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.
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."
