Friday, March 09, 2007

All the Military Medical News Fit to Print

This morning was the first time I have visited a military hospital in the three weeks since the Washington Post’s initial story on the deplorable accommodations endured by Iraq-war medical “out-patients” at Walter Reed Army Medical Center (WRAMC).

I wasn’t at WRAMC but at the National Naval Medical Center (NNMC) in Bethesda, Maryland. NNMC, located just outside the Maryland-Washington, DC boundary along busy Wisconsin Avenue, is the Navy’s equivalent of WRAMC – but without the latter’s pedigree.

As just about everyone in the country who tunes into a cable news station or one of the many radio or television talk shows knows by now, the scandal has gone well beyond the bricks and mortar issue and beyond WRAMC. Under scrutiny is the whole medical patient administrative processing system beginning with the Department of Defense’s (DoD) decision as to who among the wounded and injured will be kept on active duty and who will be medically discharged. Also under scrutiny is the process – including how to apply for and file appeals of decisions on – of determining disability levels, the level of monthly compensation a veteran will receive. Congress is also examining how DoD and the Veterans Administration (VA) interact (or fail to interact) in aiding the veteran who is transitioning from DoD medical care to the VA system.

What will not be known for a few weeks, at least, is how Congress or the administration will try to “fix” the system – and whether the changes actually help. In terms of DoD, however, the firing of the Secretary of the Army by Secretary of Defense Robert Gates and the ouster of the hospital’s commanding officer seems to have concentrated the minds of other top brass. So I was a bit amused by a large sign in the foyer of the main NNMC building announcing a seminar of the DoD/VA Medical Disability process. I didn’t read all the fine print, but from what I did read it appeared this would be a “hands on” session involving both the NNMC staff and patients from Iraq and Afghanistan who are being treated at NNMC.

Another indication that the word is out is the content of the Pentagon’s in-house media monitoring service nicknamed the “Early Bird.” This compilation is an unscientific selection by Pentagon public affairs (public relations) personnel from an array of “representative” regionally diverse daily papers and weekly news magazines. The end product, which can contain anywhere from 35 to as many as 60 or to 65 articles from daily and weekly papers and from internet sites from newspapers and on-line news sites that is made available seven days a week to military and DoD civilians. The number of stories over the last seven days discussing hospitals in the DoD and veterans departments as well as the whole disability administrative nightmare, have come to equal and even, on two days (the fifth and the seventh), exceeded the number of articles addressing the wars.

Iraq War - 55
Afghan War - 12
Iraq Reconstruction - 7
WRAMC - 49
Other hospitals and VA issues - 11

“Early Bird” articles on hospital facilities and professional care other than WRAMC or NNMC (Forts Carson and Lewis, Brooke Army Medical Center Fort Sam Houston, and Landstuhl Medical Center at Rhein-Mein Airbase in Germany originated in local papers, indicating that local commanders were acting to try to deflect criticism about the availability and quality of care and the condition of facilities before complaints gain undue credibility.

Two points sure to surface in congressional hearings and the investigations of the special commissions that have been created will be the shortages of nursing staff at DoD and VA hospitals and the lack of money to construct new medical facilities or maintain existing facilities.

With regard to the latter point, look for legislation reversing the decision of the 2005 Base Realignment and Closure Commission (BRAC) – accepted by Congress and the president – to close the densely built WRAMC facility and relocate it to the larger and relatively under-built NNMC. All construction and relocation under the BRAC plan is to be completed by 2011. That may now all be cancelled.

The shortage of trained nursing staff at military facilities is part of a national shortage. The remedy must be national as well. In fact, Congress ought to make the scandal of Walter Reed the basis of a comprehensive examination of how health care is delivered in the United States – civilian as well as military – with an eye toward simplifying procedures and processes while extending health care insurance to everyone person in the country.

If in fact real health care reform can be advanced, some lasting good might yet come from the WRAMC revelations. But don’t bet the farm on it – at least not yet.

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