For more than a century, the Walter Reed Army Medical Center was known as the hospital that catered to presidents and generals. Eisenhower was treated and died there. So too did Generals "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 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 Malogne 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 in-patient care, widely seen as some of the best anywhere. Oscar Olguin said that 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.
"And 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 two-fold: The volume of wounded soldiers coming back from Iraq and Afghanistan, and the lack of an adequate, trained staff.
After the Post series broke, Defense Secretary Robert Gates fired top Army officials who had either downplayed the problems or didn't move 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 that 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.
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