Tuesday, March 13, 2007

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.


Superdestroyer said...

A couple of comments.

MG Weightmant did not replace LTG Kiley as commander of Walter Reed. MG Farmer replaced LTG Kiley ans MG Weightman replaced MG Farmer when MG Farmer retired.

The Surgeon General’s home does not “overlook” Building 18. Buildling 18 was on the other side of Georgia avenue and would never be considered next door.

The Army has proposed setting up a separate “Wounded Warrior Transition Brigade” to function separate from the rest of Walter Reed. My guess is that the integration will be slow and difficult.

Unknown said...

Super--thanks for the clarifiction, and I've updated the blog. I've only been to Walter Reed once in my career, and never visited Building 18. I'm guess that John Barry has never been to the medical center, and accepted someone's else assertion that the commander's residence overlooked the outpatient facility--makes the scandal sound that much worse, even if the facts contradict the storyline.

Concur with your comments on the transition brigade. Sounds like more of the same, and the implementation process will likely spur more complaints.

One final point: I can guarantee that the frustrated troops in Building 18 wrote letters to their congressional representatives long before the Post published its story. But I don't see the WaPo bothering to ask any of the soliders if they contacted their congressmen about the matter, and how many of them ignored letters of complaint. Might make their Democratic friends look bad.

Anonymous said...


We've been wracking our brains (out of morbid curiosity) at work trying to fill in that blank; thanx. Even if TSG's G/FOQ did not "overlook" Bldg. 18, is it a fair to suggest that he could see some part of the building/neighborhood from his porch/window/backyard and perhaps, being responsible f/all medical care in DA, might not have at least had his curiosity piqued? FWIW, I believe that WRAMC will relocate to Bethesda due to BRAC.

Hopefully the transition brigade will put a competent officer (and several competent NCOs) in charge of helping their fellow Soldiers.

artillerysurveyor said...

You know, its a shame they fired the generals and not the nimrods who were really responsible. When was the last time you had a general come look at your quarters or barracks? NOT. Next since when was the beancounters concerned about the wounded. There thoughts are, hmmm, the walking wounded are serving no purpose other than more costs, so lets get rid of them, let them stay in bad barracks the sooner they'll want to leave. Let the VA have them. Because the medical boards want you out now. So youre passed to the VA which says, Army dude, you have to repay the severance package the Army gave you before we give you any benies. Ouch who ever heard of that?? In the mean time, you fight to get the ratings changed, taking years. Because you cant have an attorney represent you but the VA has a truck load of them shooting you down at every turn. My claim finally reached a conclusion, 10 years later. So firing a couple of generals wont do squat! All this posturing is BS. And Bush getting a board to investigate how to improve this situation is sort of negated because he has a veterans commission reporting in October trying to cut benefits. Well, I have an appointment to see a doc at the VA in 3 months, thats urgent care. Of course they cancelled it and now its 6 months out. Theres more wrong with this system, but, lets go fire a couple of generals, that will solve the problem. Oh, and what about this fisher house? Why in gods name does a civilian have to start a trust, and use that money to build fisher house for soldiers families?? Why didnt the Army do that years ago? I mean doesnt the Army take care of its own, obivously NOT if a civilian has to build fisher house with his own funds. Well enough on this soap box. Firing generals is just stupid.