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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 Reed 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 Reed.

"Certainly, the amount going into building infrastructure wouldn't be as high without it," said Rear Adm. John M. Mateczun, commander of a joint task force set up to oversee the hospitals.

Overall costs for closing Walter Reed 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 Reed was approved by the Pentagon's base realignment and closure commission in 2005. The focus was on replacing the aging Walter Reed 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 Charles 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 Reed 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 David 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 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."

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