units and nine special off-site programs for Reservists are decent, hard-working men and women, according to documents passed to the Trib by the Pentagon's Office of Wounded Warrior Care and Transition Policy in Alexandria, Va.
But the reports contend that they're also set up to fail: Cadre duty is a stigmatized chore that's detrimental to career advancement; the staffers often have been poorly trained and easily overwhelmed by the "high stress" and "complex" work and are "not able to meet the demands of the job." Some suffer from "compassion fatigue" with bad consequences for vulnerable soldiers entrusted to their care.
The Army could fix those problems by cutting back on "collateral duties" assigned to Warrior Transition staffers, who undergo the constant strain of dealing with high-risk soldiers likely to abuse drugs, cause trouble or commit suicide, records state.
At the Army's Schofield Barracks in Hawaii, for example, investigators found cadre routinely assigned collateral duties, such as manning a 24-hour office desk while still being expected to aid wounded soldiers, a practice that "divides their attention between two sets of responsibilities," according to the reports.
The files say that the cadre there "may need to be screened for their own possible PTSD and how to recognize symptoms of compassion fatigue." The reports allege that "cadre and caseworkers are overwhelmed. Caseloads too high." Commanders begged for more cadre to overcome staffing shortages exacerbated by having to drive long hours across Oahu to get patients to their medical appointments, according to the documents.
Military officials declined to tell the Trib if they got the extra help.
It was a theme the Pentagon investigators heard at other bases. The reports show that they were told at Fort Riley in Kansas that the Army's standard staffing ratio of one cadre soldier to every 10 patients should be nearly halved and that burn-out affected nearly the entire cadre after only two years of duty.
Files also show Army Brig. Gen. Jeff Mathis III, then-acting commander of Joint Base Lewis-McChord and "I" Corps in the state of Washington, telling investigators that a "great deal of pressure" affected the cadre there and they lacked a "sufficient replacement plan in place" to guide those following them.
In the report, the base's cadre to patient ratio was one to 14.
"If you look at it from the cadre's perspective, the question becomes, 'When does it end?' You're dealing with some bad people, maybe 20 who don't belong there. And you're trying to help those who are genuinely wounded and want to go back on the line, and you've got collateral duty. You have to be a strong person to put up with that, especially when there's no end in sight," said former Deputy Undersecretary of Defense Noel Koch.
Koch says he was forced to resign from the Pentagon in April after detailing Office of Wounded Warrior Care and Transition Policy investigative findings to his superiors.
Officials declined to comment.
Koch's investigators concluded that cadre staff nationwide were violating standing Army orders by scheduling garrison watch duties for recovering wounded. That practice deprived patients of sleep and often retriggered PTSD symptoms, they reported. The files disclosed a "recurring theme" of cadre forcing the wounded to "participate in physical training and meet height and weight standards despite portfolio showing medical conditions" barring the training.
After Iraqi insurgent bullets shredded his legs, cavalry scout Sgt. Dary Finck spent nine months in the Army's Walter Reed hospital in Washington before entering Fort Bragg's Warrior Transition unit. He told the Trib that despite both of his legs getting "shot out, the cadre still ordered me to come and watch everyone else PT."
"They didn't even show up to work all the time. Sometimes, they would take trips that were intended for the wounded warriors. They took their places. It was a nightmare," said Finck, today a pilot, plane mechanic and Christian missionary who lives north of Seattle.
Other veterans complained that Fort Bragg's cadre became convinced that even seriously wounded soldiers in the Warrior Transition Battalions were potential malingerers to be hounded.
"The medical care is the complete opposite of the care given to us by the cadre in the WTB," said Sgt. Andrew Harriman, one of the most decorated medics in the history of the 82nd Airborne Division and until late 2009 a Fort Bragg patient after a "friendly fire" blast from a Chinook helicopter two years earlier.
A recipient of the Silver Star medal for combat heroism in Iraq, Harriman saved Finck's life in Diyalah Province and then watched him, Katter and others in the 5-73 squadron get "terrible treatment in the WTB that took me longer to heal."
"The medical care was top-notch," Harriman said. "No expense seemed to be spared when it came to the treatments at the medical facilities. It was strictly the WTB and the cadre that were the issues."
Healing the healers
With his entire career spent in Army medicine, Fort Bragg Warrior Transition commander Schumacher says he's building on a tradition of healing to ensure that Harriman's complaints are never echoed by the soldiers under his care.
"This is a special mission unit," said Schumacher, a physician's assistant by training. "This isn't a job for everyone. I expect that the maturity level for the cadre remains high. Those who can't do that can either leave or increase their game."
Fort Bragg's leadership is backing his reforms. They're spending $90 million to build a barracks, and they've committed the base to recruiting more and better cadre volunteers. Fort Bragg's ratio of one cadre staffer to every seven patients is far below the Army average, and almost all have now attended a two-week training course in San Antonio mandated last year by the Pentagon, according to Schumacher.
Company commanders brief him on appointments soldiers miss. Last year, Fort Bragg's Warrior Transition patients averaged 180 missed medical appointments every month, often because their memory had been affected by head trauma tied to roadside bombs in Iraq and Afghanistan. But by late December that had been slashed by more than 90 percent, Schumacher said.
He's also tackling the cadre's "compassion fatigue."
"We need to take some of the negativity out of that," Schumacher said. "We recognize that good (noncommissioned officers) burn out. Sometimes, that can be corrected by letting them take some time off. But sometimes as leaders we need to take them out of the unit because that's the best thing we can do for them, too."
The Pittsburgh Tribune-Review documents life after the war for Veterans inside Wounded Warrior Care
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