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by Susan Lillard-Roberts
Sunday, 18
February 2007
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!' "
Addicted to War -- Why the U.S.
Can't Kick Militarism (Updated to Include the War in Iraq), an
Illustrated Expose by Joel Andreas
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