What happens to Injured Guardsmen Returning Home from Iraq?

By: OHA Trustee Rowena Akana

Source: Ka Wai Ola o OHA, June 2007

Last month, I met with several injured beneficiaries in the Hawaii Army National Guard who called my office about problems they were having with their medical care in the Army’s new Medical Retention Processing Unit (MRPU). After listening to the shocking treatment that they were receiving, I called the offices of Senator Daniel Akaka and Congressman Neil Abercrombie and together we coordinated a meeting between the Guardsmen and the Brigadier General of the Hawaii Army National Guard. During the meeting, a disturbing pattern emerged.


After a Hawaii Army National Guardsman gets injured in Iraq, he is sent to Tripler for treatment and assigned a case manager to help coordinate his care under the MRPU Plan. The problem is that the case managers are not following the plan’s guidelines. According to the soldiers, there is a huge disconnect between the medical personnel and their patients. Army doctors and case managers contradict each other and confuse soldiers over their treatment plan. Some soldiers are told they will be having corrective surgery, and then later told they will only be given medication.

Two Guardsmen who had the same case worker complained that she was condescending and culturally insensitive. When there was a misunderstanding, this case worker refused to make appointments or prolonged their wait for treatment. When they asked for a different case worker, they are denied and later harassed by hospital personnel for complaining. This is especially hard for local Guardsmen who feel that their communication skills may not be the best.

To make matters worse, the MRPU regularly loses or mixes-up the soldiers’ files and doesnít allow soldiers to make copies. They are also not given their medical records upon release to take to Veteran Affairs (VA).


The biggest problem with the MRPU seems to be an “unwritten” rule in the plan to rotate soldiers out after they have received 365 days of medical care. Some are rotated out without a doctor’s approval while they are still in need of operations and therapy. In several cases, a case worker’s signature appears where a doctor’s signature should be, which goes against MRPU regulations. Non-medical personnel should not be prescribing treatments.

Although an Army doctor may sign an extension for a soldier to continue his treatment beyond 12-months, this is rarely done. Soldiers are left with nowhere to go except the Veteran’s Hospital. Rotating National Guard soldiers out of the MRPU and sending them on to the VA appears to be an expedient way of getting rid of those wounded soldiers.

These soldiers are suffering from serious injuries such as dislocated shoulders and blown-off kneecaps which haven’t received all of the medical care they need to fully recover. Fixing half-a-soldier and sending them on to the Veteran’s Hospital for the rest of their medical care is simply inhumane.


To add insult to injury, because of the tremendous strain on the Veterans’ hospitals due to the many soldiers and Army National Guardsmen returning from Iraq with serious injuries, there is an 18-month wait to be processed by the VA for treatment. This leaves the Guardsmen without medical treatment for almost two years and takes a huge physical and psychological toll for the Guardsmen and their families, many of whom cannot afford expensive surgeries on their own. All of these Guardsmen are also suffering from psychological problems such as Post-Traumatic Stress Disorder and trouble sleeping from sleep apnea and are in desperate need of continued treatment.


The Guardsman assert, and rightly so, that they were wounded in combat and therefore should be treated by the Army until they can return to duty or are able to go back to some sense of a normal life. Guardsmen being rotated out with only a meager 10-20% disability pay cannot support their families when they go back to civilian life or expect to get a job that can. The Army should at least get them back into the best physical shape possible.

There is a huge disparity between the treatment of National Guardsman and a full-time Army soldier when there should be none. They both face the same dangers on the front lines and received the same horrific injuries. They deserve the same medical attention. In fact, we need to help them more since they need to re-enter the civilian workforce when they get back home.

The following needs to happen to improve their situation:

* Either disband the MRPU or treat National Guardsman the same as full-time Army soldiers if they have been injured or wounded as a result of being activated for combat duty.

* Launch an investigation of the MRPU, Tripler, and the procedures of the medical personnel and administrative staff as soon as possible.

* Establish, in Army regulations, that Army National Guardsmen can receive treatment from the MRPU until they are either ready to return to duty or ready to return to civilian life.

* Establish stricter oversight over the Army’s medical treatment system regarding wounded soldiers.

I am very happy to report that since my initial meeting with these Hawaii Army National Guardsmen, there have been some positive results. Both the offices of Senator Daniel Akaka and Congressman Neil Abercrombie have been diligent in addressing these issues with highest levels at Tripler Hospital. On the national level, Senator Akaka is looking at ways to address the Guardsmen’s concerns so that all Army National Guardsmen everywhere can be treated with parody equal to any member of the armed services who serves on active duty.

If you believe that our Hawaii Army National Guardsmen, when injured in Iraq or Afghanistan or anywhere else while serving on active duty should be extended the same kind of medical treatment as our regular forces, I urge you to write to your local and federal elected officials to express your support for these soldiers.