Friday, March 09, 2007

Walter Reed Problems

[Wrote the first two paragraphs on 2/23/07, the remainder today.] Walter Reed has been in the news since the Washington Post did a 2-part series on problems there [this gives Friday's piece, with links to earlier ones], then Lehrer Newshour included a couple pieces and then the whole world (defined inside the Beltway as the authorizing committees and appropriations subcommittees of Congress) landed on DOD and VA. If I understand, wounded soldiers are moved from the hospital when they are convalescents into a set of buildings elsewhere on the campus. They're in charge of NCO's who are also recovering. Many are in a sort of limbo--maybe needing physical therapy or other treatment but too well to be confined to a hospital. From a military standpoint, some may wind up fit for duty, while others may finally be determined to be unfit. In part the problem is accentuated because medicine is saving more wounded, so they're recuperating from more serious injuries.

The situation seems to be a classical bureaucratic problem--you have a bureaucracy, Walter Reed Hospital, that prides itself on great medical care of the wounded. You have another bureaucracy, the Army, that has rules for able-bodied soldiers. But now you have a growing number of people who don't fit comfortably into either category. So the bureaucrats in power don't take responsibility, the facilities suffer a bit from neglect, the NCO's are overwhelmed, and the soldier/patients don't get what they need.

There's further complications: many soldiers want to remain in the service, so want to minimize their injuries and maximize their chances for recover. The services want to retain soldiers (though I suspect there's some hidden prejudices against soldiers with "disabilities"). On the other hand, if a soldier can't, or doesn't want to, stay in, he or she wants to maximize the injury so as to increase the disability benefits (realizing that not all soldiers fit the economists' "maximizing utility" model).

And still more: some soldiers are Army, some are National Guard, some are Reserve (presumably some may be Navy or Marine and some Air Force). Each one has, I'm sure, a different pay system, a different set of rules and regulations, and separate personnel offices. So Building 18 becomes the focus of a perfect storm, the point where multiple bureaucracies meet, and miscommunicate. And, because the VA services veterans where they live in civilian life, a surge of casualties resulting from the deployment of a Guard unit from a state poses problems for the local staff.

The number of investigations going on reflects the underlying complexity--each bureaucracy and its overseers have to do their own thing.

It's no comfort to the soldiers to know that some of this, as it relates to the Guard, is a direct result of the wisdom of the Founding Fathers.

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