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Walter Reed Closure Begins; Wounded Warriors Surge

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"...Violence across Afghanistan is at its worst since the Taliban were overthrown by U.S.-backed Afghan forces in 2001. Civilian and military casualties are at record levels despite the presence of about 150,000 foreign troops...." Reuters By Ian Simpson, KABUL | Mon Nov 15, 2010 7:58am EST

Escalating Violence

With the escalating violence in Afghanistan and with the patient and operating rooms at Walter Reed Army Medical Center (WRAMC) and National Naval Medical Center again filling to capacity, the Department of Defense (DoD) continues tending -- not to the sacred task of caring for our wounded, but rather to the profane task of dismantling needed medical care for our military. This is not a drill but rather far too real. Several military medical experts that I know and trust related that the wounded arriving at Walter Reed continue to be as severely injured as the early casualties from Iraq.

Back in April and May, I wrote two pieces warning exactly what was happening and how medical care for our wounded and all military are being sacrificed on the altar of convenience to preserve the 'sanctity' of the BRAC process. Sadly, my warnings are turning into reality. As Walter Reed enters a year long closure process, a 'temporary' wounded warrior facility opens up at Fort Meade, MD. As a truly world class rehabilitation facility closes at Walter Reed, that facility is being replaced by fragmented and geographically separate facilities. Now care for our combat wounded is about to suffer further. I received the following expert National Capital Region (NCR) update concerning care for our war wounded and injured from Afghanistan (OEF) and Iraq (OND):

"NCR Update on OEF/OND Surgical Response Capabilities

Bottom Line Up Front (BLUF): WRNMMC will have to absorb 250-275 more surgical cases in order to support the OND/OEF patient while still not up to the number of ORs needed. No other military hospital in the region will be able to meet the mission and provide safe world class medical care to the most complex patients.

In order to support the OND/OEF mission an equal number of cases would have to be displaced to outlying facilities; e.g., overfly patients to San Antonio Military Medical Center which is also struggling with the BRAC deadline. Due to the complexity of cases that occur at WRAMC this may mandate patients being sent out to the Tricare network for surgical procedures in order to meet the BRAC deadline. And keep in mind, WRAMC performs complex trauma surgeries on very complex cases, which are the sickest of the sick. "

Closed Operating Rooms

Walter Reed Army Medical Center performed 609 operations using 16 operating rooms in October 2010. Casualties and injured from our wars amounted to 277 of the operations. During the same time period, the National Naval Medical Center at Bethesda performed 540 operations, including 208 OND/OEF patients.

After the closing of Walter Reed and the inauguration of the new Walter Reed National Military Medical Center (WRNMMC), the Bethesda campus will not possess the capability to pick up all the serious and complex cases from the closed Walter Reed. Instead, the Defense Department has cobbled together a hodgepodge of day clinic surgeries at places such as Fort Meade with four operating rooms classified as outpatient only with no intensive care unit and Malcolm Grow Hospital with six operating rooms classified as outpatient only with no intensive care unit. These 'work arounds' would be acceptable and necessary in a crisis but are hardly justified in this make do fashion during a period of increased casualties with total disregard for the troops and their families. A reminder is necessary. One of President Bush's greatest accomplishments was a result of the highly trained medical team assembled at the current Walter Reed. This great team is still unrecognized and is still being dismantled by this administration. Casualty rate deaths are almost certain to increase.

Sterile Processing Department (SPD)

The challenges are not just operating rooms and surgeons but also support units. The critical Sterile Processing Department (SPD) will not be ready for use at the New Walter Reed. Currently, WRAMC's Sterile Processing Department is a world class, state of the art facility that is able to process more than 2,000-3,000 instrument sets on a monthly basis. The current SPD at the Bethesda Navy medical facility at Bethesda is far too small to support the combined number of surgeries and is being expanded to elevate NNMC's SPD to the same level and capability as WRAMC. It will not be ready when Walter Reed ceases operation in Fall, 2011.

Stressed Medical Facilities

Incredibly, the Department of Defense (DoD) continues marching to the 'sacred' Base Realignment and Closure (BRAC) drummer even as casualties, and the severity of their wounds, mount. My information shows that military medical facilities worldwide are all under stress. Missing in this entire account is the mission of military medicine to train personnel and provide medical care for the entire military family.

While the Secretary of Defense asserts the need to control and reduce military health care costs, his medical bureaucracy is actively engaged in squandering well over a billion dollars in medical construction funding and increasingly diverting medical patients from military facilities to far more expensive TRICARE facilities.