Off With Their Heads

Newsweek's John Barry gets today's prize for stating the obvious, observing that "no one should have been terribly surprised" by the forced retirement of Army Surgeon General Lieutenant General Kevin Kiley. Yesterday, General Kiley became the latest casualty of the Walter Reed scandal with the Army's announcement that he was stepping down, effective immediately. Kiley served as commander of the Army medical center when that infamous outpatient facility opened; more recently, he was reappointed to fix conditions at Walter Reed, after the Washington Post found some soliders living in squalor at the outpatient center, while others were unable to get needed care, thanks to red tape and bureaucratic snafus.

With his retirement, Kiley becomes the third senior Army official to get the boot because of problems at Walter Reed. Major General George Weightman (who became Walter Reed's commander in 2006), was fired shortly after the scandal broke, and a few days later, Defense Secretary Robert Gates forced the resignation of Army Secretary Francis Harvey. Washington pundits claim that Gates' willingness to lop off some senior heads is evidence that he is much different that his predecessor, (the hated Don Rumsfeld), both in terms of management style and his demands for accountability from senior leaders.

So far, so good, right? Maybe. As we noted in this post (and a subsequent follow-up), the so-called "scandal" at Walter Reed is far more complex than the Post (or members of Congress) would have you believe. As the Army "downsized" in the mid-1990s, it made corresponding cuts in its health care system, believing (mistakenly) that future conflicts would be of shorter duration, and produce fewer combat casualties. Meanwhile, advances in combat medicine were improving survival rates for wounded troops, allowing more to recovery from their injuries and even remain on active duty. Those advances, coupled with extended conflicts in Iraq and Afghanistan, created a flood of wounded soldiers--requiring prolonged care--in a system that simply wasn't prepared to handle them.

But will the forced retirements of two senior medical officers (and the Army Secretary) actually produce meaningful change? Mr. Barry suggests that the "incuriousity" of Generals Weightman and Kiley was sufficient grounds for their dismissal; he claims that the commander's residence at Walter Reed overlooks the infamous Building 18, but (apparently) neither bothered to inspect the dilapidated outpatient facility. As for Dr. Harvey, the scandal happened on his watch, and Mr. Gates deemed his intial response as insufficient. If change begins at the top, then Secretary Gates certainly has the Army's attention, and it's a given that the replacements for Weightman, Kiley and Harvey won't make the same mistakes.

But you don't need to be a flag officer (or a former CIA Director) to understand that lasting change is not only a top-down process. Fixing the problems at Walter Reed (and other military health facilities) will require the support and participation of administrators and staff personnel, and that's where the real problem lies. Early reports suggest that both Kiley and Weightman were served by inefficent, unresponsive staffs, which failed to fix festering problems, or refused to elevate them to command level for resolution. That doesn't excuse the failings of Lieutenant General Kiley and Major General Weightman, but it is evidence of a system and culture that helped create these difficulties, and is exceptionally resistant to change.

Consider the problems at Building 18, where out-patient soldiers lived amid mold and peeling paint, waiting months for follow-on care. At one point, a Walter Reed staffer realized that the troops needed something help them pass the time, and received permission to buy additional recreational equipment. But that proposal was subsequently rejected by another bureaucrat, unaware of problems in the outpatient system. Many of the staffers who helped create this morass will survive the purge at the top, and they remain the greatest impediment to potential solutions. Will firing the Army Surgeon General really improve the efficiency of a GS-5 clerk with a bloated file of past-due outpatient appointments--and no real incentive for improving their performance?

Over at Newsweek, Mr. Barry believes the next round of Congressional hearings (and the recently-appointed presidential panel) will expose more administrators who bear responsibility for existing difficulties. I strongly disagree. Consider the example of the intelligence bureaucracy, which emerged largely unscathed after post-9-11 reviews. Yes, the overall structure was revamped, but there were virtually no dismissals of personnel for the actual intelligence failures. If history is any judge, the rank-and-file bureaucrats who populate the military and veterans' health care systems have little to fear from pending inquires, and will likely remain in their jobs long after the current "scandal" fades.

So, what purpose was actually served by sacking two generals and the Secretary of the Army? As a long-time Washington insider, Mr. Gates understands that high-level firings in the wake of a scandal serve two purposes: First, they generate the impetus for change at the highest levels of an organization, and secondly, they create a perception of action within the bureaucracy--useful for getting ahead of a scandal, at least from a public relations perspective. But translating these dismissals into genuine reform will take more than a house cleaning in the Walter Reed command section, or replacing the Army Secretary. It requires someone who can actually take the bull by the horns and make the system work--or, better yet--revamp the system by applying private sector solutions to the problems.

In terms of how that might work, Saturday's Opinion Journal offered two common sense solutions for the situation at Walter Reed. To ease the backlog of soliders awaiting outpatient treatment, offer "vouchers" that wounded personnel could use at a health care facility of their choosing. To improve billeting arrangements, the WSJ suggests enlisting the Fisher House foundation, which has built--and operates--dozens of private facilities that provide temporary accomodations for the families of sick and injured military personnel. Both are excellent ideas, but you'll also note that no one (outside the WSJ editorial board) is pushing those suggestions, either.