04.19.11

Giffords' Plea for Brain-Injured Soldiers

In reporting my Newsweek cover story on Gabrielle Giffords' recovery from a gunshot wound to the head, I learned from her doctors that insurance coverage for treatment of brain trauma injuries is spotty and unpredictable. One key therapy is not offered to troops, a glaring deficiency in military health care that investigative outlet Pro Publica has been persistently exposing for months. Now Rep. Giffords' office is making the case for brain trauma rehab to be included in the health reform law, setting up the possibility that Giffords' injury—already a human interest story—could become a political one as well.

In reporting my Newsweek cover story on Gabrielle Giffords' recovery from a gunshot wound to the head, I learned from her doctors that insurance coverage for treatment of brain trauma injuries is spotty and unpredictable. One key therapy is not offered to troops, a glaring deficiency in military health care that investigative outlet Pro Publica has been persistently exposing for months. Now Rep. Giffords' office is making the case for brain trauma rehab to be included in the health-reform law, setting up the possibility that Giffords' injury—already a human interest story—could become a political one as well.

The life-saving medical treatment that Congresswoman Gabrielle Giffords received in the critical first hours after being shot in the head occurred in a trauma unit headed by a former combat surgeon, Dr. Peter Rhee, whose approach was shaped on the battlefields of Iraq and Afghanistan. The crime scene had been, in essence, a combat zone, and when Rhee sought consultation on the Giffords case, he called in two of his former military colleagues. When Giffords was transferred from Tucson to the Memorial-Hermann Hospital in Houston, she was received by another Rhee military acquaintance, Dr. John Holcomb, a retired Army colonel.

But in the important next phase of Giffords’ recovery—months of intensive rehabilitation aimed at maximizing her quality of life—Giffords is receiving a level of care unattainable by thousands of Americans who have been wounded on the actual battlefield. That’s because the costly treatment Giffords is receiving at The Institute for Rehabilitation and Research at Memorial-Herman is being paid for by the federal government, but such care for U.S. troops is not.

A central component of the intensive therapy regimen Giffords is undergoing is cognitive rehabilitation therapy, a program designed to help brain-damaged patients regain abilities important to daily functioning, such as attention, planning, and finding the appropriate words in re-learning to speak. Giffords’ therapy bills are paid for by the Federal Employees Compensation fund, and will be for as long as they are needed.

Coverage of treatment for brain-injured patients has inevitably become a political issue… The case for civilians was made earlier this month by Giffords’ office.

Most military personnel, however, are covered by an insurance plan called TRICARE, which does not cover key elements of cognitive rehabilitation therapy. As revealed in a series of investigative reports by the non-profit news enterprise, ProPublica, TRICARE claims that the benefits of cognitive rehabilitation therapy are not well enough established to warrant providing it to troops. TRICARE bases this assertion on the findings of a study commissioned by TRICARE itself, and which ProPublica’s reporting has found to be “deeply flawed.”

The issue is a pressing one for military families, as brain trauma is the signature injury in wars in which the Improvised Explosive Device is the enemy’s weapon of choice.

But access to comprehensive rehabilitation therapy is also an urgent matter to the 1.7 million civilians who suffer brain trauma each year in the United States. Insurance coverage for rehabilitation is uneven and unpredictable, and patients who might have benefited from an intensive program are often directed away from facilities that provide it.

Dr. Gerard Francisco, the rehab physician who heads Giffords’ medical team at Memorial Hermann, says that he recently saw one such patient, a young man who suffered a serious brain injury in a workplace assault. Even though the patient was treated at Memorial Hermann’s trauma center, he was sent to a nursing facility for his rehabilitation care, rather than to Memorial Hermann’s Institute for Rehabilitation and Research. “We were not even consulted,” Francisco tells The Daily Beast. “That was in late January. I saw him yesterday, and that guy already has contractures” – involuntary muscle contractions – “all over.” Francisco says that if his rehab unit had been able to persuade the young man’s insurance company to allow intensive therapy for even a week, it might have made a significant difference in his recovery. “Now, this patient will need surgery," Francisco says.

Coverage of treatment for brain-injured patients has inevitably become a political issue. On the military side, money is an ongoing worry for the Pentagon, which is being “eaten alive,” as Defense Secretary Robert Gates put it, by health-care costs.

The case for civilians was made earlier this month by the office of Gabrielle Giffords, which joined in a plea to Kathleen Sebelius, secretary of Health and Human Services, to include brain trauma rehabilitation among the essential benefits mandated by the health-care reform law. Immediate action seems unlikely.

“We greatly appreciate the thoughtful ideas provided by Congresswoman Giffords’ staff and will certainly take them into account as we work to develop rules describing an essential benefits package,” says Richard Sorian, HHS assistant secretary for Public Affairs. “HHS will be engaging in a public process later this year to get broad input for the process of establishing essential benefits.”

Peter J. Boyer joined Newsweek/Daily Beast after spending 18 years as a staff writer at The New Yorker, where he wrote on a wide range of subjects, including politics, the military, religion, and sports. Before joining The New Yorker, Boyer was a reporter for the Los Angeles Times and the New York Times, a contributing editor at Vanity Fair, and a television critic for National Public Radio’s “Morning Edition.” As a correspondent on the documentary series, Frontline, he won a George Foster Peabody Award, an Emmy, and consecutive Writers Guild Awards for his reporting. Boyer’s New Yorker articles have been included in the anthologies The Best American Political Writing, Best American Science Writing, Best American Spiritual Writing and Best American Crime Writing. He is at work on a book about American evangelism.