Case Study #9: Offering Rare Care with a Common Touch
Operation Mend’s life-changing reconstructive surgery
Ronald Katz is an inventor and entrepreneur by profession, and though he never served in uniform, he now dedicates much of his energy and money to caring for members of the armed forces who were severely injured in the wars in Iraq and Afghanistan. Operation Mend, the program he started at the Ronald Reagan UCLA Medical Center, provides plastic and reconstructive surgery at no charge to those badly hurt in post-9/11 military service. In five years, Katz and other donors (like David Gelbaum’s Iraq-Afghanistan Deployment Impact Fund, which donated a crucial $10 million to Operation Mend early on) have made possible hundreds of life-changing surgeries for more than 80 patients who were severely disfigured or burned—delivering immeasurable improvements in the quality of existence for these men and women.
Finding a Place among the Helpers
In 2004, Katz recalls, “I had decided that it was important for our family to contribute to the military serving in Iraq and Afghanistan. We really owe it to our military to support them.” He met with officials at the Pentagon, discussed issues with experts, and considered endowing a fund for the children of servicemembers killed in action, until he learned that the Veterans Administration already provided a similar benefit.
After about a year of research, Katz met a senior military nurse who suggested that, given his interest in individuals, he consider visiting the San Antonio Military Medical Center (SAMMC) and supporting one of its Fisher Houses (comfort homes for families of servicemembers recovering at military medical centers—see case 8). “I went down there and was taken by the magnitude of suffering of those servicemembers who had been hurt,” says Katz. His family quickly decided to become lead funders on one of the new Fisher Houses being built.
In 2006, Katz, his wife, Maddie, and his two sons flew down to SAMMC to attend the grand opening of two Fisher Houses and the Center for the Intrepid, a state-of-the-art physical rehabilitation center also constructed with private philanthropy.
I vividly recall that there were about three or four thousand people at the opening and the first four rows of seating were roped off. I chuckled to my wife and my sons, “Boy, these must be for really important people.” And sure enough, they were. They rolled in these men and women who were just catastrophically injured.
Though moved by the experience, Katz and his family were uncertain about their next step until a few months later when Ronald and Maddie were watching an interview with a severely burned Marine on CNN. “At the end,” Katz recalls, “the interviewer said, ‘Well, what’s next for you?’ And the Marine smiled with that burned smile and said, ‘They gotta make me beautiful again.’ And my wife was sitting next to me and she jabbed me in the ribs and said, ‘Do something about this.’”
Sometimes Giving Takes Perseverance
As is often the case with the best philanthropy, the donor in this instance didn’t just supply money (a $1 million founding gift), but also offered savvy guidance and linkage to important professional partners. Katz was already a board member at the Ronald Reagan UCLA Medical Center, so he approached the head of the medical school with an idea—he wanted to complement DoD and V.A. medical services by bringing catastrophically injured servicemembers to UCLA to receive plastic and reconstructive surgery from the university’s world-class surgeons and facilities. Katz explained, “We’d like to make sure these men and women get the best this country has to offer, from both the public and the private sector.” The head of the medical school gave his immediate support.
Along with UCLA surgeons Chris Crisera and Tim Miller, Katz visited SAMMC to pitch the idea to its commanding general. “I never realized the complexity of our offer,” Katz admits. Although UCLA offered some of the very best surgeons and facilities at no cost, the partnership was not a traditional arrangement for the military. SAMMC’s commanding general was responsible for every service member under his care, and referring patients with severe combat wounds to civilian medical facilities like UCLA was relatively uncharted territory.
Katz and the UCLA team worked to reassure SAMMC. Melanie Gideon, program manager at Operation Mend, recounts the conversations: “We will do everything we can to protect them from the moment they step off the plane. We will provide them with a buddy family in Los Angeles that will check on them if they need anything. They will be at a hotel right on campus. We will have someone accompany them to every appointment.” Katz comments that “if you think of VIP treatments, we do VVIP treatments.”
The commanding general at SAMMC sent one patient to start. Sure enough, it was the Marine the Katz family had seen on CNN months before. He had suffered burns on over a quarter of his body, as well as the loss of his ears, nose, and two fingers. Slowly but surely, over the course of dozens of surgeries, Operation Mend physicians replaced what he lost, crafting prosthetic ears and a nose, and grafting new skin to heal or replace scar tissue.
After observing the remarkable effects Operation Mend was having on patients, SAMMC slowly began sending more candidates. Many of them became prominent symbols of healing and recovery from the deepest depths of injury. “And so,” as Katz puts it, “began the fabulous tale of Operation Mend.”
The Core of the Work
Though founded and funded out of philanthropic generosity and a sense of moral obligation, Operation Mend functions as a strictly run medical practice tailored to a unique clientele. Says Gideon, “We know the responsibility we have to the military and our patients, and we take it very seriously.”“We’d like to make sure these men and women get the best this country has to offer.”
First, Operation Mend aims to fill a niche, not duplicate services already provided by the Departments of Defense or Veterans Affairs. “We are a partner with the military,” says Gideon. “We are not here to do something better than they are; we’re not here to do something they already do. Our goal is to complement their services. Not every military medical center is armed with the top plastic surgeons in the world. That doesn’t make sense for them, so we want to do our part.”
By the end of its first year in 2008, SAMMC had sent Operation Mend six patients. Soon an official agreement was completed to cement the partnership. Operation Mend began receiving referrals from V.A. facilities, the Army Wounded Warrior Program, and the Marine Corps’ Wounded Warrior Regiment.
Operation Mend also receives many of its patients by word of mouth. As Gideon explains, “If one guy is wounded in an IED blast, it generally means four of his friends were wounded in that same blast. One of them comes here, and he’ll go tell his friends. Then we work backwards to get the approvals.”
So what exactly does Operation Mend mend? Initially, the team focused solely on severe facial injuries caused primarily by burns. Because patients had often tried to put the flames out with their hands, the team soon expanded to include plastic and reconstructive surgery on hands. From there, they expanded to work on prosthetics, eye injuries, orthopedic problems, spinal damage, urogenital reconstruction, and even traumatic brain injury.
“We began to span our entire health system,” says Gideon. But with each new possible patient procedure, the team goes back to the referring facility for authorization, to ensure their work doesn’t interfere with that of the patient’s military doctors.
Eligibility for Operation Mend requires that the service member be injured in post-9/11 combat or training; that the injury be one requiring unique care not available from local DoD or V.A. facilities; that a case manager from the referring institution serve as a local advocate for the patient; and that the patient travel with at least one other person. After the intake process, patients go to UCLA for an initial consultation and receive options for surgery or treatment. Patients then return home, schedule the surgery, and return for the procedure. During a surgery visit, patients will typically spend one night in the hospital immediately after the surgery and then one or two weeks in an on-campus hotel recovering before they travel home.
Operation Mend bills the patient’s insurance, then covers whatever portion is not reimbursed. Gideon explains that “we realized that to establish a sustainable program where the doctor can continue to focus on these patients consistently,” partial insurance payment was necessary. With Operation Mend’s growth in size and patient load, professionalization was a must—“We now have 80 patients, 80 families, hundreds of surgeries, hundreds of nights of stay.”
At the same time, the surgeons and other professionals who participate in Operation Mend do it because they believe in the program and its patients. They often change their practices, patient loads, and schedules to make Operation Mend patients a priority. “We have celebrities in the waiting room behind OpMend patients,” says Gideon.
Cost varies by procedure, and includes transportation and lodging expenses for patient and family. Operation Mend has spent as little as $3,000 on a patient with a single clinical consultation, and over $500,000 on patients who have required more than 20 surgeries. Thanks to Operation Mend’s host contributions and partial insurance reimbursements, it is able to provide life-changing care with reasonable philanthropic investment.
Gideon explains UCLA’s role in keeping costs low. “We don’t have to pay for physicians or nurses or anesthesiologists to come in from outside. They’re all here. The volunteers are here. It’s just a matter of getting all the moving parts together.” The program’s staff numbers only four—a program manager, clinical coordinator, and two assistant coordinators. Operation Mend benefits from sharing staff like a psychologist and finance manager with the university, and having access to the wider institution’s marketing, media relations, and development resources.
While most patients have insurance through the military or Medicare Part B, Operation Mend will not turn patients away if they are uninsured. And it will never charge these severely wounded patients a dime for its services. The $1 million gift from the Katz family got the program off the ground, and another private donation of $10 million from the Iraq-Afghanistan Deployment Impact Fund helped sustain it.
Getting the Details Right
The magic of the program is not solely in the surgery provided. Katz’s emphasis on the “VVIP treatment” seeps into every facet of Operation Mend, and makes its partnership with DoD and V.A. medical facilities work well. In order to provide the best care available, Operation Mend has “shifted from patient-centered care to family-centered care. We make sure that the whole puzzle is in one piece when patients leave,” says Gideon. Operation Mend pays transportation, lodging, and per diem costs for patients and their families; it provides accompaniment to every appointment from arrival to departure; and it offers social and psychological support during often-difficult recovery periods.
Operation Mend brought on a psychologist from UCLA to work with patients and their families on care management, to conduct traumatic-stress assessments, and to help with the pressures of injury and surgical recovery. According to Gideon, some of the family members told the psychologist “this was the first time anyone has ever asked me what this has been like for me.” In addition to immediate evaluation and counseling, Operation Mend has added a tele-health component to its treatment, so that patients and their families can get advice and counsel from UCLA professionals after returning home.
The needs of patients and their families often go beyond medical care, notes Katz. “They are here recovering for weeks after surgery—what are they going to do, sit in the hotel? So my son and daughter-in-law decided they wanted to start a Buddy Family program. The local family takes the patient out to dinner, to their home, to the beach, and many have developed a very close relationship with the individual and his family.”
As more wounded men came to Operation Mend, more Buddy Families joined—there are currently 56 caring for 80 patients. Katz recently learned about “a 13-year-old boy who announced at his bar mitzvah that he was going to take the funds he received as presents and give them to Operation Mend. His family was a Buddy Family.”