Army Still Failing to Fix Problems Leading to Walter Reed

[cato2]

Oops! We Did It Again.

By Dana Milbank
Wednesday, July 23, 2008; Page A03

The generals were nervous.

Lt. Gen. Robert Wilson moved his index finger across the page as he read his statement with a halting delivery. Maj. Gen. David Rubenstein, holding a discolored washcloth under the witness table to dry his perspiration, accidentally dropped the cloth and felt for it with his shoe.

The anxiety, even for men with two or three stars on each shoulder, was to be expected. They had come before a House Armed Services subcommittee to explain why, 16 months and at least eight fact-finding investigations after the Walter Reed scandal, the Army still hadn't fixed the health-care system for soldiers wounded in Iraq and Afghanistan.

Wisely, however, the generals armed themselves with a highly sophisticated and unexpected weapon: contrition.

"It absolutely needs to work better," said Lt. Gen. Michael Rochelle, the Army's deputy chief of staff.

"We realize that we have much work to do," offered Wilson, of the Army's installation management command.

"Some would say that we're a step slow; I have no argument with that complaint," confessed Rubenstein, the Army's deputy surgeon general.

"Certainly, this program has been imperfect and execution uneven," said Brig. Gen. Gary Cheek, an assistant surgeon general for "warrior care."

It was a tactical retreat in the face of an overwhelming enemy: the facts.
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Committee investigators had visited Army medical facilities and came back with ominous statistics. At Fort Hood, Tex., last month, they found that a "warrior transition unit" designed to support 649 had 1,342 soldiers, with 350 more on a waiting list. Instead of the promised 74 nurse case managers, there were 38. Other facilities "would shortly experience similar shortages" or already had.

The Army miscalculated the growth in the number of soldiers needing care (it's now at 12,000 and is expected to reach 20,000 next year), causing it to fall below "the required level of staffing" at most facilities -- despite the Army surgeon general's assertion in February that "we are entirely staffed at the point we need to be staffed."

"Why," inquired the panel's chairman, Susan Davis (D-Calif.), "did it take oversight visits from this subcommittee to identify and spur the Army to fix these issues?" She concluded: "We are very concerned that the Army took its eye off that ball, that you are not living up to the goals you set and the promises you made."

The ranking Republican member, John McHugh (N.Y.), was no less skeptical. "In many ways, this challenge isn't being met, and I find the current circumstances unacceptable," he said. "Do you gentlemen agree with that?" Rochelle nodded his head. "Anybody disagree with that?" Nobody moved.

But with the choreography of a Special Forces team, the four generals, each in dark olive with well-shined shoes, professed their devotion to the cause.

"Warrior care is our highest priority, second only to the global war on terror," Wilson said.

"We have no higher priority," added Rubenstein, "except for putting boots on the ground itself in Iraq and Afghanistan."

"Manning the warrior transition units is only second to manning those units preparing to deploy," affirmed Rochelle.

The officers were careful to avoid the sort of bluster that caused their predecessors to be fired in the immediate aftermath of the Walter Reed scandal -- although Rubenstein got close with his boast that "we're doing phenomenal work." Instead, they heaped flattery on their interrogators.

Cheek voiced a desire to "thank Congress for the leadership and support you provide to the Army in the development and execution of this program." Rochelle thanked the half-dozen lawmakers at the hearing for their "continued support" for the "wounded warriors and families that we are all honored to serve." Wilson chimed in with praise for congressional funding. And Rubenstein managed to find gratitude that committee staff members were "very open with all of their findings."
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The lawmakers were disarmed. Davis spoke of the "overall positive direction" and her confidence that the Army is "clearly providing better support" for the wounded.

Delicately, and with careful use of qualifiers, the generals argued that things had improved over 16 months. "We know we have come a long way," Rochelle said. "We also know that we still have a long way to go."

Rubenstein professed to be "working diligently at executing an outstanding Army Medical Action Plan," even if there are "challenges in its execution."

It didn't take much questioning for the "challenges" to trip up the generals. Asked whether the Army is offering competitive pay, Rubenstein boasted that "in some communities, we are too competitive" -- but a moment later complained about how he "can't compete" with the pay at civilian hospitals.

"But you told me you were overly competitive, General," McHugh said. "Which are you?"

After that, the generals mostly stuck with concession and contrition: "We had not sufficiently empowered our commanders. . . . We're going to review this. . . . We've had our challenges. . . . It simply wasn't nimble enough. . . . It is a logjam. . . . We are not meeting the standard. . . . That's a valid concern."

Finding no argument, the lawmakers brought the hearing to a prompt close, but not before another round of mutual flattery. Cheek thanked the committee for its support. Wilson thanked McHugh for the pleasant hearing. Rubenstein praised the staff for its "amazing openness." The chairwoman found herself telling the generals: "Thank you for thanking our staff." Rubenstein, now dry, retrieved his perspiration cloth and hid it under his papers.
Dana Milbank - Oops! We Did It Again. - washingtonpost.com

Contrary to the article that was published earlier this year from a DOD resource.

Top Army Doc Cites Progress One Year After Walter Reed Revelations

[Woodmonkey]

They're dealing with a hugh bureacracy and that is hard to turn around. They might need to start firing some middle managers and ordinary workers who are obstructing progress.

[cato2]

Or the top Doctor mis-reporting that they have it under control

[Woodmonkey]

Wounded Warriors, Empty Promises

The bad news about the Army’s treatment of wounded soldiers keeps coming. The generals keep apologizing and insisting that things are getting better, but they are not.

The latest low moment for Army brass came on Tuesday in Washington, where a subcommittee of the House Armed Services Committee held a hearing to examine the sorry state of the Army Medical Action Plan. That’s the plan to prevent the kind of systematic neglect and mistreatment exposed by The Washington Post last year at the Walter Reed Army Medical Center.

After a flurry of apologies, firings, investigations and reports, the Army resolved to streamline and improve case management for wounded soldiers. Under the plan, “warrior transition units” would swiftly deliver excellent care to troops so they could return to duty or be discharged into the veterans’ medical system. Each soldier would be assigned a team to look over his or her care: a physician, a nurse and a squad leader. It all sounded sensible and comprehensive.

It has not worked out so well. Staff members of the House subcommittee who visited numerous warrior transition units June 2007 to February found a significant gap between the Army leadership’s optimistic promises and reality.

Among other things, the Army failed to anticipate a flood of wounded soldiers. Some transition units have been overwhelmed and are thus severely understaffed. At Fort Hood, Tex., last month, staff members found 1,362 patients in a unit authorized for 649 — and more than 350 on a waiting list. Of the total, 311 were identified as being at high risk of drug overdose, suicide or other dangerous behavior. There were 38 nurse case managers when there should have been 74. Some soldiers have had to languish two months to a year before the Army decided what to do with them, far longer than the goal the Army set last year.

Under skeptical questioning during a hearing in February, Lt. Gen. Eric Schoomaker, the Army surgeon general, told the subcommittee that “for all intents and purposes, we are entirely staffed at the point we need to be staffed.” He also said: “The Army’s unwavering commitment and a key element of our warrior ethos is that we never leave a soldier behind on the battlefield — or lost in a bureaucracy.”

That was thousands of wounded, neglected soldiers ago. There are now about 12,500 soldiers assigned to the warrior transition units — more than twice as many as a year ago. The number is expected to reach 20,000 by this time next year.

The nation’s responsibility to care for the wounded from Iraq and Afghanistan will extend for decades. After Tuesday’s hearing, we are left pondering the simple questions asked at the outset by Representative Susan Davis, the California Democrat who is chairwoman of the military personnel subcommittee: Why did the Army fail to adequately staff its warrior transition units? Why did it fail to predict the surge in demand? And why did it take visits from a Congressional subcommittee to prod the Army into recognizing and promising — yet again — to fix the problem?

The Source

[Scrappy]

What are they paying these guys? They should call me, at least I'll take pictures as I progress, and keep progressing. It doesn't have to be pretty to be sanitary, and the last I saw was mold, and that's unsanitary. Get the mess fixed, if it's coming from the hvac rip it out, if it's coming from plumbing rip it out. Really, new work on this large of a project is little more than trying to fix the problems. Bureaucracy is the root of all conflagrations.

[Sally Brown]

Health care is expensive and part of that health care team is the lowly janitor and maintenance worker that are not perceived as true health care partners but simply as janitors and maintenance workers. Reset the mindset to acknowledge that real physical laborers are a necessary part of the health care team, treat them with respect, pay them fair wages, and the physical necessary sanitary conditions will come up. Try to fix the problems by only hiring in "professionals" on the top end and the infrastructure for them to work in will never exist. There has to be a balance.

We have a habit, whether as military personnel/retirees or civilians or dependents, to want to believe that some magic wand can fix health care for Americans and make it an equal quality place for all. The facts are that the money/funding does not exist for military facilities because as a nation we have failed to recognize that the soldier has a right to treatment as much as the visible and vocal economically disadvantaged of the inner cities who very vocally demand it and have not paid for it. Ironic that the soldier in need of these services has in advance paid for it with his service and his blood and bones and yet as a nation the soldier's need remains "invisible."

When will Walter Reed, Ft. Bliss, and other military medical facilities be truly improved and brought up to minimum standards? I believe that will only happen when vets and their families become as vocal and demanding as the illegal immigrant, the homeless on the street, and the minority who expects something for nothing. Our military and living vets of all conflict deserve not just "standard" care (the minimum asked for) but the very best available. But the change will ONLY happen when taxpayers LOUDLY and uniformally say to the Congress, who find the funds for military and vet health care and health care facilities, "I want my tax dollar to go to repair and treat the wounded who have sacrificed so much for me and my family and if I know that's where my tax dollar will be spent, I gladly will pay the increase in the taxes to make it possible."

Unfortunately, I don't see that happening any time soon. There are too many unemployed by choice, who will give nothing and yet receive every benefit imaginable, leaving our military and vets as a secondary priority in health care. It's wrong. Unfortunately it's how the our world works.