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An explanation, but not an excuse

Among the (well-deserved) outcry over conditions at Walter Reed Army Medical Center, one question has been repeated over and over: how the hell did things get so bad there? And amidst the muddle, a lot of people have extended that argument in wrong directions: from "how can we treat our veterans so badly" to "how did the Veterans Administration let this happen?"

That little misunderstanding -- that Walter Reed falls under the VA -- was actually a pointer to some people.

Walter Reed is not -- repeat, NOT -- a Veteran's Hospital. It is owned and operated by the United States Army, and is for active duty personnel -- not former service members.

And as part of the Army, it fell under the last round of Base Realignment And Closure (BRAC) cuts.

In 2004, a non-partisan commission took a long, hard look at our military installations, and made recommendations that many of them be reduced, consolidated, or eliminated entirely. And Walter Reed -- the Army's premiere hospital -- has been around for almost a century. The commission recommended that it be closed, effective 2011, and consolidated with the Naval National Medical Center at Bethesda, Maryland.

Here are a couple of cold, hard facts that most likely contributed to the deterioration at Walter Reed:

1) The military has a finite amount of money to spend.

2) Any money invested in Walter Reed will, in essence, be "wasted" as the whole facility will cease to exist in about four and a half years.

What SHOULD have happened was that the shut-down should have been modified, with the worst facilities being closed down, modest temporary fixes applied where possible, and patients transferred to other facilities. Administrators of the hospital should have been performing architectural "triage" on the campus, sacrificing the most deteriorated buildings and focusing on their core concerns. Instead, it appears they just watched the clock, betting that things wouldn't get too bad before the whole issue became irrelevant.

That was a losing bet -- and our sick and injured service members are having to cover it.

This in no way excuses what happens there. It needs to be fixed, and fixed NOW. Those who made that bet need to be disciplined, demoted, reassigned, or fired. Courts martial might even be in order.

But the state of matters at Walter Reed are too big to be the result of negligence, of carelessness, of even malice. They are systemic -- and the BRAC decision was a major factor in perverting that system. It should have been anticipated that this might happen when one schedules the shuttering of such a huge hospital, especially during a time of war.

At this point, I don't care if we find someone to blame now, or go looking later. The main thing we need to do first is get those sick and wounded service members the hell out of those conditions. They've suffered far too much already in service to all of us; to leave them there while trying to pin the blame on whoever you don't like is to use them in the most obscene of political theatre.

If I were in their place, if given the choice between staying in the disgusting conditions in parts of Walter Reed and being used as a political prop, I think I'd stay with the rats.


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Comments (27)

Jay,I agree with you... (Below threshold)
Allen:

Jay,
I agree with you.

Combine the 'wait it out' m... (Below threshold)

Combine the 'wait it out' mentality with the fact that last year's Congress did nothing, and this one isn't fulling funding the BRAC projects and we've got not only Walter Reed in terrible condition but the possibility that Bethesda won't be ready to handle the extra patient load by 2011.

I know that here at Ft Bragg there's concern about being ready to house all the new troops that will be coming our way by 2011. I blogged about that a while back here.

It's a mess, that's for sure.

I agree that the conditions... (Below threshold)
Bob:

I agree that the conditions described are deplorable but what no one seems to have mentioned yet is that they are over at a location at the Walter Reed annex at Forest Glenn and the facilities there are NOT normally used for hospitalization or even housing of the overflow from Walter Reed. The building in question is indeed rundown and in disrepair but it in no way should be considered a hospital. I am surprised it is being used at all and the fact that it is merely indicates that they have run out of space at the main Walter Reed location and now are reduced to using what is at hand. Does not make it right but at least before getting in a lather over the conditions, I think it appropriate to gather more facts. I used to work there so am very familiar with the location.

Walter Reed is what happens... (Below threshold)
bill:

Walter Reed is what happens when Congress cuts funds.

Actually, that BRAC will "c... (Below threshold)
Don:

Actually, that BRAC will "close" WRAMC and combine it with the Bethesda facility is only partially factual. The rest of the story is that its primary and secondary care services will be moved to the new, state-of-the-art 120-bed hospital to be built at Fort Belvoir.

I cannot understand why folks continue to believe that BRAC's closure of Walter Reed will eliminate the medical services it provides. You might review the BRAC recommendation for Walter Reed.

I do not for a moment believe that there has been any reduction of resourcing based on the BRAC decision. I do believe that poor leadership in the management of available resources is to blame.

As I've said in other threa... (Below threshold)
epador:

As I've said in other threads, the conditions at Building 18 are not unique to military housing. There have been great strides in improvement, but there are many families still living in conditions close to what has been described. As a physician, as little as three years ago, I had to go into one of these "homes" that was making an officer and his family sick, and photograph the outside as well as inside (including the heating ducts with 3 inches of mold growing in them) and send it to the folks in charge of housing before it was rectified.

As funds are not endless, the military is forced to ration its support funding as well as its force protection funding to make ends meet.

All the attention being thrown at WRAMC will ultimately draw dollars away from other housing projects elsewhere not in the spotlight.

SHAME!

and unless things have chan... (Below threshold)
stevesturm:

and unless things have changed since I was a patient there, walter reed is open to retired military and their dependents.

Chick this funny attempt at... (Below threshold)
Nikolay:

Chick this funny attempt at spin from Malkin: "Kerry, Obama and McCaskill are not sincere in their attempt to solve the Walter Reed problem since they don't full support BRAC".
Michelle is seldom a bright lady, but here she's just painfully stupid.

"1) The military has a fini... (Below threshold)
Rob:

"1) The military has a finite amount of money to spend."

Jay, this is a laughable statement. While that may be technically true, the financial needs of properly maintaining a military hospital are a drop in the ocean compared to the size and breadth of the military's overall budget.

Military Hospitals are inde... (Below threshold)
epador:

Military Hospitals are indeed open to dependents and retirees. Only veterans who are retirees are eligible to use these facilities. [For those of you who don't understand, 20+ years of AD service or an equivalent in the Reserves gives you retired status. Even 15 years service does not make you a retiree.] VA facilities are for veterans only, with few exceptions. Access for non-AD folks to military hospitals, however, is limited when staffing or facility is maxed-out caring for AD. This happens when lots of folks get deployed.

The current trend is to now hire contractors, not AD military, to staff positions in CONUS. This is pretty damn expensive too.

Military Hospital budgets include a number of expenses NOT found in normal hospital budgets including EMRs that have to talk to a whole network of hospitals, patient transfer facilities for patients being ferried from one location to another for treatment (dependents and retirees included), stockpiling and preparation for mass casualties, NBC response, readiness preparedness/deloyment equipment and exercises, and an attempt at duplication of manpower to adjust for the constant loss of personnel due to deployments, which are NOT all Iraq or Afghanistan related. They are a huge "drain" on the military budget. Not just a drop in the ocean.

Facility management of housing is not part of the military hospital budget, but the budget of the base the hospital is located on. Increasingly, the management of housing is being contracted out, which adds another hurdle of red tape for proper accountability in maintenance and restoration of housing. One missed comma in the contract, and, well, you can imagine the back and forth that can occur trying to get a contractor to fix something you think needs to be fixed and they say isn't in their "job description."

Jay, you're pretty much zero'd in. Rob, I think you need to break down your weapon and do some serious cleaning before you return to the firing range.

Folks are missing the point... (Below threshold)
nogo postal:

Folks are missing the point...there used to be a number of military hospitals that no longer exist..

In 71-72 I was an inpatient and then outpatient at Fitzsimmons Army Hospital in Denver...my wife was a nurse at Letterman Army Hospital in San Francisco..
...neither exist anymore...
We have serious casualties both physical and psychological coming back from Iraq and Afghanistan.
The remaining military hospitals are overloaded.
Many of the "returning" are becoming a part of the V.A. Hospital system. The V.A. is not set up for this...

If we cannot provide our troops top-of-the line medical treatment...we must end this war and withdraw..

BRAC does figure in, but pe... (Below threshold)
epador:

BRAC does figure in, but perhaps in ways you might not imagine,

Several budget quirks in military:

If you don't spend all your budget, then you didn't need it and you won't get as much next year. It is very difficult to divert money bracketed for one purpose to another - ie we saved money on widgets and have an excess in the widget budget, so lets spend it on gadgets instead. It is also difficult to INCREASE any budget, so any item that has been neglected will probably continue to be neglected (until something horrible happens and the knee-jerk reaction is to throw lots of money at the problem area - at the expense of other worthy budget items).

If you are worried about your base or facility getting BRAC'd, you spend LOTS of money trying to make it look great AND make it harder to justify closing down. The resources diverted to this purpose are dizzying. And could probably restore a hell of a lot of dilapidated housing.

Kyrie: "Combine the 'wai... (Below threshold)
Lee:

Kyrie: "Combine the 'wait it out' mentality with the fact that last year's Congress did nothing, and this one isn't fulling funding the BRAC projects and we've got not only Walter Reed in terrible condition but the possibility that Bethesda won't be ready to handle the extra patient load by 2011."

That is factually incorrect. Last year's Congress (and the Congress for the last 10 years for that matter) did not "do nothing" -- they actively did many things, including passing legislation and budgets which failed to address the deteriorating conditions at this facility.

The current Congress will now act to correct this situation.

Your suggestion that this mess is the fault of the current Congress is unmitigated bullshit.

Hooo NOGO (appropriate name... (Below threshold)
epador:

Hooo NOGO (appropriate name indeed).

So the military hasn't budgeted well for the current crunch - partly due to requirements imposed upon military hospitals by Congress to serve retirees and dependents rather than a strict military role, and you find another reason to withdraw from the current war.

Wow.

LOL Lee. They've been tryi... (Below threshold)
epador:

LOL Lee. They've been trying to make up for the disastrous effects of the Carter punch followed by the Clinton jabs. And the folks who you perceive as now "in charge" are the miscreants responsible for those debacles.

It's all a mater of priorit... (Below threshold)
Lee:

It's all a mater of priorities, epador. The situation at Reed is indicative of (1) the priorities of the Bush administration for the last 6 years, and (2) the priorities of the Republican-controlled Congress for the last 13 years. Plenty of tax cuts for the rich, while average Americans have been given the shaft.

Pinning this on Carter, who left office in 1980, demonstrates the depth of Republican dishonesty, and the lack of integrity on the part of those conservatives like yourself and Kyrie above, who really don't give a shit about veterans, and try to turn ever mistake they've made into something that is Carter's fault.

The Democratically-controlled Congress will now fix this mess, something the lobbyist-kisssing buttwipe Republicans have failed to do.

LOL Lee, look out for Odin'... (Below threshold)
epador:

LOL Lee, look out for Odin's hammer. So much for your "nice-guy" approach. This mess goes back decades, and the Dems and the Republicans are both responsible. However, Carter made some big mistakes in what he did to the military and there are still evidences of his blunders present. Slick WIllie had his own angle of military abuse, and I'd love for you to give one example of what good a Democratically controlled Congress has done in the past two decades for the military. As an example for where they plan to go this time around.

Oops, I meant the past two ... (Below threshold)
epador:

Oops, I meant the past two decades when there WERE Democrats in charge in Congress.

Oh yeah, and Lee: A big Bronx Cheer and a Nanny Nanny Noo Noo. [Stick and stones, etc.]

I don't know. I was wounde... (Below threshold)
Mike:

I don't know. I was wounded in Iraq in early 2004 and spent about 8 months at Walter Reed. I thought I was taken care of quite well. As I was rated as 'VSI' (very seriously ill/injured) the Army flew my wife up and put her up at the Mologne House. Once I got out of the hospital I also went there. We both stayed, at no expense, the whole time.

Every single person that worked there, from the surgeons to the janitors, was helpful and just plain 'nice'. The care I received was top notch.

Portions of the campus are indeed in rough shape. And other soldiers who don't have family there do wind up barracks. There is no doubt that the Army was not prepared for the large influx of patients. For the last 30 years or so we haven't needed that much hospital space so it was not maintained.

There's a lot of waiting around when you're undergoing extensive recovery. That sucks and there's not much you can do about it. At least the Army keeps you on duty and keeps paying you.

Oh, incidentally, I was int... (Below threshold)
Mike:

Oh, incidentally, I was interviewed by a reporter who, from the information I gathered speaking to him, I assume was one of those who wrote this story. Haven't seen anything resembling my remarks reported. Perhaps I was the only patient with anything positive to say.

Your experience is no coinc... (Below threshold)
epador:

Your experience is no coincidence Mike. With the media or WRAMC. The Army and Marines especially are used to making do with what's available and not griping outside the barracks. This media and politician frenzy is sure to set back things rather than help.

The VA is getting a bad rap... (Below threshold)

The VA is getting a bad rap for this situation.

I would like to provide a description of something our government is doing right these days with regard to Vets.

I am currently a resident in a Veteran's Home after having undergone treatment through the VA for PTSD and Depression, long overdue some 40 years after the Tet Offensive that cap stoned my military 2nd tour in Vietnam with a lifetime of illness.

My blog has attracted the stories of many veterans such as myself and other sufferers from PTSD who were victimized by elements of society other than the VA system of medical and mental treatment. I, for one, became trapped in the Military Industrial Complex for 36 years working on weapons systems that are saving lives today but with such high security clearances that I dared not get treated for fear of losing my career:

http://rosecoveredglasses.blogspot.com/2006/11/odyssey-of-armaments.html

When my disorders became life threatening I was entered into the VA System for treatment in Minneapolis. It saved my life and I am now in complete recovery and functioning as a volunteer for SCORE, as well as authoring books and blogging the world.

When I was in the VA system I was amazed at how well it functioned and how state of the art it is for its massive mission. Below is a feature article from Time Magazine which does a good job of explaining why it is a class act:

http://www.time.com/time/magazine/article/0,9171,1376238,00.html

I had state of the art medical and mental care, met some of the most dedicated professionals I have ever seen and was cared for by a handful of very special nurses among the 60,000 + nursing population that make up that mammoth system. While I was resident at the VA Hospital in Minneapolis I observed many returnees from Iraq getting excellent care.

I do not say the VA system is perfect but it is certainly being run better on a $39B budget than the Pentagon is running on $494B.

The VA is getting a bad rap... (Below threshold)

The VA is getting a bad rap for this situation.

I would like to provide a description of something our government is doing right these days with regard to Vets.

I am currently a resident in a Veteran's Home after having undergone treatment through the VA for PTSD and Depression, long overdue some 40 years after the Tet Offensive that cap stoned my military 2nd tour in Vietnam with a lifetime of illness.

My blog has attracted the stories of many veterans such as myself and other sufferers from PTSD who were victimized by elements of society other than the VA system of medical and mental treatment. I, for one, became trapped in the Military Industrial Complex for 36 years working on weapons systems that are saving lives today but with such high security clearances that I dared not get treated for fear of losing my career:

http://rosecoveredglasses.blogspot.com/2006/11/odyssey-of-armaments.html

When my disorders became life threatening I was entered into the VA System for treatment in Minneapolis. It saved my life and I am now in complete recovery and functioning as a volunteer for SCORE, as well as authoring books and blogging the world.

When I was in the VA system I was amazed at how well it functioned and how state of the art it is for its massive mission. Below is a feature article from Time Magazine which does a good job of explaining why it is a class act:

http://www.time.com/time/magazine/article/0,9171,1376238,00.html

I had state of the art medical and mental care, met some of the most dedicated professionals I have ever seen and was cared for by a handful of very special nurses among the 60,000 + nursing population that make up that mammoth system. While I was resident at the VA Hospital in Minneapolis I observed many returnees from Iraq getting excellent care.

I do not say the VA system is perfect but it is certainly being run better on a $39B budget than the Pentagon is running on $494B.

The situation at Walter Ree... (Below threshold)

The situation at Walter Reed is not indicative of anyone's priorities, Lee.

And others who have stayed at Walter Reed and been treated there have said they recieved outstanding medical care.

As far as I can tell, the problems that exist have more to do with the fact that soldiers are separated from their units and support during a time they need to be concentrating 100% on doing what needs to be done for themselves and coping with the situation they find themselves in.

One of the best suggestions that I've heard so far is that wounded soldiers need to be assigned... drat, I forgot the term, but assigned the same sort of escort that the fallen have to bring them home and make sure that everything happens the way that it should. Someone who understands just who to go to about messed up paperwork or mold (family shouldn't be expected to comprehend the system and the soldier shouldn't have to advocate for him or herself while drugged and trying to heal.)

Without complaints and follow up stuff doesn't get done.

The situations that I've been in where conditions were the worst were all situations that were transitory. Bed bugs or screwed up paperwork and whatall... it was situations where my primary focus was getting my stuff together and getting out. Take the bedbugs. The most I did about the bedbugs was to tell my room-mate when I left to be darn sure not to let the girl from special olympics that was staying the next week sleep *in* the bed. I wouldn't be suprised if the same matresses are still in use.

The paperwork issue, once it was straightened out I was gone. So who is going to be *out* of a crisis and still around to point out to someone who can do something about it just how you got screwed over? Probably I should have written a nice letter to the squadron commander, "Dear Sir, during outprocessing I was made aware of a couple of issues that may not have come to your attention ..." but who does that?

At basic training they actually had us fill out questionares, amazingly enough. On mine I wrote that while my experience was fine I felt that the treatment of trainees by the medical personel was unacceptable and listed the ways and pointed out that those who had experienced the unprofessional treatment weren't around to tell anyone because they'd been discharged and sent home.

Did it make a difference? Who knows.

Your suggestion that thi... (Below threshold)
kyrie:

Your suggestion that this mess is the fault of the current Congress is unmitigated bullshit.

Wow, I don't believe I blames this mess on either party, as both have both have been lacking here.

I placed the blame for doing ZIP on this last term on the Republicans.

but now the ball is in the Dems court. If they 'support the troops' with more than lip service here's their chance to show it.

I don't blame the 'mess' on the Dems, just the CURRENT lack of funding.

Hope that clarifies what I was trying to say. Plenty of blame to go around, but only ONE party is in the position to fix it NOW...and so far, well....

I am amazed how everyone ha... (Below threshold)
superdestroyer:

I am amazed how everyone has blamed the lack of funding from the Republicans as the root cause of WRAMC's problems even though the Defense Health Program accounts in the 2007 DoD budget where 10% greater than the 2006 DoD budget.

The problems are WRAMC are much more chronic and systemic than just the lack of funds. WRAMC has been a train wreck for decades. It is located in the ghetto, it has severe problems recruiting qualified staff. It has to comply with all of the civil service rules that make the rest of the government inefficient. It is the last place anyone in the Army wants to be assigned. It has to comly with both federal and DC environmental and building regulations.

To claim that a slightly bigger budget and changing a few leaders will make WRAMC run properly is naive.

Anyone who read "Born on th... (Below threshold)
Furball:

Anyone who read "Born on the 4th of July" will know the status of military hospitals was deplorable as far back as the Vietnam War.




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