Flawed Jewel

Marcy Gorsline has her own stories to tell about the Walter Reed Army Medical Center, similar to the tales of squalor and neglect that spawned congressional hearings last week and led to the firing of the hospital's commander.

Hers involve the care of her son, Pfc. Caleb Lufkin, who was injured by a roadside bomb in Baghdad last May and spent three weeks recovering at Walter Reed. The sink in his room kept clogging, she said, and workers left the bathroom coated with black filth whenever they finished with the plunger. Once, after complaints about urine on the floor had gone unanswered too long, a nurse scrounged up a mop and cleaned it herself.


"After what these kids did for us, we can't even give them a clean room to recover in?" said Gorsline, a registered nurse from Knoxville, Ill. "It's terrible."

But Lufkin's story is very different from the descriptions of neglect detailed in the media last week. His treatment didn't take place inside one of the run-down outpatient buildings his mother sees on the news, but rather in the main hospital at Walter Reed, the flagship of the U.S. Army medical command.


And Lufkin can't complain to a newspaper or testify before Congress because he died May 25, on an operating table at Walter Reed as doctors there attempted to repair a leg injury. The Army has never attempted to explain to Gorsline the cause of her son's death.

Now she fears that maybe the stream of Army leaders and congressmen grousing these days about the state of the military medical system won't have the nerve to truly investigate the treatment facilities at the heart of the system.

"It's not just one building they need to investigate," Gorsline said. "It's the whole system, from beginning to end."

Even as hearings were held and panels were formed in recent days to explore the shortcomings of the medical care provided to wounded troops, government leaders have been reluctant to turn their focus inside the Army's main hospital at Walter Reed - the "crown jewel" of military medicine, as it is often called.

Former Sen. Bob Dole, appointed by President Bush Wednesday to co-chair a committee that will investigate military medical care, seems already to have determined where the deficiencies begin and end.

"It's what happens when they finish their care or move off to some outpatient area where we have the problems," Dole said.

Connecticut Sen. Joseph I. Lieberman opened a hearing Tuesday by saying: "The fact is, the battlefield medical care, the acute care they're getting, and the care that they are getting as inpatients ... at Walter Reed and Bethesda, is the best in the world."

Gen. Peter Schoomaker, the Army chief of staff, told members of Congress: "I just ask you to continue to recognize the fact that ... Walter Reed is a jewel." He added: "The problem we have is an outpatient problem."


Never discussed was the fact that a greater percentage of wounded soldiers and Marines are dying in American military hospitals today than during the Vietnam War, or even the late days of World War II.

Fewer wounded troops are dying on the battlefield in Iraq than any other war - roughly 15.6 percent as of February, compared to about 20 percent during Vietnam - but those figures are driven largely by changes at the front end of the treatment chain. Body armor has made a difference, for instance, evidenced by the relative scarcity of open chest wounds in Iraq.

Vast improvements in the equipment and techniques used by combat medics and corpsmen, and the large number of foot soldiers trained as "combat lifesavers," have also likely saved lives. Unlike 35 years ago, today every soldier and Marine carries advanced medical equipment, and is trained to use tourniquets and modern dressings to stop bleeding, or tubes to open blocked airways.

Yet the percentage of wounded troops who survived the battlefield in Iraq but died in a military medical facility was 5.7 percent as of February, compared to roughly 3.2 percent in Vietnam, according to figures from the Department of Defense. One reason for the increase is probably the improved front-end care, which presents doctors with more wounded soldiers who are sure to die, and who would have succumbed on the battlefield in past wars.

Yet generals and congressmen continually attribute the relatively high battlefield survival rate to the "miracles" being performed at military medical facilities. In fact, the medical advancements most often touted by the Army's doctors are more mundane improvements like tourniquets, battlefield dressings and streamlined air-evacuation networks.

Lt. Gen. Kevin C. Kiley, the Army's embattled surgeon general, said as much this week in testimony before members of the Senate Appropriations Committee, noting that "Army medicine continues to lead the nation." As evidence he offered these examples of improved medical care: "We've provided rapid fielding of tourniquets, pressure dressings, hemostatic bandages and the use of Factor VII."


Pfc. Caleb Lufkin was treated with all of those advancements. The modern tourniquets -"rapidly fielded" in 2005 only after press reports showed soldiers were dying without them - were cinched around his arms and legs when he arrived at the hospital in Baghdad. Advanced blood-clotting dressings were applied by medics on the street, and doctors injected him with Factor VII - a blood-clotting drug - minutes after he arrived. Lufkin was airlifted back to the United States within days, a voyage that took weeks or more during Vietnam.

But Walter Reed was not a jewel for him.

Gorsline remembers the day Lufkin needed a CT scan, after apparently suffering a blood clot in his lung during surgery. Some nurses and technicians disconnected his ventilator and wheeled him down the hallway, but the door to the X-ray room was locked. As the staff members scrambled to find a key, Gorsline squeezed her son's manual ventilator bag and waited.

"They knew I was a nurse, but I work in a doctor's office," Gorsline said. "Should his mother have to stand there and bag him while somebody unlocks the door?"

U.S. Rep. Bill Young, a Florida Republican who visited Walter Reed often, told some similar stories at a hearing last week before a subcommittee of the House Appropriations Committee. He recalled a patient with a brain injury in Walter Reed's intensive care unit who fell out of bed three times before anyone did something to prevent it. His wife once found a soldier lying in a pool of urine, he said, and she had to get him clean sheets herself.

"She complained to a person who was supposedly in charge of the area and she got nothing but attitude. She was told: This is war. We have a lot of casualties. We don't have enough sheets and blankets to go around," Young said. "The soldier deserves better than this."


Like Young, Gorsline and her husband said they always found the medical staff at Walter Reed to be dedicated and professional. But they seemed stretched so thin. Lufkin's dressings sometimes stayed on too long without being changed, and the dirty ones overflowed from the trash can in his room, they said.

"You know, I never once saw them give that boy a bath," said Lufkin's stepfather, Dennis Gorsline. "His mother did, and of course she would have done it 24 hours a day. But why does his mother have to do that?"

Lufkin died of cardiac arrest during surgery three weeks after his injury, and the Gorslines have two theories about how he died. One is that the Factor VII he got in Baghdad - a largely experimental drug linked by federal regulators to unwanted clots and strokes - had caused a clot in his leg that broke loose during surgery. The other is that a bubble of air somehow got inside his heart, a circumstance that often leads to a malpractice claim. Lufkin's autopsy report is vague, and no one in the Army has ever offered an explanation beyond the official finding that he died of "complications of blast injuries."

"When I left to fly out there, everyone said, 'Oh, Walter Reed? That's the best there is,' " Gorsline said. "Well, is it? Is that the best there is?"