Sunday, March 18, 2007

The Walter Reed Fiasco

Government medicine at work in the good ol' US of A

Since its publication on Feb. 18 in the Washington Post, the story of the bureaucratic nightmares experienced at Walter Reed Army Medical Center by soldiers from the Iraq and Afghan wars has been Washington's biggest bonfire in a long time. Nearly four weeks on it still consumes official Washington--with firings, hearings, denunciations and the waving forward of commissions.

The problem with bonfires made in Washington is that the high and wild flames of politics sometimes blind the public to the fire's true cause. So it is with the Walter Reed scandal. The true cause of this bonfire is Washington itself, the local tribe. As we know from dreadful experience.

The pain caused by Hurricane Katrina in 2005 was made worse by Washington's inadequacies. In 2000, the Bremer Commission on terrorism said the national-security bureaucracy was poorly organized to protect us from a terrorist attack. The 9/11 Commission retrospectively confirmed the Bremer Commission's findings. Walter Reed is a scandal, but a familiar scandal.

It has also produced a particularly bitter irony. One of its first casualties was the career of Maj. Gen. George Weightman. Gen. Weightman, the commander of Walter Reed, is in fact precisely the kind of person the nation should wish to have in public life. But in an act of supreme self-destruction, our politics is driving him out of public life. We'll return to Gen. Weightman shortly.

Last week, a spokesman for House Speaker Nancy Pelosi came forward to announce the speaker's perspective on the manifest problems at Walter Reed: "The American people spoke clearly in the November elections that they wanted accountability and oversight. Under the Republican Congress it has been almost nonexistent, and you can certainly see that with what occurred at Walter Reed." No, you cannot see that. Rep. John Tierney, a Massachusetts Democrat, added that "we should have known all this before."

But all this was known before, though not by Reps. Pelosi and Tierney.

On Feb. 17, 2005--two years ago--GOP Rep. Tom Davis and the government reform committee held a public hearing on the maltreatment of wounded soldiers. The hearing was the culmination of an investigation, begun in 2003, by the committee and the Government Accountability Office. Virtually everything of substance in that Washington Post story was described, in numbing detail, at that hearing two years ago. Two soldiers, Army Sgts. John Allen and Joseph Perez, appeared before the Davis hearing and described their tours through the same hell painted by the Post last month.

Gen. Peter Schoomaker, the Army chief of staff, described the problems at Walter Reed in words that should be inscribed on portals across every bridge leading into Washington: "Life every day in this system is like running in hip boots in a swamp." He called it a "bureaucratic morass."

The core of the problem has been the peacetime administrative system's difficulty in handling wounded or disabled soldiers from the reserves and National Guard. In the words of the system itself, they have "fallen off orders." Here's how that happens:

To enter treatment, a wounded reservist would ask to have his "active duty orders"--i.e., the order that called him up for Iraq or Afghanistan--extended for 90 days, what is called an active duty medical extension, or ADME. But some soldiers would fall off their active orders before the ADME came through. Others, often with complex injuries, would use up their three-month ADME and again fall off orders before receiving a renewal.

Sgt. First Class Allen told the Davis committee in laymen's terms what this means: "When my orders expire, it creates a multitude of problems for me and my family: no pay, no access to the base [such as Walter Reed], no medical coverage for my family and the cancellation of all my scheduled medical appointments."

Someone should make a movie called "National Lampoon's Federal Government." The dialogue would include this line from the GAO's Gregory Kutz describing the soldiers' problem: "overall, we found the current stove-piped, non-integrated order-writing, personnel, pay, and medical eligibility systems require extensive error-prone manual data entry and re-entry." That's right--"and re-entry."

Despite the public record, the committee's new Democratic chairman, Henry Waxman, has rebooted the focus of the "mice-and-mold" scandal, from the obviously dysfunctional government to "privatization" at Walter Reed. Maintenance at Walter Reed collapsed in 2005, when the BRAC base-closing commission, whatever the merits and with President Bush's approval, ill-advisedly listed Walter Reed, amid a major war. So of course the civilian workforce went looking for permanent work elsewhere.

Into this collapsing "morass" the Army six months ago dropped Maj. Gen. George Weightman, M.D. No ordinary desk-bound doc, George Weightman spent five years in the infantry after graduating in 1973 from West Point. Then he went to medical school. It's a decision that has required him to design medical assistance techniques, in theater, with the troops that entered Saudi Arabia for the first Gulf War, in Honduras with Delta Force (there contracting malaria), in Kosovo as head of the 30th Medical Brigade for all troops in Europe, and in Kuwait training the surgeons and medics who would treat our wounded in Iraq the past four years, a model system. A former Army surgeon who served there with him told me he saw "numerous instances of George cutting through the bureaucracy on the run-up to Baghdad." And this is just the official side of the ledger. One son, also West Point, is on his second Army tour in Iraq, and the other is in the Army's medical school.

So when Defense Secretary Robert Gates ordered Army Secretary Francis Harvey to run across the Potomac River to Walter Reed and fire someone, this is who he hit. He fired the wrong person. The next day, Mr. Gates fired Mr. Harvey.

Washington of late has been giving talented civilians reason not to come there to serve, for fear of being destroyed in feckless political wars. So naturally it follows we should also drive out the best people willing to forego civilian wealth to defend us in real wars.

The powers-that-be in this sorry Walter Reed saga--Congress, Secretary Gates, the Dole-Shalala commission--could prove wisdom hasn't fled Washington by reinstating Gen. Weightman. A government establishment so profligate that it thinks nothing of throwing its best people onto bonfires of its own making will likely, over time, burn down to nothing



[TV show] "Tomorrow's World" is like our Government in its attitude to the NHS. Ministers stand, Raymond Baxter-like, with a futuristic blueprint of how life will be; and they know that if they make it sound sensational enough, and have a perpetual showcase of ideas, we will barely notice that, in essence, the gadgets from the last episode are kaput, nothing has changed and all we receive are updates of stuff that did not work particularly well in the first place.

Coming soon from Tomorrow's NHS: an air-conditioning unit for those with chronic obstructive pulmonary disease. Marvel as the Health Secretary, Patricia Hewitt, explains how it will work at a press conference today. Gasp as she neatly sidesteps the fact that if everybody with this incurable illness took up the offer of air-con installation, the cost would be in the region of o250 million. Gasp anyway when the next heatwave hits and you realise there is about as much chance of your GP springing for this as there is of your local Ford dealer contacting you about the flying four-door saloon you've had on order since 1973.

Do not be alarmed, though. There will be another glimpse of our brave new NHS world next month if Gordon pulls off his favourite trick by reinventing some old money as new in his budget. Maybe the paper-clip counters will lift their restrictions on drugs that stave off aggressive cancers or slow Alzheimer's disease. Doubt it. Most likely, there will just be the usual round of meetings, followed by a stalemate and the rearranging of figures to make it look as something has been done.

"Tomorrow's World" fizzled out because even in the computer age there are not that many new inventions. There are tweaks and refinements but it is not every week that a bloke marches into the television studio, consigns your 45s to the bin and hands you something called a compact disc. So it is with the NHS. We are led to believe that big, new ideas are happening all the time. Yet those who base their opinions on first-hand experience understand that little is different under Labour. We have various pronouncements and initiatives but, as ever, nobody gets out of casualty within four hours and waiting lists for big operations are still ticked off in years and months, not weeks.

When my father-in-law was dying of a brain tumour (called glioblastoma multiforme, the axe-wielding psychopath of the cancer family) and required round-the-clock care, three suits from the local health authority attempted to have the budgetary meeting about which department picked up his tab while drinking tea in his sitting-room, in front of his family. That was a decade ago. Now, his widow, my mother-in-law, waits for a hip replacement that was agreed to be essential the Christmas before last. The Health Secretary will tell you that care has changed and nobody waits more than six months for hip operations these days. If they do, the local trust has to pay to send the patient private. But that's another flying car. The actuality is that the six-month countdown only kicks in when a patient is on the waiting list, so if there is no availability the trick is to keep her off the register for as long as possible.

Say an elderly woman whose blood pressure is up, which it might be if she was on the highest daily dose of morphine for pain, and who is throwing up every morning as a side-effect, had hung about in a corridor for two hours and was then being seen in the NHS equivalent of a MASH unit with twin consultations taking place side-by-side in the same grubby room. Well, you cannot have the operation with raised blood pressure, so we have to get that under control before we can put you on the list. The same, next time, with that slightly high thyroid reading. We'll need to adjust your medication first, I'm afraid.

No doubt it is important. But a thyroid takes weeks to get under control, the waiting list is measured in months, but the two cannot run together because this is not about good health, but good housekeeping, the management of cost and resources, better to manipulate figures. All the patient can do is keep going back in the hope that, next time, the health service can find no reason to stall. Meanwhile, drink your morphine.

So when the Health Secretary stands up with the promise of a chilled climate for a million incurable wheezers this summer, please excuse my scepticism. She may see a vision of a healthy future, but from here it is just another holiday on Mars. Air-conditioning to be provided by people that can't find you a bed? Don't hold your breath.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when is playing up, there are mirrors of this site here and here.


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