For more than a century, the Walter Reed Army Medical Center was known as the hospital that catered to presidents and generals. President Dwight D. Eisenhower was treated and died there. So, too, did Gens. "Black Jack" Pershing, Douglas MacArthur and George Marshall.
But in recent years, Walter Reed was shorthand for scandal.
A 2007 series that dominated the front page of The Washington Post told of decrepit housing and wounded soldiers left to fend for themselves.
But the problems were identified years before. Salon.com wrote about it in 2005. Members of Congress later said they had complained to senior Army officials a year or two earlier. Nothing had happened.
Soldiers Fending For Themselves
Among those who had problems at Walter Reed was Oscar Olguin, an Army private who lost a leg in Iraq in 2004, when a suicide bomber struck his Humvee outside the city of Ramadi.
Olguin was discharged from the hospital at night in December 2005, in his wheelchair. He was simply told to find his new quarters.
"I got out. I was in my wheelchair. I was by myself," Olguin says. "I got released in the middle of the night. I'm trying to find my way. So I just started rolling around in my wheelchair and ended up taking the streets and just following the signs to get to Mologne House."
He never checked in with anybody, even as he attended his physical therapy appointments. It wasn't until three months later that Olguin was contacted by an Army master sergeant. "You're in my platoon," the sergeant told him, "and you have to check in with me every morning."
That wasn't Olguin's only problem. He also had a roommate.
"I had a roommate who was suffering from severe PTSD [post-traumatic stress disorder], who wasn't supposed to have any sharp objects," Olguin remembers. "I didn't know."
Olguin went on a ski trip with other wounded soldiers, and when he returned, his roommate was gone. Military police had taken him away.
"He tried to slash his own wrists with the knives that I had in my room," says Olguin. "That was probably the worst part. He could have killed himself, and I could've played a part in that and not even known."
The problems had nothing to do with inpatient care, widely seen as some of the best anywhere. Oscar Olguin said the care was first-rate. It had to do with outpatient care — or the lack of it.
A Flood Of Wounded, And Bureaucracy
Soldiers had to navigate the system virtually alone, arranging appointments with doctors and physical therapists, dealing with medicines and paperwork.
"Our military and veterans health care system wasn't ready for an influx of wounded warriors," says Paul Rieckhoff, an Iraq War veteran and head of the Iraq and Afghanistan Veterans of America, an advocacy group.
"So you saw bad management, you saw an antiquated bureaucracy, sometimes still paper-based," Rieckhoff says. "You saw a failure to understand new types of veterans, like women. You saw a failure to understand new types of injuries, like traumatic brain injury. And I think you saw a military health care system that was caught flat-footed."
The problem was essentially twofold: the volume of wounded soldiers coming back from Iraq and Afghanistan, and the lack of adequate, trained staff.
After the Post series broke, Defense Secretary Robert Gates fired top Army officials who either had downplayed the problems or hadn't moved fast enough to deal with the issues.
Gates brought in Lt. Gen. Eric Schoomaker, a physician himself, to clean up Walter Reed. Schoomaker told NPR that the medical community at the facility was overwhelmed.
The Army ended up hiring a lot more people — about 3,500 — to help care for the wounded soldiers. And the Army set up Warrior Transition Units at Walter Reed and around the nation, 29 in all, that now care for about 10,000 soldiers.
Schoomaker, who has since been named the Army's surgeon general, says each soldier is now being overseen by three separate officials.
"This triad of care, we call [it], around every soldier," Schoomaker says, "consists of a nurse case manager, a primary care manager and a squad leader who's looking out for care and feeding and administrative problems, pay issues, travel issues, educational issues. You're looking at doctors' appointments, or, 'You need time to recover from this before you can go to that.' "
Next Challenges: Drugs, And Long-Term Care
The Army has become more responsive, but there are still problems.
An Army inspector general's report from earlier this year found that as many as one-third of the soldiers in Warrior Transition Units are dependent on drugs, or addicted to them.
The report also found that there are still shortages of psychologists and other behavioral specialists. Those shortages, the report said, can lead to delays in diagnoses and treatment.
The Army says it is dealing with the over-reliance on drugs. It now prescribes only the minimum quantity necessary for treatment, and has started a program that assesses possible "high-risk" soldiers and closely monitors their care.
Also, the Army has increased its use of alternative therapies, such as acupuncture and yoga.
Still, veterans' advocates say that despite the change, both the military and the Department of Veterans Affairs continue to struggle with the overall issue of providing care for the wounded.
Soldiers with horrific physical and psychological wounds continue to return each week from Afghanistan and Iraq. The challenge is to provide them, and their families, with adequate care and support for decades to come.
STEVE INSKEEP, host:
And now let's continue with our series on the closing of Walter Reed Army Medical Center. It is the classic story of a military base closing. Walter Reed was known as the hospital that catered to presidents and generals and more recently the severely wounded from Afghanistan and Iraq. In the last few years, though, Walter Reed also became shorthand for scandal. A series in The Washington Post in 2007 described wounded soldiers who were neglected, put in decrepit housing with moldy ceilings, and worse.
Though the last patients have left Walter Reed, the story of how the military cares for its severely wounded is very, very relevant today, so we're going to talk about this with NPR's Tom Bowman. Tom, good morning.
TOM BOWMAN: Good morning, Steve.
INSKEEP: So remind us, what exactly happened to American troops that was revealed in 2007?
BOWMAN: Well, actually, Steve, this goes back years before the Post series in 2007. There was a series on the website Salon.com in 2005 talking about some of these problems. And even before that, patients and their families, even members of Congress, complained to senior Army officers about the plight of these wounded soldiers. Nothing happened until that front-page series in the Washington Post. And that, of course, got everyone moving.
There were a couple of elements here. There was the housing at Walter Reed, particularly this place called Building 18. It was in poor condition. And people remember that, I think. That kind of stands out. But there was a more serious problem, that the people were left to fend for themselves.
These wounded soldiers had nobody to help them navigate the system.
INSKEEP: Big hospital, big military complex, and really - people who lost limbs, really severe wounds, and you need lots of help...
INSKEEP: ...and you don't have any help.
BOWMAN: Right. And there was never a complaint about the inpatient care. That was always considered superior. But once they became outpatients and had to arrange for appointments with doctors, physical therapy, medicines, all that paperwork, in many cases there was no one to help them.
Now, here's Paul Rieckhoff. He's an Iraq War veteran himself, and he heads up the Iraq and Afghanistan Veterans of America.
Mr. PAUL RIECKHOFF (Iraq and Afghanistan Veterans of America): Our military and veterans health care system wasn't ready for an influx of wounded warriors. And so you saw bad management, you saw an antiquated bureaucracy. You saw a failure to understand new types of veterans, like women. You saw a failure to understand new types of injuries, like traumatic brain injury. And I think you saw a military health care system that was caught flat-footed.
BOWMAN: So, Steve, the problem was really two-fold. It was a volume of wounded soldiers coming back from the wars in Iraq and Afghanistan, and the lack of an adequate number of staff and a lack of a competent staff. They just didn't have the training.
INSKEEP: Which meant what for veterans individually?
BOWMAN: They essentially fell through the cracks. And this happened to many veterans - in story after story about this, in the Salon.com series, the Post series. I tracked down one soldier who'd been there back in 2004 and 2005.
His name is Oscar Olguin. He was a private first class in the Army. He lost a leg in Iraq in 2004. His inpatient care at Walter Reed was great, he said. He received a prosthetic leg and he was treated quite well. The problem began when he was discharged and became an outpatient. Now, it's 2005, he's just been discharged. It's December, in the middle of the night. He's in his wheelchair and told to find his housing on Walter Reed's campus.
INSKEEP: This is 70 acres. The middle of the night, and the guy's in a wheelchair.
BOWMAN: Absolutely. Let's listen to what he said.
Mr. OSCAR OLGUIN (Veteran): I'm trying to find my way. So I just started rolling around in my wheelchair, ended up taking the streets and just following the signs to get to the Malone House. I checked in, got a room. So I was just, for like three months I was just going back and forth just to the hospital and back, back to my room. I never did anything else. I never checked in with anybody.
BOWMAN: And Steve, he went to his physical therapy appointments by himself. And also it wasn't until three months later that Oscar Olguin was contacted by a master sergeant who told him, you're in my platoon, you have to check in with me every morning.
INSKEEP: Up until that point, nobody was helping him get to appointments, deal with therapy, anything else?
BOWMAN: No. He was doing it by himself. And other soldiers would help each other, say you have to go here, you have to go there. They were doing it among themselves.
INSKEEP: But that wasn't the only problem.
BOWMAN: That was not the only problem.
Mr. OLGUIN: I had a roommate who had - who was suffering from severe PTSD, who wasn't supposed to have any sharp objects. I didn't know. I carried pocket knives, being in the infantry. I went for a trip one of the trips going skiing. I came back. My roommate's gone, all my knives are gone, wondering what happened. One of the other individuals that lived across the way was like, hey, the cops came and got him, or the MPs. He tried to slash his own wrists with the knives I had in my room. That was probably the worst part, because, first of all, he could have killed himself, and then I could have played a part in that and not even known.
INSKEEP: So Tom Bowman, we've got a situation here where the Army did the big things right: the guy got a prosthetic leg, he got medical treatment. So many little things went wrong and this was repeated again and again and again. What has changed in the years since then as the military continues treating thousands of veterans across the country?
BOWMAN: Well, first of all, Robert Gates, who was Defense secretary at the time, he fired some top Army officials and he brought in Lieutenant General Eric Schoomaker to take over at Walter Reed and basically clean the place up. Now, Schoomaker is also a doctor. Today, he's the Army surgeon general. And I spoke with him recently. He agrees that the medical staff, especially at Walter Reed, was overwhelmed.
So the Army hired a lot more people - about 3,500 - and set up what were called Warrior Transition Units. There are 29 of them around the country - not only at Walter Reed but all over the nation - and they care for up 10,000 soldiers who are wounded or have medical problems.
General Schoomaker says that each soldier now is being looked at by three separate officials. Let's listen.
Lieutenant General ERIC SCHOOMAKER (Army Surgeon General): This triad of care, we call, around every soldier that consists of a nurse case manager, a primary care manager and a squad leader, who's looking out for care and feeding and administrative problems, pay issues, travel issues, you're looking at doctors appointments, or you need time to recover from this before you can go to that.
INSKEEP: So that's the system Schoomaker laid out for you, Tom, but is that system working?
BOWMAN: Well, in some ways it is. I mean, these additional thousands of officials and caregivers are helping. The Army's definitely more responsive now to the wounded soldiers, but there are still problems. Earlier this year, the Army inspector general's office released a report on these Warrior Transition Units. They said they're still struggling, we're short-staffing - lack of psychologists and others, for example. And that leads to delays in diagnoses and also delays in care.
And here's the other thing. The IG report estimated that as many as one-third of those 10,000 soldiers in these Warrior Transition Units are either addicted to or dependent on drugs. The Army says it's dealing with both these issues, trying to come up with alternative medicines and better care for these wounded soldiers, but there are still problems to this day.
INSKEEP: This has got to still be a huge challenge, because wounded continue coming in from Iraq - less than before but still some - and from Afghanistan more than ever.
BOWMAN: Exactly. There are dozens, or scores, of wounded people coming back, particularly from Afghanistan, today. And the military, and also the Veterans Administration, they're still struggling with how to deal with these folks. It's a volume issue. It's hiring enough staff, enough doctors, psychologists, and having the facilities to deal with them adequately. It's still a problem and will be for decades to come.
INSKEEP: NPR's Tom Bowman, thanks very much.
BOWMAN: You're welcome, Steve.
INSKEEP: And our series on the closing of the Walter Reed Medical Center in Washington, D.C. moves tonight to NPR's ALL THINGS CONSIDERED. We'll hear Tom again looking at whether the closure will save taxpayers money.
This is NPR News. Transcript provided by NPR, Copyright NPR.