Case Managers Navigate 'Medical Maze' for Patients

By Elaine Wilson
Special to American Forces Press Service

May 9, 2007 – When servicemembers injured in war first arrive at Brooke Army Medical Center here, they not only have to face the daunting task of recovery, but also must navigate a medical maze of treatment plans, appointments and paperwork. But they don't have to do it alone. The medical center's staff includes 15 outpatient case managers whose sole purpose is to guide servicemembers injured in operations Iraqi Freedom and Enduring Freedom along their road to recovery.

"We coordinate medical care for servicemembers from when they first get here to when they either return to duty or separate," said Army Lt. Col. Donna Rojas, the hospital's chief of case management. "We serve as a link between the doctors and patients so the patients can focus on getting well."

It is the case managers' job to take on the mire of challenging administrative and sometimes personal details for patients, from setting up medical appointments to making lodging reservations for incoming family members and everything in between.

"Each case is unique," Rojas said. "We've had servicemembers with family in other countries, such as Bulgaria, and helped them with their travel to the U.S. We have come across a variety of issues, many related to family, and help in any way we can.

"The key is to be resourceful and flexible," she added.

Brooke Army Medical Center employs 18 inpatient and outpatient case managers for patients from Iraq and Afghanistan, each with an average of less than 35 patients assigned at one time. Three case managers are dedicated to burn patients and three to amputees. All are experienced case managers with either a social work or nursing background. The prior knowledge is put to good use on a daily basis as they guide patients through the health care process.

"Nurses can help with the medical side, and the social workers are a great asset when it comes to assisting them with access to community resources, individual and family counseling, group and grief counseling, along with helping to adjust with changes in body image," Rojas said. "We work together well as a team to coordinate all of the needs of the servicemembers."

A case manager's myriad duties start at the first case manager-patient meeting, which is typically the next duty day after the patient arrives at the hospital.

"We talk to the patients and do a general assessment of all their needs: medical, family, pay. ... If we don't have an answer, we go to the people who do," Rojas said.

"We plan for discharge from day one; we lay out timelines, a plan of care," she said. "We let patients know what to expect, what they need to do during their recovery."

Case managers then team with their case manager assistants to set up medical appointments and take care of early concerns, which can relate to military-specific issues or family member concerns.

To complicate matters further, "Patients rarely have just one medical issue," Rojas said. "Someone may come in with a burn, but also need orthopedic care or mental health appointments. It takes a lot of coordination."

Once the health care ball is rolling, the case manager then meets with the patient once a week to track progress, gauge recovery and head off problems early on. Since most of the case managers are nurses, meeting times can also be used to help clarify complicated medical terminology for patients.

"I look at the doctor's notes and listen to the patients and try to clarify if there is confusion," Rojas said. "Sometimes the doctor needs to meet with the patient again; whatever it takes so the patient has an understanding of their progress."

At times, the doctor is the one who needs assistance. "If a doctor wants to get a soldier assigned here because he is diagnosed with cancer and needs to be closer to a major medical facility, then I can help," Rojas said. "What may take him months, we can get done in a day. We know who and where to call."

Along with doctors, case managers also serve as liaisons between servicemembers and their military units, and meet with commanders, first sergeants and platoon sergeants on a weekly basis.

"We've had situations where a soldier didn't keep an appointment," Rojas said. "We can address these issues with his leadership and also talk about if the soldier is having personal problems that may be conflicting with his appointments. We take our regular meetings with command and the servicemembers very seriously. We have a good relationship with the commands so we can resolve problems quickly."

Case managers also heavily coordinate with agencies such as the Department of Veterans Affairs, Office of Personnel Management, and the Army Wounded Warrior Program. All have representatives at Brooke Army Medical Center, which is a much-appreciated convenience, Rojas said.

"We had a soldier from Fort Carson (Colo.) who was on the priority list for on-post housing but a house wasn't due to open up for a month," Rojas said. "Opal Rieras (of the Army Wounded Warrior Program) had obtained a free apartment for the family. Having the services in the hospital made the coordination much easier."

Rojas pointed out that the Army is also quick to assist. The Army flies three family members of wounded warriors in the very seriously ill or seriously ill category here free of charge and also picks up the bill for lodging and per diem. "There are other criteria as well, and we assist in sorting this out," Rojas said. "We have terrific support from the Casualty Notification Branch."

The case managers' extensive efforts don't go unnoticed. "This place is organized," said Lt. Col. Fred Harmon, who was injured while supporting Operation Enduring Freedom. "It's obvious people here care and want people to get the best treatment possible in a timely manner."

The help is "above and beyond what I expected," he said.

With cases as unique and varied as the servicemembers, case managers never have a dull moment, Rojas said. "It's a high work tempo, but we love what we do. It's a rewarding job because, bottom line, we're helping servicemembers and their families."

Retired Army Lt. Col Leandry Lourdes said the job holds a special meaning for her. "When I was deployed to Iraq, I saw soldiers wounded and broken," said the former BAMC operating room head nurse. "Now, I can help them get the best treatment and see them heal. That's closure for me."

(Elaine Wilson works in the Fort Sam Houston Public Information Office.)

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