Losing their minds

Exactly how many brain-injured patients are being missed, going without care, or left waiting, as opposed to those who get prompt, top-shelf treatment, is difficult to say. Walter Reed officials and doctors say the Army is getting better at treating brain-injured patients but admit cases like Wilson's are a significant problem.

A November 2003 report from the Army News Service states that because brain injuries aren't always obvious, they "may be neglected, or even pushed aside as merely psychological." Patients with traumatic brain injuries "are suffering as much, but may not get the same support as someone who has an observable injury like a bullet wound or a broken leg," says Dr. Louis French, a neuropsychologist at Walter Reed, in the article.

One thing is certain: Due to today's military technology and insurgent tactics in the Iraq war, more U.S. soldiers than ever before are sustaining and surviving serious head injuries. In fact, traumatic brain injuries are a major problem among soldiers arriving at Walter Reed. According to the hospital's brain injury center, 31 percent of battle-injured soldiers admitted between January 2003 and April 2005 -- 433 patients -- had traumatic brain injuries. Half of those had what the hospital calls a "moderate, severe or penetrating brain injury."

In past wars, brain-trauma rates among combat casualties hovered around 20 percent, according to the Army. The rate of brain injuries among troops wounded in Iraq has shot much higher because the bomb, rather than the bullet, is the weapon of choice for insurgents. In addition, today's better body armor and helmets save soldiers' lives in explosions that would have otherwise killed them.

Through a spokesperson, Walter Reed and other Army officials, including Col. Babbitt, who accused Wilson of malingering, declined to be interviewed. "We cannot discuss specific cases with anyone except the Soldier due to the Privacy Act and HIPAA [the Health Insurance Portability and Accountability Act], nor could we address the case or responsibilities of the president of the [Physical Evaluation Board] without violating some portion of HIPAA," wrote Lt. Col. Kevin V. Arata, an Army public affairs officer, in an e-mail. "Therefore, I cannot arrange an interview."

But according to a written statement that hospital officials provided to Salon, Walter Reed does have a plan to identify and treat brain-trauma patients. The military has a network of eight brain-injury rehabilitation programs under the rubric of the Defense and Veterans Brain Injury Center.

The program was created in 1992 to prevent brain-injured soldiers from being misdiagnosed as mentally ill, or missing treatment completely. Some brain injury patients get treatment from neurologists or neurosurgeons; others get treatment from physical, occupational and speech-language therapists. The hospital says it screens for brain trauma all patients who arrive at the hospital who were injured in blasts, vehicle wrecks or falls, or who have obvious, penetrating head wounds.

There are many success stories, says John DaVanzo, clinical director at Virginia Neurocare, a rehabilitation center in Charlottesville, Va., where Wilson is receiving treatment. "Yes, there are soldiers being missed," DaVanzo admits, but many others with brain injuries, who would've been overlooked in past wars, are being identified and treated. Still, working in partnership with Walter Reed, DaVanzo has seen the strain on the system during the Iraq war. "There is a massive influx of injured soldiers," he says. "People are overworked."

Walter Reed hospital is renowned for state-of-the-art technology and certain kinds of care. One Walter Reed physician tells Salon that the care for amputees at the hospital is "amazing," and praises the work of colleagues, adding that the nurses "work their butts off." However, the physician is worried that a distressing number of patients at the hospital with brain injuries aren't getting adequate screening and care, and says many doctors at the hospital know little about brain injuries and are prone to making a wrong diagnosis.

"A lot of things are missed because the doctors are swamped," the physician says. Many military doctors are away serving in Iraq or Afghanistan, and some patients are forced to wait too long for surgeries they need. "We're overwhelmed in terms of resources," the physician says. (Salon agreed to withhold the identity of the physician, who was not authorized to speak to the media, and feared retribution from the hospital.)

The delay in proper diagnosis and treatment for Wilson and others with apparent brain injuries is particularly troubling because patients tend to benefit from a prompt response. An April 13, 2005, article about brain trauma from the Department of Defense's own press service says that "if the injury is detected and treated early, most victims can recover full brain function, or at least return to relatively normal lives."

Traumatic brain injury can come from a car wreck, or when the sudden pressure from shock waves from an explosion collide with the fluid-filled cavity around the brain. Diagnosis can be tricky because the memory loss, personality change or depression that can accompany traumatic brain injury can also mimic other combat injuries connected with mental health, including post-traumatic stress disorder.

But Dr. Gene Bolles, a former chief of neurosurgery at Landstuhl Regional Medical Center in Germany, says it is plain wrong to place the burden of proof on wounded soldiers. Soldiers coming out of combat who say they've suffered a head blow and who show symptoms of traumatic brain injury should be treated for it, says Bolles. "You do what you can for them," he says flatly. "You believe them."

Bolles reviewed a summary of Wilson's October 2004 MRI from Walter Reed. He says it showed "evidence of loss of blood supply" to the brain and was "compatible with a head injury." Alongside Wilson's story and symptoms, he says, "This sounds like typical head injury syndrome to me; you can make that diagnosis."

He notes that the "shearing effect" on nerve tissue that comes with a serious head blow can be invisible to MRIs and CAT scans and that "there are no definitive tests that prove this syndrome." But soldiers even remotely suspected of having a brain injury, he says, should be treated aggressively for it, rather than with skepticism.

Bolles, who now practices at Denver Health Medical Center, treated U.S. soldiers evacuated from Iraq and Afghanistan for two years at Landstuhl. While many soldiers get good treatment, in other cases "the system is kind of like you have to prove yourself with an injury before anyone believes you," he says. "I wish we would accept the word of a patient if a patient says, 'This is what I'm feeling,' rather than trying to prove somebody is malingering." It is better to treat soldiers for what they say is wrong with them, he says, even if that means a few cheaters get through the system.

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