Pentagon Forms Committee to Oversee Walter Reed Repairs
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KWAME HOLMAN: It was a series of Washington Post reports in February that led to a public outcry over the state of outpatient care for injured troops at Walter Reed Army Medical Center in Washington, D.C. Defense Secretary Robert Gates called for an independent review group to investigate conditions at the Army facility and at the naval medical center in Bethesda, Maryland.
ROBERT GATES, Secretary of Defense: We need to know the scope of this problem.
KWAME HOLMAN: It was one of at least six panels or commissions to investigate the matter, also the subject of numerous congressional hearings. As a result, several top generals and Army officials, including the commander of Walter Reed Hospital, the secretary of the Army, and the Army surgeon general, resigned.
Today, the Defense Department’s independent review group, headed by two former secretaries of the Army, delivered its findings to Secretary Gates and held a news conference. Jack Marsh, former secretary of the Army under President Reagan, said the problems were faced almost exclusively by outpatients.
JACK MARSH, Independent Review Group: That is a very substantial population. The population of that group today at Walter Reed is probably around 640, 650 outpatients who are necessary that they stay in the area in order to obtain the medical attention. There, it was breaking down, and broke down very, very severely. And this is an area that we want to correct it. We feel it’s being corrected.
KWAME HOLMAN: The group found major health care shortcomings throughout the Departments of Defense and Veterans Affairs, including in: quality of outpatient care; diagnosis and treatment of traumatic brain injury and post-traumatic stress disorder; and in the system for evaluating soldiers’ physical disabilities.
The commission concluded the Walter Reed Army Medical Center was hit by a “perfect storm,” including: an increase in patients from the wars in Iraq and Afghanistan; inadequate staffing; poor facilities maintenance on the heels of the decision to close the facility by 2010; and outsourcing of services to private contractors who did not perform.
Marsh and co-chair Togo West suggested that some of the needed changes would have to be enacted by Congress.
'Deficiencies in maintenance'
JIM LEHRER: And to the co-chairman of the independent review group, Togo West. He was secretary of the Army and then secretary of the Department of Veterans Affairs in the Clinton administration.
Secretary West, welcome.
TOGO WEST, Co-Chairman, Walter Reed Independent Review Group: Thank you.
JIM LEHRER: What went wrong over there at Walter Reed, Mr. Secretary? How were things allowed to happen that did happen?
TOGO WEST: One of the things is that deficiencies in maintenance had been accumulating over time at Walter Reed. Now, when a system, a medical center, is doing as well as that distinguished facility was in peacetime, and without the stress of a war-time engagement, you can miss some of that.
But once you get the numbers that were forced into Walter Reed -- Jack Marsh mentioned 640; at the height, there were some 800 in the medical hold among outpatients -- then the cracks begin to show, the difficulties begin to come clear.
For example, if you go to that number of outpatients in the whole facility, and the case worker staff stays at the same or even drops, well, then, cases are going to be unattended to, in terms of getting servicemembers to appointments and the like.
JIM LEHRER: And why was the number of caseworkers not increased?
TOGO WEST: Walter Reed had been placed on the black list. It had been through A-76.
JIM LEHRER: What is that?
TOGO WEST: The A-76 procedure is a procedure by which a facility evaluates whether it should take governmental assignments and convert them into private contractor assignments. It almost freezes any hiring until that process is completed.
It was a long process. Once it was done, Walter Reed was down by as much as 37 percent among its most important caseworker, nursing, and the like functions.
JIM LEHRER: In other words, the number of people available to do the work was going down while the number of patients was increasing, both of them dramatically, right?
TOGO WEST: That's right. That's exactly right.
Army awareness and response
JIM LEHRER: And nobody knew about it?
TOGO WEST: Oh, sure, sure, they were aware.
JIM LEHRER: Who was "they"? Who was "they"?
TOGO WEST: They, the Army personnel there, they, the intermediate supervisors, and, yes, to get to your real question, they, the people in charge, the commander, the surgeon general. And they were soldiering ahead, like the Army, does trying to make do as best they could in time of war and with a lot of funding going to other things.
JIM LEHRER: But they sounded no alarms and did nothing about it?
TOGO WEST: There must have been some alarms sounded, because one of the big things that we looked at in the independent review group was a very detailed, very thorough report by the Army inspector general that was just released just as we were beginning.
That was a yearlong review; it had started a year ago. So alarms must have been raised enough so that the then-secretary of the Army, Dr. Francis Harvey, commissioned the I.G. to do that long look-see.
JIM LEHRER: But while the review was being done, things were continuing to deteriorate, is that...
TOGO WEST: That's exactly right. That's a fair statement.
JIM LEHRER: As a matter of leadership or command, looking back on it, was Secretary Gates right to clean house, to fire all those people, or to ask those people to resign at the very top?
TOGO WEST: Only Secretary Gates can answer that. What is clear was that what he did sent a message that reverberated throughout the Pentagon, the services, in terms of his determination to get, a, to the bottom of it, but also, b, to see what lessons needed to be learned to care for servicemembers.
This is the all-volunteer military. This is a nation and a service at war in two theaters. He had to do that, in his view, I am certain, and it certainly did send a strong message.
JIM LEHRER: But based on your independent investigation, you agree with what he did, in other words, that those at the top, heads needed to roll, it was that serious a thing?
TOGO WEST: Frankly, I have to say to you that, both for me and for the rest of the IRG, we did not look in it. We have no opinion on it, other than that what he did do sent a strong message.
JIM LEHRER: Now, you said "get to the bottom of it." Are you satisfied now that the bottom has now been gotten to?
TOGO WEST: Oh, yes. There are no secrets. This has been a relatively transparent set of circumstances from the outset. It was not that hard to determine what was going on.
First of all, remember the distinction that was made in the clip you just showed, and that is that concerns were not with the clinical work being done by the talented doctors and nurses at either Walter Reed or Bethesda Naval or any of our other medical centers. That work that's done as soon as they get off that plane and are rushed into the surgery are where the real expertise...
JIM LEHRER: This is inpatient people, people who are in the hospital?
TOGO WEST: That's fine. And, indeed, even when you speak of outpatient, you have to draw a distinction between outpatients as we normally think of them.
JIM LEHRER: What do you mean?
TOGO WEST: People who live in their own homes and then go to the hospital for treatment. These are outpatients whose care was so sensitive, they were kept on the grounds at Walter Reed -- or, in the case of Building 18, just across the street.
Those are the outpatients we're talking about, the population that still needed follow-up there at Walter Reed and, for that reason, could not be sent too far away from the place. That is where the issues have arisen.
Opening a 'closed society'
JIM LEHRER: Have you looked at the simple question as to why it took two reporters from the Washington Post to find out about this and make this public?
TOGO WEST: Well, we didn't look into the question, but I do think that it's impossible to have walked around up there as much as we did, to have talked to as many people as we did, and not have it be fairly clear.
And it's no surprise, Jim. The fact is that the military, the Army, are a closed society. They are proud of what they do, and they keep their secrets, and, what shall we call it, their dirt linen, to themselves. Soldiers, even wounded soldiers at the worst time of their lives, and families, don't like to complain.
And so it takes someone to come and ask, "How are you doing? What's happening here?" before all that pent-up anguish, and most of all, uncertainty begins to gush out.
JIM LEHRER: And some of these physical things that were happening in some of these buildings that were allowed to deteriorate, somebody must have seen those, too, shouldn't they?
TOGO WEST: Well, we have a strong piece, section in our report that talks about both leadership and facilities. And the language I can quote is pretty stark. Leadership should have known.
Leadership probably knew that Building 18 was in the condition it was. How could they not? It is the job of leaders to know. If they have to walk around, they should walk around. But they have reports, and they get to read the reports.
There are those who say, this is the way the Army has been accustomed to living. You can go to any post in the world and find some barracks that are occupied by servicemembers and say, "How can this be so?" as the Army tries to juggle its accounts and fund operations. The fact is, it's not the way you expect our wounded and most vulnerable soldiers to live and to have their families find them.
Collaboration to fix problems
JIM LEHRER: Well, you have a lot of experience here. I mean, you were a soldier yourself, and you were wounded, and you were later the secretary of Army and secretary of veterans affairs. One of the big complaints, too, was there was very little coordination, all kinds of bureaucratic problems between what was going on in the Department of Defense, the Army Medical Service, and the Veterans Affairs Department. Have those been fixed?
TOGO WEST: First, in fairness to those who have served in combat and who were wounded, I was not one of those. I did serve on active duty for four years, and I had the experience you said.
And in terms of the cooperation between the two -- they certainly cooperate -- but the seamless hand-off that we would like to see for a wounded servicemember who has been determined not to be able to return to service, and must then move into civilian life, and become the responsibility of the Department of Veterans Affairs is not yet as seamless as we would like, and, indeed, is a large part of the concern of servicemembers that we looked into.
JIM LEHRER: What do you think of Secretary Gates' idea of having this group meet once a week to go over this? Is that the proper response? Is that going to get the job done?
TOGO WEST: We look at it, and the IRG, as if it was...
JIM LEHRER: IOG?
TOGO WEST: ... IRG, the independent review group -- as if it is the immediate response to the very last recommendation we put in there.
The question is: What's going to happen to this report? Is it going to become yet another dust-laden encyclical on a shelf? And so we had said, appoint somebody whose job is to review what's happening and compare what's happening against what we've recommended. He's done that, so we think it's a great idea.
JIM LEHRER: OK, Secretary West, thank you very much.
TOGO WEST: Thank you.