Troops battle neglect at Army hospital

Published 9:00 pm Monday, February 19, 2007

“If Iraq don’t kill you, Walter Reed will” – wife of a wounded soldier at Walter Reed Army Medical Center

WASHINGTON – Behind the door of Army Spc. Jeremy Duncan’s room, part of the wall is torn and hangs in the air, weighed 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.

The common perception of Walter Reed is of a surgical hospital that shines as the crown jewel of military medicine.

But 51/2 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.

The Other Walter Reed

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.”

“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.”

This world is invisible to outsiders. Although Walter Reed is awash in the generosity of volunteers, businesses and celebrities who donate money, plane tickets, telephone cards and steak dinners, 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.

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.”

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.

“They’ve been behind from day one,” said Rep. Tom Davis, 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.”

Acknowledging the problems with outpatient care, Maj. Gen. George Weightman, commander at Walter Reed, 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. 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.”

Forgotten and left alone

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.

On Monday, Weightman said repairs had begun to Building 18.

Staff Sgt. John Daniel Shannon, 43, arrived 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 the post.

A reconnaissance and land-navigation expert, Shannon was so disoriented that he couldn’t even find north.

Shannon 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.

The paperwork bog

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.

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 Wolfowitz, who got the erroneous paperwork corrected with one phone call.

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 young soldier down the hall died, Shannon knew he had to take action.

Caring for their own

The soldier, Cpl. Jeremy Harper, returned from Iraq with PTSD after seeing three buddies die. The 19-year-old 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 the 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.