At Walter Reed, a New Approach

"The squad leader is kind of a battle buddy," Guna said. "Making them feel like they're a soldier -- that's what a lot of it is."

Guna said that combat veterans are better able to establish rapport with outpatients. "That's one good thing the Army did, bringing in combat vets," Guna added. "You can say, 'Where'd you get blown up at?' And they'll tell you and you can say, 'Oh, I got hit there myself.' "

But the squads have little of the cohesion typical of a small Army unit. Apart from the thrice-weekly formations -- which many soldiers miss because of medical appointments or other conflicts -- outpatients in a squad have little interaction. Their medical treatment, living quarters and meals are usually separate.

Guna said that some recovering soldiers and their families "like being stars" and try to take advantage of their status.

The wife of one soldier "cussed me out on the phone," Guna said, when he told her they were not entitled to keep a room at the guest lodge that they were not regularly occupying. Guna said he did not respond in kind.

Commanders have told him to "be happy" that he is no longer under enemy fire, Guna said. He added, however, that "sometimes, I'd rather be shot at."

A few recovering soldiers have little interest in cooperating with their squad leaders, McKenrick said. "Some are noncompliant, deliberately missing appointments," he said. "Some of that is based on despair of the condition they're in."

The battle-tested soldiers of the brigade cadre have encountered systemic problems beyond their ability to address. "We've fixed things," said Capt. Steven Gventer, a company commander in the brigade and veteran of intense street fighting in Sadr City. "Where we can't fix the problem is where we're dealing with boards and doctors. We can identify problems, but can't fix them."

Some in the brigade are critical of the hospital's civilian workforce, which they view as stubborn and resistant to change. "It is going slow," Guna said. "We're bumping heads with the hospital. They don't want to see us succeed, because that would mean they were wrong."

But some patients argue that the brigade is not addressing the underlying problems in the military medical bureaucracy. "To me, it's cosmetic stuff," said Army Maj. Lionel Walton, who has been treated at Walter Reed since January 2005.

The frustration and anger felt by many of those being treated at Walter Reed boiled over at a town hall meeting with the full brigade at 8 a.m. one day last week in the hospital gymnasium.

The bleachers were packed with soldiers bearing evidence of terrible wounds. Many used canes or crutches. Others wore prostheses and some had eye patches or disfigured faces.

Maj. Gen. Eric B. Schoomaker, Walter Reed's commander, took the floor. "This is the first brigade of its kind," he told the soldiers. "This concept is sweeping across the Army, in how we care for warriors. . . . We acknowledge that this is a work in progress."

When Schoomaker asked for comments, the complaints spilled out: Evelyn Williams, the mother of a wounded soldier, described how he had been given discharge papers to sign with no explanation of his options. Two soldiers complained that an orthopedic surgeon had been repeatedly "abusive and demeaning" to patients and should be fired -- a demand that prompted cheers from the bleachers.

People were using the hospital's guest lodge as a party house, someone said, and soldiers who had suffered brain trauma were drinking alcohol. Every soldier's room at Abrams Hall, where many outpatients are housed, had been outfitted with a plasma TV and a computer -- but many phones were not working, Sgt. Charles Eggleston complained.

Schoomaker and McKenrick addressed the complaints as best they could, but the answers did not satisfy all in the audience.

"It breaks my heart," Williams responded. "I'm standing here and hearing a bunch of hogwash."

McKenrick asked for patience. "We are just beginning, and have a lot of changes to make. . . . There isn't anyone here that's against you."