By Fred W. Baker III
American Forces Press Service
Navy Senior Chief Jim Pitts, a non-clinical case manager for wounded warriors, talks with Veterans Affairs social work supervisor Scott Skiles and Army Sgt. 1st Class Lee Smith, a wounded warrior military liaison. All are stationed at the Palo Alto Polytrauma Rehabilitation Center in Palo Alto, Calif. DoD photo by Fred W. Baker III Hi-Res
WASHINGTON, Aug. 8, 2008 — The wars in Iraq and Afghanistan are fought in deserts and mountains far removed from the oceans' blue waters. But U.S. Navy sailors are increasingly seeing desert and mountain combat as they augment the units of traditional foot soldiers and medics.
Seeing their numbers of combat wounded increase, Navy leaders launched its Safe Harbor program in 2005 to take care of sailors injured in Operations Iraqi and Enduring Freedom. The program started with three staff working out of the Navy Annex, an office building located just a stone's throw from the Pentagon.
There were 20 wounded sailors in the program at that time, said Navy Capt. Key Watkins, commander of the Safe Harbor program.
In 2006, the number of wounded sailors doubled as they were increasingly assigned to augment units deployed in theater.
By late 2007, there were 120 sailors in the program.
By then Navy leadership, along with the rest of the services, was deep into restructuring its wounded warrior care program in an effort to keep up with the increasing demand placed on its systems by the war on two fronts. Although the Navy had far fewer seriously injured personnel than the Army and Marine Corps, the types of injuries, length of treatment and the extra care required for families began to strain its decades-old system.
The continuum of clinical and nonclinical care was there, Watkins said. But, like the other services, the Navy's wounded care system was complicated and complex.
"The problem is it's such a vast organization. There are so many different disparate entities involved with it, it's very confusing," Watkins said. "And then it's compounded if you're medically incapable of navigating this vast bureaucracy and even worse if you're a family member of a servicemember who's incapacitated … and you don't understand the system.
"You need an advocate. You need somebody who can help you navigate the bureaucracy."
In January, the Safe Harbor program expanded to include all seriously injured sailors, not just those injured in combat. A month later, the program was expanded again to include the non-clinical oversight of all wounded, ill or injured sailors - more than 6,000 of them - including those in the reserves.
Most of those in the program don't need a lot of support. But their cases are now tracked to ensure no sailor slips through cracks in the health care system, Watkins said.
Leaders 'Kick Down' Doors of Bureaucracy
The primary focus of Safe Harbor remains those who are severely wounded, ill or injured, Watkins said. The Navy has more than 200 sailors in that category. They are assigned case managers who help take care of the sailors' and their families' needs from the time of the injury through the rest of their lives, he said.
"We'll provide case management support as long as they need help," Watkins said. "Unless they put us on the national do-not-call list, we're going to keep in touch with them and follow up with them."
The Navy leans toward a "triad of care" similar to that of provided by the Army and the Marine Corps. The triad approach emphasizes a direct relationship between those providing medical care, medical case management and non-clinical support.
Every seriously injured sailor is assigned a nurse case manager at the military treatment facility, as well as a non-clinical case manager who will manage every other aspect of the sailor's care, from fixing pay problems to finding temporary housing for the family.
"When I first took the job, I swore that I would never say in public 'concierge service,'" Watkins said. "But we really are a five-star concierge service -- with a kick. Because sometimes we have to kick doors down to get things done."
Those doors are sometimes outdated regulations and policies that conflict with today's practices of caring for wounded warriors. Senior Navy officials have vowed to work around any policies that are not in the wounded sailors' best interests until the policies are updated or thrown out.
"If it becomes a question of complying with the rules or doing the right thing, we will do the right thing every time," said Navy Rear Adm. Garry White, who reports directly to the Navy's top officer on wounded warrior care. "And we will either get a waiver or get the policy changed or get the law changed, whatever it is. But we will do the right thing for the individual and for the Navy."
White is the director of total force manpower requirements in the office of the Chief of Naval Operations. As part of a casualty care working group that he started, White has traveled the country with other senior Navy leaders, talking to wounded sailors at their bedsides and asking about their needs. That group now drives policy governing the care of the wounded, ill and injured in the Navy.
"There are no boundaries, there are no rules. There are no limits to what we can and will do. There are no barriers," White said. "If we see a need, we will address that need, no matter where it goes. If it goes outside of Navy, we'll go out there."
Growing and Planning
Safe Harbor has not grown to its fruition, Watkins said. In fact, Safe Harbor is not officially designated as a command - yet, said Watkins, explaining that he is working on that issue.
"We're not just doing this because of the war. We're doing this because we will always have wounded, ill and injured sailors," Watkins said. "It needs to be an enduring organization. I want to get established policy written in place that directs us what to do, how to do it, and then we'll have the right policy, right funding and the right support that we need.
"Right now we're just working on 'Go, and do good things.'"
Ultimately, Safe Harbor will have 15 case managers deployed nationwide at all the fleet concentration areas, major military treatment facilities and the four Veterans Affairs polytrauma centers. It also is to have 12 headquarters staff in Washington, D.C., and a couple at its personnel headquarters in Millington, Tenn. These should be in place by the end of this year, Watkins said.
Currently, five case manager jobs are being filled by reservists on two-year tours. Those will eventually be converted to active duty slots, Watkins said.
The Navy program is similar to the Air Force's in that there are no large units specifically designed to house wounded warriors. Injured sailors receive care at the military hospital closest to their home station. If the sailor is assigned to a ship, the sailor is reassigned to the ship's home port, Watkins said.
The Road to Recovery
Each sailor that enters the Safe Harbor program is screened and, if the service is needed, assigned a non-clinical case manager.
The non-clinical case manager then meets with the sailor, and his or her family, and completes a needs assessment. An assigned nurse case manager completes a similar assessment from a medical perspective. The two assessments are combined and later matched with the goals of the sailor and his or her family.
Less seriously injured sailors who are expected to return to duty will be put in a limited duty program. Once they recover, they go back into the assignment pool and are eventually reassigned, Watkins said.