Behind the walls of Ward 54 at Walter Reed Hospital with Iraq war combat veterans

Mark Benjamin, Behind the walls of Ward 54Salon, 18 February 2005. “They’re overmedicated, forced to talk about their mothers instead of Iraq, and have to fight for disability pay. Traumatized combat vets say the Army is failing them, and after a year following more than a dozen soldiers at Walter Reed Hospital, I believe them.”

Excerpts from story:

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.’…

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….