Unlike Walter Reed, VA's hospitals work

By JONATHAN V. LAST
PHILADELPHIA INQUIRER
Revelations about broken bureaucracy, insufficient care and poor living conditions at Walter Reed Medical Center's outpatient facilities have prompted a flurry of activity in Washington. These revelations should also teach us a number of lessons.
The first is that -- despite everything -- the mainstream media in general, and newspapers in particular, are indispensable. The Washington Post's work on Walter Reed has been thoughtful and diligent, and it helped bring attention to a situation that needed to be fixed. It took four months of on-the-scene reporting from Dana Priest and Anne Hull to expose not just the physical disrepair of Walter Reed's Building 18, but also, more important, the bureaucratic disaster.
Moldy walls and leaky ceilings pale next to the fact that the average soldier at Walter Reed was filing 22 documents with eight different commands; that paper forms were regularly disappearing; that patients were waiting for months to receive care; that some soldiers were having difficulty getting replacement uniforms for those destroyed when they were wounded in the field; and that some soldiers were at pains even to prove to the system that they were injured while serving in Iraq or Afghanistan.
Such a story can be adequately told only in print, and only newspapers and magazines remain committed to doing this kind of reporting. Remember Priest and Hull the next time a blogger complains about the uselessness of the Old Media.
Another lesson is that Walter Reed is an Army facility, not a Veterans Administration hospital. This is an important distinction, because we want to fix what's broken, not break what's working.
Unlike the outpatient system at Walter Reed, the VA system is a model of efficient care. This was not always the case. As Phillip Longman explains in his forthcoming book on the VA system, "Best Care Anywhere," that system was born into catastrophe. The first head of its forerunner, the Veterans Bureau, was Col. Charles R. Forbes. At the end of his tenure, Forbes was sentenced to jail at Fort Leavenworth for graft and waste that would equal about 2.1 billion in today's money. Matters did not improve much for the VA in subsequent decades. By the 1970s, it had become so thoroughly wrecked that the agency had to begin a complete, bottom-up transformation in 1981. The results since then have been startling.
Consumer satisfaction
As Longman points out, for six straight years the VA has received the highest consumer satisfaction ratings of any public or private health-care system. According to a 2004 Rand study, the VA outperforms all other sectors of American health care in 294 measures of quality. As a study out of Harvard's Kennedy School of Government observed in 2006, "While the costs of health care continue to soar for most Americans, the VA is reducing costs, reducing errors and becoming the model for what modern health-care management and delivery should look like."
This isn't to say that the VA is perfect -- it most certainly isn't. But its problems are those of funding and access to the system, not delivery and efficiency of care for those in the system.
The problems at Walter Reed are different and seem to be specific to the Army hospital network. We should not confuse the two.
The improbable, happy lesson from Walter Reed is that, evidence to the contrary, our politicians can do things right every so often. Defense Secretary Robert Gates deserves praise for acting swiftly and seriously. In these types of stories, it's often hard to find bad guys, since the problem is the system. But if there was a bad guy in the Walter Reed saga, it was Lt. Gen. Kevin Kiley.
Kiley ran Walter Reed from 2002 until 2004, and by most accounts, he was not only responsible for much of the mess, but had knowledge of the situation under his command. Kiley lived across the street from Building 18, the now-notorious former hotel used to house outpatients recuperating from injuries suffered in Iraq and Afghanistan.
Building 18 is now world-famous for mold, bad plumbing and crumbling walls. When the Walter Reed scandal broke, Kiley tried to stonewall, saying: "I want to reset the thinking. ... While we have some issues here, this is not a horrific, catastrophic failure at Walter Reed." Speaking about the squalid conditions in Building 18, Kiley said problems "weren't serious, and there weren't a lot of them."
Accountability
This was the man Secretary of the Army Francis J. Harvey put back in charge of Walter Reed after the story broke. Gates sacked them both. And his response was accountability itself: "I'm grateful to reporters for bringing this to our attention, but thoroughly disappointed we did not identify it ourselves."
Much credit is also due to congressional Democrats, who seem to be addressing the problems in the Army hospital system seriously and with a minimum of grandstanding. In particular, Sens. Claire McCaskill and Barack Obama have done fine work with their bill, the Dignity for Wounded Warriors Act, designed to attack the physical and bureaucratic problems manifested at Walter Reed and open the system to closer supervision. It's a serious bill, crafted not to score political points but to mend the Army's broken system of dealing with the medium-term care of soldiers.
It's encouraging to see that, even at this late date, there are still some matters that bring out the best on all sides.
Jonathan V. Last is a columnist for the Philadelphia Inquirer. Distributed by McClatchy-Tribune Information Services.