Money woes and Pentagon neglect are to blame for shoddy outpatient conditions and bureaucratic delays at Walter Reed Army Medical Center, an independent review has concluded.
The blistering report called for major changes in troop care and cautioned that problems probably extend to Army hospitals around the country.
"The American ethic is that America always takes care of its wounded," said John O. "Jack" Marsh, Army secretary during the Reagan administration and co-chairman of the review. "We must make certain that America continues that ethic."
Co-chairman Togo D. West, secretary of the Army and Veterans Affairs under President Clinton, blasted the Pentagon's "virtually incomprehensible" inattention to maintenance at Walter Reed as well as an "almost palpable disdain" for troop care.
"Although Walter Reed's rich tradition remains to this day unchallenged, its high reputation has not been maintained," he said.
The investigation, ordered two months ago by Defense Secretary Robert Gates, is the first Pentagon review since the disclosure of problems at Walter Reed, one of the premier facilities for treating those wounded in Iraq and Afghanistan.
Citing lapses in leadership and oversight as main reasons for the problems, the nine-member independent group concluded that the Defense Department was, or should have been, aware of the widespread problems but neglected them because they knew Walter Reed was slated for eventual closure.
In addition, the Pentagon made problems worse by ordering a hold-down on costs and expenses — dubbed "efficiency wedges" — even as Walter Reed began experiencing an influx of thousands of veterans returning from Iraq and Afghanistan.
"Leadership at Walter Reed should have been aware of poor living conditions and administrative hurdles and failed to place proper priority on solutions," according to the report draft released Wednesday.
The report said the Pentagon was ill-prepared to deal with growing numbers of troops suffering from traumatic brain injury or post-traumatic stress disorder.
While making clear the problems lie with outpatient treatment, the report also faulted the Army's complex disability ratings, which critics contend are manipulated to limit disability compensation to wounded soldiers. That issue is to be the subject of a joint hearing Thursday of the Senate Armed Services and Veterans Affairs committees.
The review group, made up of former military officials and lawmakers, called for an overhaul of the disability ratings system.
It said the Pentagon should establish a new "center of excellence" in partnership with the Department of Veterans Affairs that would be geared specifically for brain injury and post-traumatic stress cases, calling the U.S. "behind the curve" in its treatment.
And it urged a separate review to determine whether overworked Walter Reed staff are being adequately paid, noting that many wounded soldiers are being left to fend for themselves in navigating a complicated bureaucracy.
Regarding Pentagon neglect, the group also urged the quick release of money to facilitate construction of a new Walter Reed center. The Army facility is expected to merge in 2011 with the National Naval Medical Center in Bethesda, Md., where a $2 billion expansion is being planned after a recommendation by a federal commission in 2005.
Following disclosures of shoddy conditions in February, Gates ordered the review and warned that senior military leaders could be disciplined based on the findings. Since then, three high-level Pentagon officials have been forced to step down, including Maj. Gen. George W. Weightman and Lt. Gen. Kevin Kiley, both former commanders of Walter Reed, as well as former Army Secretary Francis Harvey.
Responding to the report's findings, Maj. Gen. Eric B. Schoomaker, the new commander of Walter Reed, said the Army was aggressively looking into the growing number of cases of brain injury and was working to fix problems.
"We will not rest until these problems are solved," Schoomaker told the review group at a public hearing.
Top Army officials also have acknowledged many problems, including a confusing disability ratings system, as well as possible funding shortages that until recently the Army had denied were a factor affecting the care of wounded soldiers.
Army Vice Chief of Staff Gen. Richard Cody has said that officials have added caseworkers, financial specialists and others to work with soldiers' families on problems they have related to the injuries such as getting loans or help with income taxes.
A worldwide telephone hotline also has been established for soldiers having medical or family issues.
Bush has appointed a presidential commission chaired by former Sen. Bob Dole, R-Kan., and former Health and Human Services Secretary Donna Shalala, a Democrat, to improve veterans care.
The commission holds its first public hearing Saturday and is to release recommendations by late July.