When wounded soldiers return from Iraq, they are sent to Walter Reed Army Medical Center. Then their troubles begin.
WASHINGTON -- 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
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 or helping a brain-damaged soldier remember his next
"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 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 most
recent 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."
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, Md., 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 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
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 Army
literature had been helpful.
"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."
Maj. Gen. George 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 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.
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
The outpatients are assigned to one of five buildings attached
to the post, including Building 18, just across from the front gates.
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.
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 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 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 staff to
arrange them. 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 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 had been there, after a clerk couldn't find a record of her
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
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.
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, 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 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. 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."
Shannon 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."
"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
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 the problem is now at a
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, 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 the funds were no longer available
and 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.
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!' "