Captain Jason

The latest news on the recover of Jason after his injury in Iraq by an IED.


Snail Mail:

Cpt. Jason Scott
WRAMC Building 20
Mologne House Hotel #316
6900 Georgia Ave. NW
Washington DC 20307

Phone: 202 577 0092

Friday, February 23, 2007

"Unacceptable" is NOT the word that I would use!

Care of wounded U.S. troops "unacceptable": Gates

By Andrew Gray1 hour, 39 minutes ago

Defense Secretary Robert Gates on Friday branded the outpatient care of U.S. troops wounded in Iraq and Afghanistan "unacceptable" and promised officials would be held accountable for the failings.

The Bush administration has scrambled to address problems at the flagship Walter Reed Army Medical Center after newspaper reports showed wounded troops were living in shoddy conditions and struggling with bureaucratic procedures.

"After the facts are established, those responsible for having allowed this unacceptable situation to develop will indeed be held accountable," Gates said on a visit to the hospital, making his first public comments on the issue.

The Pentagon has announced an independent review into outpatient care due to the reports. Gates said some people most directly responsible for the problems had already been relieved of their duties but scrutiny would not end there.

"We will be looking (at) and evaluating the rest of the chain of command as we get more information," he told reporters at the hospital on the outskirts of Washington, D.C. No one had offered to resign, he said.

After a lengthy investigation, The Washington Post reported on Sunday that recuperating soldiers were living in a dilapidated building infested with mice, mold, and cockroaches.

The U.S. Army says it has already fixed some of the problems.

The newspaper also found wounded troops forced to untangle a web of bureaucratic red tape to obtain benefits and treatment as they coped with physical and psychological trauma.

Government investigators found the typical soldier must file 22 documents with eight different commands to enter and exit the medical processing system, the Post reported.

"They battled our foreign enemies -- they should not have to battle an American bureaucracy," Gates declared. (My emphasis)

President George W. Bush has frequently praised wounded U.S. troops for their sacrifices.

After a visit to Walter Reed last December, he said: "We owe them all we can give them -- 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."

Gates said he had briefed Bush on Friday before visiting the hospital. "He is understandably concerned and emphatic in wanting the best possible care for our wounded soldiers and for their families," he said.

About 31,000 U.S. soldiers have been evacuated for medical reasons, 4,000 of them with battle injuries, from the wars in Iraq and Afghanistan, a top Army officer said this week.

Outpatients at Walter Reed are largely troops who have received initial medical care but require further treatment before they can go home or return to duty. The average outpatient stay lasts 10 months, the Washington Post said.

Army Fixing Patients' Housing-WP 2/20/07

Army Fixing Patients' Housing
Changes Underway At Walter Reed

By Dana Priest and Anne Hull
Post Staff Writers
Tuesday, February 20, 2007; A01

Walter Reed Army Medical Center began repairs yesterday on Building 18, a former hotel that is used to house outpatients recuperating from injuries suffered in Iraq and Afghanistan and that has been plagued with mold, leaky plumbing and a broken elevator.

The facility's commander, Maj. Gen. George W. Weightman, said Army staff members inspected each of the 54 rooms at the building and discovered that outstanding repair orders for half the rooms had not been completed. He said that mold removal had begun on several rooms and that holes in ceilings, stained carpets and leaking faucets were being fixed.

Walter Reed, the Army's premier medical facility, has turned into a holding ground for wounded soldiers during 5 1/2 years of sustained combat. Almost 700 outpatients suffering from physical injuries and psychological problems live on the 113-acre military post or in nearby quarters. Many linger there for 18 months or longer as they move through the Army's numbing bureaucracy.

A Washington Post series over the weekend described "The Other Walter Reed," where overdoses, suicide attempts and depression among outpatients are the parallel narrative to the spit-polish hallways of the renowned hospital.

Building 18, in particular, symbolizes the indifference and neglect that many of the wounded say they experience at Walter Reed.

Yesterday, Weightman said a broken elevator in the building had been repaired and soldiers were working to improve the outside of the building, including removing ice and snow. The slippery conditions have kept some soldiers in their rooms. A garage door that has been broken for months will soon be repaired as well.

Spec. Jeremy Duncan, whose room has a moldy wall that was featured in one photograph in the Post series, has been moved to another room while workers make repairs. Duncan will be able to return to his room when the work is completed, Weightman said.

Walter Reed and Army officials have been "meeting continuously for three days" since the articles began appearing, Weightman said. A large roundtable meeting with Army and Defense Department officials will take place at the Pentagon early this morning to continue talks about improvements in the outpatient system, he added.

Weightman said the medical center has received an outpouring of concern about conditions and procedures since the articles appeared and has taken steps to improve what soldiers and their families describe as a messy battlefield of bureaucratic problems and mistreatment.

"We're starting to attack how we'll fix and mitigate" some of the problems, he said.

Social workers will now be stationed around the clock at Mologne House, the 200-room hotel on the post where many of the outpatients live. Plans are being developed to better train other staff members who deal with outpatient needs.

The Army will also consider moving some outpatients to its other medical centers throughout the United States and will determine over the next weeks whether more workers are needed at Walter Reed.

WRAMC investigates Dr. Michael Wagner, Head of Family Assistance while we were at WR

Hospital Investigates Former Aid Chief

Walter Reed Official Had Own Charity

By Dana Priest and Anne Hull

Washington Post Staff Writers
Tuesday, February 20, 2007; Page A01

For the past three years, Michael J. Wagner directed the Army's largest effort to help the most vulnerable soldiers at Walter Reed Army Medical Center. His office in Room 3E01 of the world-renowned hospital was supposed to match big-hearted donors with thousands of wounded soldiers who could not afford to feed their children, pay mortgages, buy plane tickets or put up visiting families in nearby hotels.

But while he was being paid to provide this vital service to patients, outpatients and their relations, Wagner was also seeking funders and soliciting donations for his own new charity, based in Texas, according to documents and interviews with current and former staff members. Some families also said Wagner treated them callously and made it hard for them to receive assistance.

Last week, Walter Reed launched a criminal investigation of Wagner after The Washington Post sought a response to his activities while he ran the Army's Medical Family Assistance Center, a position he left several weeks ago. Maj. Gen. George W. Weightman, the commander at Walter Reed, said the probe by the Criminal Investigation Command (CID) "reflects the seriousness with which we take these allegations."

Weightman's legal adviser, Col. Samuel Smith, said that "it would clearly be a conflict of interest" prohibited by federal law, Army regulations and Defense Department ethics rules if Wagner used his position to solicit funds for his own organization.

The saga of the Medical Family Assistance Center is just one example of the problems at Walter Reed, where nearly 700 soldiers and Marines from the wars in Iraq and Afghanistan live as outpatients while recuperating. Some families are happy with the help they received from Wagner and his office, and many soldiers and their families applauded the dedication of workers there. Others said that they had problems with Wagner and that the center seemed chaotic and disorganized.

"We had many family members who came to me because they couldn't get a respectful and compassionate response from Dr. Wagner," said Peggy Baker, director of a charity that helps wounded soldiers, Operation First Response.

Wagner, who has a doctorate in education, resigned his position last month to work full time on his Military, Veteran and Family Assistance Foundation, based in Dallas. The foundation includes the Phoenix Project, which runs marriage retreats for soldiers returning from combat. According to its Web site, the foundation is supported by several corporations, other foundations and individuals.

In a phone interview, Wagner denied he had solicited funds or made contact with donors during office hours. "It's just not true," he said. "I intentionally stayed out of that. I couldn't do that. I couldn't do both." He said he is not paid by the foundation. The documents that would verify that have not yet been filed with the Internal Revenue Service.

Wagner said his superiors "knew of my involvement right from the beginning." Weightman said the command had been unaware of Wagner's Texas charity until recently.

Wagner defended his work at the center. "My only purpose and my priority 12 to 19 hours a day was to assist the families of the wounded," he said. "I saw 6,000 people coming back from Iraq and Afghanistan. I did my best, but I'm not God. What I did there was a job that was superhuman."

Wagner said that the charity was founded by his brother and that he did not officially become its executive director until he left Walter Reed. But fundraising documents from early January, before he resigned, list him as the director, and the organization's Web site called him its executive director months before he resigned.

In a fundraising letter he signed shortly before he quit the Medical Family Assistance Center, Wagner referred to his work at Walter Reed. As head of the center, he wrote, "I have had over a thousand citizens in this great country asking what they might be able to do at Walter Reed for our wounded troops and their families. I found myself telling them that Walter Reed was blessed with the outpouring of the goodness and generosity of the American public and that if they were really interested in assisting, they should look within their own communities."

But, his letter continued, "I realized they were not working with their local communities so . . . I decided to found the Military, Veteran and Family Assistance Foundation to do just this, to do what I am able to help our soldiers reenter their home and local community."

Wagner included an ambitious business plan to take the charity from a $237,000 pilot project in the first year, which ended in August 2006 -- while he was working at Walter Reed -- to a $145 million foundation by 2011. He signed the letter "Executive Director and Founder."

Leita Sosin, an 11-year Army veteran who worked in Wagner's office for two years, said she complained to him and to co-workers about his involvement with the charity. "It really broke me to see what he was doing," said Sosin, 29, a former Army operating-room technician. "Instead of working with the families at Walter Reed and with us, he spent all his time putting together the Phoenix Project."

Moscow Spencer, a case manager fired by Wagner in October, also complained to her co-workers. "All day long he'd work on his program," she said. "If someone came in to donate money, he would talk to them about his project."

Sosin said the office was overwhelmed by the number of families who needed assistance and who were confused by the complex bureaucracy. "Everyone needed help, but you couldn't get them the help as fast as they needed it," she said. "Someone like me could scream all day about how it was broken, but no one wanted to take the time to fix it."

She also said Wagner was arrogant toward some staff members and families. "People got hurt in the process, whether it be financially or because he promised a lot of things he never followed up on," she said.

In April, Sosin said, she laid out her concerns in a three-page letter to her superiors. She received no response and resigned. Wagner said that Sosin never complained to him and that he had no idea why she quit.

Poverty among soldiers returning from war is not uncommon. While they continue to live on the Army payroll until they return to active duty or are discharged, some experience a substantial decrease in pay when combat pay or hazard pay disappears.

Some Army families breach the poverty line when a spouse quits a job to help the soldier recuperate; mortgage payments don't stop, and they still need to feed their children. Many turn to the generosity of Americans eager to prove they have not forgotten the troops' sacrifices. While staff members and soldiers acknowledge that some families take advantage of the plentiful freebies at Walter Reed, many others ask for help only as a last resort.

The assistance center is supposed to be the connection between a soldier's family and private donors. Until recently, it did not accept cash contributions but instead matched families' needs -- for bus or plane tickets, clothing, emergency food vouchers, grants for mortgages or living expenses -- with organizations set up to help.

According to Walter Reed, 14 families on average seek assistance from the center each day. Although it is difficult to quantify the value of donations, the center received $4,500 worth of phone cards in 2006 and handled $1.9 million worth of donated plane tickets. Weightman said the center's staff was recently increased from five to nine employees, with two people assigned to keeping track of the donations, and training has been improved.

The system for receiving donations is often confusing, even for the staff, Weightman said. "There's too much for any one person to know, but depending on the question, they may know [the answer] or direct you to the person who does know it."

Some soldiers go directly to the many volunteer organizations set up to help the wounded. Last year, Wagner began an effort to funnel all requests and donations through the family assistance center. It was a good idea, said Sosin and others, but because Wagner seemed preoccupied, a bottleneck of requests resulted.

"It was really all at the expense of the service member," said Sandra Butterfield, who worked at Walter Reed as an ombudsman for a Defense Department-funded relief organization. "He decreed that everything had to go through him," and it didn't seem to matter if that slowed the process. Officials, she said, "don't understand what it meant to have no money. Family members changed the sheets, empty the bedpan. But they are leaving their homes across the country. . . . Every day I came home angry."

Some families were also angered by the way Wagner treated them.

"The patient care was absolutely wonderful, but the administration was horrible, especially Dr. Wagner," said Maria Mendez, whose 25-year-old nephew, Spec. Roberto Reyes Jr., suffered severe brain and limb damage when a mine exploded near him outside Baghdad. "It was like running around in circles. He was never around."

"They were unprofessional, discourteous and uncompassionate all in one," Mendez said. "I was very surprised. You figure any family who's gone through such devastation, then faces this, to be treated with such unprofessionalism . . . it's like you're putting salt on the wounds."

Frustrated, Mendez set up an account for her sister, Aida Rivera, Reyes's mother, to pay for her stay at Walter Reed. Rivera eventually got financial assistance from the Army and outside organizations, but she also received a $3,519 bill from Mologne House, a hotel at Walter Reed, for her stay as her son's nonmedical attendant.

Staff members from other offices also complained to the command about Wagner, according to memos obtained by The Post. In one, an employee, who asked not to be named, questioned why a soldier's mother "who had subsisted on dried soups . . . due to her lack of funds" could not get help. Four months after approaching the center, the memo said, the mother had not received the per diem owed her as her child's nonmedical attendant "and has no cash for essentials nor emergencies."

A wife who accompanied her wounded husband, who was based in Germany, said Wagner asked her repeatedly why she did not return to Germany so she could continue working. The woman "reported she felt harassed and bullied but that she held her ground," the employee's memo states.

Wagner said families were often angry at his office, not because it failed them but because they were distraught over their situation. "Their true need is an emotional one. They're going to be angry at somebody. . . . I did my best; no, more than my best."

Staff researcher Julie Tate contributed to this report.

Sunday, February 18, 2007

WP 2/18/07: Soldiers Face Neglect, Frustration at Army's Top Facility

Soldiers Face Neglect, Frustration at Army's Top Medical Facility

By Dana Priest and Anne Hull
The Washington Post

Sunday 18 February 2007

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 overseas.

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 sand 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 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 H. 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 last 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."

Along with the government promises, 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 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 two 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 disorienting."

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 any Army literature had been helpful.

"They've been behind from Day One," said Rep. Thomas M. Davis III (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."

Among the public, Davis said, "there's vast appreciation for soldiers, but there's a lack of focus on what happens to them" when they return. "It's awful."

Maj. Gen. George W. 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 be able 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.

Bureaucratic Battles

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 Afghanistan.

The outpatients are assigned to one of five buildings attached to the post, including Building 18, just across from the front gates on Georgia Avenue. 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, when the typical guest was a visiting family member or a retiree on vacation.

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 stream down Georgia Avenue. Sirens blaring, they 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 that 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 the staff to arrange them. Many disappeared even longer. 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 different 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 that had been there, after a clerk couldn't find a record of her service.

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 Defense Department.

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, the Army equivalent of a parent.

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, however, 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 that 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 D. 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."

The lack of accountability weighed on Shannon. He 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."

Frustration at Every Turn

The frustrations of an outpatient's day begin before dawn. On a dark, rain-soaked morning this winter, Sgt. Archie Benware, 53, hobbled over to his National Guard platoon office at Walter Reed. Benware had done two tours in Iraq. His head had been crushed between two 2,100-pound concrete barriers in Ramadi, and now it was dented like a tin can. His legs were stiff from knee surgery. But here he was, trying to take care of business.

At the platoon office, he scanned the white board on the wall. Six soldiers were listed as AWOL. The platoon sergeant was nowhere to be found, leaving several soldiers stranded with their requests.

Benware walked around the corner to arrange a dental appointment - his teeth were knocked out in the accident. He was told by a case manager that another case worker, not his doctor, would have to approve the procedure.

"Goddamn it, that's unbelievable!" snapped his wife, Barb, who accompanied him because he can no longer remember all of his appointments.

Not as unbelievable as the time he received a manila envelope containing the gynecological report of a young female soldier.

Next came 7 a.m. formation, one way Walter Reed tries to keep track of hundreds of wounded. Formation is also held to maintain some discipline. Soldiers limp to the old Red Cross building in rain, ice and snow. Army regulations say they can't use umbrellas, even here. A triple amputee has mastered the art of putting on his uniform by himself and rolling in just in time. Others are so gorked out on pills that they seem on the verge of nodding off.

"Fall in!" a platoon sergeant shouted at Friday formation. The noisy room of soldiers turned silent.

An Army chaplain opened with a verse from the Bible. "Why are we here?" she asked. She talked about heroes and service to country. "We were injured in many ways."

Someone announced free tickets to hockey games, a Ravens game, a movie screening, a dinner at McCormick and Schmick's, all compliments of local businesses.

Every formation includes a safety briefing. Usually it is a warning about mixing alcohol with meds, or driving too fast, or domestic abuse. "Do not beat your spouse or children. Do not let your spouse or children beat you," a sergeant said, to laughter. This morning's briefing included a warning about black ice, a particular menace to the amputees.

Dress warm, the sergeant said. "I see some guys rolling around in their wheelchairs in 30 degrees in T-shirts."

Soldiers hate formation for its petty condescension. They gutted out a year in the desert, and now they are being treated like children.

"I'm trying to think outside the box here, maybe moving formation to Wagner Gym," the commander said, addressing concerns that formation was too far from soldiers' quarters in the cold weather. "But guess what? Those are nice wood floors. They have to be covered by a tarp. There's a tarp that's got to be rolled out over the wooden floors. Then it has to be cleaned, with 400 soldiers stepping all over it. Then it's got to be rolled up."

"Now, who thinks Wagner Gym is a good idea?"

Explaining this strange world to family members is not easy. At an orientation for new arrivals, a staff sergeant walked them through the idiosyncrasies of Army financing. He said one relative could receive a 15-day advance on the $64 per diem either in cash or as an electronic transfer: "I highly recommend that you take the cash," he said. "There's no guarantee the transfer will get to your bank." The audience yawned.

Actually, he went on, relatives can collect only 80 percent of this advance, which comes to $51.20 a day. "The cashier has no change, so we drop to $50. We give you the rest" - the $1.20 a day - "when you leave."

The crowd was anxious, exhausted. A child crawled on the floor. The sergeant plowed on. "You need to figure out how long your loved one is going to be an inpatient," he said, something even the doctors can't accurately predict from day to day. "Because if you sign up for the lodging advance," which is $150 a day, "and they get out the next day, you owe the government the advance back of $150 a day."

A case manager took the floor to remind everyone that soldiers are required to be in uniform most of the time, though some of the wounded are amputees or their legs are pinned together by bulky braces. "We have break-away clothing with Velcro!" she announced with a smile. "Welcome to Walter Reed!"

A Bleak Life in Building 18

"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 sacrifices.

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 that the problem is now at a "manageable level." They also say they will "review all outstanding work orders" in the next 30 days.

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 in that setting, 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 that the funds were no longer available and that 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 from elsewhere.

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!' "

Staff researcher Julie Tate contributed to this report.