Winkenwerder Leaving After Six Years at Helm of DoD Health Affairs

By Jim Garamone
American Forces Press Service

Feb. 26, 2007 – After nearly six years in office, the Defense Department's top doctor said he will miss the people of the department who make things happen for servicemembers around the world. In a long-planned decision, Dr. William Winkenwerder Jr. soon will step down as assistant secretary of defense for health affairs and move to a job in the private sector.

President Bush has nominated Dr. S. Ward Casscells to replace Winkenwirder. Casscells is a professor of medicine and public health at the University of Texas Health Science Center, in Houston. The Senate must confirm the doctor before he takes office.

Casscells has served as medical advisor in Baghdad and understands the complexities of the position he is moving into, Winkenwerder said in a Feb. 23 interview with American Forces Press Service.

Winkenwerder said the position is demanding, but rewarding. "It has been a tremendous honor and privilege to work and serve in this position," he said. "It's been a great opportunity and pleasure, and one I never anticipated."

The war on terror has made this a unique time to be assistant secretary for health affairs, Winkenwerder said. "I know that Health Affairs is probably always a hopping place, but I think it has been more of a hopping place in the last five years than it has ever been," he said with a smile.

DoD has been engaged worldwide, and medical support always follows. "I've very proud of the battlefield medicine support," the doctor said. "I'm particularly proud of the advances in mental health and the fact that (seeking mental health care) is less a stigma."

More must be done in this regard, he said, but the military understands the importance of mental health readiness.

Winkenwerder also is pleased that the services have been operating more jointly, he said. The consolidation of Walter Reed Army Medical Center here and the National Naval Medical Center, in Bethesda, Md., is going well, he said, as is the consolidation of Brooke Army Medical Center and the Air Force's Wilford Hall Medical Center in San Antonio.

In addition, the anthrax vaccination program is going well, and the troops are getting better protection. "In November 2001 we didn't have a licensed anything," Winkenwerder said. "(There was) no production, no contract, and it's running well today."

DoD also has invested almost $1 billion in combating bioterrorism facilities and labs, he said.

The doctor said he is also proud of DoD's efforts to assess servicemembers before and after deployments, "so we know much more clearly what has happened to them during their deployments." Part of this is putting in place the information technology to capture all that data. This also helped as the department put in place the individual medical readiness system. This system standardized the way the services viewed servicemembers' readiness for deployments.

DoD health professionals continue to lead in integrating information technology with new hand-held battlefield systems, he said.

Winkenwerder noted he never served in the military, and this both hindered and helped him. "It took me a while to learn the culture of the place," he said. "You have to balance bringing private-sector ideas (into the military), with a recognition of and respect for the existing culture and the existing way of doing things. What I've learned is there is a certain speed and rhythm of change in a large organization. DoD has such a strong culture, and you have to work within the system to get the system to change."

On the Tricare front, he said the health plan was average-rated when he came into office in 2001. "Now it is one of the top-rated in the country; satisfaction in Tricare has gone up," he said. "We've been able to implement all the new contracts -- some $45 billion worth -- and didn't have procurement problems or scandals."

Health professionals are sometimes the best capability the country has to change peoples' minds about America, Winkenwerder said. Military medics rushed to help the people of the Indian Ocean area affected by the December 2004 tsunami and also helped thousands hurt by the 2005 earthquake in Pakistan. The department also has a $100-million-a-year military-to-military assistance program to help combat HIV/AIDS.

However, Winkenwerder said, he does leave the department with some regrets, he said. In 2006, DoD proposed raising fees for some groups for Tricare membership. The doctor said DoD needs to implement changes in the benefit to create a stable financial foundation for the long run.

"It certainly was my fervent hope that we would advance beyond debate and into action with respect to sustaining the benefit discussion," he said.

"I think that will happen," he said. "I'm reasonably confident because there is a growing realization in DoD and Congress that we have to make some of these adjustments. We can debate about how much and how fast, but the adjustments need to take place. My regret is I didn't think of a better take on that issue so we would be further down the road today."

Winkenwerder said he also wishes he could have spent more time on revising and updating DoD's medical personnel system. He wanted to do more with management of the resource and recruiting and development of leaders. "It's a hard thing to do in government, and there is a need to do more," he said.

He said he thinks most of the people in Iraq and Afghanistan who are on the "medical front lines" of the war on terror. "I've seen so many faces, and whether taking care of one of our own of a child or an insurgent, it's an amazing thing to see our people in action," he said.

"The will of the military is remarkably strong," he continued. "What we have to sustain is the will of the American people. That's going to be a challenge. That's a bit of my concern with the focus on the shortcomings at Water Reed. We need to keep the focus on the problems that are really problems of processing and bureaucracy. They are not problems of medical care or the professionalism of the staff."

The doctor said he believes military medical professionals have "done too many great things for people to conclude that they are not top-notch."

He also believes that the next few years will see a growing cooperation between DoD and the Department of Veterans Affairs and that the department will move to the next stage of electronic health records.

His advice for his successor? "Enjoy this experience," he said. "Take advantage of the opportunity to advance positive changes."

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