Bureaucracy's Cost

Walter Reed Army Medical Center (WRAMC) is not a Veteran's Administration Hospital (VA).  It is a facility of the full time Army which is used to treat a varied population of patients;  active service members, retired service people and military families.  A VA hospital is quite different.  It treats inpatient and outpatient personnel who are eligible under US law for lifetime care for service connected disabilities.  Most of these people are former service members rather than retired service members.  The latter continue to be eligible for military medical care or for service connected health insurance.  The difference in kind between these two types of hospitals seems to be beyond the comprehension of the MSM.

There is a major general of the Army Medical Service who commands WRAMC.  He is a doctor. Like all Army officers he is responsible for all that his command does or fails to do.  Don't bother to tell me that this is an unreasonable standard.  The Army is not a "reasonable" calling, and it should not be.

The general responsibility for the provision of and policy supervision of the functions of the Army Medical Service falls on the Secretary of the Army, the civilian politician who is the departmental head of the Department of the Army.

IMO both of these men failed miserably in their duty, failed to the point of criminality and should be fired at once pending an investigation to see if criminal charges can be justified.

The present sociology of the enlisted force of the US Army and Marine Corps is such that there are a lot of people in the ranks who have no home but the Army or Marines.  When wounded and placed in a convalescent status requiring frequent outpatient care, many of them have no civilian home to go to, no disposable funds to deal with the additional expenses of maintaining aplace to live for such close family as they may have, and no one to care for them but the "big green machine."  That machine and the two men I named failed miserably in that "familial" responsibility.  They should pay for that failure toward those who had every right to expect to be cared for.

Why did they fail?  They failed because they had other priorities.  The base closing commission's (BRAC) decision to close Walter Reed was probably a factor.  A focus on budgetary problems in an atmosphere in which the costs of war are "sucking" so much money into the wars was probably a factor.  A stupefyingly bureaucratic approach to problem solving is now pervasive in the Army.  That was probably a BIG factor.  I am going to write more on that general problem.

Did Dana Priest and her colleague tell the commanding general of WRAMC about this problem before WAPO printed the story?  An interesting question, but it does not alter the situation. The general and the secretary are responsible.

That is Dr. Walter Reed's picture at the top.  He was a serious Army doctor.  He would have burned the hides off these people.

Imagine what George Marshall's reaction would have been if he had discovered something like this on his watch.  General cody, the Vice Chief of Staff of the army said that he thought it "reflected on him" that he had never been to building 18 at WRAMC.  Really?  pl

Comments

[Chris Marlowe]

There is a thread here; the politicization of the bureaucracy to a far greater degree under the Bush/Cheney administration than under any previous administrations.

They have appointed political hacks (Republican party donors) over real people who had the domain knowledge and experience to get the job done. It happened at FEMA after Katrina, and now it is happening with America's veterans.

If the American people were not reduced to Pavlovian dogs by the mainstream corporate media, they would be out in the streets, demanding justice. Didn't something like that happen in the Hoover years with WWI vets, and didn't MacArthur (or some other general) have to put down the riots in DC?

[Cloned Poster]

When Bush, Cheney, Rice and quisling Blair do not do hospital visits or funerals what do you expect the Murdoch press to do?

IGNORE

[arbogast]

This is what happens when a criminal clique takes over a government.

Get used to the idea that China is the US through the looking glass.

Two criminal cliques, running two countries, sucking the life blood out of their people.

Add the hapless patients at Walter Reed to the pile of bodies being created by these crooks.

[SubKommander Dred]

Charlottesville, Virginia
21 February 2007

Sir;
From what I understand of Major Reed, I don't think he would have resorted to arson on these fool's hides so much as made sure in the first place that our facilities and care were first rate.
He was not only a decorated Army Medical officer, he was also a scientist and put himself at great risk on the "Yellow Fever Investigation" (Cuba, 1900-01) in which a personal friend and colleague died of the disease. His work in parastitic infections was revolutionary and contributed greatly to basic medical science.

Regarding the current Secretary of the Army and Commanding General of WRAMC (is it possible he is impersonating a physician?) Dr Reed would have given them duties more commensurate with their abilities. Things like emptying the trash baskets and washing test tubes, menial tasks that require little attention to detail, performed without difficulty by simpletons and dolts.
I suppose the same could be said by the current crop of NeoCon geeks and mental defectives running our country, and naturally, Congress...ever quick to spout praise for the troops and pose for a photo op...is just shocked...SHOCKED...to find that Our Troops are forced to endure not only a war in Iraq or Afghanistan, but a war at home as well, waged by a CNNFOXMSNBC zombiefied electorate and heartless, soulless government that performs human sacrifices on the altar of the Free Market.

I think that sound you hear is Dr Reed spinning in his grave.

Your humble servant,
Subkommander Dred

[Charles]

The CBC recently reported on the valiant work of our Canadian personnel treating our Afghan op wounded at Rammstein. Consensus: the most rewarding and the most traumatic work of their careers. I can't imagine what American doctors are going through - though they have the goods no Iraqui hospital has seen for years. About four years.

We're short 75 doctors. 56% of those surveyed want Canada to withdraw from that once noble mission BEFORE our current commitment ends in 2009. The 20 year commitment needed doesn't play too well with our public or our pols as an election approaches. The same kind of unthinking bureaucratic procedure abusing our returning wounded has been reported with some salutary effect on practice.

For example, our blown up troops were being stripped of their in- field "danger" pay immediately upon being medivaced from the field. Seems reasoanble, they no longer "qualify", no? About $2K extra a month, and the soldiers make peanuts to begin with. It was returned after a light was shone on it by the press, who somehow slipped under the wire and off the reservation on this one.

Yet our government this week announced the purchase of four of those gigantic strategic lift planes for the tidy sum of FOUR BILLION DOLLARS(U.S.)to ferry our modest forces to the front. We were apparently "embarrassed" by having to piggyback on Americans, or its argued that leasing some of those many available giant Russian planes as we have done previously just won't be timely enough in the future. (I guess there's a lot of demand for strategic airlift these days) We've just leased 10 Leopard tanks from our German Nato friends, who decline to drive them around down south where they're apparently required. The army has also acquired 10(ten)trick howitzer shells at a cost of $150,000 a pop. I think they're satellite guided, so if we could find the buggers, we could shell them - ten times.

First, the best gadgets - just not enough of them. Then War. Then the wounded.

Every coffin, every bloody operating theatre should be shown, forcefed down our people's and our brasses comfy throats. Instead, our muckety-mucks have just paid $76,000 to be told which words to sell, er, describe the mission with.
You know, use action words - rebuilding, constructing
rehabilitating, etc. None of those meaningless mushy value words like democracy, freedom, rule of law, etc.

Couldda found it in any resume writing guide, $20 a pop. That'd leave $74,980 to use as danger pay, maybe payoff this weeks innocent collateral damage in the streets of Khandahar. I think we pay $5000 a pop for those.

AAAAAAARRRRRRRRRGGGGGGHHHHHH!

[Michael Keyes]

One of the many things that demonstrates the incompetence of the present administration is the fate of wounded soldiers.

All of the soldiers mentioned in the article in WaPo and throughout the net are active duty soldiers, most of them awaiting boards who decide their fate. They are basically lost to the system with inadquate ombudsmanship available and no place to turn to.

This sort of thing always happens when you are in administrative limbo in the Army medical system, I know of several soldiers who were in this status for almost 2/3's of their enlistment when I was on active duty. It happens, but in this case the (predictable) sheer size of the problem turned it into a critical mass. It is one thing for a soldier to get lost in the system and have to live at one of the smaller military hospitals, but we are talking about hundreds or perhaps more who are not only lost, but placed in the crapper. The soldiers I knew at least had decent living quarters, people looking after them, and some hope that the paperwork would be done.

Ironically, if you are wounded and then in rehab and at Walter Reed, you would be much better off at one of the VA hospitals which used to be the crapper 30 years ago. Soldiers are like other poor people, they have no advocates until it is convenient for someone to use them. According to one report, the president knew about this and then turned to his press secretary to get it fixed.

That makes me feel better.

[BillD]

What would General Marshall have done, indeed. And he, or someone on his staff, would have discovered it before a couple of reporters.
Let us not talk about "criminal cliques." Or "political hacks." This situation is nothing more or less than a failure of command on a grand scale up and down the chain of command. This failure rests with the army. I spent a lot of time in the army hospital system in the late sixties and I personally never saw anything this egregious. I can understand in a perverse way civilians treating soldiers and marines with disdain and disregard. I cannot for the life of me understand how officers and ncos can do it.

[jon]

The men and women who serve this country in uniform deserve the finest medical care possible. Their health and welfare should not be compromised or politicized. We ask them to serve in our stead and for our protection, and proper care is the absolute minimum that we can offer for their willingness to risk their life and health.

These reports of substandard care and treatment are shameful and conditions should be corrected immediately.

It is appalling to see VA coverage, veterans benetits, and now care for the serving wounded to be pared back at a time when military casualties are increasing by orders of magnitude.

This war has a tremendous cost to the nation in many ways, but it should not be balanced on the backs soldiers who have already contributed far more than their fair share.

However my shock is tempered by the fact that we have seen this administration act similarly to our own countrymen after Katrina. Incompetence coupled with callous indifference and greed have brought us to a place where those least able to cope, more than simply being cast aside, are being forced to benefit those who have risked the least yet stand to benefit the most. These are sad days for America. Perhaps we will be able to redeem ourselves and provide our fellows what they need and deserve.

[MarcLord]

According to the WaPo article, there is no counselor available for the 300 residents of Mologne House. That's gone beyond mere incompetence. It's hostile contempt veiled by policy.

"I could not dig:
I dared not rob:
Therefore I lied
to please the mob.
Now all my lies
are proved untrue
And I must face
the men I slew.
What tale shall serve me here among
Mine angry
and defrauded young?"

Rudyard Kipling, Epitaphs of the War, 1914-1918

[PSD]

well, conspiracy theorist that i am, I'm tempted to think that the sorry conditions at WRAMC are indicative of the administration's "grand" plan to starve every single govt. agency that they feel should be privatized. It would not surprise me at all to have some libertarian, quasi-Republican ideologue say that the poor conditions at WRAMC would not have happened if military medical care was left to "market forces" and privatized!

[Joe Northrop]

Just watched the Newshour follow-up on the Priest story...Once again, those enlisted folks are the culprits. Nobody with nobody with a bar or a star canned, nobody with command responsibiity relieved, says the Vice. Just some misguided NCO's who done it...What do officers do in today's army? Oh, yeah, I forgot...they write Op/Ed's in the NYT and WaPo cheerleading the President and his policies...

[b]

Priest did interview the Maj.General:
/quote/Maj. Gen. George W. Weightman, commander at Walter Reed, said in an interview last week that a major reason outpatients stay so long, a change from the days when injured soldiers were discharged as quickly as possible, is that the Army wants to be able to hang on to as many soldiers as it can, "because this is the first time this country has fought a war for so long with an all-volunteer force since the Revolution."

Acknowledging the problems with outpatient care, Weightman said Walter Reed has taken steps over the past year to improve conditions for the outpatient army, which at its peak in summer 2005 numbered nearly 900, not to mention the hundreds of family members who come to care for them. One platoon sergeant used to be in charge of 125 patients; now each one manages 30./endquote/
http://www.washingtonpost.com /wp-dyn/content/article/2007/02/17/AR2007021701172_pf.html

Looks like he wasn't smart enough to see that truck hitting him.

[Grimgrin]

I don't know if VA hospitals are better equipped to handle the kind of outpatient care these soldiers need. I'd like to say they'd have to be, given the description of outpatient care at Walter Reed. The question is, why are there so many outpatients in a regular army hospital?

"Maj. Gen. George W. Weightman, commander at Walter Reed, said in an interview last week that a major reason outpatients stay so long, a change from the days when injured soldiers were discharged as quickly as possible, is that the Army wants to be able to hang on to as many soldiers as it can, "because this is the first time this country has fought a war for so long with an all-volunteer force since the Revolution." "

I hope he's lying. Because if what he's saying is true and the Army is trying to hang on to soldiers who have brain injuries, amputated limbs or psychological issues then something is seriously, dangerously wrong.

How bad is the personnel situation if the Army is looking to hold on to trauma cases?

[robert newman]

Hi,
Regarding your post "Bureaucracy's Cost," you may want to see the article at Salon at the following link: http://www.salon.com/politics/war_room/2007/02/21/walter_reed/index.html

This short piece summarizes Salon's efforts to warn Walter Reed officials quite some time ago about the problems at the hospital.

Two paragraphs are worth quoting:

They shouldn't have been so surprised. In early 2005, Salon brought to the attention of Walter Reed officials disturbing information based on interviews, medical records and other Army documents which showed that soldiers receiving outpatient treatment for mental wounds were suffering from a shocking pattern of neglect. At that time, Walter Reed officials refused to discuss Salon's findings. Instead, they issued a statement saying it just wasn't so: "We are satisfied that there is a very high level of patient satisfaction with their treatment," the statement read.

In early 2006, Salon alerted Army and Walter Reed officials of a very similar set of concerns: some soldiers with traumatic brain injuries were not being screened, identified or treated. They were falling through the cracks. The Army and the hospital declined to talk with Salon about those issues, this time citing privacy concerns of patients. "I cannot arrange an interview," Lt. Col. Kevin V. Arata, an Army public affairs officer, wrote in an e-mail. In a separate written statement to Salon, Walter Reed said they had a good program to take care of brain injuries.

[VietnamVet]

Decades ago I spent a month at Madigan Army Hospital. My experience was first class once they got the diagnosis right. In that war, the injured stayed as long as they could in the military health care system. The Army was accused of moving the disabled out as fast as they could into the inadequate VA system.

In this war the civilian leadership are radicals who hold a deeply felt belief that government is evil. Led by George W Bush, they are simply incapable of assuring that the federal government serves its citizens or soldiers.

[Patrick Henry]

I agree with everyone here..I just saw the News showing film of the interior of Walter Reed..building 18..with the black mold..peeling paint..and other deteriorating conditions..that look like housing in a slum rental somewhere..

Sickening and Deplorable..

Typical of this Administration ..Constantly Standing in Front of the Troops..Using them to Promote the War..Talking about thier Sacrifice and service..Not Letting them Down..Saying one thing and doing another ..The Worst kind of Political manipulation and Double Speak in the History of the United States..

Not a Commander in Chief..

He is a CON~MANNER in Chief

The Bush Administration Record and Performance speak for themself..Lies and Alibis..DECEIT..

Betrayal of the Public trust..The People of the United States Know It..by now about President Bush and His Administartion..

OutRage and Outrageous..

All they have ever wanted to use Taxpayer dollars for is WAR..and More WAR..
and they show resentment when they have to spend Funds on any Domestic Program..Takes away from the WAR CHEST..

Katrina Made thier attitude Clear about helping folks here at Home..

Domestic Problems are not even a focus for this Administration..or we would Now have the Best Emergency Response Proceedures and Programs in the world after 9/11..Katrina and On going National Disasters every month..

All that is still done at the local grass roots level..like local people on Snow Mobiles going down Frozen Snow piled freeways
trying to help Stranded Motorists..

Whwere is the National response to these Disasters..Where are the federal Funds to Help Build and Create ffective and efficient Homeland Security and Emergncy response Programs..

They are probably loading up another 8.8 BILLION Dollars Cash on another C -130..so they can pass out those $100,000 Bundles to Motivate people in Iraq to Help President Bush find another Way to tell us..

"MISSION ACCOMPLISHED."

Thank You ALL for Speaking Out about this DISGRACE..

[Steve Jones]

Well said, and what jon said, too. You as well, Charles.

My blood has been coming to a slow boil reading the stories of bureaucratic snafus, of tricking wounded warriors into signing away their rights, and the denials and diversions you read about in the IAVA's soldiers' stories and elsewhere.

Yes, part of the problem is the impending closure (2011 I hear). But in the end that's no excuse. We're showering money all over the place - but not where it's needed.

And yes, there are way too many PowerPoint Rangers showing each other presentations. Most of them would be better used manning a desk, a phone and a computer at Walter Reed, managing cases. It's hell on their careers, I know. But where are our priorities? (Pardon me for my cynicism in noting that the president has told us that the job of us common folk in these times is to go shopping and traveling, keeping the economy churning. I can't blame the PowerPoint Rangers all that much.)

Then today I heard LT Gen Kevin Kiley on the Diane Rehm show:

"But there were issues about who was available at Walter Reed to assist in making those repairs, specifically the Department of Public Works (DPW) folks who were in the process of transitioning over to contractors."

Oh, goodie. We can't spend money to fix the problems directly, or hire contractors to do the work, but we can contract out the entire job of managing a facility which will be shut down in 4 years. I'd love to see the PowerPoint presentations from THAT "process".

As with the proverbial old prude upset by the idea that someone, somewhere, might be experiencing pleasure, we deeply fear that someone, somewhere, might not be operating at maximum productivity. They may reduce the profitability of the enterprise. They might even be wasting their time helping someone who needs it while on the company (or the gummint) dime.

Marshall and his ilk were not wasteful or inefficient. But in a bottom-line world, so they would appear. They threw money where it needed to be thrown, and threw personnel where they needed to be thrown. They were human. They had morals. In the end, they brought peace and prosperity to a war-ravaged world.

Their ghosts must be sad.

[Frank Durkee]

I simply can not relate to this level of incompetence. If I had performed at this level in any regular job or consultancy I would have been fired forth with. You have a real sense that no one is genuinely 'in charge'. That is consultant jargon, ' no one genuinely and passionately has the wounnded for their clients, especially as they reach a certain place in their journey. For some iexplicable reason they no longer seem to be actually visible to the system. This is bith an individual, up and down the chain of command, and a system problem, up and down the chain of command that devised and monitors the system. My guess is that once again a few low level people will bear the brunt and those who are higher up will be left in place or promoted. I will say that given my experience of the old Brown Shoe Army in the late '50's it doesn't surprise me that much. I had hoped things would have improved. One would think that 'the Decider' would have insured that this kind of thing didn't occur, if only for PR purposes and spin. Perhaps they don't care, perhaps it all really is a great game in which they are not actually staked.

[Chris Marlowe]

When it comes to the military, I'm convinced that politicians believe a few basic things:

1. They want a strong military to win all conflicts.

2. They secretly wish all in the military to die valiantly in the field of battle when the conflict is won, so that they will not have to care for the wounded, pensions, etc. And they want to give medals to their families (photo ops). If they survive,they would probably vote against us anyway. Automate warfare as much as possible, preferably with very expensive combat systems (see below).

3. Outsource logistics, protection and other duties to private defense contractors owned by your political donors. This way some of the government money flows back into your party's coffers to finance elections. For details, please ask Jack Abramoff, Grover Norquist and Ralph Reed.

4. Spend huge amounts on huge weapons systems which are absolutely useless in counter-insurgency warfare, such as the F-22 and F-35 fighters and other high-tech toys. This money flows back to both parties' congressmens' and womens' election funds. They can then claim more jobs for making these useless and expensive systems. This is where the "war on terror" comes in handy for propaganda, er, publicity, purposes.

5. Continue to cut taxes during wartime, so that you can make the idiot base of your party happy. Get guys like Grover Norquist and Ralph Reed (Jack Abramoff is temporarily indisposed) in front of the public to tell them how you are dedicated to making government smaller and more efficient, and to winning the war on terror. Put your talking heads on Fox News to get the message out. Tim Russert is also a very good government spokesman. He sounds more educated than Fox; especially handy for interviews with Cheney.

6. If anyone criticizes, just accuse them of siding with the terrorists and wanting America to lose. Shout loud, repeat often.

[H.G.]

The real problem in general is that so few people in leadership positions in this country have good old-fashioned American balls anymore.

If the current (hopefully soon former) commander of this facility had any balls he would have been yelling into the phone at his superiors from 4AM through the next 1AM, 7days a weekd 356 days a year demanding resources to get something done. If that wasn't working he would have personally escorted the loudest of press, including cameras, on a guided tour through the entire facility, specifically pointing out the worst of it, to shame the country and his superiors into action.

Of course that would have meant actually doing your duty rather than fluffing your resume and plucking nose hairs.

The lack of balls is sytemic as apparently having balls (whether you are male or female) is considered passe, but I think we would be well served by a few more Jim Webbs, thank you very much.

[J.T.Davis]

"If the American people were not reduced to Pavlovian dogs by the mainstream corporate media, they would be out in the streets, demanding justice. Didn't something like that happen in the Hoover years with WWI vets, and didn't MacArthur (or some other general) have to put down the riots in DC?
Posted by: Chris Marlowe"

And Patton.

You are referring to The Bonus Army post WWI.

http://en.wikipedia.org/wiki/Bonus_Army

The opposing General is Smedley Butler.

And he figured in the Business Plot or the White House Putsch. He refused to take part in the coup to bring down FDR.

http://en.wikipedia.org/wiki/Business_plot

[J.T.Davis]

"well, conspiracy theorist that i am, I'm tempted to think that the sorry conditions at WRAMC are indicative of the administration's "grand" plan to starve every single govt. agency that they feel should be privatized. It would not surprise me at all to have some libertarian, quasi-Republican ideologue say that the poor conditions at WRAMC would not have happened if military medical care was left to "market forces" and privatized!

Posted by: PSD"

Why is it that when Grover Norquist has said as much - (Using the image of drowning a baby in a bathtub, no less!)- that we feel the need to put on a "tin foil hat" to state the obvious?

[arbogast]

A word of praise is in order for the VA system.

While it, like all other hospital systems, has its faults, it has been a leader in honesty and attention to chronic health conditions. Its computerized medical record keeping system is the best there is.

[Larry Mitchell]

All:

Some of the readers here who would like to help the cause may wish to look into this group: http://www.woundedwarriors.org/

A man with whom I served recommended this group to me and said that one of his veteran's groups had checked them out. I cannot personally guarantee its integrity, but I have donated to this group.

Along with hundreds of billions of dollars in debt that this war is producing, a large debt to wounded and broken fighting men and women is also accumulating. I'm sure it will take a mix of aid from both governmental and private sources to get the job done right. I hope it's not a debt that we choose to ignore when the spotlight moves to something else.

[bh]

While I share the sentiments expressed by most of the commenters in this thread, no one has mentioned the larger and longer term source of this problem.

The current matrix of corporate and military connections has generated a focus on "hardware" not soldiers. Hugely expensive, and largely irrelevant, "weapons systems" absorb most of our government's budget while the needs of individual soldiers are ignored.

As we have seen demonstrated time and again in recent years, our fancy weaponry is nearly useless in the current situation. One infantry soldier who can speak Arabic is much more valuable in Iraq than a $2 million "smart" bomb.

Our increasingly militarized economy is built on creating "weapons systems." Government spending, like war, is a zero sum game. When the well connected arms merchants win, the individual soldiers lose.

When general officers are focused on the corporate gravy train, they aren't much interested in the guys who fight the wars, before or after they are killed or damaged.