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Report Says Fixes Slow To Come at Walter Reed

By Steve Vogel
Washington Post Staff Writer
Thursday, September 27, 2007; Page A01

More than half a year after disclosures of systemic problems at Walter Reed Army Medical Center and other military hospitals, the
Pentagon's promised fixes are threatened by staff shortages and uncertainty about how best to improve long-term care for wounded
troops, according to a congressional report issued yesterday.

Army units developed to shepherd recovering soldiers lack enough nurses and social workers, and proposals to streamline the
military's disability evaluation system and to provide "recovery coordinators" are behind schedule, according to the Government
Accountability Office report.

Members of a congressional oversight committee, discussing the report at a hearing yesterday, said the effort to reform the
medical bureaucracy has itself become mired in bureaucracy.

"After so many promises but so little progress, we need to see more concrete results," said Rep. Thomas M. Davis III (Va.), the
ranking Republican on the panel. His staff hears "appalling stories" every week from soldiers dealing with the disability
process, he said, adding that "they're trapped in a system they don't understand and that doesn't understand them."

"The pace of change is frustratingly slow," said Rep. Henry A. Waxman (D-Calif.), chairman of the oversight committee. "Still the
horror stories continue."

Members of the House oversight subcommittee on national security laid the blame on the Defense Department, the Army and the
Department of Veterans Affairs for what Rep. John F. Tierney (D-Mass.) termed an "utter lack of urgency."

The preliminary GAO report said the Army has taken steps to streamline its disability evaluation process, which determines
whether soldiers are fit for duty and, if not, what disability payments they should receive. Nonetheless, the report noted, "Many
challenges remain, and critical questions remain unanswered."

For example, the Army has established "warrior transition units" at 32 installations around the country, with recovering soldiers
assigned to a team of physicians, case managers and squad leaders. Whereas the unit at Walter Reed is almost fully staffed, more than
half the units had less than 50 percent of workers in place by mid-September, the GAO found.

Maj. Gen. Eric B. Schoomaker, the Walter Reed commander, told the subcommittee that the units have 65 percent of their manpower and
should be fully staffed by January.

In July, a presidential commission led by former senator Robert J. Dole and former health and human services secretary Donna E.
Shalala recommended that "recovery coordinators" be assigned to shepherd each seriously wounded service member through medical
care. A high-level oversight committee established by the Pentagon and the VA agreed to begin implementing the recommendation by

But the oversight committee has not determined how many recovery coordinators will be needed or how to decide which injured
soldiers need them, the GAO found.

Moreover, the Dole-Shalala commission recommended that the recovery coordinators come from outside the Defense Department or
the VA, suggesting instead the Public Health Service.

The oversight committee has balked at the suggestion in favor of recovery coordinators supplied by the VA. But the GAO questioned
the beleaguered VA's ability to handle the job, noting that it "may face significant human capital challenges in identifying and
training individuals for these positions."

A slew of commissions and task forces have agreed that at the heart of the bureaucratic maze is a system in which the military
services and the VA evaluate injured service members. The often-conflicting evaluations leave many recovering soldiers in
limbo for months or even years.

A pilot program to establish a single joint system was slated to begin Aug. 1. But the date slipped as the Pentagon and the VA
reviewed options.

Michael L. Dominguez, a deputy undersecretary of defense, testified that a pilot program was approved this week but probably
would not begin evaluating wounded soldiers until January.

"We're seven months into this process, and we're just now getting off the ground," Tierney said. "Why has it taken so long?"

Dominguez responded that the Pentagon and the VA needed to exercise "due diligence" before plunging forward with fundamental
changes. "It does take some time to develop those details," he said.

Members of the panel sharply criticized Walter Reed for the hospital's handling of the case of Staff Sgt. John Daniel Shannon,
who testified before the panel in March about his more than two years spent navigating the disability system. The Washington Post
reported this month that a paperwork glitch further delayed his retirement. Schoomaker said the problem has been resolved, but
panel members described the episode as highly troubling, given the public prominence of Shannon's case.