'Post' Gets Results from Walter Reed Hospital Probe

Soldiers Face Neglect, Frustration At Army's Top Medical Fac
Soldiers Face Neglect, Frustration At Army's Top Medical Facility
By Dana Priest and Anne Hull
Washington Post Staff Writers
Sunday, February 18, 2007; A01

Behind the door of Army Spec. Jeremy Duncan's room, part of the wall is torn and hangs in the air, weighted down with black mold. When the wounded combat engineer stands in his shower and looks up, he can see the bathtub on the floor above through a rotted hole. The entire building, constructed between the world wars, often smells like greasy carry-out. Signs of neglect are everywhere: mouse droppings, belly-up cockroaches, stained carpets, cheap mattresses.

This is the world of Building 18, not the kind of place where Duncan expected to recover when he was evacuated to Walter Reed Army Medical Center from Iraq last February with a broken neck and a shredded left ear, nearly dead from blood loss. But the old lodge, just outside the gates of the hospital and five miles up the road from the White House, has housed hundreds of maimed soldiers recuperating from injuries suffered in the wars in Iraq and Afghanistan.

The common perception of Walter Reed is of a surgical hospital that shines as the crown jewel of military medicine. But 5 1/2 years of sustained combat have transformed the venerable 113-acre institution into something else entirely -- a holding ground for physically and psychologically damaged outpatients. Almost 700 of them -- the majority soldiers, with some Marines -- have been released from hospital beds but still need treatment or are awaiting bureaucratic decisions before being discharged or returned to active duty.

They suffer from brain injuries, severed arms and legs, organ and back damage, and various degrees of post-traumatic stress. Their legions have grown so exponentially -- they outnumber hospital patients at Walter Reed 17 to 1 -- that they take up every available bed on post and spill into dozens of nearby hotels and apartments leased by the Army. The average stay is 10 months, but some have been stuck there for as long as two years.

Not all of the quarters are as bleak as Duncan's, but the despair of Building 18 symbolizes a larger problem in Walter Reed's treatment of the wounded, according to dozens of soldiers, family members, veterans aid groups, and current and former Walter Reed staff members interviewed by two Washington Post reporters, who spent more than four months visiting the outpatient world without the knowledge or permission of Walter Reed officials. Many agreed to be quoted by name; others said they feared Army retribution if they complained publicly.

While the hospital is a place of scrubbed-down order and daily miracles, with medical advances saving more soldiers than ever, the outpatients in the Other Walter Reed encounter a messy bureaucratic battlefield nearly as chaotic as the real battlefields they faced overseas.

On the worst days, soldiers say they feel like they are living a chapter of "Catch-22." The wounded manage other wounded. Soldiers dealing with psychological disorders of their own have been put in charge of others at risk of suicide.

Disengaged clerks, unqualified platoon sergeants and overworked case managers fumble with simple needs: feeding soldiers' families who are close to poverty, replacing a uniform ripped off by medics in the desert sand or helping a brain-damaged soldier remember his next appointment.

"We've done our duty. We fought the war. We came home wounded. Fine. But whoever the people are back here who are supposed to give us the easy transition should be doing it," said Marine Sgt. Ryan Groves, 26, an amputee who lived at Walter Reed for 16 months. "We don't know what to do. The people who are supposed to know don't have the answers. It's a nonstop process of stalling."

Soldiers, family members, volunteers and caregivers who have tried to fix the system say each mishap seems trivial by itself, but the cumulative effect wears down the spirits of the wounded and can stall their recovery.

"It creates resentment and disenfranchisement," said Joe Wilson, a clinical social worker at Walter Reed. "These soldiers will withdraw and stay in their rooms. They will actively avoid the very treatment and services that are meant to be helpful."

Danny Soto, a national service officer for Disabled American Veterans who helps dozens of wounded service members each week at Walter Reed, said soldiers "get awesome medical care and their lives are being saved," but, "Then they get into the administrative part of it and they are like, 'You saved me for what?' The soldiers feel like they are not getting proper respect. This leads to anger."

This world is invisible to outsiders. Walter Reed occasionally showcases the heroism of these wounded soldiers and emphasizes that all is well under the circumstances. President Bush, former defense secretary Donald H. Rumsfeld and members of Congress have promised the best care during their regular visits to the hospital's spit-polished amputee unit, Ward 57.

"We owe them all we can give them," Bush said during his last visit, a few days before Christmas. "Not only for when they're in harm's way, but when they come home to help them adjust if they have wounds, or help them adjust after their time in service."

Along with the government promises, the American public, determined not to repeat the divisive Vietnam experience, has embraced the soldiers even as the war grows more controversial at home. Walter Reed is awash in the generosity of volunteers, businesses and celebrities who donate money, plane tickets, telephone cards and steak dinners.

Yet at a deeper level, the soldiers say they feel alone and frustrated. Seventy-five percent of the troops polled by Walter Reed last March said their experience was "stressful." Suicide attempts and unintentional overdoses from prescription drugs and alcohol, which is sold on post, are part of the narrative here.

Vera Heron spent 15 frustrating months living on post to help care for her son. "It just absolutely took forever to get anything done," Heron said. "They do the paperwork, they lose the paperwork. Then they have to redo the paperwork. You are talking about guys and girls whose lives are disrupted for the rest of their lives, and they don't put any priority on it."

Family members who speak only Spanish have had to rely on Salvadoran housekeepers, a Cuban bus driver, the Panamanian bartender and a Mexican floor cleaner for help. Walter Reed maintains a list of bilingual staffers, but they are rarely called on, according to soldiers and families and Walter Reed staff members.

Evis Morales's severely wounded son was transferred to the National Naval Medical Center in Bethesda for surgery shortly after she arrived at Walter Reed. She had checked into her government-paid room on post, but she slept in the lobby of the Bethesda hospital for two weeks because no one told her there is a free shuttle between the two facilities. "They just let me off the bus and said 'Bye-bye,' " recalled Morales, a Puerto Rico resident.

Morales found help after she ran out of money, when she called a hotline number and a Spanish-speaking operator happened to answer.

"If they can have Spanish-speaking recruits to convince my son to go into the Army, why can't they have Spanish-speaking translators when he's injured?" Morales asked. "It's so confusing, so disorienting."

Soldiers, wives, mothers, social workers and the heads of volunteer organizations have complained repeatedly to the military command about what one called "The Handbook No One Gets" that would explain life as an outpatient. Most soldiers polled in the March survey said they got their information from friends. Only 12 percent said any Army literature had been helpful.

"They've been behind from Day One," said Rep. Thomas M. Davis III (R-Va.), who headed the House Government Reform Committee, which investigated problems at Walter Reed and other Army facilities. "Even the stuff they've fixed has only been patched."

Among the public, Davis said, "there's vast appreciation for soldiers, but there's a lack of focus on what happens to them" when they return. "It's awful."

Maj. Gen. George W. Weightman, commander at Walter Reed, said in an interview last week that a major reason outpatients stay so long, a change from the days when injured soldiers were discharged as quickly as possible, is that the Army wants to be able to hang on to as many soldiers as it can, "because this is the first time this country has fought a war for so long with an all-volunteer force since the Revolution."

Acknowledging the problems with outpatient care, Weightman said Walter Reed has taken steps over the past year to improve conditions for the outpatient army, which at its peak in summer 2005 numbered nearly 900, not to mention the hundreds of family members who come to care for them. One platoon sergeant used to be in charge of 125 patients; now each one manages 30. Platoon sergeants with psychological problems are more carefully screened. And officials have increased the numbers of case managers and patient advocates to help with the complex disability benefit process, which Weightman called "one of the biggest sources of delay."

And to help steer the wounded and their families through the complicated bureaucracy, Weightman said, Walter Reed has recently begun holding twice-weekly informational meetings. "We felt we were pushing information out before, but the reality is, it was overwhelming," he said. "Is it fail-proof? No. But we've put more resources on it."

He said a 21,500-troop increase in Iraq has Walter Reed bracing for "potentially a lot more" casualties.

Bureaucratic Battles

The best known of the Army's medical centers, Walter Reed opened in 1909 with 10 patients. It has treated the wounded from every war since, and nearly one of every four service members injured in Iraq and Afghanistan.

The outpatients are assigned to one of five buildings attached to the post, including Building 18, just across from the front gates on Georgia Avenue. To accommodate the overflow, some are sent to nearby hotels and apartments. Living conditions range from the disrepair of Building 18 to the relative elegance of Mologne House, a hotel that opened on the post in 1998, when the typical guest was a visiting family member or a retiree on vacation.

The Pentagon has announced plans to close Walter Reed by 2011, but that hasn't stopped the flow of casualties. Three times a week, school buses painted white and fitted with stretchers and blackened windows stream down Georgia Avenue. Sirens blaring, they deliver soldiers groggy from a pain-relief cocktail at the end of their long trip from Iraq via Landstuhl Regional Medical Center in Germany and Andrews Air Force Base.

Staff Sgt. John Daniel Shannon, 43, came in on one of those buses in November 2004 and spent several weeks on the fifth floor of Walter Reed's hospital. His eye and skull were shattered by an AK-47 round. His odyssey in the Other Walter Reed has lasted more than two years, but it began when someone handed him a map of the grounds and told him to find his room across post.

A reconnaissance and land-navigation expert, Shannon was so disoriented that he couldn't even find north. Holding the map, he stumbled around outside the hospital, sliding against walls and trying to keep himself upright, he said. He asked anyone he found for directions.

Shannon had led the 2nd Infantry Division's Ghost Recon Platoon until he was felled in a gun battle in Ramadi. He liked the solitary work of a sniper; "Lone Wolf" was his call name. But he did not expect to be left alone by the Army after such serious surgery and a diagnosis of post-traumatic stress disorder. He had appointments during his first two weeks as an outpatient, then nothing.

"I thought, 'Shouldn't they contact me?' " he said. "I didn't understand the paperwork. I'd start calling phone numbers, asking if I had appointments. I finally ran across someone who said: 'I'm your case manager. Where have you been?'

"Well, I've been here! Jeez Louise, people, I'm your hospital patient!"

Like Shannon, many soldiers with impaired memory from brain injuries sat for weeks with no appointments and no help from the staff to arrange them. Many disappeared even longer. Some simply left for home.

One outpatient, a 57-year-old staff sergeant who had a heart attack in Afghanistan, was given 200 rooms to supervise at the end of 2005. He quickly discovered that some outpatients had left the post months earlier and would check in by phone. "We called them 'call-in patients,' " said Staff Sgt. Mike McCauley, whose dormant PTSD from Vietnam was triggered by what he saw on the job: so many young and wounded, and three bodies being carried from the hospital.

Life beyond the hospital bed is a frustrating mountain of paperwork. The typical soldier is required to file 22 documents with eight different commands -- most of them off-post -- to enter and exit the medical processing world, according to government investigators. Sixteen different information systems are used to process the forms, but few of them can communicate with one another. The Army's three personnel databases cannot read each other's files and can't interact with the separate pay system or the medical recordkeeping databases.

The disappearance of necessary forms and records is the most common reason soldiers languish at Walter Reed longer than they should, according to soldiers, family members and staffers. Sometimes the Army has no record that a soldier even served in Iraq. A combat medic who did three tours had to bring in letters and photos of herself in Iraq to show she that had been there, after a clerk couldn't find a record of her service.

Shannon, who wears an eye patch and a visible skull implant, said he had to prove he had served in Iraq when he tried to get a free uniform to replace the bloody one left behind on a medic's stretcher. When he finally tracked down the supply clerk, he discovered the problem: His name was mistakenly left off the "GWOT list" -- the list of "Global War on Terrorism" patients with priority funding from the Defense Department.

He brought his Purple Heart to the clerk to prove he was in Iraq.

Lost paperwork for new uniforms has forced some soldiers to attend their own Purple Heart ceremonies and the official birthday party for the Army in gym clothes, only to be chewed out by superiors.

The Army has tried to re-create the organization of a typical military unit at Walter Reed. Soldiers are assigned to one of two companies while they are outpatients -- the Medical Holding Company (Medhold) for active-duty soldiers and the Medical Holdover Company for Reserve and National Guard soldiers. The companies are broken into platoons that are led by platoon sergeants, the Army equivalent of a parent.

Under normal circumstances, good sergeants know everything about the soldiers under their charge: vices and talents, moods and bad habits, even family stresses.

At Walter Reed, however, outpatients have been drafted to serve as platoon sergeants and have struggled with their responsibilities. Sgt. David Thomas, a 42-year-old amputee with the Tennessee National Guard, said his platoon sergeant couldn't remember his name. "We wondered if he had mental problems," Thomas said. "Sometimes I'd wear my leg, other times I'd take my wheelchair. He would think I was a different person. We thought, 'My God, has this man lost it?' "

Civilian care coordinators and case managers are supposed to track injured soldiers and help them with appointments, but government investigators and soldiers complain that they are poorly trained and often do not understand the system.

One amputee, a senior enlisted man who asked not to be identified because he is back on active duty, said he received orders to report to a base in Germany as he sat drooling in his wheelchair in a haze of medication. "I went to Medhold many times in my wheelchair to fix it, but no one there could help me," he said.

Finally, his wife met an aide to then-Deputy Defense Secretary Paul D. Wolfowitz, who got the erroneous paperwork corrected with one phone call. When the aide called with the news, he told the soldier, "They don't even know you exist."

"They didn't know who I was or where I was," the soldier said. "And I was in contact with my platoon sergeant every day."

The lack of accountability weighed on Shannon. He hated the isolation of the younger troops. The Army's failure to account for them each day wore on him. When a 19-year-old soldier down the hall died, Shannon knew he had to take action.

The soldier, Cpl. Jeremy Harper, returned from Iraq with PTSD after seeing three buddies die. He kept his room dark, refused his combat medals and always seemed heavily medicated, said people who knew him. According to his mother, Harper was drunkenly wandering the lobby of the Mologne House on New Year's Eve 2004, looking for a ride home to West Virginia. The next morning he was found dead in his room. An autopsy showed alcohol poisoning, she said.

"I can't understand how they could have let kids under the age of 21 have liquor," said Victoria Harper, crying. "He was supposed to be right there at Walter Reed hospital. . . . I feel that they didn't take care of him or watch him as close as they should have."

The Army posthumously awarded Harper a Bronze Star for his actions in Iraq.

Shannon viewed Harper's death as symptomatic of a larger tragedy -- the Army had broken its covenant with its troops. "Somebody didn't take care of him," he would later say. "It makes me want to cry. "

Shannon and another soldier decided to keep tabs on the brain injury ward. "I'm a staff sergeant in the U.S. Army, and I take care of people," he said. The two soldiers walked the ward every day with a list of names. If a name dropped off the large white board at the nurses' station, Shannon would hound the nurses to check their files and figure out where the soldier had gone.

Sometimes the patients had been transferred to another hospital. If they had been released to one of the residences on post, Shannon and his buddy would pester the front desk managers to make sure the new charges were indeed there. "But two out of 10, when I asked where they were, they'd just say, 'They're gone,' " Shannon said.

Even after Weightman and his commanders instituted new measures to keep better track of soldiers, two young men left post one night in November and died in a high-speed car crash in Virginia. The driver was supposed to be restricted to Walter Reed because he had tested positive for illegal drugs, Weightman said.

Part of the tension at Walter Reed comes from a setting that is both military and medical. Marine Sgt. Ryan Groves, the squad leader who lost one leg and the use of his other in a grenade attack, said his recovery was made more difficult by a Marine liaison officer who had never seen combat but dogged him about having his mother in his room on post. The rules allowed her to be there, but the officer said she was taking up valuable bed space.

"When you join the Marine Corps, they tell you, you can forget about your mama. 'You have no mama. We are your mama,' " Groves said. "That training works in combat. It doesn't work when you are wounded."

Frustration at Every Turn

The frustrations of an outpatient's day begin before dawn. On a dark, rain-soaked morning this winter, Sgt. Archie Benware, 53, hobbled over to his National Guard platoon office at Walter Reed. Benware had done two tours in Iraq. His head had been crushed between two 2,100-pound concrete barriers in Ramadi, and now it was dented like a tin can. His legs were stiff from knee surgery. But here he was, trying to take care of business.

At the platoon office, he scanned the white board on the wall. Six soldiers were listed as AWOL. The platoon sergeant was nowhere to be found, leaving several soldiers stranded with their requests.

Benware walked around the corner to arrange a dental appointment -- his teeth were knocked out in the accident. He was told by a case manager that another case worker, not his doctor, would have to approve the procedure.

"Goddamn it, that's unbelievable!" snapped his wife, Barb, who accompanied him because he can no longer remember all of his appointments.

Not as unbelievable as the time he received a manila envelope containing the gynecological report of a young female soldier.

Next came 7 a.m. formation, one way Walter Reed tries to keep track of hundreds of wounded. Formation is also held to maintain some discipline. Soldiers limp to the old Red Cross building in rain, ice and snow. Army regulations say they can't use umbrellas, even here. A triple amputee has mastered the art of putting on his uniform by himself and rolling in just in time. Others are so gorked out on pills that they seem on the verge of nodding off.

"Fall in!" a platoon sergeant shouted at Friday formation. The noisy room of soldiers turned silent.

An Army chaplain opened with a verse from the Bible. "Why are we here?" she asked. She talked about heroes and service to country. "We were injured in many ways."

Someone announced free tickets to hockey games, a Ravens game, a movie screening, a dinner at McCormick and Schmick's, all compliments of local businesses.

Every formation includes a safety briefing. Usually it is a warning about mixing alcohol with meds, or driving too fast, or domestic abuse. "Do not beat your spouse or children. Do not let your spouse or children beat you," a sergeant said, to laughter. This morning's briefing included a warning about black ice, a particular menace to the amputees.

Dress warm, the sergeant said. "I see some guys rolling around in their wheelchairs in 30 degrees in T-shirts."

Soldiers hate formation for its petty condescension. They gutted out a year in the desert, and now they are being treated like children.

"I'm trying to think outside the box here, maybe moving formation to Wagner Gym," the commander said, addressing concerns that formation was too far from soldiers' quarters in the cold weather. "But guess what? Those are nice wood floors. They have to be covered by a tarp. There's a tarp that's got to be rolled out over the wooden floors. Then it has to be cleaned, with 400 soldiers stepping all over it. Then it's got to be rolled up."

"Now, who thinks Wagner Gym is a good idea?"

Explaining this strange world to family members is not easy. At an orientation for new arrivals, a staff sergeant walked them through the idiosyncrasies of Army financing. He said one relative could receive a 15-day advance on the $64 per diem either in cash or as an electronic transfer: "I highly recommend that you take the cash," he said. "There's no guarantee the transfer will get to your bank." The audience yawned.

Actually, he went on, relatives can collect only 80 percent of this advance, which comes to $51.20 a day. "The cashier has no change, so we drop to $50. We give you the rest" -- the $1.20 a day -- "when you leave."

The crowd was anxious, exhausted. A child crawled on the floor. The sergeant plowed on. "You need to figure out how long your loved one is going to be an inpatient," he said, something even the doctors can't accurately predict from day to day. "Because if you sign up for the lodging advance," which is $150 a day, "and they get out the next day, you owe the government the advance back of $150 a day."

A case manager took the floor to remind everyone that soldiers are required to be in uniform most of the time, though some of the wounded are amputees or their legs are pinned together by bulky braces. "We have break-away clothing with Velcro!" she announced with a smile. "Welcome to Walter Reed!"

A Bleak Life in Building 18

"Building 18! There is a rodent infestation issue!" bellowed the commander to his troops one morning at formation. "It doesn't help when you live like a rodent! I can't believe people live like that! I was appalled by some of your rooms!"

Life in Building 18 is the bleakest homecoming for men and women whose government promised them good care in return for their sacrifices.

One case manager was so disgusted, she bought roach bombs for the rooms. Mouse traps are handed out. It doesn't help that soldiers there subsist on carry-out food because the hospital cafeteria is such a hike on cold nights. They make do with microwaves and hot plates.

Army officials say they "started an aggressive campaign to deal with the mice infestation" last October and that the problem is now at a "manageable level." They also say they will "review all outstanding work orders" in the next 30 days.

Soldiers discharged from the psychiatric ward are often assigned to Building 18. Buses and ambulances blare all night. While injured soldiers pull guard duty in the foyer, a broken garage door allows unmonitored entry from the rear. Struggling with schizophrenia, PTSD, paranoid delusional disorder and traumatic brain injury, soldiers feel especially vulnerable in that setting, just outside the post gates, on a street where drug dealers work the corner at night.

"I've been close to mortars. I've held my own pretty good," said Spec. George Romero, 25, who came back from Iraq with a psychological disorder. "But here . . . I think it has affected my ability to get over it . . . dealing with potential threats every day."

After Spec. Jeremy Duncan, 30, got out of the hospital and was assigned to Building 18, he had to navigate across the traffic of Georgia Avenue for appointments. Even after knee surgery, he had to limp back and forth on crutches and in pain. Over time, black mold invaded his room.

But Duncan would rather suffer with the mold than move to another room and share his convalescence in tight quarters with a wounded stranger. "I have mold on the walls, a hole in the shower ceiling, but . . . I don't want someone waking me up coming in."

Wilson, the clinical social worker at Walter Reed, was part of a staff team that recognized Building 18's toll on the wounded. He mapped out a plan and, in September, was given a $30,000 grant from the Commander's Initiative Account for improvements. He ordered some equipment, including a pool table and air hockey table, which have not yet arrived. A Psychiatry Department functionary held up the rest of the money because she feared that buying a lot of recreational equipment close to Christmas would trigger an audit, Wilson said.

In January, Wilson was told that the funds were no longer available and that he would have to submit a new request. "It's absurd," he said. "Seven months of work down the drain. I have nothing to show for this project. It's a great example of what we're up against."

A pool table and two flat-screen TVs were eventually donated from elsewhere.

But Wilson had had enough. Three weeks ago he turned in his resignation. "It's too difficult to get anything done with this broken-down bureaucracy," he said.

At town hall meetings, the soldiers of Building 18 keep pushing commanders to improve conditions. But some things have gotten worse. In December, a contracting dispute held up building repairs.

"I hate it," said Romero, who stays in his room all day. "There are cockroaches. The elevator doesn't work. The garage door doesn't work. Sometimes there's no heat, no water. . . . I told my platoon sergeant I want to leave. I told the town hall meeting. I talked to the doctors and medical staff. They just said you kind of got to get used to the outside world. . . . My platoon sergeant said, 'Suck it up!' "
-------------------------------------------

Staff researcher Julie Tate contributed to this report.

If Walter Reed were the Top Notch facility it is claimed to be then how come they are opening a new facillity to take its place? I beleive it is being built in Tx.

Walter Reed is overwhelmed by the number of war casulties and are not prepared for the "serge" results. Typical of the Bush administration's lack of preparation and understandings of war requirements.

BBB

I meant to type "Surge"...I hope we didn't lose our ability to edit posts.

BBB

When was the last time a major facility like this one was built? All the blame can't fall on Bush even though he is calling for a surge the lack of proper facilities can't all fall on him.

Baldimo
The Bush Administration is responsible because no previous president would have gone to war with Iraq. Even George W's father would not invade Iraq because he understood the disasterous consequences for the region.

BBB

His budgets haven't exactly been kind to the injured vets..

Cycloptichorn

BBB
War veterans have a long history of not being able to trust presidential adminstrations. Promises to Vets have rarely been kept.

BBB

More Fallout from 'Wash Post' Probe of Veterans' Care
More Fallout from 'Wash Post' Probe of Veterans' Care
February 20, 2007
E & P

Walter Reed Army Medical Center is investigating the former head of a program that aids injured soldiers.

The probe is into the activities of Michael J. Wagner, who until last month ran the Army's Medical Family Assistance Center, Army spokesman Paul Boyce said Tuesday. The center links businesses, charities and other donors with wounded troops who need financial help or families strained by living costs, air fares and other expenses when they come to Washington to visit or help care for injured soldiers.

The Washington Post - citing documents and interviews with current and former staff members at the assistance center - said Wagner was seeking funders and soliciting donations for a Dallas, Texas, charity at the same time he administered the Army program.

Wagner is now a director of the Texas-based charity, the Military, Veteran and Family Assistance Foundation, a nonprofit group that provides services and resources for veterans and their families.

He could not immediately be reached for comment Tuesday at the foundation office, where another official said Wagner would issue a statement later in the day.

The newspaper said that in a telephone interview Wagner denied he had solicited funds for the charity or made contact with donors during office hours. "It's just not true," he was quoted as saying. "I intentionally stayed out of that. I couldn't do that. I couldn't do both."

Wagner said the charity was founded by his brother and that he did not officially become its executive director until he left Walter Reed, according to the Post.

The story was the latest in a Post series that also disclosed bureaucratic delays and substandard living conditions endured by some soldiers there as outpatients, as well as problems in receiving benefits.

Two senators on Tuesday urged Defense Secretary Robert Gates to launch an inspector general's investigation into what they called the "deplorable living conditions facing returning Iraq and Afghanistan war veterans."

In their letter to Gates, Democratic Sens. Barbara Mikulski of Maryland and Patty Murray of Washington also urged him to investigate conditions at the Navy's top hospital - the National Naval Medical Center - in Bethesda, Md.

"If conditions at Walter Reed, the crown jewel of military health care facilities, have degraded to the point where mouse traps are handed out to patients, how can we feel confident that our troops and veterans truly have the care and transition assistance they have been promised at any facility across the country?" the senators wrote.

Walter Reed Hospital Scandal is 'The Last Straw'
Galloway: Walter Reed Hospital Scandal is 'The Last Straw'
By Joseph L. Galloway
February 21, 2007

As The Washington Post probe proves, there's more to supporting our troops than making "Support Our Troops" a phrase that every politician feels obliged to utter in every speech, no matter how craven the purpose. How can they look at themselves in the mirror every morning?

There's a great deal more to supporting our troops than sticking a $2 yellow ribbon magnet made in China on your SUV. There's a great deal more to it than making "Support Our Troops" a phrase that every politician feels obliged to utter in every speech, no matter how banal the topic or craven the purpose.

This week, we were treated to new revelations of just how fraudulent and shallow and meaningless "Support Our Troops" is on the lips of those in charge of spending the half a trillion dollars of taxpayer's money that the Pentagon eats every year.


The Washington Post published a probe, complete with photographs, revealing that for every in-patient who's getting the best medical treatment that money can buy at the main hospital at the Walter Reed Army Medical Center, there are out-patients warehoused in quarters unfit for human habitation.

Some of the military outpatients are stuck on the Walter Reed campus, a couple of miles from the White House and the Capitol, for as long as 12 months. They've been living in rat and roach-infested rooms, some of which are coated in black mold.

There was outrage and disgust and raw anger at this callous, cruel treatment of those who have the greatest claim not only on our sympathies, but also on the public purse.

Who among the smiling politicians who regularly troop over to the main hospital at Walter Reed for photo-op visits with those who've come home grievously wounded from the wars the politicians started have bothered to go the extra quarter-mile to see the unseen majority with their rats and roaches?

Not one, it would seem, since none among them have admitted to knowing that there was a problem, much less doing something about it before the reporters blew the whistle.

Within 24 hours, construction crews were working overtime, slapping paint over the moldy drywall, patching the sagging ceilings and putting out traps and poison for the critters that infest the place.

Within 48 hours, the Department of Defense announced that it was appointing an independent commission to investigate. Doubtless the commission will provide a detailed report finding that no one was guilty -- certainly none of the politicians of the ruling party whose hands were on the levers of power for five long years of war.

They will find that it all came about because the Army medical establishment was overwhelmed by the case load flowing out of Iraq and Afghanistan.

Meanwhile, brave soldiers who were wheelchair-bound with missing legs or paralysis, have been left to make their own way a quarter-mile to appointments with the shrinks and a half-mile to pick up the drugs that dim their minds and eyes and pain, and make the rats and roaches recede into a fuzzy distance.

All this came on the heels of my McClatchy Newspapers colleague Chris Adams's Feb. 9 report that even by its own measures, the Veterans Administration isn't prepared to give returning veterans the care they need to help them overcome destructive, and sometimes fatal, mental health ailments. Nearly 100 VA clinics provided virtually no mental health care in 2005, Adams found, and the average veteran with psychiatric troubles gets about a third fewer visits with specialists today than he would have received a decade ago.

The same politicians, from a macho president to the bureaucrats to the people who chair the congressional committees that are supposed to oversee such matters, have utterly failed to protect our wounded warriors.

They've talked the talk but few, if any, have ever walked the walk.

No. This happened while all of them were busy as bees, taking billions out of the VA budget and planning to shut down Walter Reed by 2011 in the name of cost-efficiency.
Among those politicians are the people who sent too few troops to Afghanistan or Iraq, who failed to provide enough body armor and weapons and armored vehicles and who, to protect their own political hides, refused to admit that the mission was not accomplished and change course.

But it's they who are charged with the highest duty of all, in the words of President Abraham Lincoln in his Second Inaugural in 1865: "to care for him who shall have borne the battle and for his widow, and his orphan."

How can they look at themselves in the mirror every morning? How dare they ever utter the words: Support Our Troops? How dare they pretend to give a damn about those they order to war?

They've hidden the flag-draped coffins of the fallen from the public and the press. They've averted their eyes from the suffering that their orders have visited upon an Army that they've ground down by misuse and over-use and just plain incompetence.

This shabby, sorry episode of political and institutional cruelty to those who deserve the best their nation can provide is the last straw. How can they spin this one to blame the generals or the media or the Democrats? How can you do that, Karl?

If the American people are not sickened and disgusted by this then, by God, we don't deserve to be defended from the wolves of this world.

Critics: Army Holding Down Disability Ratings
Critics: Army Holding Down Disability Ratings
By Kelly Kennedy
Army Times
Saturday 24 February 2007

The Army is deliberately shortchanging troops on their disability retirement ratings to hold down costs, according to veterans' advocates, lawyers and services members, and the Inspector General has identified 87 problems in the system that need fixing.

"These people are being systematically underrated," said Ron Smith, deputy general counsel for Disabled American Veterans. "It's a bureaucratic game to preserve the budget, and it's having an adverse affect on service members."

The numbers of people approved for permanent or temporary disability retirement in the Navy, Marine Corps and Air Force have stayed relatively stable since 2001.

But in the Army - in the midst of a war - the number of soldiers approved for permanent disability retirement has plunged by more than two-thirds, from 642 in 2001 to 209 in 2005, according to a Government Accountability Office report last year. That decline has come even as the war in Iraq has intensified and the total number of soldiers wounded or injured there has soared above 15,000.

The Army denies there is any intentional effort to push wounded troops off the military rolls. But critics say many troops being evaluated for possible disability retirement accept the first rating they are offered during their first informal board - but that if they were to request a formal board, and then appeal the decision of that board, they would receive higher ratings.

The system is complicated - "unduly so," the Rand Corp. think tank said in a 2005 report - and the counselors who advise troops often have insufficient training or experience. Service members also assume that after months spent in a war zone, the military will look out for them, critics say.

Those who try to navigate the process beyond their initial evaluation - to include hundreds of combat veterans in limbo at Walter Reed Army Medical Center in Washington - face long waits, lost paperwork and months or even years away from home as they try to complete the process. If they receive a rating of above 30 percent, they receive disability retirement pay, medical benefits, and commissary privileges. Those rated under 30 percent receive severance pay and no benefits.

Many eventually give up and take their chances with the Department of Veterans Affairs, which may give a higher rating for the same disability.

But under the separate disability payment systems of the Defense Department and the VA, a higher VA rating does not necessarily translate into more money - and forgoing military disability retirement also means giving up lifetime commissary and exchange privileges, military health care and other benefits.

While the number of soldiers placed on permanent disability retirement has declined in the past five years, the number placed on temporary disability retirement - with medical conditions that officials rule might improve so they can return to work over time or worsen to the point that they must be permanently retired - has increased more than fourfold, from 165 in 2001 to 837 in 2005.

Troops on temporary disability leave convalesce for 18 months while receiving reduced basic pay. After 1½ years, they are reevaluated and either returned to duty, or rated for separation or permanent disability retirement, or sent back to temporary disability for another 18 months - up to five years.

Along with paying them reduced wages during that time, the eventual reevaluation often leads to downward revisions in their disability ratings - and lower disability payments.

Service members' conditions must be deemed stable before they receive a permanent disability rating, unless they are rated at less than 30 percent. In that case, they are discharged with severance pay - whether they are in stable condition or not. If their conditions then worsen, they'll receive no more money from the military.

Compared to the overall size of the defense budget, disability retirement costs are relatively small. In 2004, the military paid more than $1.2 billion in permanent and temporary disability benefits to 90,000 people, the GAO said.

That does not include the costs of lump-sum severance pay - up to 24 months of basic pay - given to 11,174 disabled troops that year in lieu of disability retirement pay. The Pentagon was unable to provide data on severance costs, the GAO said.

Officials with the Army's Physical Disability Agency say there is no ploy to save money and that troops going through the process are treated well.

"There is absolutely no attempt on the part of the Army or this agency to deny soldiers any disability benefits or to push them off on the VA," said Col. Andy Buchanan, the agency's deputy commander.

Adjudicators "are committed to ensuring all disability decisions are made fairly and accurately and based on the evidence in the soldier's medical record," he said. "We have never received any guidance, official or otherwise, from anywhere within DoD to limit findings for budgetary or other reasons."

In 2005, Ellen Embrey, deputy assistant secretary of defense for force health protection and readiness, told House lawmakers the reason for the comparatively large numbers of troops placed on temporary disability was actually to keep end strength up. A premature medical evaluation board decision, she said, "may negatively impact the individual's ability to continue serving."

"I Couldn't Believe It"

Smith said he began hearing tales about two years ago of service members who said they were not getting proper disability ratings based on the VA Schedule for Rating - the document used by both the military services and the VA to determine percentage ratings for disabilities, which in turn sets compensation rates.

"I finally decided to take on a case myself," Smith said. "It's been a while since I took a case."

He found an Army captain whose radial nerve in his right arm had been destroyed in Iraq - the same injury that has left Bob Dole, the World War II veteran and former Kansas senator, unable to use his arm to do more than hold a pen.

Smith followed the captain through the physical evaluation board process. He said that under the ratings schedule, this was an easy call: 70 percent disability. But at his first informal medical evaluation board, the captain initially was offered just 30 percent, and he had to fight to raise it to 60 percent through a subsequent formal evaluation board and then a final appeal.

"His first offer ... I couldn't believe it," Smith said. "I was just incensed."

Many troops accept the first rating offered them at their initial informal evaluation board, Smith said. "Soldiers are trained. When the evaluation board says, ?'This is what you get,' the soldiers say, ?'Yes sir.' A lot of people don't appeal."

Dennis Brower, legal advisor for the Army's Physical Disability Agency, acknowledged as much, saying only 10 percent of soldiers request a formal board.

But when the Army wouldn't budge on raising the captain's rating above 60 percent, Smith took the case a step beyond where most soldiers can go.

"I called the adjutant general and said I wanted a meeting," Smith said - and added that if he didn't get one, he was "going to Congress.' "

That was in January. He got his meeting. He has demanded that the Army's Physical Disability Agency look for patterns of incremental increases in disability ratings as troops move through the process, and how closely their ratings match what the VA schedule mandates.

Smith is still waiting to hear back, but suspects the pattern will show that a large proportion of troops with less than 20 years of service - who don't already qualify for retirement - are rated at under 30 percent, the threshold for being considered for disability retirement pay and all other military benefits that come with it. Many of those troops instead receive one-time, lump-sum disability severance pay that is much lower in value than lifetime retirement compensation.

Pentagon spokesman Marine Maj. Stewart Upton said the disability retirement process is being looked at.

"We are in the midst of a business-process review that will generate improvements to program effectiveness, including timeliness goals for processing cases and standard definitions of start and end points as well as other metrics to ensure that progress can be accurately measured over time against common metrics," Upton said.

"We are especially concerned with a balance of what constitutes prompt adjudication, while maintaining reasonable flexibility within the system to ensure recoveries are not inappropriately rushed."

Fit for Duty?

Army Lt. Col. Mike Parker was diagnosed with reactive arthritis, which causes painful swelling and eventual calcification of the joints. He was put on drugs that suppress his immune system, but kept on active duty - even though his medication must be refrigerated and he must remain near specialized medical care.

With a suppressed immune system, there is no chance of him being deployed, much less to a combat zone. "If I get shot, it's not good," he said.

Though pleased that he could continue to serve, he wondered how a medical evaluation board could find him fit. After he talked to a dozen other service members from all branches with similar diagnoses of reactive arthritis or ankylosing spondylitis, he realized they were all evaluated based on different criteria. He produced hundreds of pages of medical records, letters and rulings to support his claims.

Some were handed disability ratings that would provide them with the $20,000 in drugs that they would need for the rest of their lives, while others were told they had preexisting conditions and given no benefits. Still others - including some with medical evidence proving otherwise - were told that because their diseases had improved and would not worsen, their disability ratings were based on the idea that they had improved from chronic illnesses that, in reality, could worsen.

Parker began making calls - to lawmakers, doctors, veterans' groups and the media. He sought out troops having problems and offered to help them through the process, piecing together medical paperwork to make sure people got what they deserved.

He said he has seen case after frustrating case of the services ignoring their own rules. For example, an evaluation board is supposed to provide "clear and unerring evidence" for a ruling that a particular condition was preexisting - but Parker said that often does not happen.

He cited a Marine who had received a 10 percent disability rating for post-traumatic stress disorder from a Navy physical evaluation board - and was later rated at 50 percent for the same condition by the VA, using the same ratings schedule and the same medical records.

Unrelated to Service

In May 2003, Army Cpl. Richard Twohig was thrown from an armored personnel carrier in Iraq. The 82nd Airborne Division paratrooper landed on his head, said his lawyer, Mark Waple, of Fayetteville, N.C.

Twohig suffers headaches at least once a week that last up to 14 hours, as well as short-term memory loss, and is dependent on pain medication.

"This is well substantiated by his doctors - Army medical doctors," Waple said.

But his physical evaluation board rated him only 10 percent disabled for another injury because he had no substantive proof the headaches were a result of the accident - even though regulations call for evaluation boards to give troops the benefit of the doubt in such instances.

"I believe it is budget-related," Waple said. "I believe that there is a feeling the service member should turn to the VA for both their health care and their veterans' benefits."

Twohig can't work because of the disabling headaches, and even if he receives VA benefits, his family has lost its medical insurance. And if a physical evaluation board rules that injuries are not related to service or were preexisting conditions, troops are not eligible for VA benefits, either.

Waple said he began helping soldiers through the physical evaluation board process in the 1970s while he was still an Army lawyer, and he said he has watched the system change since the wars began in Iraq and Afghanistan.

The system "has become less friendly toward service members with compensable decisions on disability" in the past few years, especially since the war in Iraq began, Waple said.

"I think there is a definite bias on the physical evaluation board to medically separate service members with a zero-, 10- or 20-percent disability rating when it ... should be medical retirement."

Waple said he has about a dozen cases out of Fort Bragg, N.C., similar to Twohig's.

Army Spc. Ruben Villalpando, who was featured in the Military Times coverage of the problems at Walter Reed, said that since the stories were published, contractors have fixed the elevator in Building 18 - the facility where troops on "medical hold" are housed - and have inspected each room to determine what needs to be fixed.

But more importantly to him, a Judge Advocate General lawyer looked at his case after he filed a complaint that he received no disability rating because his depression was ruled to have existed prior to his enlisting.

Villalpando said he became depressed because his cousin, a Marine, was electrocuted while they were both serving in Iraq. He has been at Walter Reed for just over a year.

"The JAG wanted to know how they knew it was existing prior to service if they didn't have my medical records," Villalpando said.

He has appealed that decision, and his appeal is still pending. "I'm keeping my fingers crossed," he said.

A Complicated Process

Brower, the Army disability agency's legal advisor, said part of the problem is that service members don't understand how the process works. For example, he said a soldier who carries a notepad because of short-term memory loss will not be rated for that disability because he can function. But if he loses a foot, he would be rated for that.

"There's no need to compensate" for the short-term memory loss because it "didn't end your military career," he said. "The foot did. We compensate for the loss of a career."

And Upton said soldiers have plenty of opportunity to appeal.

"Service members are afforded due process to ensure their cases and concerns can be fairly considered whichever direction they choose," he said. "Service members also have rights of appeal at specific points in the process should they disagree with their rating."

Buchanan, the Army Physical Disability Agency's deputy commander, said the system is not as bad as government reports have led people to believe.

"It really is a fair process," he said. "It's wide open. We have nothing to hide."

Buchanan also said he had "no visibility" on the costs related to disability retirement pay, so he doesn't know if the budget is going up or down.

He said he gives medical evaluation board adjudicators one instruction:

"Do the right thing. That's the guidance I give them."

Top Officials Knew About Walter Reed Problems Long Ago
'Wash Post': Top Officials Knew About Walter Reed Problems Long Ago
By E&P Staff
Published: March 01, 2007

Continuing with their scoops in this area well into a second week, Anne Hull and Dana Priest on Thursday reveal in a front-page Washington Post story that top officials at Walter Reed Army Medical Center, including the Army's surgeon general, "have heard complaints about outpatient neglect from family members, veterans groups and members of Congress for more than three years.

"A procession of Pentagon and Walter Reed officials expressed surprise last week about the living conditions and bureaucratic nightmares faced by wounded soldiers staying at the D.C. medical facility," they write. "But as far back as 2003, the commander of Walter Reed, Lt. Gen. Kevin C. Kiley, who is now the Army's top medical officer, was told that soldiers who were wounded in Iraq and Afghanistan were languishing and lost on the grounds, according to interviews....

"In 2004, Rep. C.W. Bill Young (R-Fla.) and his wife stopped visiting the wounded at Walter Reed out of frustration. Young said he voiced concerns to commanders over troubling incidents he witnessed but was rebuffed or ignored. 'When Bev or I would bring problems to the attention of authorities of Walter Reed, we were made to feel very uncomfortable,' said Young, who began visiting the wounded recuperating at other facilities.

"Beverly Young said she complained to Kiley several times. She once visited a soldier who was lying in urine on his mattress pad in the hospital. When a nurse ignored her, Young said, 'I went flying down to Kevin Kiley's office again, and got nowhere. He has skirted this stuff for five years and blamed everyone else.'

"Soldiers and family members say their complaints have been ignored by commanders at many levels."

The rest of the report can be found at www.washingtonpost.com.

Kiley tried to deflect attention away from the conditions in a news conference last week:

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/22/AR2007022201649.html

"Army Secretary Francis J. Harvey has resigned in the wake of the Walter Reed hospital scandal, Defense Secretary" CNN

BBB
Lt. Gen. Kevin C. Kiley is a major bad guy in this scandal at the Army's Washington hospital. There are many more like him scattered around the country who put their careers before the welfare of our troops.

BBB

Squalor surrounding wounded Iraq veterans shocks America
The Bush administration has gone into damage control as the scandal over the treatment of injured soldiers grows, Sarah Baxter reports from Washington
--------------------------------------------------------------------------------

March 05, 2007

WHILE he was recovering from a double amputation at the Walter Reed Army Medical Centre in Washington, Latseen Benson, 27, met a parade of VIPs.
Every time the President, the Vice-President or the Defence Secretary passed by, the military hospital would be thoroughly scrubbed. But the improvements would not last long, according to Diane Benson, the mother of the injured Iraq war veteran.
"I wasn't so bothered by the rats, although there were a lot running around outside, but I really wanted his room to be swept and kept clean," she said.

"You couldn't get people to mop the blood and urine from the floor while my son was there with his legs wide open." http://www.theaustralian.news.com.au/story/0,20867,21324938-2703,00.html

Soldiers Share Troubling Stories Of Military Health Care Across U.S



It appears to me there is no political axe to grind, they are blaming everybody in charge on both sides, rightfully so.

'Post' Looks Beyond Walter Reed -- Finds Problems Elsewhere
National Disgrace: 'Post' Looks Beyond Walter Reed -- Finds Problems Elsewhere
By E&P Staff
Published: March 04, 2007 11:45 PM ET

After uncovering, over the past two weeks, scandalous conditions for many veterans at the Walter Reed Army Medical Center, Washington Post reporters Anne Hull and Dana Priest on Monday take a look outside that one case, what they find is not pretty.

Their latest report opens as follows. The rest of the lengthy article can be found at www.washingtonpost.com.

Ray Oliva went into the spare bedroom in his home in Kelseyville, Calif., to wrestle with his feelings. He didn't know a single soldier at Walter Reed, but he felt he knew them all. He worried about the wounded who were entering the world of military health care, which he knew all too well. His own VA hospital in Livermore was a mess. The gown he wore was torn. The wheelchairs were old and broken.

"It is just not Walter Reed," Oliva slowly tapped out on his keyboard at 4:23 in the afternoon on Friday. "The VA hospitals are not good either except for the staff who work so hard. It brings tears to my eyes when I see my brothers and sisters having to deal with these conditions. I am 70 years old, some say older than dirt but when I am with my brothers and sisters we become one and are made whole again."

Oliva is but one quaking voice in a vast outpouring of accounts filled with emotion and anger about the mistreatment of wounded outpatients at Walter Reed Army Medical Center. Stories of neglect and substandard care have flooded in from soldiers, their family members, veterans, doctors and nurses working inside the system. They describe depressing living conditions for outpatients at other military bases around the country, from Fort Lewis in Washington state to Fort Dix in New Jersey. They tell stories -- their own versions, not verified -- of callous responses to combat stress and a system ill equipped to handle another generation of psychologically scarred vets.

The official reaction to the revelations at Walter Reed has been swift, and it has exposed the potential political costs of ignoring Oliva's 24.3 million comrades -- America's veterans -- many of whom are among the last standing supporters of the Iraq war. In just two weeks, the Army secretary has been fired, a two-star general relieved of command and two special commissions appointed; congressional subcommittees are lining up for hearings, the first today at Walter Reed; and the president, in his weekly radio address, redoubled promises to do right by the all-volunteer force, 1.5 million of whom have fought in Iraq and Afghanistan.

But much deeper has been the reaction outside Washington, including from many of the 600,000 new veterans who left the service after Iraq and Afghanistan. Wrenching questions have dominated blogs, talk shows, editorial cartoons, VFW spaghetti suppers and the solitary late nights of soldiers and former soldiers who fire off e-mails to reporters, members of Congress and the White House -- looking, finally, for attention and solutions.

Several forces converged to create this intense reaction. A new Democratic majority in Congress is willing to criticize the administration. Senior retired officers pounded the Pentagon with sharp questions about what was going on. Up to 40 percent of the troops fighting in Iraq are National Guard members and reservists -- "our neighbors," said Ron Glasser, a physician and author of a book about the wounded. "It all adds up and reaches a kind of tipping point," he said. On top of all that, America had believed the government's assurances that the wounded were being taken care of. "The country is embarrassed" to know otherwise, Glasser said.

Lt. General "Coverup" Kiley: From Abused Detainees to Neglected Soldiers
The Army Surgeon General, Lt. Gen. Kevin Kiley, may be the next person fired or forced to resign in the wake of the Walter Reed outpatient care scandal that has already cost the jobs of the Secretary of the Army, Francis Harvey, and Walter Reed's commander, Maj. Gen. George Weightman. It was Harvey's appointment of Kiley, who essentially brushed off for years concerns about the squalor and degrading care facing Walter Reed's outpatients, to replace the fired Weightman that help trigger Harvey's forced resignation on Friday. The only question on Kiley's future is this: will he be fired before the week's out, after he testifies before Congress, or will he keep his job until assorted independent reviews and panels finish their work investigating outpatient care and issue their scathing criqiques?

But the Walter Reed scandal isn't the first time that Kiley has covered up abuses. He was a point person for the Army's coverup of the torture and degrading treatment of detainees by health professionals, including psychologists, at Guantanamo and other unaccountable military detention sites. He commissioned whitewashed "studies" of the problem that concluded that there wasn't any abuse abetted by health professionals -- even though his investigators never talked to any detainees or their attorneys. The problems were so widespread that the American Psychiatric Association and the American Psychiatric Association banned its members from being involved in interrogations, but the American Psychological Association allowed its members to continue to aid military interrogators. (The American Prospect and Salon , among others, helped publicize these issues in the last two years. ) Even so, Kiley appeared last year at the psychologists' conference to plead for their continued involvement, while blithely downplaying the impact of coercive interrogation strategies. As I reported recently in The Washington Monthly, opening my article on the psychologists' role in torture with a presentation by Kiley:
http://www.huffingtonpost.com/art-levine/lt-general-coverup-kil_b_42596.html

BlueFlame
BlueFlame

Kiley reminds me of Hitler's doctors.

He shouldn't just befired. He should be indicted and sent to prison.

BBB