Soldiers face neglect at medical facility

WASHINGTON -- Behind the door of Army Specialist 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 outpatient building, constructed between the world wars, often smells like greasy carryout food . Signs of neglect are everywhere: mouse droppings, belly-up cockroaches, stained carpets, and 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 torn left ear, nearly dead from blood loss.

But the old lodge, just outside the gates of the hospital and 5 miles up the road from the White House, has become housing for hundreds of maimed soldiers recuperating from injuries from Iraq and Afghanistan.

The common perception of Walter Reed is of its surgical hospital that shines as the crown jewel of military medicine. But 5 1/2 years of sustained combat have transformed the 113-acre institution into something else -- a holding ground for physically and psychologically damaged outpatients.

Almost 700 of its outpatients -- the majority of them 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 have brain injuries, have lost limbs, have organ and back damage, and various degrees of post-traumatic stress. Their legions have grown so exponentially that they outnumber hospital patients at Walter Reed 17 to 1. The average stay is 10 months, but some have been stuck there for as long as two years.

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.

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.

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 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, 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 Sergeant 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.

Vera Heron spent 15 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."

Major General 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."