Headlines screamed of neglect as the nationís highest leaders, from the Pentagon, Congress and the White House demanded an answer as to how this could have happened.

In fact, there was no single answer. And Army officials soon discovered that the problem was systemic and not isolated at Walter Reed.

Five-and-a-half years of combat on two fronts, coupled with historically high combat survival rates, had thrust hundreds of soldiers, battered and broken, and their families, into a bureaucratic health and rehabilitation system that had all but lay dormant for nearly 30 years.

ìOnce we became engaged in the two wars, when we started to look for those rehabilitative capabilities, they really didnít exist,î said Army Brig. Gen. Gary Cheek, the Armyís assistant surgeon general for warrior care and transition. ìWe didnít take good care of the families. We werenít watching out for the soldiers. ... We also really didnít know what was going on.î

Soon, Defense Secretary Robert M. Gates would proclaim that, next to fighting the wars in Afghanistan and Iraq, taking care of wounded warriors was to become the Defense Departmentís highest priority.

What followed was an all-out Army assault on the broken systems, substandard living conditions, scattered family support programs, and even passive leadership that had contributed to the breakdown in wounded warrior care.

Over the past 20 months, the Army has reinvented its wounded warrior care program, creating a system that puts soldiers and family members at the center of care, surrounded by protective layers of leadership, case managers, doctors, support specialists and senior leader oversight.

Transformation Goes Full Circle

The model for the transformation began at the same place the problems were first discovered. The first newly-designed wounded warrior brigade stood up at Walter Reed only three months after its hand-picked top leaders put boots on the ground there.

ìWe have made tremendous progress here at Walter Reed, and even more importantly, across the Army in establishing systems that provide much more comprehensive care for our warriors,î said Army Col. Terrence McKenrick, the brigadeís first commander.

Each platoon sergeant there now has three squad leaders who care for about 12 soldiers each. The squad leader is the point man in what the Army has coined the ìtriad of care.î Central to the newly formed layers of support, every soldier has a squad leader, a nurse case manager and a primary care physician.

Before, there were 24 case managers handling an average of 55 soldiers each.

Now, there are 39 case managers watching over about 18 soldiers each, McKenrick said.

ìItís a much more proactive involvement ... in helping individual warriors,î he said. ìThey now have the time to do that well and manage those care plans a lot closer than they did in the past.î

Delivering Quality Care

There were no primary care physicians in the past, either, McKenrick said. Now each company has an assigned primary care physician who takes on no other patients. Each cares for about 230 soldiers.

The nurse case managers and the physicians are supported by about 20 other staff in a newly renovated warrior clinic housed on the first floor of the main hospital. The area is only for wounded warriors and gives them a central location for all of their primary medical needs. Appointments with specialists throughout the hospital are scheduled by the nurse case managers and squad leaders to ensure the soldiers know when and where to make their appointments.

Also new is the development of a comprehensive transition plan. Launched across the Armyís medical command in March, the plan is a collaboration of doctors, case managers, occupational therapists, specialty care providers and the soldiers. The idea is to map out goals that are needed for each wounded soldier to successfully transition either back into the Army or into civilian life.

For some seriously injured soldiers, the Army also has added another layer of advocacy and oversight.

The Armyís Wounded Warrior program, or AW2, includes in its fold soldiers who have a single disability rating of 30 percent or a combined disability rating of 50 percent. If a soldier is injured and is anticipated to receive either of those disability ratings, he is entered into the program even before the rating is awarded.

The program encompasses soldiers injured in combat, as well as in training and off-duty accidents.

The soldiers and families are assigned an AW2 advocate who oversees their care, even as they are still being cared for at the transition units by the ìtriad of care.î

An Advocate for Life

Over time, the role of the AW2 advocate increases as the nurse case managerís role decreases, so that by the time the medical board makes a determination, ìthe person working with them most is the one that is going to be with them for the rest of their life,î said Col. Jim Rice, the AW2 program director. In fact, the advocate will continue to work with the soldier and family as long as needed, even if the soldier transitions back to active duty, Rice said. So far, 70 soldiers have returned to duty, he said. Most have been medically retired and have returned to their communities where they receive care at Veterans Affairs facilities.