Army Program Allows for More Healing at Home

Staff Sgt. Mitch Riviera needs therapy on his left knee and an operation to mend his bad back, enduring and painful consequences of a yearlong deployment in Iraq. But this holiday season, because of a new Army program, the injured National Guardsman hasn’t been marooned in a military hospital on some faraway base, but is back home.

“I wake up every day happy,” said the 33-year-old mechanic with the 743rd Maintenance Company of the Florida National Guard. “You’re just happy to be home.”

Under the Community Based Health Care Initiative, wounded or ailing members of the Army National Guard and Reserve are able for the first time to live at home and recuperate while still on active-duty status.

They receive medical care at local Veterans Administration facilities or from healthcare providers authorized by Tricare, the U.S. military’s equivalent of an HMO, and are given light duties at a local armory or other military facilities.

The impetus was a public embarrassment for the Army: media reports in 2003 that hundreds of wounded reservists and guardsmen were languishing in barracks as they waited to see doctors or be admitted to overcrowded medical facilities. That was Riviera’s experience after his company returned from Iraq in April.

Nearly all members of his unit were allowed to go home, but the staff sergeant said he was kept on base at Ft. Stewart, Ga., for three months, housed in a 16-person trailer as he awaited his turn for medical treatment.

“They were just overwhelmed. They couldn’t cope with the wounded people they had,” said Riviera, who hurt his back and knee in Tikrit, north of Baghdad, while lugging the heavy tools needed in his job as a front-line mechanic and wearing 80 pounds of “battle rattle” combat gear. At one point, he said, he couldn’t walk for three weeks.

“I was disorganized with all the surgery I had to go through” at Ft. Stewart, 400 miles from South Florida, Riviera said. “You’re so close to home, but you can’t go there, and you can’t go off post.”

It was his fiancee, Diana Villescaz, 24, of Bakersfield, a legal secretary, who came to his rescue, Riviera said. She heard about the Army’s new community-based healthcare program, and sent an e-mail to Florida Gov. Jeb Bush asking for help.

Within 48 hours, Riviera said, he received a phone call from an officer inquiring about his case.

Lt. Col. Bruce Cornelison is in charge of the initiative in Florida, which in March became the first state to implement the program. He called it “an absolutely wonderful improvement,” in large part because it gets wounded or injured men and women “back to their families and loved ones.”

“An individual cures faster if he is surrounded by his support system,” Cornelison, an officer in the Army Medical Service Corps, said from the program’s Florida offices in Plant City east of Tampa. “Soldiers were so far from their home, and facilities were being overcrowded.”

Offices have also been opened in California, Arkansas, Massachusetts and Wisconsin to arrange for and supervise medical care for 1,335 soldiers in 23 states. The initiative was deemed so successful, and demand grew so fast, that the Army has announced that by April, more centers would be opened in Virginia, Alabama and Utah, expanding coverage to all 50 states and Puerto Rico.

A total of $23 million in funding has been set aside, and nearly 800 additional physicians, nurses, clerks and case managers have been hired or mobilized to help, the Pentagon announced Dec. 6.

According to Col. Barbara Scherb of Army Forces Command, the program’s overall manager, the innovation is a response to the new realities of today’s Army, where active-duty troops in Iraq, Afghanistan and elsewhere have had to be heavily and repeatedly supplemented by part-time soldiers from the Guard and Reserve.

“It quickly became apparent that we might exceed the [medical] capacity at the installations for these folks” if they suffered the same level of casualties as troops in World War II, Vietnam and Operation Desert Storm,” Scherb said. “That’s why we looked at establishing something that was community-based.”

Since active-duty soldiers typically live on or near an Army base, families and friends can be by their side as they are treated in a location familiar to them. The community-based care program extends that psychological and emotional boost to soldiers in the Guard and Reserve, as well as easing them back into civilian life.

“The quality of the care is really the same as it was before,” Scherb said. “The quality of life is the thing that is improving, because they are able to get home and get back with their families.”

The National Military Family Assn. is still monitoring how the novel program will work in practice, especially for soldiers who live in remote locales where medical resources may be scarce, said Julia Pfaff, the not-for-profit group’s executive director. “We’re cautious,” Pfaff said. “A lot of these individuals are stuck in this Catch-22 of knowing they can be closer to home, but also having healthcare requirements that are enormous and can overwhelm the system.”

For Riviera, an 11-year veteran of the Guard with thick black hair and a ready smile, being home has meant being able to buy diamond earrings for Villescaz (they plan to get married in March) and joining his mother and other family members in Tampa for Christmas. Last Thursday, he had an afternoon date to drive his fiancee, who had a cold, to the doctor. Riviera laughed at the irony of it.

Since coming back to Florida in late June, Riviera has been operated on at a Veterans Administration facility in Miami for a torn meniscus in his knee, and he will learn this month what sort of surgery he needs on his lower back. “The lower disk is gone,” Riviera said. “They are probably going to have to fuse two lower disks together.”

Two times a week, the sergeant, in civilian life a service technician for a cable company, attends physical therapy sessions at the VA’s outpatient clinic in the Fort Lauderdale suburb of Oakland Park. There, he is treated with ice and electrical stimulation, and does exercises to strengthen his muscles.

“It’s painful, but it’s getting the job done,” Riviera said. “That therapist doesn’t let you slack.” At his apartment complex in Davie, he regularly walks in the swimming pool, with the water buoying his body so he doesn’t put too much weight on his back and knee.

Not all of the wounded or injured who might want to take part in the program are eligible, Cornelison said.

“It wouldn’t make any sense to bring someone home who required constant hospitalization,” he said. Before going home, the soldiers spend a few days at a program office like the one in Plant City, meeting their case manager, discussing a treatment plan with a physician and arranging for a duty assignment for the time they will remain on active duty.

At 8 a.m. most days, Riviera reports to a National Guard armory near Fort Lauderdale’s airport, where he assists military recruiters with administrative tasks. A third-generation military man, he wants to stay in the National Guard. He will continue on active duty in his current “medical hold” status, he said, until the VA treats his medical problems or decides it can’t do anything more.

For the moment, Riviera must be careful even when making the simplest of movements -- like reaching for a bottle of milk.

His immediate goals are to get married, buy a house and start a family. Despite the pain and uncertainty about his back, he seems cheerful and upbeat. He’ll be happy, the guardsman said, if he can get 90% of his old physical ability back.

“The rest I’ll chalk up to life,” he said.

Times researcher Jenny Jarvie in Atlanta contributed to this report.