Mark Benjamin was ahead of the Washington Post

All the horror stories that Dana Priest and Anne Hull wrote about in Feb 2007 had already been reported by Mark Benjamin in Salon a year before the now famous Washington Post expose which led to Congressional Hearings and 2 Presidential Panels looking into healthcare and paperwork fiasco's facing wounded soldiers and veterans.

Night Flights March 2005

Ralph Begleiter, a journalism professor at the University of Delaware and a former CNN world affairs correspondent who has filed a suit to force the Pentagon to release photographs and video of the caskets arriving at Dover, said news images of wounded American soldiers have been "extremely scarce." Wounded soldiers, like caskets, mostly show up in the news only after they arrive back in their hometowns. Begleiter said the Pentagon has tried to minimize public access to images and information that might drain Americans' tolerance for the war. "I think the Pentagon is taking steps to minimize the exposure of the costs of war," said Begleiter. "Of course they are."

A Salon investigation has found that flights carrying the wounded arrive in the United States only at night. And the military is hard-pressed to explain why. In a series of interviews, officials at the Pentagon's Air Mobility Command, which manages all the evacuations, refused to talk on the record to explain the nighttime flights, or to clarify discrepancies in their off-the-record explanations of why the flights arrive when they do. In a written statement, the command said that "operational restrictions" at a runway near the military's main hospital in Germany, where wounded from Iraq are brought first, affect the timing of flights. The command also attempted to explain the flight schedule by saying doctors in Germany need plenty of time to stabilize patients before they fly to the United States.

From Germany, the military flies the wounded into Andrews Air Force Base in Maryland. Troops with some of the worst injuries are delivered from there to the military's top hospitals nearby, Walter Reed Army Medical Center in Washington and National Naval Medical Center in Bethesda, Md. But both hospitals bar the press from seeing or photographing incoming patients, ostensibly to protect their privacy. Other patients flown from Germany are held at a medical staging facility at Andrews until they are transported to other military hospitals.

Feb 18, 2005

Editor's note: Kudos to the Washington Post's Dana Priest and Anne Hull, who exposed the mistreatment of wounded Iraq war veterans at Walter Reed Army Medical Center over the weekend. But exactly two years to the day before their first story appeared in the Post, Salon's Mark Benjamin wrote this searing expose of the way the hospital treated wounded vets, especially those with psychological injuries. Benjamin spent months at Walter Reed researching a series of articles uncovering the neglect of these vets and their difficulties obtaining the treatment they need. His reporting on one sad angle to the story -- that veterans treated as outpatients were being billed for their meals at the hospital -- resulted in the Army's reversing that policy.

Feb. 18, 2005 | WASHINGTON -- Before he hanged himself with his bathrobe sash in the psychiatric ward at Walter Reed Army Medical Center, Spc. Alexis Soto-Ramirez complained to friends about his medical treatment. Soto-Ramirez, 43, had been flown out of Iraq five months before then because of chronic back pain that became excruciating during the war. But doctors were really worried about his mind. They thought he suffered from post-traumatic stress disorder after serving with the 544th Military Police Company, a unit of the Puerto Rico National Guard, the kind of unit that saw dirty, face-to-face combat in Iraq.

A copy of Soto-Ramirez's medical records, reviewed by Salon, show that a doctor who treated him in Puerto Rico upon his return from Iraq believed his mental problems were probably caused by the war and that his future was in the Army's hands. "Clearly, the psychiatric symptoms are combat related," a clinical psychologist at Roosevelt Roads Naval Hospital wrote on Nov. 24, 2003. The entry says, "Outcome will depend on adequacy and appropriateness of treatment." Doctors in Puerto Rico sent Soto-Ramirez to Walter Reed in Washington, D.C., to get the best care the Army had to offer. There, he was put in Ward 54, Walter Reed's "lockdown," or inpatient psychiatric ward, where the most troubled patients are supposed to have constant supervision.

But less than a month after leaving Puerto Rico, on Jan. 12, 2004, Soto-Ramirez was found dead, hanging in Ward 54. Army buddies who visited him in the days before his death said Soto-Ramirez was increasingly angry and despondent. "He was real upset with the treatment he was getting," said René Negron, a former Walter Reed psychiatric patient and a friend of Soto-Ramirez's. "He said: 'These people are giving me the runaround ... These people think I'm crazy, and I'm not crazy, Negron. I'm getting more crazy being up here.'

"Those people in Ward 54 were responsible for him. Their responsibility was to have a 24-hour watch on him," Negron said in a telephone interview from his home in Puerto Rico. While Soto-Ramirez's death was by his own hand, Negron and other soldiers say the hospital shares the blame.

In fact, repeated interviews over the course of one year with 14 soldiers who have been treated in Walter Reed's inpatient and outpatient psychiatric wards, and a review of medical records and Army documents, suggest that the Army's top hospital is failing to properly care for many soldiers traumatized by the Iraq war. As the Soto-Ramirez case suggests, inadequate suicide watch is one concern. But the problems run deeper. Psychiatric techniques employed at Walter Reed appear outmoded and ineffective compared with state-of-the-art care as described by civilian doctors. For example, Walter Reed favors group therapy over one-on-one counseling; and the group therapy is mostly administered by a rotating cast of medical students and residents, not full-fledged doctors or veterans. The troops also complain that the Army relies too much on pills; few of the soldiers took all the medication given to them by the hospital.

Perhaps most troubling, the Army seems bent on denying that the stress of war has caused the soldiers' mental trauma in the first place. (There is an economic reason for doing so: Mental problems from combat stress can require the Army to pay disability for years.) Soto-Ramirez's medical records reveal the economical mindset of an Army doctor who evaluated him. "Adequate care and treatment may prevent a claim against the government for PTSD," wrote a psychologist in Puerto Rico before sending him to Walter Reed.

"The Army does not want to get into the mental-health game in a real way to really help people," said Col. Travis Beeson, who was flown to Walter Reed for psychiatric help during a second tour with one of the Army's special operations units in Iraq. "They want to Band-Aid it. They want you out of there as fast as possible, and they don't want to pay for it." Indeed, some psychiatric patients at Walter Reed are given the option of signing a form releasing them from the hospital as long as they give up any future disability payments from the Army. One soldier from Pennsylvania, who was shot five times in the chest and saved by body armor, told me he would do anything to get out of Walter Reed, even relinquish disability pay. "I'll sign anything as soon as I can get my hands on it," he told me several days before being released from the hospital. "I loved the Army. I was obsessed with it. The Army was my life. Fuck them now."

The conditions for traumatized vets at the Army's flagship hospital are particularly disturbing because Walter Reed is supposed to be the best. But leading veterans' advocate and retired Army ranger Steve Robinson, executive director of the National Gulf War Resource Center, agrees that when it comes to psychiatric care, Walter Reed doesn't make the grade. "I think that Walter Reed is doing a great job of taking care of those suffering acute battlefield injuries -- the amputees, the burn victims, and those hurt by bullets and bombs," said Robinson, who has spent many hours visiting psychiatric patients at Walter Reed. "But they are failing the psychological needs of the returning veterans."

Walter Reed officials declined requests for interviews, although two spoke to me on the condition of anonymity. In written statements to Salon, Walter Reed said the mental and physical health of patients is the hospital's top priority and described its PTSD treatment regimen as being in line with modern medical standards. The hospital said patients see both "board certified" and "board eligible" psychiatrists, including medical students and residents who "participate in the clinical activities on the ward as part of their training, and as is appropriate for their level of training and needs of the soldiers."

The hospital also cited a recent survey in which 42 out of 45 psychiatric inpatients surveyed, or 94 percent, felt that their care was either outstanding or good. "We are satisfied that there is a very high level of patient satisfaction with their treatment," the statement read. The hospital gave few details about the inpatient survey, such as whether it was anonymous, or whether the patients surveyed were even soldiers who recently fought in Iraq. (Inpatients can include military dependents or soldiers who fought in wars decades ago.)

The high level of satisfaction among inpatients as reported by Walter Reed is completely opposite what I saw and heard while tracking soldiers there over the last year. The soldiers I interviewed invited me to their bedsides in the lockdown ward. They handed over their private medical records. They allowed me to call their buddies, their girlfriends, their mothers. All professed to loving the Army, though some said their trust in the institution had been irrevocably shattered. All said their symptoms either stayed the same or worsened while at Walter Reed; two said they made suicide attempts. While it's true that patients' self-reports about treatment are not always objectively based, the repeated, bitter complaints I heard over the course of more than a year, in combination with conversations with civilian experts, cast serious doubts on Walter Reed's approach to treating PTSD sufferers. It all convinced me that something is seriously amiss at the Army's top hospital.

Next page: "They asked me if I missed my wife. Well, shit yeah, I missed my wife. That is not the fucking problem here"

Mark Benjamin has not received the kudo's he deserves for the stories he has written to help wounded soldiers nor the veterans, I feel the military community owes Mr. Benjamin many thanks and SALUTES he has EARNED them.

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