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Family fights VA for improved care
Hospital gave up on him, say wife, mother

POMONA, Calif. - On a December afternoon in 2005, Sgt. Corey Briest sacrificed his ambitions, his dreams - his very well-being - to a roadside bomb and a patriot's sense of duty.

By Steve Young

POMONA, Calif. - On a December afternoon in 2005, Sgt. Corey Briest sacrificed his ambitions, his dreams - his very well-being - to a roadside bomb and a patriot's sense of duty.

For that, his wife and mother say, the Yankton National Guardsman should have come home to a hero's welcome and the best medicine available to America's wounded soldiers.

Instead, Jenny Briest and Diane Briest say their husband and son received inadequate care at a Department of Veterans Affairs Medical Center in Minneapolis. They say staff there shortchanged him on his therapy, tried to shuffle him off to a nursing-home setting and basically gave up on his recovery from a traumatic brain injury.

"It's sickening to me," Jenny Briest, 24, says as she sits at the kitchen table of her rented home next to the private Casa Colina rehabilitation hospital in Pomona where her husband now is being treated. "He was fighting in the line of duty; then we have to fight for him just to get good care. It's very disappointing."

VA officials in Minneapolis dispute the Briests' characterization of medical care and service there. But the family's disappointment has resulted in an inquiry by the Inspector General's office in the Department of Veterans Affairs. It also has drawn in South Dakota's congressional delegation, particularly Rep. Stephanie Herseth, whose Southeast Area director, Mark Gerhardt, is a good friend of Diane Briest.

The family's complaints center on what they think was unsatisfactory treatment Corey Briest received during the five months he was at the VA Medical Center's polytrauma unit in Minneapolis.

It's a concern that Herseth and other political leaders say could be playing out in other injured soldiers' families, too, especially if the influx of brain-injured soldiers is putting a strain on a VA budget that already is underfunded.

The big fear, Herseth says, is that such a strain could translate into decisions by the VA to opt for less costly nursing home care for soldiers who haven't fully reached their recovery potential.

"If Jenny and Diane hadn't been vigilant, I fear the VA would have made a decision that was not in Corey's best interest based on budget constraints," Herseth says.

'The best we can'
At the same time they have battled the VA, the Briests have been critical of the South Dakota National Guard's efforts after Corey's injury. Maj. Gen. Michael Gorman, head of the state National Guard, acknowledges the Briest case has been a public relations problem for him. "But the fact remains," Gorman says, "that everybody in our organization, their main concern is to do the best we can, not only by Corey but by the family."

That didn't seem so clear to Jenny Briest last Dec. 4 when she learned that her husband had been injured near Baghdad.

Doctors told her she needed to get to her husband's bedside quickly, that his time appeared short. After waiting two days for the Department of Defense and National Guard to get her a plane ride, she enlisted Herseth's help to get a private plane to the National Naval Medical Center in Bethesda, Md., where Corey Briest had been flown.

"The Army was telling me they would get me over there," she says. "But on Monday, they didn't have a flight for me. On Tuesday, they didn't have a flight for me."

Nor did she see anyone from the South Dakota National Guard until two days after she learned her husband was injured. Jenny Briest understands that Gorman's staff had to deal with two deaths in Corey's unit - Charlie Battery, 1st Battalion of the 147th Field Artillery. Still, she thought she would have seen someone.

The frustration of that memory rings in Gorman's voice as well. The Wounded in Action branch of the Pentagon typically handles communicating with families of injured service members, he says. Somehow, there was a glitch in the Briest case. And the South Dakota National Guard didn't even learn who was wounded that first day, Gorman says.

"We did change the way we do things because of this first incident," he says.

'Basically abandoned'
There would be other issues for Jenny and Diane Briest with the National Guard. But their greatest frustration centered around Corey's long stay at the VA center in Minneapolis.

In a journal they keep on a Web site called Caring Bridge, the women have detailed a list of complaints, starting his first night at the center, when they say Corey was left alone in his room and ended up coughing off his tracheotomy mask, covering himself in sweat and mucus.

In the weeks and months ahead, they say some of the nursing assistants at the center were careless and injured Corey when moving him. They say he routinely missed therapy sessions because staffers didn't get him there on time or because therapists cut sessions short to leave for other assignments.

"Never once did I dream he would end up giving 95 percent of his life for his country, only to end up being basically abandoned and subjected to a setting where everything is 'just good enough,' " Diane Briest says.

Minneapolis VA officials dispute many of the charges. Dr. Barbara Sigford, chief of physical medicine and rehabilitation at the center, says staffing there is good, and rescheduling missed sessions isn't an issue.

"I understand that they were frustrated," Sigford says. "I do know, generally speaking, that families coming into our polytrauma rehabilitation centers are very stressed, and they find different ways of coping with and managing that stress.

"Some of these families cope ... by being angry at the treatment teams instead of being angry at the brain injury. I don't want to make that sound like an excuse; we need to do what we can to support the family. But because of their grief, they can be aligned against the team instead of the brain injury."

But the Briests dispute that was the case in their situation. And last month, the Inspector General's office contacted them as part of an inquiry into the complaints. Herseth, who sits on the House Veterans Affairs Committee, says the agency's interest probably was piqued after she discussed Briest's situation with Defense Department staff, or after she and Sen. Tim Johnson, D-S.D., sought permission from the Department of Defense to allow Briest to be moved to a private rehabilitation hospital.

Sigford says the VA Medical Center welcomes such scrutiny. "I'm very pleased to see they are jumping in and reviewing and responding to a family's concern," she says.

The Briests say they told the Inspector General investigators that VA officials made it clear early on that they didn't think Corey was progressing significantly enough in his recovery. The implication, Jenny Briest says, was that he should go into extended care - a nursing home.

"They didn't even give him a chance to recover," she says.

Herseth went unannounced to the medical center in March. She saw the long-term care unit, which the Briests said the hospital staff was pushing for Corey.

"This floor had veterans who had served in World War II and Korea," she says. "This was a long-term care unit. It appeared they got some therapy, but just enough to maintain them."

Sigford says the staff never intended to send Corey Briest to an extended care unit and she didn't hear anyone tell the family that.

Complex needs
Sigord also says staff in Minneapolis and elsewhere have not been overwhelmed by the influx of brain-injured soldiers. In fact, she points out an Inspector General's report released in July that looked at the health status of and services for veterans with traumatic brain injuries. The study found that VA patients had similar outcomes as far as overall well-being, functional status and social integration when compared with a matched group of brain-injured patients from the private sector.

"We have dedicated polytrauma rehab units at four different sites across the VA, and we always have open beds," Sigford says. "We have not been overwhelmed."

But the Inspector General's report also noted that the VA needed improvement in long-term case management and in providing additional support to families.

"There are some issues about family support, issues about the complexity of the medical and specialized needs that have to be addressed," Lucille Beck, chief consultant to the VA for rehabilitative services, recently told USA Today. "We have survivors now who come to us with medical conditions, rehab needs and multiple impairments that we've not seen before."

That family support issue is a critical one to Diane and Jenny Briest, who say they have often been accused of being unrealistic about Corey's ability to recover.

Diane Briest says she was told by Steven Kleinglass, Minneapolis VA center director, that the family's expectations for Corey's recovery "were too high."

"We were pretty shocked to hear that," she says. "We have never once placed demands on how we thought Corey should be improving or expressed any expectations on what his improvement should be. We fully understand that there is little room to recover from a traumatic brain injury."

Sigford doesn't know what Kleinglass told them, but says, "it sounds uncharacteristic to me."

Military status an issue
The Briests say the lack of support also played out in a battle with Defense Department and VA officials over their assessment of Corey's post-injury military status - a process that is called "medical boards."

In that process, the military determines whether an injured soldier is fit to return to duty. If not, he or she can be medically discharged, retired or placed in a medical hold. The decision affects the kinds and amount of care and therapy provided, Herseth says.

Corey Briest wasn't going back to duty. But the Briests worried that if he were medically retired, he would remain on the military's health insurance program but would be ineligible for important cognitive therapy that would help him to regain his personality.

They sought help from Herseth, Johnson, even doctors who had cared for Corey, to stop the process and keep him from losing therapy he still needed. But that effort was hurt after representatives from the South Dakota National Guard visited the Minneapolis center last spring, the Briest women say. The National Guard's follow-up report on his care was so positive that "instead of helping us, the South Dakota National Guard helped to push along" the process, Diane Briest says.

That was not the National Guard's intention, Gorman says. They had come to Minneapolis to help pursue concerns the family had about Corey's care.

"There were missed appointments, and the family told us cleanliness there was bad," Gorman says. "The man in charge of that visit for us wrote a very comprehensive response to me of what exactly he thought was and wasn't happening. It wasn't all glowing. But certainly, it was never my intent to have them hurry this ... along."

'To the ends of the earth'
Eventually, thanks again to Johnson and Herseth, Corey's medical status was put on hold, the level of therapy continued, and he was allowed to transfer to the private hospital in Pomona last June so he could continue his therapy under the military health plan, Jenny Briest says.

Since that move, he has begun talking. He is starting to walk again. He is interacting more with his family every day.

"I think that shows Diane and Jenny's expectations weren't too high," Herseth says. "And I'm sure the VA is pleased that he is making progress. But they have to answer the question, 'Why wasn't he making progress in one of our four top polytrauma centers in the country?' "

Sigford says Corey Briest is following the course of recovery the VA would have predicted for him. "He is continuing to make natural recovery and progress due to the natural recovery cycle," she says. "If he had come back here, he also would have done very well."

In either case, a number of things probably could have been done differently, Gorman says. The Guard maybe could have done more at the beginning to help reunite the family after Corey was injured. It could have helped more with travel vouchers to Yankton, as well, he says.

With the family probably coming back to South Dakota the first half of next year, Gorman wants to heal whatever rift exists between them and assist in getting Corey the care he will need for the rest of his life. And so does Joe Dalpiaz, director of the VA Medical Center in Sioux Falls.

Well aware of the Briest situation, including the family's misgivings about the VA's abilities to care for Corey Briest, Dalpiaz says: "We will go to the ends of the earth to serve this soldier. If that means making special arrangements, we are willing to go wherever we can to take care of his needs."

Jenny Briest isn't thinking about that right now. When she does bring her husband and their two children home to Yankton, Corey will continue to need therapy. At some point, they probably will need care for him in the home, especially on those occasions when she can't be there.

But those decisions are for tomorrow. Today, Diane Briest says, the message they want to get out is much bigger than simply a difference of opinion about the care given her son.

"How many thousands of soldiers get injured, and who's taking care of them?" she says. "What's being done? That's what is important to us. I'm not sure people would like to know the answers."

Reach reporter Steve Young at 331-2306.


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