Officials' Testimony Focuses on Fixing Health Care System

By Fred W. Baker III
American Forces Press Service

March 6, 2007 – Questions to top Army and DoD officials before the Senate Armed Services Committee today focused on how to eliminate the bureaucracies that many say permeate servicemembers' outpatient health care. The committee questioned top defense officials regarding reports of substandard living conditions and delays in outpatient services at Walter Reed Army Medical Center here.

Army and defense leaders did not dispute the claims. The Army's top officer, Chief of Staff Gen. Peter J. Schoomaker, compared the system's bureaucracy to "running in hip boots in a swamp."

"It sucks the energy out of you," he said.

Schoomaker said the Army is acting quickly to fix the problems it can, and the service will work with DoD and other agencies on those that cross service boundaries or require legislative support. "I stand accountable. All of our energy is going into making sure the proper actions are taken," he said.

Schoomaker offered up a list of steps taken by Army leadership so far that includes installing a new commander and deputy commander at the center, as well as a new battalion commander and command sergeant major, all combat veterans.

A one-stop family assistance center there now allows soldiers and family members access to all of the services they need in one spot, he said.

Also, officials opened a telephone hotline that allows anytime access for reporting problems.

Two teams have been dispatched to review services at in- and out-patient facilities across the Army, Schoomaker said.

Assistant Defense Secretary for Health Affairs Dr. William Winkenwerder Jr., said his office's top priority is finding and fixing the problems, and he wants patients to speak up about the quality of care they have received. "We welcome public scrutiny, even when it's critical and painful to hear," he said.

"Defensiveness and explanations are not the route to getting things done," Winkenwerder said.

He divided the problems into three categories for the committee: facilities, the disability determination process, and care coordination.

Winkenwerder said he believes the Army is fixing the facilities that were not up to standards.

Changes to the disability determination process cross organizational boundaries and will not happen quickly, but the process should be fair, consistent and timely, and not adversarial, he said.

When pressed by a committee member, Army Surgeon General Lt. Gen. Kevin C. Kiley conceded that some soldiers have probably been shortchanged by the Army's disability evaluation system because it is set up to recognize the value of a "loss of limb" but not designed to understand the "nuances" of post traumatic stress disorder or traumatic brain injuries.

To aid the process of care coordination, officials are hiring more case managers and other staff to lower the ratio of patients to staff. "No servicemember should ever have to work through a maze ... to figure things out," Winkenwerder said.

Kiley said a complete system overhaul is required. "We really need to reinvent this entire process," he said.

The individual obstacles of the system are being fixed by Kiley's office, but the way disability compensation is awarded, which is governed by regulations, needs to be revamped, he said.

Kiley said he shared in responsibility for the failures in outpatient care at Walter Reed and "accepts the responsibility of rapid corrective action."

"I am committed to fixing it," he said.

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