"Doc, if you try to take me out of the 82d, you'll be heating from my congressman." The young soldier with tattooed arms strained against the bedrails, his eyes searching the doctor's face above, his twisted, purplish leg surrounded by a black steel cage of bolts and rods that held his shattered bones together.
He was one of many men and women wheeled from surgery to therapy to their rooms and back again, in a circle of hope and pain on Ward 57 at Walter Reed Army Medical Center. I was so new in the job as Deputy Commander for Clinical Services (Top Doc) at the medical center that I had not finished orientation. I met this soldier on one of my first daily walk-rounds through the wards of wounded soldiers. He had been severely injured several months before. Every new orthopedic trick known was being applied to save his injured limb and return him to the ranks. In any other war, the injury he had sustained would have led to amputation, a medical disability board, and a rapid transition to care in a Department of Veterans Affairs (VA) facility. But not this war. This soldier was a soldier by choice. He did not want to leave his unit, his fellow soldiers, and the life he had found in uniform. I did not suggest a transfer to him again.
My job at Walter Reed was to ensure that soldiers received the best, safest medical care America had to offer. My boss outlined a two-pronged approach to the tasks at hand. First, the hospital had to continue to exceed the standards of the Joint Commission on Accreditation of Healthcare Organizations. Second, working with the other deputy commanders, I was to address the problem of the "medical hold" population.
Soldiers who were receiving treatment at Walter Reed were generally transitioned into the "Medical Hold Company" for purposes of military accountability and medical continuity. Before the war, there were about 100 soldiers in the medical hold unit. When I joined the staff after Thanksgiving 2005, there were more than 800. Not all had been formally assigned; some were simply "attached" and remained on the rosters of their former unit. The staff assigned to direct their care, including company commanders and platoon sergeants, had come from positions at the hospital.
A significant number of the medical hold soldiers were men and women caught in the mire of the Army's archaic physical disability evaluation system. This system's disability rating and arduous compensation processes were more than half a century out of date. It had created a subculture of soldiers undergoing physical disability evaluation who could no longer perform their duties as soldiers (or, in the case of reservists and guardsmen, their civilian jobs), but whose Army disability rating would not provide enough income to support them and their families.
During the year that followed, we made some progress improving the coordination of care for patients who had transitioned from the hospital beds into an "outpatient" status--staying in hotels, barracks, and temporary housing arrangements on the 114-acre post and in the surrounding community. We had begun to consolidate the multiple agencies and activities responsible for the soldiers' care and to organize the bewildering business of military disability processing. Wounded and ill soldiers were being routed to other medical facilities across the nation to better balance workload and resources. Our efforts were, unfortunately, not enough.
Beginning 18 February 2007, a series of Pulitzer Prize-winning articles in The Washington Post highlighted the challenges still plaguing some of the veterans receiving outpatient care at Walter Reed. The conditions reported in the three articles, and the media attention that followed, captured headlines around the world. The ire of the American people was raised at the thought of veterans being subjected to "squalor" and "mindnumbing bureaucracy." In the following 40 days, the medical center was subjected to the glare of negative national attention and weathered the loss of its Commanding General, the Army Surgeon General, and the Secretary of the Army. …