18 March 2007
Building 18
Last week Major John Kallerson had enough. He is mad as hell, and despite his spirit of Christian charity and service, he isn't going to take it any more. As the Senior Chaplain Clinician at Walter Reed Army Medical Center, he wrote a passionate e-mail defending his hospital, his leadership, and the troops they care for.
It has been all over the world now, and it is a passionate note. The Major is upset that "The news media and politicians are making it sound like Walter Reed is a terrible place and the staff here has been abusing our brave wounded soldiers." He says it is "a bunch of bull!"
John knows a lot about his craft, having been at WRAMC nearly four years, and having come out of the combat arms end of the Army to get there. He supervises the staff that provides for the spiritual needs of the two hundred inpatients, nearly seven hundred daily outpatients, four thousand staff and three thousand daily clinical appointments. He is proud of how his hospital had cared for over four hundred troops who have been maimed in the fighting.
The situation in WARMC's Building 18 is what the firestorm of controversy is about. There is mold on the walls there, cockroaches infest the place, pipes have burst, and rats reign in the darkness where the lights don't work.
John did not know about conditions at Building 18, which is not surprising. WRAMC sprawls over 113 acres of the north-central District of Columbia . It is located in a neighborhood that has its challenges, one that sprung up to accommodate the great expansion of the city after the Civil War. The Medical Center dates it official history to War Department General Orders No. 83, Military District of Washington, dated May 2, 1906, as a result of deeds obtained the year before from farmer George W. Madert, who grew tobacco there.
The hospital was christened in honor of the courageous Army doctor who was among the first to understand the nature of the transmission of Yellow Fever in Cuba . His experiments on insect-borne transmission permitted the elimination of the scourge the troops called “Yellow Jack,†and eliminated the major public health obstacle to the construction of the Panama Canal.
WRAMC sits on land where the Confederates positioned their lines during the Battle of Fort Stevens, the only major attack on the Nation's Capital. Jubal Early and his Army of the Valley came within sight of the unfinished Capitol Dome, and for my money, his attack on Fort Stevens in 1964 represents the actual high-water mark of the Rebellion. Some of the ramparts remain on WRAMC property, and the Rebel sharpshooter who fired at President Lincoln did so from what is now the grounds of the hospital.
There is a plaque to mark the spot where the Tulip tree once stood from which he took cover.
Around the plaque is a hodge-podge of buildings constructed over the years in response to the nation's wars. There is the museum where Union Brigadier Dan Sickle's leg bones are displayed. He used to visit them after the war, and he did not insist that they be interred with the rest of him when the time came. There are sixty-six buildings on the property now, and more outside the fence. They were added to meet the stress of the World Wars, and construction of the big main hospital building followed Vietnam . Building 18 was a hotel, once upon a time, and been in a state of decline since its acquisition by the Army. And if you think Building 18 is bad, you should see Building 40. It is about to collapse.
Chaplain Kallerson is incensed by the fact that a sudden rise in demand for housing long-term care patients caused Building 18 to be utilized at all. The demand was unanticipated by the Pentagon, and middle management at WRAMC failed in their mission to deal adequately with the problem. In the media witch-hunt for someone to take the blame, they pinned the rose on Major General Geroge Weightman, the commander who had been at the hospital for just six months.
He requested additional funds to attempt to meet the needs, and he got them, just a few days before he was publicly sacked as part of the ritual sacrifice for the Washington Post. The injustice of the whole process made Kallerson furious, since by all accounts, George Weightman is a fine doctor with abundant concern for his troops. But the Chaplain launched off on the his own at that point, blaming the Congress for the very procedures that caused the very problems at WRAMC that caused the wounded to live in the mold and destroyed a good doctor's career.
I am not for an instant defending the Congress of the United States , but in this case, grandstanding, obfuscating and the appropriations process is all that they are responsible for. I am certainly not critical of the Chaplain, and I know that this problem will be swept away soon enough by something else. So, I think while we are at least dimly aware of the problem, we should take a quick look at where the problem lies.
I have been treated at WRAMC myself, and the best surgeons in the country were able to rebuild my son's hand after a nasty lacrosse injury. I have nothing but the highest praise for their standard of care, and the abilities of their medical personnel. It is one of those little ironies that the health care system on the outside has become so fraught with malpractice suits from the Trial Lawyers that very high quality physicians are choosing to stay in the military system, rather than fleeing to the private sector at the first opportunity.
I recently visited the rehabilitation ward where a young sergeant from my home-town is learning to use his prosthetic limb. He and his wife were very upbeat, and the ward was filled with proud men and women.
Some of them were desperately hurt, though, and it was immensely sobering to see a young person with a massive head wound and severed limbs who is never, ever, going to be all right again.
That said, there is something the Chaplain is missing. He is quite correct about the political agenda in this- the politicians making the most hay from this will not care a whit for the soldiers when the smell of the gunpowder is gone, the spotlight moved on, and the American people distracted about something else. The sorry facts of this were known in hearings held two years ago, even under Republican control of the Congress. Nothing was done, and that was the time of some high-profile visits by the President.
He was not offered a tour of Building 18.
BRAC and the A-76 process are indeed two blunt fiscal instruments, but they are creatures of the Executive Branch, not the Congress. It was DoD's decision to hold a round of the Base Reallocation and Closure Commission, on which I served as a contractor on the intelligence panel. It was all DoD, with its own peculiar rules that produced the report that the President signed, and sent to Congress for an up-or-down vote, all or nothing. No pork-barreling or earmark shenanigans are permitted.
There was much that was sensible in the BRAC 2005 recommendations, since the DoD is a product of all the wars we have ever fought. There are posts and forts out there that date from the Civil War, and the Indian-fighting days and have no rational function in the war on terror. But their very existence can be useful as real estate that will never be recovered once given up. The future is a great unknown.
Still, that is what the Secretary decided to do. The decision to close WARMC in the midst of a shooting war is not one of the useful decisions, whether it saves money or not. That is an inappropriate metric. But there is was, part of the arcane calculus of the COBRA decision-making tool used by the BRAC Commission to process the positive and negatives of DoD facilities. The computer-based tool made it appear that the two major service medical campuses, both located in Washington a few miles apart, were redundant and duplicative.
Bethesda Naval Hospital was saved because parts of it were newer, and there vacant land available on the campus for further development. Having been there recently, I can tell you that the campus is not adequate to serve those who need it now, much less the needs of those active and retired personnel who depend on Walter Reed. Being one of them, I am filled with trepidation for the quality for the care in the future.
The process for competing government-operated functions with the private sector is outlined in the Office of Management and Budget Circular A-76. OMB resides in the executive office of the President. The provisions of A-76 are obtuse, but exist to guarantee "best value" for the expenditure of public funds. The circular mandates a competition in which the costs for the Government to provide a service are measured against what an outside contractor can provide for the same money. It is a process completely under the control of the Administration. We all know the hazard of the low-bid, since they can promise the moon for nothing, and then not deliver.
The combination of A-76-driven outsourcing to low-bid contractors and Army's natural unwillingness to put additional funds into a facility marked for closure created this perfect storm of political controversy. It is our high-bid politicians who are exploiting the situation to their own ends. The wounded will be left to their own devices just as soon as there is no further political advantage to be gained from their pain.
Just for the record, before the moving hand writes on, it was the Administration that blundered into this awful situation, just as it blundered into so many things of late.
Secretary Rumsfeld was determined to transform the Department during the very time when it needed to perform its core missions. Reducing infrastructure costs by 20% through the BRAC was one of the tools he intended to use, and the rules of that process brought us through the looking glass to the place where we are closing one of the major facilities devoted to those that have borne the burden of the war, and providing for their care with the fewest personnel provided by the lowest-bidder.
The wounded are the ones who are paying the highest cost. We know the politicians will play their games, and they are fully worthy of our contempt. But in the interest of accuracy and accountability, we should know exactly who got us where we are.
Copyright 2007 Vic Socotra
www.vicsocotra.com