WASHINGTON (Army News Service, Sept. 22, 2004) -- More than 11,000 mobilized National Guard and Army Reserve Soldiers with medical problems have been treated and sent home during the past year. Those 4,200 that remain on active duty have better facilities, officials said, and receive timely treatment.

Medical officials briefed the director of the Army staff Sept. 20 on medical holdovers and new policies that have stressed sending reserve-component Soldiers home for treatment.

Last fall, media reports indicated mobilized reservists at Fort Stewart, Ga., felt they were not receiving the same care as other active-duty Soldiers returning from Iraq. That launched an Army-wide assessment.

Since then, the Army has hired or mobilized 780 physicians, nurses, clerks and case managers to help with medical holdovers, said Col. Michael Deaton, the Army’s deputy assistant surgeon general for force projection.

The number of medical holdovers at Fort Stewart has been reduced from 600 to fewer than 250, he said. Despite an average 200 new holdovers Army-wide each week, Deaton said the current total has gone down from 4,852 last year to 4,200 and about 25 percent of those now live at home and receive treatment nearby.

Community Based Health Care Initiative

Under a new program, hundreds of medical holdovers receive treatment in their home towns and their case managers are mobilized National Guard Soldiers. The medical care is provided through TRICARE, Veterans Affairs hospitals, or other government facilities.

The Community Based Health Care Initiative began this spring and now has certified programs treating medical holdovers in five states: Florida, Arkansas, California, Massachusetts and Wisconsin.

“Overwhelmingly, the Soldiers assigned to CBHCI’s love it,” said Col. Barbara Scherb, who manages the program for Forces Command. She said under the initiative, reserve-component Soldiers retained on active duty live at home, receive treatment nearby, and work at Title X jobs if they are able.

The medical holdovers work at National Guard armories, help with rear detachments of mobilized units, and some even work at recruiting offices, Scherb said.

“We’re being Semper Gumby,” Scherb said about flexibility in the program that requires most Soldiers to work, but places some of the badly injured on convalescent leave. “We’re trying to be rational about this. This is an entirely new program.”

New policies cutting holdovers

A couple of new policies are helping reduce the number of medical holdovers at installations, Deaton said.

The Army has cut in half the number of medical holdovers who arrive at installations and can’t deploy. Last year, about 4 percent of the mobilized Guard and Reserve Soldiers arriving at installations became medical holdovers. Now that’s down to 2 percent.

“We no longer make people stay on active-duty to receive care,” Deaton said, explaining that Medical Retention Processing became voluntary in March.

“If a Soldier has good insurance, or wants to be treated by the VA, he can,” Deaton said.

The 25-day rule also cut pre-deployment holdovers, Deaton said. Until last fall, if a mobilized reservist arrived at an installation with medical problems, the Army was obligated to keep that Soldier on active duty for treatment. Now, if a physician determines in the first 25 days of mobilization that the Army did not cause or worsen the medical problem –- that it was pre-existing -- the Soldier can be released from active duty.

High standards of treatment

Medical holdovers that remain on installations now have better housing conditions and receive treatment faster, Deaton said.

Standards initiated last fall require medical holdovers to receive:

• specialty referrals within 72 hours
• diagnostics within a week
• surgery, if required, within two weeks

“We meet that metric about 90 percent of the time,” Deaton said.

The median time that a medical holdover stays on active duty is now 130 days, he said, from the time the Soldier arrives back from theater, until going home.

“Healing takes time,” Deaton said. “We make every effort to expedite the admin stuff, but the last thing we want to do is unnecessarily rush the healing process.”

“We’ve done a lot of work,” he said, explaining that 11,000 injured or sick came into the system during the past year and Army medical professionals treated and sent 11,000 home.

“Think about it -- that’s a division plus,” Deaton said.

Teams visiting 40 sites

Deaton is now part of a multi-disciplinary team visiting the 40 sites across the Army that have medical holdovers. Last week the team visited Fort Bliss, Texas, and Deaton spent seven hours listening to Soldiers in sensing sessions.

“Many complaints were historical,” Deaton said, explaining that the Soldiers might say “Boy it was so bad here six months ago.”

“Is it perfect now?” Deaton asked. “Nope.”

“But the hospitals, installations and chain of command know what the issues are,” he said, “and are working to make even more improvements.”