Walter Reed's Deep Roots

In watching all the news and comments about the conditions at Walter Reed Army Medical Center, it strikes me that this is (sadly) another instance of the old saying, that there is a right way, a wrong way, and the Army way. The Army has saved the lives of thousands through quick and efficient treatments, but the post-treatment care sucks, and there's miles of paperwork to go with it. Major General (ret) Paul Eaton, certainly no fan of this administration, has an editorial in the NY Times discussing the current situation.

*Soldiers have long joked: “If you are really sick or injured, Army medical care is O.K. But if you are hurting only a little, especially if it isn’t visible, you’re in big trouble.” The American soldier still receives the best trauma care in the world, especially at Walter Reed.
*

The problem there has been with deplorable outpatient care management. The military health system is seriously undermanned and underfinanced for the number of casualties coming home. Also, there has been little preparation for identifying and treating post-traumatic stress injuries.

*Last year, because of spending in Iraq, the Army had a $530 million shortfall in its budget for posts at home and abroad. This forced the Army’s vice chief of staff, Richard Cody, to tighten belts that were already at the last notch. *

*Hospitals have taken a big part of the financial hit. General Cody has warned Congress that failure to shore up the tottering military health care system could become a “retention issue.” David Chu, the Pentagon’s under secretary for personnel and readiness, told The Wall Street Journal that veterans’ costs “are taking away from the nation’s ability to defend itself.” *

*The result is that Walter Reed and every other domestic Army post have struggled to house soldiers properly after their release from the hospital. For the lucky ones, family members pick up the slack, making sure that follow-up care is provided, that prescription drug regimens are followed, that therapists show up for rehabilitation sessions. Those without family help tend to slip between the cracks. *

Walter Reed, in particular, has another problem. The Base Realignment and Closure Commission [BRAC] d**ecided in 2005 to shutter this critical hospital. I won’t debate that decision now — what’s done is done — but when the commission decides you will close within a few years, money dries up real fast. It is no wonder that buildings fell into disrepair and recovering soldiers slipped off the radar screen.

This retired colonel writing to the Washington Times echoes this sentiment:

*The resignation of Secretary of the Army Francis J. Harvey and his firing of Maj. Gen. George W. Weightman at Walter Reed Army Medical Center are unfair. Secretary of Defense Robert M. Gates has overreacted and caved in to the outrage of some members of Congress even before the commission he appointed to find the reason for the situation has reported its findings. Mr. Harvey and Gen. Weightman are scapegoats for the mismanagement of facilities maintenance by the Office of the
Secretary of Defense, the Office of Management and Budget and Congress.
*

*I worked many years in the Office of the Secretary of
Defense and saw the multimillion-dollar Backlog of Maintenance and
Repair (BMAR) that the department carried for decades. Congress handles the budget for new construction separately, and that money cannot be used to maintain existing structures. Facilities maintenance has been at the bottom of the priority list for many years and still is. The problem of underfunded maintenance was so bad in the past that base commanders had to use troop labor to perform even the most elementary tasks, such as mowing the grass and painting the old wooden buildings left over from World War II. That problem has been resolved, but funds for base operations and maintenance are still reduced arbitrarily during the budget cycle to make room for things that are deemed more important. Because Walter Reed is scheduled to be closed in a few years, it is likely that some anonymous persons thought it would be wasteful to spend money on old facilities such as Building 18. *

I served 29 years in the Army, and most of that time our facilities were shabby. This was not because we wanted them to be shabby or were poor managers but because we were not provided enough money to take care of our facilities properly. It is commonplace for budget examiners required to reduce the Department of Defense budget to make arbitrary reductions in the operations and maintenance appropriation. It is very likely that Building 18 was in bad shape not because the commander and his staff overlooked it but because they did not have enough money to fix it. I hope the commission that is addressing this issue delves into the money and the work orders to find and disclose the real cause of the problem. Unfortunately, the truth will come too late to save the sacrificial lambs to Mr. Gates'
premature version of "accountability."

Beyond the outcry of those disabled veterans seeking well-deserved assistance from the federal government, there's another story here. The initial military care given to our soldiers has been first class, in as much as those wounded in battle can be quickly stabilized, evacuated to a state-side hospital, and treated to ensure that they live to see another day. As has been noted, it's the recovery period that's a bitch.

There are lots of complicating factors here. Walter Reed being on the BRAC list doesn't give it priority for repairs and certainly not for new buildings. The Army's working off a budget that was set two years ago and approved by the White House looking to tighten the belt on the budget. The military and VA hospitals can't compete with the private sector health services. These are all rationale for why things happened to soldiers at Walter Reed, but they aren't excuses. This should have not happened. But let's not let a few
Army general officers be the scapegoats.

As other accounts relate, the poor condition and heavy paperwork associated with the military health services was not news.
There have been other reporters on this issue, starting a few years back. Why was there no earlier outcry? Congress people toured these hospitals, but at the same time, they were getting mail from their constituents about the problem. How'd they miss this? Bush vows that he'll take any step to support the troops, but the White House has been reducing VA benefits since 2000. Will he increase funds now? There's plenty of blame to go around, and we ought not to let these others off the hook.

-- Jason Sigger, cross-posted at Armchair Generalist