Military Hospitals Meet New Realities

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 Reed 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 Reed, will be rebuilt in Bethesda, and the state-of-the-art equipment used to rehabilitate soldiers will be moved.

The new Walter Reed 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 Franklin 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 Reed 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 Donald 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. Kenneth 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."