Ever since the February 18, 2007, Washington Post article recounted problems with outpatient care in Building 18 at the Walter Reed Army Medical Center, the U.S. Army has been busy responding to the problem.
Busy is the key word. Congress held hearings on veterans’ medical care. President Bush appointed two groups: 1) an outside bipartisan Commission headed by former Senator Robert Dole and Donna Shalala, member of former President Clinton’s cabinet, and 2) an Interagency Task Force of his cabinet members. Secretary of Defense, Robert Gates, convened an Independent Panel to examine why the problems were raised by the media and not by his staff. There are reports of other inquiries as well.
The Understanding Government Foundation asked the Department of Defense and the Secretary of the Army to explain their internal review procedures for managing and reviewing medical care facilities. We wanted to determine why the Walter Reed situation went unnoticed and why an outside party, and not the Army, was first responsible for unearthing these shortcomings.
Robert Gates, Secretary of Defense, was quoted in an American Forces Press Service report as being disappointed that his staff did not first learn of this problem and implement remedial action. His also opined that an attitude of defensiveness existed within the Army when these troubles were first reported.
In attempting to research this story, the Foundation’s Contributing Editor, Fred Apelquist, spoke first with Cynthia O. Smith, Secretary Gates’ spokesperson. When asking to discuss how the Office of the Secretary of Defense (OSD or SecDef) interacted with the Secretary of Army on matters such as this, our editor was referred to the Army. Paul Boyce, an Army public relations official, said that the Office of the Army Surgeon General could provide assistance. Cynthia Vaughn, in the Surgeon General’s Public Affairs office, said that she doubted that any assistance could be provided as the office was extremely occupied in addressing the problems first identified by The Washington Post. [To gather a different perspective, two calls were made to Lawrence Halloran, Deputy Staff Director of the House Oversight and Government Reform Committee, but were not returned.]
It is clear, however, that much activity has taken place since that February article by Dana Priest and Anne Hull. One interesting development, which was the impetus for our inquiry, was that the Army Inspector General (IG) completed a report on the Army’s Physical Disability Evaluation System (APDES) on March 6, two weeks and two days after the Post report about Walter Reed. Was the issuance of this report several days later (March 12) coincidental? Was it designed to mute further public criticism by demonstrating that internal action had been underway long before the Post published its account?
Several other relevant questions needed to be answered. Why did this study, ordered 11 months earlier by former Secretary of the Army, Francis Harvey, take seemingly so long to complete? Were not some of the issues about outpatient care and disability evaluations related to problems raised by the Post? Were not many members of the Walter Reed command structure interviewed for the IG’s report?
Groups ordered by Secretary Gates and President Bush in early March were told to report findings promptly, within 45 days, and they did. Both groups, the President’s Task Force on Returning Global War on Terro Heroes and Secretary Gates’ Independent Review Panel, laid blame squarely on the commanders’ shoulders. As we know, many officers at Walter Reed and elsewhere have lost their positions.
Why did the IG report not criticize the command structure as did these two independent inquiries? The report was quite extensive: nine employees interviewed “652 leaders, Soldiers and civilians at 32 installations” worldwide and within the U.S. Forty-one (41) recommendations were presented, which seemed in places to blame and penalize soldiers for failing to follow procedures about which the report later acknowledged soldiers lacked adequate awareness. Few explicit leadership failures were identified. Further, one “excellent internal assessment tool” developed at Walter Reed was cited as a Best Practice to track its Medical Evaluation Board (MEB) process.
These facts raise questions about the efficacy of the Army’s internal review process. How rigorous and open is it? How well can subordinate staff investigate senior officer operations, draw candid, meaningful conclusions, and advance sensible recommendations that are accepted and implemented when appropriate?
Did the two groups who presented their findings within 45 days dismiss or contradict some of the findings in the APDES report? It appears so. If so, what are the implications for the Army and how does it plan to address them?
This is what the Understanding Government Foundation would like to know and share with its reader so that we all can better appreciate the demands and inner workings of our government agencies.
Work by the President’s Task Force and the Secretary’s Panel has been completed and recommendations – 45 in all – have been published. The Dole-Shalala Commission will present its report and recommendations in late July. Most of the suggested changes are fairly basic. However, effective implementation will require energy, competency, and persistence.
How will success be measured and tracked? By review processes, of course. This is why the manner in which the Army, or any government entity, designs and implements internal review responsibilities is so important.
It is unfortunate that the pace of activity remains so high that the Army is unable to offer 30 minutes of key officer and staff time to explain how it will meet its daunting challenges. The Department of Veteran Affairs (VA) has about 1,400 medical centers and clinics under its authority. One can imagine how difficult it must be to keep strict tabs on that many offices. Interestingly, one of the APDES report recommendations suggested VA deficiencies in its disabilities rating system. Is this mere finger-pointing? Did the VA and the Army talk about and agree on this? What does this say about the efficacy of internal review processes, which are critical to quickly and correctly identifying and fixing major operational problems?
How many buildings, bases, and operational areas are under the auspices of Army review is not known, as our Foundation was unable to discuss this or other matters with Department representatives. Such information may not excuse any operational deficiencies – if any exists – but it would clearly put the challenge in perspective. For example, if a staff of 50 people were responsible for in-depth annual reviews of 500 facilities across the country and around the globe, that insight would help policy makers and citizens better understand the conditions under which certain operations are performed. It would also demonstrate clearly whether or not sufficient resources are allocated to this type of work.
Many people are very busy in the Army and the Department of Defense trying to remedy conditions mentioned in the Post story and others exposed through a myriad of internal reviews.
This is to be expected; however, we invite the Army to respond to this article and share the lessons it has learned through the intense public scrutiny that it has experienced.
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Fred W. Apelquist, III, M. Ed.
Approximately 1165 words.
© May 2007