A group of military, veteran and community health care heavyweights began meeting last year in San Diego to think big about improving treatment for amputation and traumatic brain injury.
The plan that took shape is unlike any nationwide, organizers say: a community center offering medical treatment, family and mental health counseling, job placement and education services under one roof.
The facility would pool resources from the Defense Department, Veterans Affairs and civilian hospitals, consolidating health care and research in an area with the largest population of Iraq and Afghanistan war veterans in the country.
The idea has gained traction with startup funding and community backing. The next step is to decide on the scope of the project, including how many patients it should serve, and a location. Eventually, about $50 million to $100 million may need to be raised, depending on whether the center requires one building or a campus.
The prospective rehabilitation center has been christened “Invictus San Diego,” from the Latin for “undefeated” and the Victorian-era poem by William Ernest Henley, an Englishman who lost a leg as a boy to tubercular arthritis.
As befits the last lines of the poem, “I am the master of my fate; I am the captain of my soul,” the center would be a place for the severely wounded to gain control over their health and other aspects of their lives.
The idea draws on two facilities built on military property with private donations: the Center for the Intrepid, an outpatient rehabilitation center for amputees and burn care patients established in 2007 at Brooke Army Medical Center in San Antonio; and the National Intrepid Center of Excellence in Bethesda, Md., which opened in 2010 with a focus on traumatic brain injuries and psychological disorders.
Those facilities had their genesis during the height of the war in Iraq and a surge of wounded service members. The same overflow eventually led to the establishment in 2007 in San Diego of the Comprehensive Combat and Complex Casualty Care (C5) facility at Naval Medical Center San Diego in Balboa Park, adding a West Coast option for troops recovering from amputation and other severe wounds.
Invictus, however, would not be located on military property. Organizers hope to transfer C5 staff and services for active-duty troops from the naval hospital to the community center. Over time those patients would continue to use Invictus as veterans. Meanwhile, the center would remain viable after combat operations end by caring for more civilians who lose limbs to diabetes or those with brain and body injuries from vehicle accidents, organizers said.
Then, when the next war erupts, Invictus would be ready for a new surge of wounded service members.
We’re “putting it together for the now, and the now is predominantly wounded warriors. But we are also building it for the future, whatever that is,” said retired Rear Adm. James A. Johnson Jr., a surgeon who is president of the San Diego Military Advisory Council and a member of the board of Invictus.
Looking at the treatment centers built in the past decade at military medical centers around the country, Invictus organizers wondered, “What do you do with them when the last guy goes out the door?” Rear Adm. C. Forrest Faison III, commander of Naval Medical Center San Diego, told U-T San Diego last fall.
“How does the greater community leverage that, so the 70-year-old lady with diabetes who just lost her foot — how does she leverage everything we’ve learned about prosthetics? Or the high school athlete who got a head bonk, how do we leverage all we’ve learned about traumatic brain injury?” he said.
Organizers credit Faison as one of the key visionaries behind Invictus San Diego. (Faison, who has applied to be a Navy liaison to the foundation spearheading the project, is restricted because of Defense Department rules from speaking about it during fundraising.)
“We are blessed in San Diego. We have got a phenomenal community. All the resources these guys need are here,” but they’re spread across the county between civilian providers like Sharp HealthCare and Scripps Health, veterans facilities, military hospitals and academia, Faison said.
“What if we could bring all of this together in one location and make it a wounded warrior center that the community owns and runs and operates? We (in military health care) would participate, but care coordination becomes easier. … We can all share best practices. It’s one-stop shopping.”
Scripps staff might work at Invictus or merely coordinate care through teleconferencing or consultations, said Dr. Michael Lobatz, a neurologist and director at Scripps Rehabilitation Center in Encinitas, which treats service members and civilians with severe brain injuries, amputations, stroke and other ailments.
Among civilians, “there is an increase and growing number of brain injuries, especially in the baby boomer population now. And there is an epidemic of diabetes in the country. That will mean more amputations down the line,” Lobatz said.
The huge infusion of research funding from the Defense Department into brain injury and prostheses may one day pay off with significant advances benefiting civilians, Lobatz said.
In the interim, Invictus could nurture hands-on cross-pollination. “If it can be done right, and people can share in those resources and the costs and benefits of such an endeavor, then I can’t see anybody losing. I see only a model of care that is going to be unparalleled in the United States and an actual partnership between the military and the civilian community in providing care,” Lobatz said.
Duane Roth, a member of the Invictus planning committee and chief executive of Connect, an organization fostering entrepreneurship in technology and life sciences, said the county is a wellspring of next-generation research in the field of prosthetic science.
For instance, San Diego State University was among a group of academic institutions, which included the University of Washington and MIT, awarded an $18.5 million grant by the National Science Foundation in September to develop artificial limbs controlled by neurotransmissions, or thought.
In such a fertile petri dish of research and development, “the vision of having maybe the best place in the West Coast, if not the country and hopefully the world, to go if you lose an arm or a limb, whether it’s through disease or military action or an accident, to me it just fit. The question became how can we map this out and go for it,” Roth said.
“We have all the ingredients here. This isn’t pulled out of thin air. There is a real need, a real opportunity, and San Diego of all places should do this.”
The Rancho Santa Fe Foundation signed on to the project in November as fiscal sponsor. In May, Invictus San Diego filed for incorporation in California as a nonprofit, a process that may take 10 months or more to complete, including federal approval.
MaryAnn Stewart, president of Invictus, said she feels a sense of urgency to build the center while the public remains focused on caring for service members wounded in Iraq or Afghanistan. Yet she has no doubt that Invictus will be built.
“We have a tremendous amount of determination. We have tremendous support from community members we talk to, and support outside of the state,” she said. In fact, the first gift came from Texas in December, when John Paul DeJoria, co-founder of Paul Mitchell salon products, donated $50,000 for startup costs.
“We owe these men and women. We owe this to them. They have literally given parts of themselves to defend our freedom,” Johnson said. “We have a sacred obligation to treat these veterans, these men and women who sacrificed, way better than we treated our Vietnam veterans.”
U-T San Diego
September 30, 2012