Military health care an ordeal for injured Marine

Rehabilitation is interrupted amid conflicts over the extent of his recovery and the role of Military Hospitals vs. VA
By Amy Argetsinger

PHOENIX — When Marine Lance Cpl. Chris Shotwell developed dysentery in Iraq, the physicians attached to his unit were on the case immediately, giving him an IV for dehydration and ordering him to bed rest. Same thing when his elbow became infected from a desert bug bite. They fixed him up with antibiotics in no time.

So, months later, when he awoke in a hospital, stitches in his head and tubes in his arm, with no recollection of his Grand Am flipping end to end on the highway that led back to his California base, he expected the same level of attention. I’m a Marine, he remembers thinking. I’m going to get taken care of….

But when doctors declared he would need rehabilitation, Shotwell received a surprising response from base officials: Go get it at a veterans’ hospital.

His days as a Marine, it turned out, were numbered, owing to memory problems and other brain damage from the accident that had left him unfit for duty. But the VA couldn’t take him until he was officially out of the Marines. And that discharge wouldn’t become official until more than nine months after his accident — a period doctors say is most crucial for the long-term recovery of patients with brain trauma.

Exactly what happened in Shotwell’s case is in dispute. Navy medical officials say their tests indicated the Marine did not need further rehabilitation, though reports from both his civilian therapists and a military neuropsychologist recommended it.

Federal officials and veterans’ advocates say that the case may represent a bureaucratic glitch but one that is nonetheless worrisome in a system that will soon have to help move thousands of badly wounded veterans into civilian life.

“There’s no excuse to let anyone fall through the cracks,” said Steve Robinson, executive director of the National Gulf War Resource Center, an advocacy group. “There are protocols for taking care of people when they are injured. Whether it’s systemic or an individual [error], the effect on this Marine is devastating and there’s no excuse for it.”

The transition from military to civilian life is receiving renewed attention from lawmakers and the Pentagon now that more than 10,000 troops have been wounded or injured in Iraq and Afghanistan, many of them badly enough to end their careers in uniform.

A recent report by the U.S. Government Accountability Office found that some wounded veterans may be missing out on vocational rehabilitation and job training programs offered by the Department of Veterans Affairs. The report called for closer working relationships between the major military hospitals where wounded troops receive their first stateside care and the VA centers that treat them after their discharge.

The report, though, pointed to a roadblock to closer collaboration between the agencies: If the VA reaches out to injured service members whose discharge decisions are still up in the air, those efforts could clash with the Pentagon’s attempts to boost retention.

Congressional aides and others said they have heard stories about service members seeing some disruption in their health care as they move from the Pentagon’s roster to the VA’s. Still, they said Shotwell’s case stands apart. “No service member should have to wait for care,” said Peter Gaytan, director of the veterans affairs and rehabilitation division of the American Legion.

Shotwell, 23, an Ohio native, joined the Marines in 2002 after flailing through two years of college. “Life-wise, best decision I ever made,” he said. In February 2003, his unit shipped to the Middle East and became one of the first to move into Iraq. After spending most of their time in Najaf, they returned home in October of that year.

He had been back in the United States for six months, awaiting another deployment to Iraq, when the April 4 accident occurred. He and a fellow Marine were returning to their base, at Twentynine Palms, Calif., from a weekend trip to Phoenix to see Shotwell’s new girlfriend. Shotwell was asleep in the passenger seat of his own car while his friend drove. Near the California state line, his friend tried to pass a semi and struck the median instead.

Shotwell was comatose when he was airlifted to a Phoenix hospital. According to medical records provided by his family, tests showed bleeding and other trauma in his brain; later exams suggested a possible spinal cord injury. Shotwell’s friend suffered minor injuries.

Shotwell emerged from his coma within a day but spent the next week in a fog. And though the initial signs were encouraging, his family and friends soon realized that things weren’t quite right.

“We’d tell him the story of what had happened” in the accident, said his then-girlfriend Stacy Horvath, whom he married seven months later. “By the time we’d get to the end of the story, he wouldn’t remember the beginning.” Shotwell himself noticed as soon as he tried to move around that he had trouble with tasks requiring fine motor skills, such as lighting a cigarette or buttoning his cuffs. His left side was wobbly, his right side plagued by a pins-and-needles sensation. Tests soon showed he had lost big patches of his peripheral vision.

Shotwell spent nearly three months in outpatient rehab, showing some slow improvement, according to his family and medical records. In late July, Shotwell was ordered to report back to base and told he could continue his treatment at the Naval Medical Center in San Diego. His rehab team in Phoenix recommended that he continue with physical, occupational and speech therapy, and undergo testing to determine what kind of neuropsychological therapy he needed for his memory and cognitive problems.

After Shotwell had spent a few weeks at the San Diego hospital, his mother, Teresa Haddix, became concerned that he had not received rehabilitation; most of the tests he underwent there, she said, seemed only gauged to determine his fitness for duty.

In mid-September, Navy specialists completed a report recommending that Shotwell be discharged based on his memory, motor skills and sensory problems — a decision validated two months later by a military panel in Washington that reviewed his records. Haddix, who had claimed power of attorney over her son, tried to get him transferred to a suitable military hospital for rehabilitation.

She said a Twentynine Palms medical official turned them down flatly, directing them to the VA instead. Four more months would pass, however, before Shotwell’s military discharge would come through, on Jan. 31. “Once they got that letter showing he would not be able to carry a gun, they were done with him,” Haddix said.

Navy medical officials at Twentynine Palms and San Diego, however, dispute the family’s account. They noted that Shotwell had made substantial progress in civilian care before he was sent to San Diego. There, they said, he was seen by a dozen specialists who determined he did not need any more therapy at the time.

“He has received the best treatment that one could reasonably expect given the injuries he sustained in this motor vehicle accident,” said Capt. Robert J. Engelhart, commanding officer of the Twentynine Palms naval hospital. Officials also noted that by getting permission to move to Phoenix while awaiting his discharge, Shotwell removed himself from the continuing medical services he could have received on base.

The report from the Navy neuropsychologist who deemed him unfit for duty stated that Shotwell “would likely benefit from further follow-up and rehabilitation services,” according to the records provided by his family. The report also recommended counseling.

But Capt. Lisa L. Arnold, head of patient relations at the San Diego hospital, said those statements were intended solely as “a foot in the door” to guarantee that Shotwell’s disabilities be closely considered when his discharge is reviewed by future medical panels, which could recall him to service if they determine he has sufficiently recovered from the accident.

Now that he has entered the VA system, Shotwell said he has been referred to vocational and physical rehab; he is still awaiting an appointment to determine whether he needs more rehabilitation for his memory problems, which his family believes have worsened since he left therapy. Meanwhile, he remains concerned about his career options after leaving the Marines. His lingering cognitive difficulties could make office work or school impossible, while his coordination problems could rule out manual labor. He’s still hoping that rehab, however late, will improve his prospects.

“I don’t want to live off the government all my life,” he said. “The Marine Corps may have given up on me, but I haven’t given up on the Marine Corps.”