Fort Myers, long a venerated Army post, is now a joint military installation. The transformation displayed extreme common sense and, by all accounts, the base functions well. Now, look at the dysfunctional National Navy Medical Center in Bethesda, Maryland. Kenneth W. Kizer, M.D., M.P.H., Chairman of the National Capitol Region BRAC Health Systems Advisory Subcommittee submitted a refreshingly honest evaluation of the growing debacle involving the new Walter Reed National Military Medical Center and then confronted the Department of Defense (DoD) when it attempted to make light of the subcommittee's devastating report on the facility. In an earlier piece, I said:
"Congress should halt further construction as soon as possible. Guarantee the needs of our military are properly met and tax payers dollars not squandered further. As an "Air Force guy" with no axe to grind, DoD should assign the Bethesda project lead to the US Army as the Navy clearly is not up to the task "
I ignored the Joint Task Force National Capital Region-Medical (JTF) because it appeared to have no authority. The JTF has the responsibility but not the authority, to accomplish its assigned duties. An overextended, highly stressed DoD simply relied upon the military services and the JTF to act in the best interest of the military and military medicine. Increasingly evident is the fact that in the absence of a clear directive establishing precisely who possesses BOTH the authority and the responsibility, petty service rivalries can dominate discussion and hamper progress. The tactic appears to be "go forward slowly", the typical axiom of an entrenched bureaucracy unable to innovate and improvise. A quick look at military history demonstrates that the "authority/responsibility" challenge dates back at least to the ancient Greeks, most often with disastrous results.
If you are unfamiliar with the Walter Reed closure and new hospital complex, a recap of the entire sorry tale is available from testimony at November's Defense Health Board meeting in Fairfax, Virginia. Now, after direct congressional hearings, numerous articles and much beseeching by military and civilian medical personnel, reportedly the operating rooms at the new Walter Reed are being corrected to make them the proper size rather than instantly obsolete. However, two very important questions remain. How did the new Walter Reed changes develop? Second, and much more important, how does this administration correct the previous and the ongoing failures? Do the answers lie in how the changes came about? The short answer is perhaps.
From conversations with folks involved on both sides, public attention clearly caused the changes to construction. More changes can be expected. Specific questions concerning operating room size during an Authorization Committee hearing convinced someone in DoD that stonewalling those changes was a lost battle. The Joint Task Force National Capital Region-Medical was given the single authority to direct the changes to the operating rooms and, rumor has it, to the end of the two person, double rooms folly. Here is where both the answer and a possible solution lies.
The options available to the Obama administration appear to be three. First, delay or do nothing and allow the debacle to continue unchanged damaging military medicine and the military family. Second, do what a growing number of leaders at senior levels are considering; remove the entire project from an overstretched and perhaps worn out DoD leadership and put responsibility and authority for the project elsewhere. Finally, place both the authority and responsibility for the project under the Joint Task Force.
Placing both authority and responsibility with the JTF is the fastest and most effective course to begin reversal of the debacle at Bethesda. Creating a Bethesda/Walter Reed Joint military base and requesting an extension of the BRAC deadlines are the next steps to guarantee a world class medical institution. Many issues remain that will require administration and congressional involvement. A congressional insider's comments were:
"The JTF has no control over resources like people and money. In Bethesda's case, money is controlled by the Navy except the BRAC only Milcon (military construction). The Base Operations for Bethesda belongs to the Navy and gosh knows who is responsible for items such as the world class Joint Pathology Center---NO ONE and it is reportedly part of this mess."
His view is that JTF Cap Med must possess both the money and manpower authorities required to address the challenges identified by Dr. Kizer and his subcommittee.
Until DoD provides the Joint Task Force National Capital Region-Medical BOTH the authority AND the responsibility, Congress must continue specific hearings to address every identified problem. Even if DoD agrees and takes quick action, the administration or congress should guarantee someone with the proven integrity and expertise of Dr. Kizer maintain oversight of the entire project.
The military is at war but You sure wouldn't know it by this mess. The majority of the casualties come to Walter Reed as the first location when they return to CONUS and casualties are but a small portion of the treated population. They all deserve better than they received.
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