05/11/2010 09:42 am ET | Updated May 25, 2011

Diversion of Wounded From Walter Reed to Less Capable Hospitals Ordered (Part II) the Sanctity of BRAC

The Department of Defense (DoD) continues to resist Congressional concerns for military healthcare at Walter Reed and the transformation of military healthcare in the entire capital region. On April 21 before the House Committee on Appropriations Sub Committee on Defense (HASC), DoD representatives denied that problems with BRAC are negatively impacting military medical care.

Amazing as it seems, Ms. Dorothy Robyn, Deputy Under Secretary of Defense, Installations & Environment admitted that BRAC, not patients, were the DoD priority. From a hearing attendee:

There was a general follow-on question as to why we were still proceeding with this BRAC. Dr. Robyn stated that the previous BRACs were designed to reduce infrastructure while BRAC 2005 was intended to enhance warfighting capabilities. She then added that "We must meet the BRAC deadline so as to maintain the integrity of the BRAC process."

Another attendee said that was an error and that Robyn actually said "...maintain the sanctity of the BRAC process." In either case (I prefer the sanctity version), DoD clearly places more importance on the BRAC process rather than on our military and families. This is exactly the meaning of Ms. Dorothy Robyn, Deputy Under Secretary of Defense, Installations & Environment's statement.

A major unstated "assumption" of BRAC, which DoD chooses to ignore, is that BRAC assumed the Iraq and Afghanistan wars would be ended. BRAC is a political and military convenience that served the nation well until this round. However, nothing is sacred in political horse trading and bartering taking place under the BRAC flag. To imply that "the process" is more important than the welfare of our military personnel epitomizes the worst kind of bureaucratic arrogance.

April 21, 2010 testimony before the House Committee on Appropriations Sub Committee on Defense (HASC):

"Now, with less than 17 months to go before the BRAC deadline, we are on
schedule and on track to provide state-of-the-art facilities under the BRAC program for
our wounded warriors and other beneficiaries in the NCR."

Specifically, we are using $65 million in FY2010 to expand the existing operating rooms at Bethesda to meet this standard. We have also realigned $125 million of BRAC FY 2010 funding for WRNMMC to address other DHB recommendations, including the incorporation of input from clinicians and end users. We have also requested $80 million in military construction projects in our FY 2011 budget for warrior lodging and parking at WRNMMC, Bethesda. Once we finish the BRAC renovations, conversion to single patient hospital rooms (one of the newly established world-class standards) will be more than 50 percent complete at Bethesda.

All of the above actions were driven by outside DoD pressures. Congressional oversight and the integrity of the Defense Health Board worked to force these changes. The use of the "newly established world-class standards" phrase is misleading. Much of Walter Reed is "world class" now. The goal was always to provide at least the same level of care with no loss of capability. DoD admits that goal will not be achieved. As with the operating rooms at Bethesda, multiple patient rooms do not even meet industry standards let alone any "world class" standard. One must question why the present and past Navy Surgeon Generals allowed Bethesda Naval Hospital to fall below current medical design and practice. Are there problems with Navy medicine? Certainly considering current operations at Bethesda, Navy medical standards and practices merit an independent review.

On April 23, 2010, Deputy Secretary of Defense, William J. Lynn III forwarded a letter and plans to Congress as required by law. In the letter Secretary Lynn stated:

Dear Mr. Chairman:
APR 23 2010
Section 2714(a) of the National Defense Authorization Act (NDAA) for Fiscal Year (FY)
2010 requires the Department to develop and implement a Comprehensive Master Plan to
provide sufficient world-class military medical facilities and an integrated system of health care
delivery for the National Capital Region (NCR). Section 2714(b) of the law requires the
Department to submit this plan to Congress.
"...The Department also provides two required certifications. It certifies that the new
WRNMMC, Bethesda and FBCH construction will meet Joint Commission standards, as
required by the NDAA for FY 2010. It also re-certifies that the closure of WRAMC will not
result in a net loss of capacity in the NCR, as required under Section 1674(c) of the NDAA for

The New Walter Reed National Military Medical Center demonstrably falls far short of maintaining capacity. First, it is not up to current standards. Operating rooms are being closed for renovation and wounded military are being reduced by triage (better than the proposed Landstuhl) in the capital region while operating rooms are brought to standard. Second, multiple patient rooms are identified as spreading infection a critical hospital concern and major factor in civilian medicine and especially relevant for wounded patients.

On the support level, Walter Reed serves FAR more meals than Bethesda to meet the requirements of patients, visitors and staff. The WRNMMC will have the current Bethesda meal facility modernized but not near adequately enlarged. Testimony before the HASC (HAC) pointed out that even now Navy Bethesda must rely on the charity of a veteran service organization to provide evening and weekend meals to wounded soldiers. Committee members were told by DoD representatives that the challenge was under review. Congressional oversight is working. Pressure must be maintained because DoD information appears unreliable.

Where are the Veteran Service Organizations?