Friday, March 02, 2007

Fixing Walter Reed

The Commander of Walter Reed Army Medical Center in Washington, Major General George Weightman, was fired yesterday, after the Army said it had lost confidence in his ability to lead, following disclosures about sub-standard living conditions for wounded service members receiving out-patient care at the facility. Weightman's dismissal came less than two weeks after the Washington Post published a two-part series on squalid living conditions for some soldiers at Walter Reed, and bureaucratic nightmares that prevented others from getting the care they need.

But was it fair to get rid of Weightman, a West Point graduate and career Army physician who took over the top post at Walter Reed only six months ago? Many of the soldiers and officials contacted by the Post say that the problems at the hospital began well before Weightman assumed command. That may be one reason that the Army has named Weightman's predecessor, Army Lieutenant General Kevin Kiley, as acting commander of Walter Reed, with a mandate to fix the difficulties ASAP. There is considerable evidence that Kiley has been aware of problems at Walter Reed for years, and is being given one last chance to correct the situation.

Was General Weightman a scapegoat for facility problems and management issues that began before his watch? The answer to that question is probably a qualified "yes," with the understanding that (a) if serious problems are discovered during your tenure, the guy with the stars is the first to get the axe, and (b) General Weightman, despite his considerable skills as a physician and administrator, appeared to be either blind or tone-deaf during his last tour at Walter Reed. Decrepit living conditions at Building 18 apparently did not improve during his tenure; bureuacratic snafus remained a serious problem, and (apparently, unknown to him) there were WaPo reporters hanging out at the facility, gathering information for their expose.

From what I've gathered, General Weightman was either unaware of these issues, or unable to demonstrate progress toward their resolution, so in that regard, his dismissal was warranted. I would also argue that Kiley probably deserved to get the boot as well, but Defense Secretary Robert Gates has decided to keep the Army Surgeon General on the job, at least for now. Kiley will likely be remembered as the only top doctor in the service's history whose job performance --and continuation as surgeon general--was based on his ability to fix specific problems at a single military hospital. And, I'm guessing if the situation at Walter Reed doesn't improve significantly in the next six months, General Kiley may find himself in an earlier-than-planned retirement.

But the problems at Walter Reed don't end with the General Weightman or General Kiley. Based on my reading of the Post series, I get the impression that both were served by a woefully inefficient staff, unable to deal with festering problems, or (as required) elevate them to command level and demand proper resolution. In one example cited by the Post, a staffer received money to order recreational equipment for patients in Building 18, but that request was delayed by an administrator who feared the order would trigger an audit. When the request was finally approved by the admininistrator, the money was no longer available, and the process had to start all over again.

There also appears to have been a lack of initiative and creativity among the hosptial staff. The Post reports that some patients had been moved to off-base hotels and apartments, to ease over-crowding. If conditions in Building 18 were that bad, why not shut the building down, and put everyone capable of residing off-post in contract quarters, with the necessary transportation, logistical and support services needed to support patients at those locations. Yes, it's a more expensive approach, but it would have saved the Army from a major public relations debacle, and allowed faster repairs to Building 18.

Then, there's the idea of using self-help and GI labor to complete some of the repairs. Somewhere out there in the vast expanses of the DoD, you'll find an Air Force Prime BEEF or Navy Seabee unit that could do most of the work, in minimal time, with the necessary planning and coordination. And, if contractng rules prohibit the use of military engineering units, then the Army has to find some way to fast-track a rehab of Building 18, while arranging long-term off-base quarters and support services for patients. Given the high-level interest in conditions at Walter Reed, it should not be difficult to accomplish. This is not rocket science, folks; it's the type of planning and execution effort that any competent military organization should be able to pull off with ease. We'll soon find out if the staff at Walter Reed is up to the task.

I will agree with General Weightman on one point. The Post's recent series on the hospital was unfair in the sense that it focused solely on problems in Building 18 and the out-patient care program. The world-class. life-saving care delivered by the medical center's doctors was largely ignored by the paper; in one section, the reporters actually contrasted the "spit-and-polish" amputee section (Ward #57), with the relative squalor of Building 18. Could the series have been a bit more balanced? Perhaps. But there have been plenty of articles about the miraculous combat medical system that has saved countless lives in Iraq and Afghanistan. Soldiers who survived because of that care deserve better than Building 18, and a system that often "forgets" them during long-term follow-up services.

The Post provided a public service by pointing out the problems at Walter Reed; now they owe us a follow-up report on facilities where these issues have (apparently) been resolved. For example, we haven't heard of similar problems at Bethesda Naval Medical Center in D.C.; Brooke Army Medical Center in Texas, or the Air Force's Sprawling Wilford Hall Medical Center in San Antonio. The public has as much right to know what's being done correctly at these (and other) military hospitals, just as they need to know about the difficulties at Walter Reed.


Finally, there is one slight irony in this debate over military health care. Not too long ago, liberal politicians were citing the military health system in general (and the VA in particular) as models for a national health care program. Having dealt with military heath care facilities and providers for more than 20 years, I can assure you that the squalor discovered at Walter Reed is--thankfully--rare. On the other hand, the bureaucratic indifference and incompetence is not. And remember: the VA and military health systems deal with a relatively small number of patients. Now, imagine those problems writ large, in a nation-wide, single-payer system. I have seen the future of national health care, and believe me, you don't want it.


JRM said...

It is rarely noted that Walter Reed is on the latest base closure list. That must make it even more difficult to get maintenance funds for older buildings.

Superdestroyer said...

The articles in the Post do not mention that Walter Reed has been a train wreck for decades. When the reporter describe the Heaton Pavillion as spit shined, I concluded that she had probably never been in the building.

Heaton Pavillion has significant structural and maintenance issues. So why would the commander spend money of a guest house when his major inpatient building is millions of dollars behind on maintenance.

Also, one of the problems with WRAMC is that the usually solutions used in the Army just do not work such as morning formations or GI labor. Many senior NCO's have tried the "Fort Bragg" solution as WRAMC and had it fail horribly.