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Walter Reed tries new approach

After revelations this year of squalid living conditions and bureaucratic nightmares at Walter Reed Army Medical Center, the Army took the unusual step of creating the Warrior Transition Brigade. It brings in combat-seasoned officers and sergeants to assist the facility's nearly 700 outpatients.
/ Source: a href="" linktype="External" resizable="true" status="true" scrollbars="true">The Washington Post</a

It was the sort of message that sergeants have delivered to soldiers since time immemorial: Formations would be held three days a week at 7:30 a.m., and attendance was mandatory. "NO EXCEPTIONS!" screamed the e-mail, sent this month by a staff sergeant to his squad.

"I am sick and tired of chasing everyone around when it should be simple," the message read. "This [is] the United States Army NOT the Salvation Army."

Normally, no one in the Army would blink. But the e-mail recipients were stationed at Walter Reed Army Medical Center, where many are missing limbs, coping with post-traumatic stress disorder or suffering from brain injuries. The backlash was swift. After fielding a complaint from a soldier's mother, a commanding officer ordered the sergeant to apologize.

After revelations this year of squalid living conditions and bureaucratic nightmares at Walter Reed, the Army took the unusual step of creating the Warrior Transition Brigade. It brings in combat-seasoned officers and sergeants to assist the facility's nearly 700 outpatients -- tracking their recovery, ensuring that their appointments are kept and watching out for their morale.

But the effort to help wounded soldiers navigate the medical bureaucracy has also produced a culture clash, with many battle-hardened noncommissioned officers having difficulty adapting to Walter Reed's civilian atmosphere. As some injured troops and their families publicly voice complaints, the brigade leaders face a dilemma: Should they treat the recovering troops as patients first and foremost, or as soldiers?

Staff Sgt. John Guna, 38, received only three weeks' notice that he was being sent to Washington to oversee wounded soldiers. "When they first told me I was going to Walter Reed, I said, 'Did they put a tank out there at the front gate?' " recalled Guna, a tanker and veteran of three tours in Iraq.

‘Boots on the ground’
Brig. Gen. Michael S. Tucker, the deputy commanding general at Walter Reed, told reporters yesterday that the brigade proves the Army's commitment to fixing problems at the hospital. "When the Army is serious about something, it puts boots on the ground," he said.

To lead the brigade, senior Army officials tapped Col. Terrence McKenrick, a highly regarded Army Ranger whose previous assignment was at the Joint Operations Center for Multi-National Corps-Iraq. Combat arms officers and noncommissioned officers with proven records were chosen from infantry and armor units -- the core of the Army's fighting machine. Drill sergeants also joined the brigade.

"They understand the dynamics of motivating people under the most demanding of conditions," McKenrick said. "The greatest challenge is how to inspire these warriors and bring them out of their despair."

The brigade has replaced Walter Reed's much-maligned Medical Hold Company, in which platoon sergeants -- many of them former patients or medics and other medical command soldiers -- were each responsible for an average of 55 outpatients, and often more than 100. Platoon sergeants operated with little support and found it impossible to track so many patients with serious physical and emotional wounds.

"How could we expect a platoon sergeant to handle that?" McKenrick asked. "It makes me realize how short we came up as an Army."

In the new brigade, the companies are divided into three platoons, which are in turn broken down into three squads, with each squad leader overseeing about a dozen soldier-patients. Outpatients interviewed said that under this new structure, problems can be detected and responded to more quickly.

"The squad leader is kind of a battle buddy," Guna said. "Making them feel like they're a soldier -- that's what a lot of it is."

Guna said that combat veterans are better able to establish rapport with outpatients. "That's one good thing the Army did, bringing in combat vets," Guna added. "You can say, 'Where'd you get blown up at?' And they'll tell you and you can say, 'Oh, I got hit there myself.' "

But the squads have little of the cohesion typical of a small Army unit. Apart from the thrice-weekly formations -- which many soldiers miss because of medical appointments or other conflicts -- outpatients in a squad have little interaction. Their medical treatment, living quarters and meals are usually separate.

Guna said that some recovering soldiers and their families "like being stars" and try to take advantage of their status.

The wife of one soldier "cussed me out on the phone," Guna said, when he told her they were not entitled to keep a room at the guest lodge that they were not regularly occupying. Guna said he did not respond in kind.

Commanders have told him to "be happy" that he is no longer under enemy fire, Guna said. He added, however, that "sometimes, I'd rather be shot at."

A few recovering soldiers have little interest in cooperating with their squad leaders, McKenrick said. "Some are noncompliant, deliberately missing appointments," he said. "Some of that is based on despair of the condition they're in."

The battle-tested soldiers of the brigade cadre have encountered systemic problems beyond their ability to address. "We've fixed things," said Capt. Steven Gventer, a company commander in the brigade and veteran of intense street fighting in Sadr City. "Where we can't fix the problem is where we're dealing with boards and doctors. We can identify problems, but can't fix them."

Some in the brigade are critical of the hospital's civilian workforce, which they view as stubborn and resistant to change. "It is going slow," Guna said. "We're bumping heads with the hospital. They don't want to see us succeed, because that would mean they were wrong."

But some patients argue that the brigade is not addressing the underlying problems in the military medical bureaucracy. "To me, it's cosmetic stuff," said Army Maj. Lionel Walton, who has been treated at Walter Reed since January 2005.

The frustration and anger felt by many of those being treated at Walter Reed boiled over at a town hall meeting with the full brigade at 8 a.m. one day last week in the hospital gymnasium.

The bleachers were packed with soldiers bearing evidence of terrible wounds. Many used canes or crutches. Others wore prostheses and some had eye patches or disfigured faces.

Maj. Gen. Eric B. Schoomaker, Walter Reed's commander, took the floor. "This is the first brigade of its kind," he told the soldiers. "This concept is sweeping across the Army, in how we care for warriors. . . . We acknowledge that this is a work in progress."

When Schoomaker asked for comments, the complaints spilled out: Evelyn Williams, the mother of a wounded soldier, described how he had been given discharge papers to sign with no explanation of his options. Two soldiers complained that an orthopedic surgeon had been repeatedly "abusive and demeaning" to patients and should be fired -- a demand that prompted cheers from the bleachers.

‘A bunch of hogwash’
People were using the hospital's guest lodge as a party house, someone said, and soldiers who had suffered brain trauma were drinking alcohol. Every soldier's room at Abrams Hall, where many outpatients are housed, had been outfitted with a plasma TV and a computer -- but many phones were not working, Sgt. Charles Eggleston complained.

Schoomaker and McKenrick addressed the complaints as best they could, but the answers did not satisfy all in the audience.

"It breaks my heart," Williams responded. "I'm standing here and hearing a bunch of hogwash."

McKenrick asked for patience. "We are just beginning, and have a lot of changes to make. . . . There isn't anyone here that's against you."