US Military Hospitals in DC Meet New Realities

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Military Hospitals Meet New Realities

By Steve Vogel, Washington Post Staff Writer

Monday, February 11, 2008; B01

When Pentagon planners first proposed consolidating military hospitals

in the Washington region, it was aging infrastructure, not casualties

from Iraq and Afghanistan, that drove the decision.

But the outcry last year over conditions at Walter Army Medical

Center has forced the Pentagon to rethink how it will care for troops

in the Washington region, the hub for wounded service members

returning to the United States.

As the Defense Department moves forward with a $2 billion undertaking

that includes a massive expansion of the National Naval Medical Center

in Bethesda and the construction of an Army hospital at Fort Belvoir,

the scale and the cost of the projects have grown in direct response

to the fallout from Walter .

" Certainly, the amount going into building infrastructure wouldn't be

as high without it, " said Rear Adm. M. Mateczun, commander of a

joint task force set up to oversee the hospitals.

Overall costs for closing Walter and moving its services to

Bethesda and Fort Belvoir have risen 71 percent since the initial 2005

projection, making this " the largest infrastructure investment that

has ever been made in military medicine, " Mateczun said.

Advanced neurological equipment for troops with brain injuries, a

rehabilitation center for amputees, more space for visiting families,

even renovated hospital rooms will come with Bethesda's expansion. In

addition, a nonprofit group plans to build a state-of-the-art center

for troops suffering from traumatic brain injury or post-traumatic

stress disorder.

At Fort Belvoir, a 120-bed hospital will be built faster and will

accommodate some wounded troops with orthopedic and mental health

concerns. The Army will begin pouring the foundation this month for a

facility three times the size of DeWitt Army Community Hospital.

The decision to close Walter was approved by the Pentagon's base

realignment and closure commission in 2005. The focus was on replacing

the aging Walter with a premier medical center at Bethesda,

saving money in the long term and streamlining Army, Navy and Air

Force medical care in the region, said Battaglia, executive

director of the 2005 BRAC Commission.

But even as the proposal was approved by Congress and President Bush

in 2005, wounded soldiers were pouring into Walter at the rate of

about 1,000 a month.

A year ago, a series in The Washington Post documented poor living

conditions for veterans recovering from wounds there, as well as red

tape that left many of the soldiers trapped in bureaucracy.

" The BRAC world didn't really think about the war in Iraq or the

patient load, " said K. Oliveria, BRAC program manager for the

Navy hospital. " It's kind of like driving a race car while it's racing

down the track, and saying, by the way, I need two new tires. "

The need to rethink the new hospital's design led the Navy to delay

completion of its draft environmental impact study from July, then

October, before finally releasing it in December.

The extended review " gave new emphasis " to both the higher number of

casualties and the complicated injuries suffered by service members in

Iraq and Afghanistan, Oliveria said. " The uniqueness of the injuries

has complicated that design, " he said.

The expanded hospital, to be known as the Walter National

Military Medical Center, is to serve as the Defense Department's

premier medical center and primary casualty reception site.

The 345-bed medical center will have specialized facilities for the

most seriously injured patients and will include neuroimaging

capability that " will be unparalleled in the country, " Mateczun said.

The 50,000-square-foot center for traumatic brain injury and

post-traumatic stress disorder probably will cost more than $50

million and will be funded by the Intrepid Fallen Heroes Fund, a

charity founded by Arnold Fisher, senior partner of a New York City

real estate firm, to assist members of the military and their families.

Three " Fisher Houses, " funded by a Fisher family foundation, will

provide lodging for patients and their families. An amputee center,

which opened in September at Walter , will be rebuilt in Bethesda,

and the state-of-the-art equipment used to rehabilitate soldiers will

be moved.

The new Walter will be the U.S. military's leading teaching hospital.

Also planned are a physical fitness center for staff members and

patients, a garage and improvements to roads and utilities on the base.

The hospital's landmark tower, based on a design by President lin

D. Roosevelt, will continue to be used for administrative offices.

During a public review process, the plan was roundly criticized by the

Montgomery County Council and neighborhood groups, chiefly over

concerns that the Navy is preparing inadequately for increased road

congestion that could come with the expansion. Mateczun said the

Pentagon would evaluate whether road improvements, including the

widening of Wisconsin Avenue, should qualify for Defense Department

funding. " We're looking at all ways that might be applicable, " he said.

Although much public attention has been on the expansion at Bethesda,

Mateczun noted, " We're building an extraordinary capability down south

at Fort Belvoir. "

Until 2005, the Army had planned to replace the 50-year-old DeWitt

with a smaller hospital, and in preparation for downsizing, had closed

the intensive-care unit.

BRAC dramatically altered the plan, and the uproar over Walter

added urgency to the project. Fort Belvoir chose the old South Nine

golf course for the hospital, over the protests of some military

retirees who play the course.

On an Army post with a history as a training ground dating to World

War I, the golf course offered a reasonable expectation of

encountering no environmental hazards to slow the project, said

N. Carr, a Fort Belvoir spokesman. The site's location near Richmond

Highway was also key.

An additional $27 million was allocated to accelerate and finish

construction by August 2010, allowing the hospital to open by the

following spring, about a half-year ahead of the BRAC-mandated

deadline, said Col. G. Canestrini, commander of the DeWitt

Health Care Network.

The new DeWitt will be a seven-story, 1.2 million-square-foot facility

with many of the capabilities of a medical center and could cost up to

$900 million, construction of " similar magnitude " to the Bethesda

expansion, Mateczun noted. It will include a large ICU, 10 operating

rooms, a cancer center and diagnostic centers. War wounded are

expected to be sent to DeWitt for some specialty care, including

orthopedic and mental health.

" The scope of the practice will increase dramatically compared to

today, " Canestrini said. " Belvoir is going to be a major player in

delivering health care. "

http://www.washingtonpost.com/wp-dyn/content/article/2008/02/10/AR2008021002214.\

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