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He Lost an Arm in Iraq; the Army Wants Money    •

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    Army Doctors Scrambling, Report Says
    By Esther Schrader
    Los Angeles Times

The military medical system has been overwhelmed by the scope and severity of injuries among troops, a health expert writes.

    Washington - A shortage of surgeons to treat the wounded in Iraq has left Army medical teams in the country scrambling to handle the largest number of military casualties since the Vietnam War, the New England Journal of Medicine reports today.

    The Army has fewer than 50 general surgeons and 15 orthopedic surgeons in Iraq at any one time to serve more than 138,000 troops. Despite the numbers, advances in battlefield surgical techniques and care mean a greater percentage of soldiers wounded in Iraq are surviving than in any previous American conflict.

    The article describes a military medical system that has undergone fundamental changes since the 1991 Persian Gulf War, but that nonetheless has been overwhelmed by the scope and severity of injuries occurring among troops in Iraq. It was written by Atul Gawande, an assistant professor at the Harvard School of Public Health and a former senior health advisor to the Clinton White House.

    Since March 2003, 1,276 U.S. military personnel have died in the Iraq war, with an additional 9,765 wounded, according to Pentagon figures. The number of deaths directly related to combat passed 1,000 this week, the Pentagon said.

    "Just as the rest of the military structure was unprepared for the length of the war and the evolution in the nature of the war, so has the military medical establishment been understandably unprepared for that," Gawande said in an interview.

    "What is striking is that they have been able to adapt in ways that allow them to keep a high rate of survival for the soldiers," he said. "But there are costs, and what you see is a potential problem on the horizon."

    Gawande did not specify the number of surgeons he thought the military should have in Iraq. He said there were several indications, though, that the current level was insufficient.

    With just 120 general surgeons on active duty, the Army has been forced to use urologists, plastic surgeons and cardiothoracic surgeons to perform general surgery on soldiers in Iraq.

    Many surgeons have been deployed for more than two years in the Iraq campaign, and military planners are contemplating pressing some to return, Gawande writes.

    The physicians are working under difficult circumstances. In many cases, the military has taken over Iraqi hospitals, and the facilities are flooded with civilian patients whom the Americans are unable to treat. With no clear directive from the Pentagon on treating civilians, some physicians refuse to help even pediatric patients out of fear the children could be booby-trapped with bombs, Gawande writes.

    Dr. Michael Kilpatrick, deputy director of deployment health support with the Pentagon's Office of Health Affairs, acknowledged that Army surgeons working in Iraq had had to improvise in some cases and had been forced to work outside their specialties in others. But he said the relatively low number of deaths proved the system was working.

    "There are certainly going to be times in any location where the workload is going to exceed the personnel present," Kilpatrick said. "There are going to be some extremely long hours at times."

    But, he added, "the fact that they have responded as well as they have speaks to the fact that they were well prepared. You can't anticipate every eventuality. I think the training and preparation that people had has stood them in good stead."

    Detailing the nature of combat injuries and their complications, Gawande says that blast injuries from suicide bombs and land mines are up substantially in recent months and have proved particularly difficult to treat without risking infection. Eye injuries have caused blindness among a "dismaying" number of soldiers, he says.

    Soldiers who survive the initial blasts and field treatment are suffering at high rates from later complications, including pulmonary embolisms (when a blood clot travels to the lungs) and deep venous thrombosis (blood clots in the legs). Some of those soldiers have died of the complications.

    Army medical teams are also worried about what Gawande calls an epidemic of multi-drug resistant bacterial infection in military hospitals. Among 442 medical evacuees seen at Walter Reed, 8.4% tested positive, a far higher rate than previously seen among wounded troops.

    Despite the challenges, Gawande credits nurses, anesthetists, helicopter pilots, other transport staffers and a rethinking of the combat medicine system for improvements in soldiers' survival rates.

    The system now focuses on damage control, not definitive repair, Gawande writes. Field doctors carry "mini-hospitals" in Humvees and field operating kits in backpacks so they can move with troops and undertake surgery on the spot.

    They limit surgery to two hours or less, often leaving temporary closures and even plastic bags over wounds, and send soldiers to one of several combat support hospitals in Iraq.

    The strategy seems to be working, Gawande finds. Although at least as many U.S. troops have been wounded in combat in the Iraq war as in the first five years of Vietnam, 90% are surviving, compared with 76% in Vietnam.

    Other experts also have credited superior body armor and equipment for improving combat injury survival. But the survivors often have injuries so severe that their future prospects are uncertain, Gawande writes.

    One airman lost both legs, his right hand and part of his face. "How he and others like him will be able to live and function remains an open question," Gawande said.

 

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    He Lost an Arm in Iraq; the Army Wants Money
    By Dianna Cahn
    Times Herald-Record

    Friday 10 December 2004

Spc. Robert Loria is stuck at Fort Hood, Texas.

    Middletown - He lost his arm serving his country in Iraq.

    Now this wounded soldier is being discharged from his company in Fort Hood, Texas, without enough gas money to get home. In fact, the Army says 27-year-old Spc. Robert Loria owes it close to $2,000, and confiscated his last paycheck.

    "There's people in my unit right now - one of my team leaders [who was] over in Iraq with me, is doing everything he can to help me .... but it's looking bleak," Loria said by telephone from Fort Hood yesterday. "It's coming up on Christmas and I have no way of getting home."

    Loria's expected discharge yesterday came a day after the public got a rare view of disgruntled soldiers in Kuwait peppering Defense Secretary Donald Rumsfeld with questions about their lack of adequate armor in Iraq.

    Like many soldiers wounded in Iraq, Loria's injuries were caused by a roadside bombing. It happened in February when his team from the 588th Battalion's Bravo Company was going to help evacuate an area in Baqubah, a town 40 miles north of Baghdad. A bomb had just ripped off another soldier's arm. Loria's Humvee drove into an ambush.

    When the second bomb exploded, it tore Loria's left hand and forearm off, split his femur in two and shot shrapnel through the left side of his body. Months later, he was still recuperating at Walter Reed Army Medical Center in Washington, D.C., and just beginning to adjust to life without a hand, when he was released back to Fort Hood.

    After several more months, the Army is releasing Loria. But "clearing Fort Hood," as the troops say, takes paperwork. Lots of it.

    Loria thought he'd done it all, and was getting ready to collect $4,486 in final Army pay.

    Then he was hit with another bomb. The Army had another tally - of money it says Loria owed to his government.

    A Separation Pay Worksheet given to Loria showed the numbers: $2,408.33 for 10 months of family separation pay that the Army erroneously paid Loria after he'd returned stateside, as a patient at Walter Reed; $2,204.25 that Loria received for travel expenses from Fort Hood back to Walter Reed for a follow-up visit, after the travel paperwork submitted by Loria never reached the correct desk. And $310 for missing items on his returned equipment inventory list.

    "There was stuff lost in transportation, others damaged in the accident," Loria said of the day he lost his hand. "When it went up the chain of command, the military denied coverage."

    Including taxes, the amount Loria owed totaled $6,255.50. The last line on the worksheet subtracted that total from his final Army payout and found $1,768.81 "due us."

    "It's nerve-racking," Loria said. "After everything I have done, it's almost like I am being abandoned, like, you did your job for us and now you are no use. That's how it feels."

    At home in Middletown, yesterday, Loria's wife, Christine, was beside herself.

    "They want us to sacrifice more," she said, her voice quavering. "My husband has already sacrificed more than he should have to."

    For weeks now, Christine has been telling her 3-year-old son, Jonathan, that Robbie, who is not his birth father, will be coming home any day now.

    But the Army has delayed Loria's release at least five times already, she said, leaving a little boy confused and angry.

    "Rob was supposed to be here on Saturday," she said. "Now [Jonathan] is mad at me. How do you explain something you yourself don't understand?"

    Christine said the Department of Veterans Affairs has been helpful in giving Loria guidance about how to get his life back on track, offering vocation rehabilitation to "teach them to go back out in the world with the limitations they have."

    But the Army brass has been unreceptive, she said.

    The Lorias also contacted the offices of U.S. Sen. Hillary Clinton, D-N.Y., and Rep. Maurice Hinchey, D-Saugerties. Hinchey's office responded.

    "There's enough to go on here to call the Army on it and see if it can get worked out," said Hinchey aide Dan Ahouse. "We are expressing to the Pentagon that based on what we see here, we don't see that Mr. Loria is being treated the way we think our veterans returning from Iraq should be treated."

    Army officials at Fort Hood could not be reached for comment yesterday.

    "I don't want this to happen to another family," Christine Loria said. "Him being blown up was supposed to be the worst thing, but it wasn't. That the military doesn't care was the worst."

    The End of Her Rope

    Christine Loria was at the end of her rope earlier this week when she called her wounded husband's commanders at Fort Hood, Texas, and gave them a piece of her mind.

    The Army was discharging her husband, Robert, after he lost his arm and suffered other severe injuries in Iraq, without even gas money to drive his car home.

    "I am up here and he's there. That's 1,800 miles away," she said. "I had to call his chain of command and scream at them."

    Their reaction she said, was "very mature."

    If he feels that way, why is his wife talking for him? Why doesn't he come talk to us himself?" she remembers them asking her.

    "Because on some level, he still respects you," she answered. "I don't have that problem."

    

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    Who to call to Help

    Outraged about Army Spc. Robert Loria's plight? Speak your mind. Below are contact numbers for federal legislators and defense officials.

    U.S. Senate: Hillary Clinton: 202-224-4451; Charles Schumer: 212-486-4430
    U.S. House of Representatives: Maurice Hinchey: 845-344-3211; Sue Kelly: 845-897-5200
    Secretary of Defense: Donald Rumsfeld: 703-692-7100
    Fort Hood: Major General James D. Thurman: 254-288-2255 or Fort Hood operator at 254-287-1110; Public Information Officer Jim Whitmeyer: 254-287-0103

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  Jump to TO Features for Saturday December 11, 2004   

Today's TO Features -------------- Army Doctors Overwhelmed by Severity, Scope of Iraq Wounded Guantanamo Detainee Details Torture David J. Sirota | The Democrats' Da Vinci Code Don't Let Iraq Vets Become Homeless Tom DeLay: More Cash, More Questions Carl Luna | Rumsfeld's Double Standard Devastating Oil Spill in Alaska Feared Intelligence Bill Greatly Expands Police Powers Le Monde | To Defend the U.N. David Lytel | Silencing the Vote 'French CNN' to Challenge U.S. View of World Affairs Bill Moyers Retiring from TV Journalism Doubts Persist about Election Results Ahmad Chalabi and the Secret Iraq Election Campaigns Debate over Secret Spy Program Bursts Into the Open U.S. Army Plagued by Desertion and Plunging Morale Rumsfeld Misled Troops on Armor for Iraq t r u t h o u t  Home

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