NPR News And ProPublica Investigation Reveals Failure Of Military To Diagnose, Treat And Document Mild Traumatic Brain Injuries
Investigation Finds Routine Misdiagnosis, Poor Screening, Substandard Treatment And Lost Documentation Of ’Signature Wound’ From Wars In Iraq And Afghanistan
Despite years of warnings and hundreds of millions of dollars in funding, the military’s medical system is failing to diagnose and adequately treat as many as tens of thousands of soldiers who suffered from so-called mild traumatic brain injury in Iraq and Afghanistan, often called the signature wound of those wars, according to a major investigation by NPR News and ProPublica. The investigation is based on dozens of interviews with soldiers – from sergeants to doctors to generals – and leading brain injury specialists, an extensive visit to Fort Bliss in Texas and access to previously unreleased military studies, documents and emails. NPR and ProPublica also found that some of the nation’s most senior medical officers are attempting to downplay the seriousness of mild traumatic brain injury – or TBI. The web of problems has created a military medical system that is plagued by questionable statistics, haphazard care and lack of treatment for soldiers.
NPR correspondent Daniel Zwerdling and T. Christian Miller of ProPublica report the startling findings of their four-month-long investigation on “Brain War,” a three-part series airing today and tomorrow on NPR News’ Morning Edition and All Things Considered, and appearing in detail at NPR.org and ProPublica.org. At the web sites, find the audio of Zwerdling’s radio pieces, original text reports by Miller, a video and multimedia slideshow of soldiers interviewed for the series and a timeline of the history of TBI and the military. Listeners are also invited to share their stories of TBI or military medical treatment at NPR.org.
Among the findings as reported by Zwerdling and Miller, in Part 1 today on Morning Edition:
· Military doctors and systems to screen for potential brain injuries routinely miss wounded soldiers, from the battlefield to stateside military hospitals. An unpublished study shows that one of the Pentagon’s primary screening methods misses as many as 40 percent of possible mild traumatic brain injuries. Millions have been spent on a second exam, though its results are considered no better than a “coin flip” at diagnosing potential injuries.
· Even when military doctors diagnose head trauma, such injuries are often not documented in soldiers’ medical files. In some cases, medical records from Iraq and Afghanistan have been burned or abandoned in warehouses. In an unpublished Army analysis from 2007 reviewed by NPR and ProPublica, clinicians interviewed soldiers to determine whether they had suffered a possible concussion. More than 70% of soldiers who reported such an injury had no record of the injury in their official military medical file.
· Soldiers lacking diagnosis and documentation of head wounds have had to battle for appropriate treatment.
· Some top military medical officials continue to question the importance of diagnosing mild traumatic brain injuries and are skeptical about the potential seriousness of long-term consequences. Maj. Remington Nevin, an Army epidemiologist who served in Afghanistan and has worked to improve documentation of brain injuries, tells NPR and ProPublica: “It’s obvious that we are significantly underestimating and underreporting the true burden of traumatic brain injury. Absolutely. This is an issue which is causing real harm. And the senior levels of leadership that should be responsible for this issue either don’t care, can’t understand the problem due to lack of experience or are so disengaged that they haven’t fixed it.”
Zwerdling and Miller visited soldiers and veterans suffering TBI to understand the particular details of their injuries, and of their fight to get proper diagnosis and treatment. In Part 2, airing on All Things Considered and published at NPR.org and ProPublica.org this afternoon, Zwerdling and Miller meet former Army Reserves major Michelle Dyarman who suffered mild TBI from roadside bomb attacks, and today struggles to perform basic cognitive functions, such as finding her way home while driving and filling out reports on her job. For years, Dyarman says she fought with Army doctors who did not believe that she was suffering lasting effects from the blows to her head. Finally in 2008, Veterans Administration doctors linked her cognitive problems to her head traumas.
In the final part of “Brain Wars,” airing Wednesday, June 9 on All Things Considered, Zwerdling and Miller report on the Army’s failure to provide adequate care at what is supposed to be one of its main centers for TBI treatment: the massive Ft. Bliss base in Texas. NPR and ProPublica’s examination of care at Ft. Bliss found that even when soldiers are diagnosed, they have faced haphazard care and skepticism about their condition from senior medical officials. Zwerdling and Miller report that soldiers struggling with brain injuries were often told that the main causes of their cognitive problems were headaches and anxiety. A building constructed a year and a half ago to serve as a clinic for TBI sits vacant.
Other soldiers tell wrenching stories, supported by medical documents and family members, of how they can no longer “think straight.” For instance, one soldier went to vocational school to learn how to make furniture; now he struggles to build a simple birdhouse for his son. Another has to label every drawer and cabinet in the kitchen, because he can’t remember where anything goes. He can’t help his 10-year-old son with his homework, because he can’t understand it.
In response to inquiries from NPR and ProPublica for this investigation, Surgeon General Eric Schoomaker issued a memo forbidding medical officers at local bases from giving interviews. Schoomaker wrote in the email, obtained by NPR and ProPublica: “We have some obvious vulnerabilities here as we have worked to better understand the nature of our Soldiers’ injuries and to manage them in a standardized fashion. I do not want any more interviews at a local level.” When confronted by the results of NPR’s and ProPublica’s investigation, Schoomaker acknowledged there is a “black hole” of information about mild TBI.
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The NPR News Investigative Unit crosses all news desks and programs to build upon, and strengthen the commitment to, NPR’s established investigative work. The team has been reporting extensively on the mining accident at Upper Big Branch in West Virginia, the thwarted terrorist attack on Times Square and the continuing oil spill and clean-up in the Gulf of Mexico. Last month, a four-month-long investigation in Juarez and Mexico City uncovered signs that Mexico’s war on drugs is a rigged fight, favoring its most powerful cartel. Other recent series include a collaboration with the Center for Public Integrity examining the failure of colleges to protect women from sexual assault and a three-part series produced in partnership with the Center for Investigative Reporting on the U.S. government’s use of confidential informants.
ProPublica is an independent, non-profit newsroom that produces investigative journalism in the public interest. In 2010, it was the first online newsroom to win the Pulitzer Prize for Investigative Reporting. With the largest news staff in American journalism devoted solely to investigative reporting, ProPublica is supported by philanthropy and provides the articles it produces, free of charge, both through its own web site and to leading news organizations selected with an eye toward maximizing the impact of each article. For more information, please visit www.ProPublica.org.
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