Clinic Provides One-Stop Shop for Wounded Warrior Care

Army Secretary Pete Geren spoke to a packed auditorium during a ceremony honoring the addition of the Wounded Warrior Clinic at Walter Reed Army Medical Center.

“Today we can say with growing confidence that, in outpatient care, Army medicine is taking care of those who’ve borne the battle,” Geren said.

Geren and Army Vice Chief of Staff Gen. Richard A. Cody both attended the event and heralded the changes in the way the Army now handles its wounded warriors as they work through the process of physical therapy, medical boards and either returning to duty or separating from the service.

The secretary cited a series of newspaper articles that were published a year ago that brought to light problems with outpatient care at the center. He commended the articles and said that they led to better care throughout the Army for wounded soldiers.

And, while the articles sparked a nationwide outcry, nowhere was it felt harder than within the Army’s own ranks, he said.

“Soldiers take care of soldiers. Soldiers give their lives … for each other. Strip away everything else, and at its core Army is about soldiers taking care of soldiers,” Geren said. “It was the soldiers that demanded action. And what we see today is evidence of that.”

The new center offers a “one-stop shop” for the soldiers healing at the hospital. It brings together, for the first time in Army medical history, a case manager, physician and soldier leadership all in one place. The three make up the triad of care established by the Army as part of an action plan to fix the problems highlighted last year.

Army Spc. Kelly O’Connor is a patient at the center and arrived in September, before the clinic opened. She is diagnosed with an illness that requires her to work through the medical board process, as well as to be seen by several specialists at the hospital.

Before, her medical board doctor worked out of different offices in the hospital. One day, while trying to make an appointment, O’Connor was literally going up and down the floors in the hospital trying to find the doctor, while her doctor was also going up and down the floors between the offices. The two kept missing each other.

“When I had to see her a couple of weeks ago it was nice, because I knew right where she was, … centrally located in the clinic,” O’Connor said.

Another benefit of the Army’s new approach is that each of the three wounded warrior companies is assigned its own primary care physician in the clinic. Before, soldiers who were sick or needed care would have to go to “sick call” and be seen by whatever doctor was seeing patients.

For O’Connor, this presented a problem, because some of her medications had side-effects. Because she sees the same physician now, he understands her medication and her history of side-effects.

“I benefit because he knows the history and … has close contact with my specialists here. They have close contact with each other about my case, so for me that’s really helpful,” she said.

The physicians meet regularly with the nurse case managers and the company leadership to discuss the soldiers’ care and work through any issues.

Army Capt. (Dr.) John Betteridge, the primary care physician for Battle Company, said he meets weekly with the case manager, squad leader and other leadership. They review all 240 patients weekly. He said this system is not something that you would see anywhere else in medicine, military or civilian.

He said the there is value in having a squad leader the soldier trusts who interacts with the soldier every day.

“The squad leader talks to them every day,” Betteridge said. “If an issue comes up that the squad leader is concerned about, they can call me. They can walk the soldier over and we can all talk and we can address issues. So there is someone with constant vigilance and accountability to make sure that the soldiers are getting through and getting the things they need.”

Army Spc. Marco Robledeo, a patient, said his squad leader and platoon sergeant visited him as soon as he arrived at the hospital.

“When I got in the hospital, my squad leader and platoon sergeant came and visited me, and I didn’t even know who they were yet,” Robledeo said.

Robledeo’s mother is helping him work through rehabilitation as an amputee. But she does not speak English. This causes some problems when he cannot be with her to take care of some administrative matters, he said. At one point, he had an administrative problem with his mother’s official orders allowing her to be there. He went to his squad leader and was able to fix the problem.

“It was just a minor detail, but the problem was solved,” Robledeo said.

The nurse case managers are also housed in the center. They manage all aspects of the care and treatment for the soldier, from setting up appointments to see specialists, to helping the soldier through the medical board process.

Before, most outpatients would have had to manage all of those things on their own.

“We all know what’s going on; … we just work together for a common goal. Really it’s irreplaceable,” Betteridge said. “Communicating face to face is really the best way to do this. If a soldier has a problem they know where to come. If a squad leader has a question … they know where to come. Case manager, the same thing. We can all just sit face to face and work it out.”

Army Lt. Col. Mary Cunico is in charge of the 17-person clinic. Cunico and her staff designed the model for the clinic, managed the renovations, and even picked the warm earth-tone colors on the walls and floors. She came to the center in March 2007 when the Army sent out a call for nurses. But she was quickly singled out to head the clinic efforts because of her previous clinic experience.

She said the clinic’s first-floor location in the hospital is ideal because it affords soldiers easy access to the other services they need while there, including the pharmacy, laboratory and radiology as well as all special care within the building.

“This physical location is probably the best prime real estate you can find here at Walter Reed,” she said.

Cunico said so far the clinic is a hit with soldiers. Many soldiers lounge in the waiting area, which boasts comfortable seating and large-screen televisions, while they wait for other appointments in the hospital. In all of the clinic care surveys, comments have been positive, she said.

“They like to come here. They know this is their clinic,” she said. “The beauty of it is we’ve built a relationship now -- the warrior to the provider to the health care team. They know that we are here to take care of them, to meet the needs that they have.”