Veterans Blog

More "Boots on the Ground" at Walter Reed

The Washington Post ran a story the other day by Steve Vogel with the headline: Combat Veterans Assigned to Aid Recoveries.  Here’s a snapshot of the “New Walter Reed".

After revelations this year of squalid living conditions and bureaucratic nightmares at Walter Reed, the Army took the unusual step of creating the Warrior Transition Brigade. It brings in combat-seasoned officers and sergeants to assist the facility's nearly 700 outpatients -- tracking their recovery, ensuring that their appointments are kept and watching out for their morale.

But the effort to help wounded soldiers navigate the medical bureaucracy has also produced a culture clash, with many battle-hardened noncommissioned officers having difficulty adapting to Walter Reed's civilian atmosphere. As some injured troops and their families publicly voice complaints, the brigade leaders face a dilemma: Should they treat the recovering troops as patients first and foremost, or as soldiers?

The brigade has replaced Walter Reed's much-maligned Medical Hold Company, in which platoon sergeants -- many of them former patients or medics and other medical command soldiers -- were each responsible for an average of 55 outpatients, and often more than 100. Platoon sergeants operated with little support and found it impossible to track so many patients with serious physical and emotional wounds.

The battle-tested soldiers of the brigade cadre have encountered systemic problems beyond their ability to address. "We've fixed things," said Capt. Steven Gventer, a company commander in the brigade and veteran of intense street fighting in Sadr City. "Where we can't fix the problem is where we're dealing with boards and doctors. We can identify problems, but can't fix them."

Some in the brigade are critical of the hospital's civilian workforce, which they view as stubborn and resistant to change.  While some patients view the brigade as not addressing the underlying problems in the military medical bureaucracy.

The frustration and anger felt by many of those being treated at Walter Reed boiled over at a town hall meeting with the full brigade at 8 a.m. one day last week in the hospital gymnasium.

The bleachers were packed with soldiers bearing evidence of terrible wounds. Many used canes or crutches. Others wore prostheses and some had eye patches or disfigured faces.

Maj. Gen. Eric B. Schoomaker, Walter Reed's commander, took the floor. "This is the first brigade of its kind," he told the soldiers. "This concept is sweeping across the Army, in how we care for warriors. . . . We acknowledge that this is a work in progress."

When Schoomaker asked for comments, the complaints spilled out. Schoomaker and Col. Terrence McKenrick, a highly regarded Army Ranger whose previous assignment was at the Joint Operations Center for Multi-National Corps-Iraq addressed the complaints as best they could, but the answers did not satisfy all in the audience.

In his closing remarks to the group, McKenrick asked for patience. "We are just beginning, and have a lot of changes to make. . . . There isn't anyone here that's against you."

Gee I hope not!...Lets give the Warrior Transition Brigade a chance!  And from all of us to all of you...Thank you for your service and your sacrifice!

Walter Reed Chaplain Speaks Out

A fellow blogger recently commented on this very blog about the Walter Reed fiasco by passing along some first-hand insights made by John L. Kallerson, the Senior Chaplain Clinician at Walter Reed Army Medical Center (comments that seem to have been authenticated rather than "made up"). The Chaplain's message was in an internal email he sent to colleagues that he reportedly said never was intended to be made public. But now it's all over the Internet.  Read these comments on the Walter Reed Fiasco to view the Chaplain's entire message.  However, I took particular note of the following and it sounds like it’s right on target...ever hear the term A76 before?  Read on:

What I am furious about is that the media is making it sound like all of Walter Reed is like building 18. Nothing could be further from the truth. No system is perfect but the medical staff provides great care in this hospital. What needs to be addressed, and finally will, is the bureaucratic garbage that all soldiers are put through going into medical boards and medical retirements. Congress is finally giving the money that people have asked for at Walter Reed for years to fix places on the installations and address shortcomings. What they don't want you to know is Congress caused many problems by the BRAC process saying they were closing Walter Reed (emphasis added). We cannot keep nor attract all the quality people we need at Walter Reed when they know this place will close in several years and they are not promised a job at the new hospital. Then they did this thing call(ed) A76 where they fired many of the workers here for a company of contractors (emphasis added again), IAP, to get a contract to provide care outside the hospital proper. The company, which is responsible for maintenance, only hired half the number of people as there were originally assigned to maintenance areas to save money.

Walter Reed leadership fought the A76 and BRAC process for years but lost. Congress instituted the BRAC and A76 process; not the leadership of Walter Reed.

Well said Chaplain! Thank you for having the courage to state your convictions and for speaking up on behalf of those who fell victim to the "blame game"!

Passing laws is a "first step"

As you know, I like the site military.com.  I came across this piece the other day and as I read through the article I thought..."contractor"!  I'm not sure which contractor is going to benefit, I just hope they do the right thing and focus on hiring disabled veterans who have "navigated" through the system's bottlenecks and can relate to the customer and his/her family.  It's a tall order I know...I just hope those contractors get it right and stay accountable, because Congressional involvement doesn't end after the vote is taken and the law is passed.  The bureaucrats that make up our fourth branch of government will have a loud say in how the contract is written, which can influence the quality of people the contractor hires.  We've got to get this right so here is a short snippet of what’s proposed:

Representatives Christopher Shays (R-CT), Vern Buchanan (R-FL) and Gus Bilirakis (R-FL) recently introduced four bills designed to help wounded service members and their families more easily navigate the Department of Defense (DoD) medical system.

Shays, Ranking Member of the Oversight and Government Reform Subcommittee on National Security and Foreign Affairs, introduced H.R. 1577, which creates a DoD Patient Navigators program for wounded service members. The Navigators will be representatives for patients and their families, independent of current military service and DoD processing authorities. Shays also introduced H.R. 1578, which establishes, publishes and monitors medical holdover (MHO) process performance standards, which will allow patients, their families, case managers and others who need to know where the process stands and how to keep it moving.
Buchanan introduced H.R. 1579, which creates a standard Soldier Patient Tracking System so any patient can be located in the MHO process by a family member, installation commander, patient advocate or ombudsman office representative. Bilirakis introduced H.R. 1580, which creates a DoD ombudsman to provide oversight of the process, answering and assisting all patient and family questions concerning MHO administrative processes, and financial and non-military related services available to help throughout a patient's recovery (Courtesy of Military.com).

In other news, "...committee votes more help for war wounded and their families."  Hum!  "War wounded service members and their families will have a stronger team of advisers and advocates to guide them through care, recovery and disability evaluation under a package of initiatives unanimously approved March 20 by the House Armed Services Committee."

The Wounded Warrior Assistance Act (HR 1538) is the first and unusually swift legislative action taken by lawmakers to address a host of problems encountered by outpatients at Walter Reed Army Medical Center in Washington D.C. and perhaps in other military and VA facilities.

Committee Chairman Ike Skelton (D-Mo.) called it a "first step" in response to "the inadequate living conditions and the administrative snafus" experienced at Walter Reed. The full House is expected to vote on the package soon even as an independent task force and various government investigations continue to study what went wrong at Walter Reed (Courtesy of Military.com).
 
After reading through the article, I found a couple of things I'm still a little skeptical about.  OK, for instance, "...no case manager would be responsible for more than 17 patients."  With reference to the new service member advocate position: "...No advocate would be assigned more than 30 cases at a time."  I guess I'll believe it when I see it!  I know, I know...it's a quality benchmark!

That said, our fourth branch of government (bureaucrats) has its work cutout and they'll be plenty of veterans now and in the future praying they don't screw this up!

VA Patient Advocate "Surge" Plan

Just saw this today in Military.com:

100 New Patient Advocates for Wounded

The Department of Veterans Affairs (VA) is immediately hiring 100 new patient advocates to help severely injured veterans and their families navigate VA's systems for health care and financial benefits. The 100 new patient advocates will be veterans of the combat theaters in Iraq or Afghanistan. Their job will be to ensure a smooth transition for wounded service members to VA health care facilities throughout the nation, while also cutting through red tape for other benefits.

Based on what I’ve been reading, 100 new patient advocates doesn’t sound like it’s hardly enough.  I mean there is a large backlog already and approximately how long will it take to get these new patient advocates up to speed with regards to battling the bureaucracy?  My suggestion...! The bureaucracy needs to change...ensuring that severely injured veterans move to the head of the line.  Which I trust, or one hopes, is already a priority.  Next, I would encourage hiring veterans who have battled the system personally, and therefore know how to navigate through the bottlenecks in order to be an effective patient advocate.

Anybody out there interested in battling the bureaucracy?  My sense is that there are plenty of veterans currently receiving some kind of disability compensation who have the proper tact and communications skills that would make them outstanding patient advocates. 

Let me put a plug in for AMVETS.  AMVETS is an organization I found to be staffed with outstanding individuals serving as advocates for veterans separating from the military.  I encourage service members leaving the armed forces to contact their local AMVETS representative, who is typically located in the vicinity of a regional VA hospital.

I’m interested in hearing if you think 100 new patient advocates is a token effort or a sincere attempt to try and clear some of the disability claims currently in the system.

House Says: VA Not Doing Enough for Iraq Vets

The House hearing is the latest to review the quality of care for wounded troops returning from Iraq - from emergency medical care at military hospitals, to long-term rehabilitation at VA clinics and eventual transition to civilian life with VA disability payments.

According to their findings, the Veterans Administration:

-Took between 127 to 177 days to process an initial claim and an average of 657 days to process an appeal, resulting in significant hardship to veterans. In contrast, the private sector industry takes about 89.5 days to process a claim with a claims backlog of roughly 600,000 (Data: Courtesy of Military.com). Read more.

Read this tidbit about the Army holding down disability ratings.

After reading this stuff you have to wonder!  How does it go again?  Something like: "...if you fail to plan, your plan will probably fail."

Folks! We need a plan to expedite the processing of these claims…let’s keep the heat on!

Seamless transition from active service to VA care?

A colleague just sent me the following video link which brings into question the lack of a seamless transition from active service to VA care.  http://abcnews.go.com/Video/playerIndex?id=2938668

This transition can take as much as 125 days to a full 6 months for the service member's paperwork to be processed and the necessary care and benefits to be approved.  Can you believe this?  The video is an honest look at some of the shortfalls inherent in the system that needs to be more responsive to the service member and his family during their transition back to mainstream life. 

I had another colleague who was shocked by the deaths posted on Defense Link News at: http://defenselink.mil/releases/.  I reminded him that we need to remember those who survived their injuries and now face a long path to recovery filled with uncertainty.

Responsibility…accountability...we need to ensure a seamless transition from active service to VA care for our wounded soldiers. DOT! PERIOD!

The blame game is in full swing!

I don’t know about you, but I’m getting tired of the "blame game" surrounding the Walter Reed mess.  I want them to bring in a SWAT team of civil engineers to fix what needs to be fixed and improve those facilities at Walter Reed that need fixing and start worrying about the customer - the wounded American soldiers (stats here) who put their trust in a government that sent them off to war!  That's right - the government!  And it consists of more than the President and the cabinet, but includes the Congress and our "fourth branch" of government.  I’m referring to the government bureaucracy, which at times can become overwhelming and insensitive to the needs of some of its citizens.  Especially those wounded citizens that proudly wear the uniform of our Armed Forces.  I have always been impressed with those civil servants (and there are many) who, while obeying the law, concern themselves with figuring out ways they can help customers - not giving reasons why they can't!  I think putting up roadblocks, slow rolling, and lacking certain communication skills only fuels further dissatisfaction with the bureaucracy and the people that run it.  It's amazing sometimes, isn't it, when the wrong people are in charge?

We need to stop totally blaming the management at Walter Reed for the substandard conditions that just didn't materialize overnight and address our options.  First, fix the substandard conditions at Walter Reed now!  We have the resources!  The Army Corps of Engineers can take the lead role in directing efforts to correct the facility's aesthetics. Next, if Walter Reed is to stay on the closure list, ensure that full funding is in place for the replacement facility, while maintaining Walter Reed as a quality care facility for our wounded soldiers.  Because of the large number of wounded, the government should consider running both for a time after the new facility is operational.  Also, the government needs to take a good hard look at the military health care system in general and the VA network around the country.  Let's stop with the band-aid fixes, which usually occur after shortfalls in the bureaucracy are revealed and come under public scrutiny.  I think a bi-partisan commission can help shed a spotlight on our options...providing we follow their recommendations.

But you know, fixing these facilities is only part of the problem; we need to put people in place, such as administrators who are capable of doing the right thing in positions of authority and responsibility.  Dedicated people need to be led by dedicated supervisors/administrators that aren't afraid to tell it like it is...enough with the sugar-coating!  If it's ugly, it's ugly.  Period.  During my career in the military, I was evaluated more times than not on how I reacted to correct things, rather than blamed for things I couldn't control.  Let's just do it!

More Reaction to the Walter Reed fiasco

I just got this from Mike Jones, former Army Captain who served in Iraq.  I asked him to comment on the Walter Reed fiasco and here’s what he said:

Here's my view on it...from a wounded soldiers perspective.  75% of the wounded soldiers that go through WWMC never experienced any significant issues beyond a little red tape.  Unfortunately 25% had some major issues.  That 25% is unacceptable.  Our VA system was designed to handle the WWII generation as it aged and was, unfortunately, not prepared to handle the influx of tens of thousands of young, wounded soldiers that have required assistance over the past three years.  That has put a significant strain on the system.  It is not perfect and there are portions of it that are broken.  We must look at it with an inquiring eye and figure out how to fix it, permanently.  Bottom line, for every bad story there are 3 good stories of excellent care, but there should not be this many bad stories (and I have heard so many others before this even broke last week).  I had walked to halls of the Mologne house myself.

Here's what I had to say yesterday.

Stop cheating the soldiers

Last night my wife called me a FOX News junkie!

Ok! Ok! So I guess this story about Walter Reed Army Medical Center really gets me going!  I’m sorry, CNN doesn’t resonate with me anymore!  CNN’s graphics are better, but I don’t think anybody working there ever served in the military, or if they did, they didn’t earn an Honorable Discharge. I could be wrong, but that’s what I wonder sometimes listening to their coverage!  Where’s my remote?  Back to FOX!

This whole Walter Reed Hospital thing has really got me pissed off!  I mean, when the hell did someone finally figure out that things were not going well at this hospital.  I heard outpatient care was substandard and the bureaucracy has slow-rolled some of our wounded soldiers from getting what compensation is due.

Well now the President has appointed two respected individuals (one at least is qualified to address this issue) to head up a commission with the charge of proposing a more streamlined process for transferring soldiers from deployment to civilian life, assuring high quality services are available to returning service members and to make sure they have increased access to benefits and services.

I hope they look hard into what effects budget cuts have had over the past couple of years that contributed to this mess.  I mean when you cut the budget, you reduce manpower, resources, and upgrades to facilities and equipment…everybody with me so far?  This especially comes to pass when you announce the facility will be closing in a couple of years, so people naturally say, “…why do anything to the place, it’s a waste of money!”  Yeah! But we have soldiers who need medical attention!  So let’s do the right thing and stop cheating the soldier who lays his or her life on the line everyday in the combat zone. 

If you need to vent, speed dial or email your representatives in DC.  I just hope this isn’t another episode of “same circus, different clowns all over again!”  Later!