By Steve Vogel
Washington Post Staff Writer
Thursday, April 10, 2008
Army Maj. Steven Gventer stuck his trusty Garmin GPS on the windshield of a white van idling in a garage before dawn at Walter Reed Army Medical Center.
"Take us to Glen Burnie, darling," Gventer instructed.
An Army lieutenant, a hospital outpatient, was missing. Gventer was angry that an officer under his command hadn't shown up at Walter Reed for four days -- normally the lieutenant would be considered absent without leave -- but he was also concerned: Doctors had diagnosed depression in the young man after he served in Iraq.
"I need to look him in the eye and find out what's going on," Gventer said.
A year ago, the officer's absence might not have been noted, much less have prompted a search. Case managers, each with dozens of outpatients, were overwhelmed. The lack of accountability, including soldiers left to live in broken-down apartments and mired in medical bureaucracy, was documented last year by The Washington Post.
The Army's response included bringing in combat veterans to impose military order on the medical task of tracking recovering soldiers. The approach, which the Army is replicating across the country, depends on the decisions of a small group of officers such as Gventer, a cavalry trooper without a medical background, and on young squad and platoon leaders new to the world of helping heal physical and psychological wounds.
As commander of Able Troop of the Walter Reed Warrior Transition Brigade, Gventer was responsible for 240 of the medical center's 700 outpatient soldiers. In the two weeks before he searched for the missing lieutenant, he and his sergeants had saved the lives of two soldiers, including one who tried to kill himself with alcohol and pills.
Initially, the combat cadre had trouble adapting to the civilian atmosphere at the hospital and clashed with the medical system. Soldiers complained that some improvements were cosmetic. The brigade was criticized for pursuing criminal charges against a lieutenant recovering at Walter Reed who had attempted suicide in Iraq.
But a year into it, the Army can point to progress: Congress and government auditors say the system is improving. In a poll of recovering soldiers released last month, 71 percent said the military health system is on track.
"There's more we want to do," said Col. Terrence J. McKenrick, the brigade commander, who is recommending that the Army beef up the Walter Reed unit. The ratios -- one squad leader for every 12 soldiers, one caseworker for every 18 and one doctor for every 200 -- are still too high, he said.
Army leaders have enough confidence in the approach that they have set up similar units at 34 posts. Gventer has been assigned to the Army surgeon general's office to help with the broader effort. As he left Walter Reed last month, commanders credited him with helping turn around outpatient care. "Steve has always been at the center of gravity," McKenrick said.
Monday, 8:30 a.m., Wagner gym
Top of the list at Able Troop's regular Monday formation recently was a new alcohol ban. "Beer mixed with the right meds can be as deadly as guns," Gventer said, walking into the hospital gym.
The soldiers -- wounds of war reflected in their missing limbs, canes and eye patches -- sat on the wooden bleachers, light streaming in behind them and slanting on the floor.
Gventer, 38, a lanky Texan, told them that alcohol would no longer be allowed in Abrams Hall, where many of the outpatients live. The only place on the grounds where they could drink would be the lounge at the Mologne House guest lodge.
"Sometime this week, your room will be inspected by your squad leader," he added. "If there is alcohol, you will pour it out."
No one protested. The two close calls were fresh in many minds.
A squad leader checking on a soldier found him in his room in pulmonary distress. Gventer raced to the scene and found him barely breathing, bloody mucus on his face. A soldier performed mouth-to-mouth, probably saving his life. The patient had mixed medicines to get high and overdosed.
A few nights later, Gventer came in at midnight, just as a report arrived from an Army hotline: A soldier's mother had called, worried about his state of mind.
Hurrying to the soldier's room, Gventer and a sergeant found him slumped in a chair, vomit with pill residue on the floor, a bottle of liquor nearby. The soldier had left a suicide note. After his stomach was pumped, he apologized to Gventer. Now he was back home recovering with his family.
There were other signs of trouble: The Army Criminal Investigation Command was probing a soldier accused of distributing heroin in Ward 54, the psychiatric unit.
Gventer ended the morning formation with a plea: "Make sure you make your appointments. Take care of one another."
10 a.m. Abrams Hall
Gventer strode through the Able Troop offices, talking to platoon sergeants and case managers, trying to get word of any brewing crises. He foraged chocolate off any desk he passed, his standard practice for avoiding lunch breaks.
"What've you got that's hot?" Gventer demanded.
Doctors had still not signed paperwork to determine whether a soldier could return to active duty, a squad leader said. Gventer fired off an e-mail on his BlackBerry and followed up with a phone call.
Gventer came to Walter Reed about a year ago, the day the hospital commander was fired. The secretary of the Army was fired the next day. Walking around in his tanker boots, Gventer felt like an alien. The hospital staff looked exhausted, almost shell-shocked.
Confident and charismatic, Gventer was a natural choice as a leader: He had trained cavalry troops at Fort Knox. He had led a tank company into Iraq, fighting street battles in Sadr City. And he had served as an aide to the second-ranking commander in Iraq.
But Walter Reed was entirely different. "Of my three commands, I think this is the toughest as far as the unpredictability and the level of the challenges and the emotion of the challenges," he said.
Doctors, nurses and caseworkers, even some who have butted heads with him, regard Gventer with affection. "He's been the right person for this," said Col. Patricia D. Horoho, commander of Walter Reed's health-care system.
The soldiers of Able Troop, including some who had lost faith in the Army leadership a year ago, still find themselves battling bureaucracy. But many have come to view the brigade as their ally.
"I love working with these guys," said Spec. Blayne Sheets, who suffered a broken spine and a shattered ankle last April in Iraq. "They actually get it. They've been there."
1 p.m. Abrams Hall
Gventer was preparing for room inspection when a platoon leader arrived to report an 18-year-old private from Arkansas missing. "I tried cell, I tried text messaging, nothing," Staff Sgt. John Guna said.
Guna offered one clue: "The kid ordered a set of tires for his car," delivered just the other day.
Gventer quickly grasped the point: "Once he got the new tires, he might have rolled."
"I'm going to try to call his mom," Guna said.
Gventer moved on to the weekly inspection, making sure the soldiers and their rooms were in good shape and checking for alcohol or improper medications.
In one room, he noticed Spec. Kain Schilling wearing a hero bracelet in honor of lost comrades.
"Who's on your bracelet?"
"Six of my buddies, killed," Schilling replied. "We were coming out of a village and got hit."
Gventer has his own bracelet, with the name of Spec. Carson Ramsey, a soldier from his tank company killed in Baghdad.
The next stop was Spec. Chad Spears's room. The soldier had been at Walter Reed more than a year, being treated for traumatic brain injury and post-traumatic stress disorder and coping with an alcohol problem. "I had a suicide attempt, went through divorce," Spears said. "I was a troubled soldier for the longest time."
Spears had done well enough in an Army substance abuse program that he is no longer considered high-risk. Even so, the major peered into his refrigerator.
"I've still got to check, man."
4 p.m., Abrams Hall
"We've got [him], sir," Sgt. 1st Class Micheal Brown announced, arriving with a text message from the missing private.
"Where is he?" Gventer asked.
Brown read the message: "I am alive, I am in Arkansas, I am aware of the consequences."
Gventer exhaled. "I'm getting more gray hair right now."
Tuesday, 6:30 a.m.,
on the road to Glen Burnie
Now all he had to do was find the missing lieutenant.
Gventer munched a chocolate Easter bunny as 1st Sgt. Matthew Duesbery, his right-hand man, drove the van up the Baltimore-Washington Parkway, arriving at the townhouse shortly after 7.
A middle-aged woman answered the door. No lieutenant lived there, she said. A neighbor related that the officer had moved out.
Gventer called the lieutenant's cellphone and left a message, trying to modulate his irritation. "You failed to inform your squad leader of your move," he said. "I'm trying to get a face-to-face with you."
His BlackBerry rang. A sergeant said he had reached the lieutenant, who promised to come in soon.
"He's said that for four days now," Gventer replied. "How come he won't answer my phone calls? I don't get it."
The lieutenant appeared the next morning, wearing a cowboy hat and smoking a cigar. Gventer laid into him, reminding him of his responsibilities as an officer.
He consoled himself, though, that similar episodes had not ended badly. One soldier went on a binge and ended up with a Hooters girl. Gventer and his men brought him back and straightened him out. Now the kid is lined up to study engineering at an Ivy League university.
"It's not always the kick in the pants that works," Gventer said. "Sometimes you need a hug."