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chopper

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Is that were we're at? A couple of cockroaches and a stained carpet and you've got a scandal. hmmmmmmmmmm

Wow, Lt. Gen Kiley - I didn't realize you posted on SDN.

No matter how much you want to minimize this - the hammer is coming. Dont' think the Sec of the Army is going to be the last one to get the boot b/c of this.
 
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IgD

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I read a report that the XO of WRAMC is going to be a line General. I've observed that possibly the MTF's get so focused on productivity they lose sight of their real purpose which is to serve our Soldiers, Sailors and Marines. I'm trying to picture a line General at a typical MTF productivity meeting. It's an interesting concept.
 

USAFdoc

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Is that were we're at? A couple of cockroaches and a stained carpet and you've got a scandal. hmmmmmmmmmm

paradude; I wouldn't believe you are even for real, except 50% of the USAF Senior Admin people I met had the same attitude you have. I hope milmed improves, despite the fact of people with attitudes such as yours. Troops, retirees, and dependents deserve better than what it seems you are willing to give them.

We'll save the roaches and stained carpets for your office, ok?:smuggrin:
 

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Is that were we're at? A couple of cockroaches and a stained carpet and you've got a scandal. hmmmmmmmmmm


This is the propogation of mediocrity and stupidity, and unfortunately likely the future of mil med.........here comes the new boss, same as the old boss...........
 

paradude

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This is the propogation of mediocrity and stupidity, and unfortunately likely the future of mil med.........here comes the new boss, same as the old boss...........

Right, right, lets pick on paradude. I'm just salty over a true patriot, GEN Weightman, getting axed over something like this. His 33 year career is over because of a politically inspired "piece" written in the Washington Post by an America hater. The man jumped into Panama for Christ's sake, he certainly cares for the troops as much as the rest of us do.

I'm at Walter Reed on a regular basis, anybody gonna dispute that our soldiers receive world class care on a daily basis? This "scandal" is all about politics and absolutely lacks substance. GEN Weightman's son is in Iraq along with my brother, do any of you former milmed docs think his firing was justified? You think the man was still doing this job for any other reason than his concern for the soldier in the field??!!

In any case, military medicine IS a noble calling, there are funding issues (some of you might remember that Walter Reed is on the chopping block due to BRAC) which are being resolved. I hate to be the only one around here stirring the pot on a regular basis but somebody has to! However, please don't question my devotion to this profession or patient population.
 

Galo

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Right, right, lets pick on paradude. I'm just salty over a true patriot, GEN Weightman, getting axed over something like this. His 33 year career is over because of a politically inspired "piece" written in the Washington Post by an America hater. The man jumped into Panama for Christ's sake, he certainly cares for the troops as much as the rest of us do.

I'm at Walter Reed on a regular basis, anybody gonna dispute that our soldiers receive world class care on a daily basis? This "scandal" is all about politics and absolutely lacks substance. GEN Weightman's son is in Iraq along with my brother, do any of you former milmed docs think his firing was justified? You think the man was still doing this job for any other reason than his concern for the soldier in the field??!!

In any case, military medicine IS a noble calling, there are funding issues (some of you might remember that Walter Reed is on the chopping block due to BRAC) which are being resolved. I hate to be the only one around here stirring the pot on a regular basis but somebody has to! However, please don't question my devotion to this profession or patient population.

Being "salty" over "patriot" Weightman's being used as a scapegoat, and minimizing the problems that are occuring and have for a long time plauged military medicine are two different things.

I think he is certainly accoutable for the issues under his command, even though he had made an effort to change things, (someone had posted a quote from a memmo of his). The problems are beyond the line officers who rarely seem to fully understand the issues that are troubling military medicine today. I certainly do not think the piece is politically motivated, its just the truth. The aftermath is just how the army has decided to do business. Possibly more heads will roll, but the change will only be spackle on the wall.

What really upsets me about your expressions, is that by pointing out that he is a patriot, you seem to say anyone that is not down with the ways military medicine, (or the military in general), is NOT a patriot. You denigrate our service and demand for excellence by saying we should not complain about a system that is leaving the most deserving people completely underserved. Till you understand that, (I doubt you will), you will continue on to be part of the problem. I would dare say that is the signs of a traitor, and not a patriot, one who should demand change where change is due.
 

met19

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Right, right, lets pick on paradude. I'm just salty over a true patriot, GEN Weightman, getting axed over something like this. His 33 year career is over because of a politically inspired "piece" written in the Washington Post by an America hater. The man jumped into Panama for Christ's sake, he certainly cares for the troops as much as the rest of us do.

I'm at Walter Reed on a regular basis, anybody gonna dispute that our soldiers receive world class care on a daily basis? This "scandal" is all about politics and absolutely lacks substance. GEN Weightman's son is in Iraq along with my brother, do any of you former milmed docs think his firing was justified? You think the man was still doing this job for any other reason than his concern for the soldier in the field??!!

In any case, military medicine IS a noble calling, there are funding issues (some of you might remember that Walter Reed is on the chopping block due to BRAC) which are being resolved. I hate to be the only one around here stirring the pot on a regular basis but somebody has to! However, please don't question my devotion to this profession or patient population.

This reminds me of the feedback that 60 minutes received from the extreme conservatives following those soldiers who went on....all they did was question their patriotism.

No one questions that Weightman wanted to help the soldiers, but the situation continued on his watch. He might be the fall guy, but he could've thrown some dollars to atleast clean the mold and take care of the roaches. No soldier that is rehabing serious wounds (whether physical, emotional, or other) deserves to be in moldy, roach and rodent infested conditions.

The fact that Weightman's son is serving with your brother has no affect upon the conditions of walter reed. That statement sounds like it is designed to pull on emotional "heart strings" to convince us that you are right. Use facts and we will listen to them. Where is your proof of lacking substance? The funding issues is what lead us to be in these circumstances.


3 points:
1) Gen Kiley should be fired. He was in charge for 2 years during this and did nothing.
2) Describing a reporter as an America hater does not prove your point. It only proves you have an adgenda. Part of the idea of America is freedom of speech. Also part of the idea is the ability to publish a piece of journalism. To call a journalist an america hater just because you disagree with her work does not do anything but destroy the freedoms we protect. I personally find it disgusting to accuse someone of being an america hater without proof.

3) A quick, but long point that I think is extremely useful: both military and regular citizens have the right to let their opinions be known. Regular citizens also have the right to question the government's motivations, actions, and words. Last time I checked this is why we fought the revolutionary war (besides the tax issue).
 

met19

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Galo spoke up quicker and more eloquent that I.....
 

Gastrapathy

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Is that were we're at? A couple of cockroaches and a stained carpet and you've got a scandal. hmmmmmmmmmm


OK, you've been flamed enough but dude, ask the Secretary of the Army if this was a scandal. Lots of CO's have been relieved for less than Weightman's failures. Maybe its not his fault, but thats the way it works in the military. You don't think the Secretary of the Army knew where the f*** building 18 was do you?

Now, the flip side is that anyone who's worked there in the last 10 years knew this was happening.
 
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core0

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Right, right, lets pick on paradude. I'm just salty over a true patriot, GEN Weightman, getting axed over something like this. His 33 year career is over because of a politically inspired "piece" written in the Washington Post by an America hater. The man jumped into Panama for Christ's sake, he certainly cares for the troops as much as the rest of us do.

So he jumped into Panama. I was there, and for the record, he's was good doc and a decent guy. His career is over because indisputable negligence took place on his watch. It was not a hack piece by the Washington post. It was a decent expose on a system that the President claimed is the best in the country and the Pentagon told the public there were no problems. This depsite multiple memos and other evidence that things were not allright. The real suprise here is that the standard **** up move up standard no longer applies. The former secretary of the army apparently did not see the change and paid for it with his job. Having met Secretary Gates, I can tell you his temper does not appear to have changed in 20 years.

I'm at Walter Reed on a regular basis, anybody gonna dispute that our soldiers receive world class care on a daily basis? This "scandal" is all about politics and absolutely lacks substance. GEN Weightman's son is in Iraq along with my brother, do any of you former milmed docs think his firing was justified? You think the man was still doing this job for any other reason than his concern for the soldier in the field??!!

Walther Reed represents the nomral dichotomy that you see in military medicine. They do an excellent job with acute care, catostrophic illness and routine primary care. Anything else tends to fall through the cracks. The problem is that nobody thought far enough ahead to decide what to do with all these soldiers waiting to be medically evaluated. Nobody was in charge and with the expanded civilian staff nobody cared. To be brutally honest medical commanders don't see the same range of problems that line commanders do in garrison. Hopefully they are trying to fix this.

In any case, military medicine IS a noble calling, there are funding issues (some of you might remember that Walter Reed is on the chopping block due to BRAC) which are being resolved. I hate to be the only one around here stirring the pot on a regular basis but somebody has to! However, please don't question my devotion to this profession or patient population.

Yes there are funding issues. However any line commander who's troops were living in that kind of squalor would be out of a job. What happened was very appropriate and hopefully will lead to some real changes.

David Carpenter, PA-C
 

FizbanZymogen

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come one guys, were missing just a few more of the regular haters.
 

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Is that were we're at? A couple of cockroaches and a stained carpet and you've got a scandal. hmmmmmmmmmm

*sigh*... Paradude... I just get to thinking that there might be some hope for you (I saw a little glimmer with your obvious disdain for the PC lecture on "diversity" you were forced to attend), and then you go and drop a stinker like your above comment.

I don't disagree that Weightman is a fall guy... you'll get little argument from me on that point. He's only been there for a few months, and reportedly did attempt to bring attention to some problems. If anything, the blame should fall more squarely on Kiley's shoulders (someone please explain to me why Kiley still has a job?).

It's more than a few cockroaches and stained carpet, and your post only makes you look like an apple-polisher. "America hater?" "Politically-motivated?" Even if those things were true, it doesn't mean their underlying point isn't valid There are plenty of issues in Milmed... for instance, I don't think the funding issues are anywhere close to "being resolved."

Then there's the entire culture and climate of Milmed... that's going to take a lot longer (and an incredible amount of political will) to fix.


PS: You talkin' to me, Fizban? Are YOU talkin' to ME?
 

core0

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Homunculus

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Any comments on the current scandal?

i think this was a long time coming. after kiley there was farmer, then weightman. the problem from the outset was the failure of the leadership to own up to the problem. i was on leave and saw it on the national news-- my first thought was "oh, someone finally did a stroy on it"-- 'cause the outpatients had been having these issues since i rotated through the ED 3 years ago-- even then they were like "doc, i live in mold/rats/bad plumbing/etc" which isn't news-- our callroom (and clinic) has mousetraps and gluetraps sitting out in plain sight. sometimes i cringe when i see my patients crawl on the floor.

regardless-- i knew they were in deep **** when i heard something to the effect of "we want to thank the media for bringing this to our attention and we will fix it right away" or something like that. flat out lie. everyone knew it, and i'm surprised they thought they'd get away with it. i went t oa sensing session a year ago and heard it mentioned then. there's documented evidence of this being a problem for years. and instead of addressing current problems they build a brand new multi-million dollar amputee center that after the BRAC won't be used anymore. the rumor i heard was that stuff used at WRAMC will be duplicated when BRAC'd to NNMC-- so if they build it now they will get to build it again later. instead of just builiding it over there to begin with. could be wrong, but would not surprise me at all.

the media is currently off limits to everyone with strict orders to send them to the public affairs office and to report where they are to security. which is kinda odd considering we're on public taxpayer property.

after last weeks 2 firings, kiley is next. if the guy in front of you and the guy behind you get whacked, chances are good you are next, lol. not sure how farmer fits in, but i doubt he gets away scot-free. (edit-- gen farmer retired after leaving WRAMC) anyone affiliated with the system there is going to have a major blemish on their career. and although most of us couldn't give a rat's @ss about that kinda thing (being in for a "career") the people it's happening to *do* care. and they aren't all bad people.

the sad thing is that this really tarnishes the WRAMC system-- the medicine practiced here is good, and people do a good job. it's true the outpatient treatment system was flawed, and it illustrates the typical institutional mindset where everything is someone else's job to fix. ultimately all it would have taken was for one of those generals to walk through those areas to see how bad they were and to talk to the soldiers who were having problems with outpatient care to figure out it neded to be a higher priority. the system is taxed, yes, but you can't tell me we don't have the resources to fix it.

anway, i guess we'll see how things pan out. with any luck maybe the spotlight will uncover a few other things as well to get fixed.

it's also sad that only now are the politicians really getting involved. it's too bad they weren't proactive about it-- i have no doubt many of them knew about it as well since soldiers often go to their representatives when having issues with military admin.

--your friendly neighborhood may see a senator or two tomorrow caveman
 

AF M4

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This is a completely off-the-wall comment, but there has to be some political scientist or policymaker in the current administration or at Fox News or CNN with a "how to spin your way out of anything" book in them. It's been made more difficult to notice because of various technological advances over the past few years (iPods, HDTV, computing power) that are so obviously flashy, but in my opinion the art/science of manipulating public opinion is advancing at least as quickly if not more so. I'm looking forward to a mind-blowing read about how I can be made to believe anything despite a huge amount of compelling evidence to the contrary, simply because deep down I really want to believe it.

This whole Walter Reed affair will be the true test of all those yellow ribbon "support the troops" bumper magnets I see every day - will people stay on this issue for the long haul it will take to see it properly addressed? Do the American people REALLY support the troops, or do we just tell ourselves that to make ourselves feel better?
 

IgD

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the sad thing is that this really tarnishes the WRAMC system-- the medicine practiced here is good, and people do a good job. it's true the outpatient treatment system was flawed, and it illustrates the typical institutional mindset where everything is someone else's job to fix. ultimately all it would have taken was for one of those generals to walk through those areas to see how bad they were and to talk to the soldiers who were having problems with outpatient care to figure out it neded to be a higher priority. the system is taxed, yes, but you can't tell me we don't have the resources to fix it.

I think it also tarnishes the physicians involved. I pasted a link here for a book called Oath Betrayed. http://forums.studentdoctor.net/showthread.php?t=359335

The author cites physician participation in the prisoner abuse scandal in Abu Ghraib and in interrogations in Cuba. The premise of the book is "Where were the doctors?". If patients are coming through the ER like you said complaining about the terrible living conditions you have to wonder why the doctors didn't take action. Don't we have an obligation to report suspected abuse?
 

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How do you know doctors didn't report it, or address it? If it was after hours, I guarantee there was no way to reach anybody (after-hours meaning 1631 or later Mon-Thurs, and after 1531 Friday).

Also, how are the ER docs supposed to know who to call for outpatient medhold housing issues? ER docs don't make good social workers... we don't know how that system works. We also are more and more pressed for time as outpatient clinics cut back on staff, leaving patients no other option but to present to the ER for the chronic medical problems. There's not an ER doc in the world who has the time to spend hours calling around, waiting on hold, leaving voicemails... all to figure out where a specific medhold problem really is. I'm not even sure the Commanders know where the system has broken down.

Also, if the system is unresponsive to your inquiries (which happened to me more than once as an Active Duty doc, and more than once as a civilian attempting to get people plugged into the milmed system after botched PCS hand-off's for medical "special needs" families, and the ball being dropped because a doc PCSs and nobody is there to follow them up), what are you supposed to do then?

All sorts of people fall through the cracks in the milmed. It is a system problem. I think most docs help where they can, but we have so many other responsibilities that the time to chase these things just isn't there. I'm lucky if I see the bottom of my chart-rack more than a couple of times a shift.

Well, I guess it's one more duty for the docs to take on, in addition to doing their own data entry, their own secretarial work, their own T-cons, their own casting, etc, etc.
 

R-Me-Doc

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I'm looking forward to a mind-blowing read about how I can be made to believe anything despite a huge amount of compelling evidence to the contrary, simply because deep down I really want to believe it.

Why don't you just catch up on your newspaper reading, starting in about January 2003?
Sounds like you've nicely summed up how we got into this mess to begin with.
 

R-Me-Doc

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I'm just salty over a true patriot, GEN Weightman, getting axed over something like this.


Agree 100% -- He's getting screwed for 4 years of previous mismanagement.

I bet MEDDAC commanders all through the Army are ****ting bricks over this right now, because I can tell you that what's going on at WRAMC is even worse at the smaller MEDDACs where a lot of the Reserve and NG injured get sent back to. I don't necessarily mean the substandard housing, but rather the bureaucratic issues of guys sitting in med holding for months or years, basically untreated, before their cases are wrapped up. At least at WRAMC they theoretically have access to decent medical facilities and specialty care. Go out to the Ft Sills, Ft Drums and Ft Leonard Woods of the world, where medical care amounts to basically a glorified outpatient clinic (and no meaningful local civilian medical infrastructure either), and you will see how complicated and ineffective this system can really be. These posts draw in mobilizing reserve and NG troops from multi-state regions. When they are injured, the ultimately wind up for disposition back at their orignal mob site, regardless of how well equipped medically that site may be. Imagine some amputee/brain damaged/PTSD guy trying to get squared away at someplace with no subspecialty care and no decent civilian or VA facilities for a hundred miles. The local primary-care-based military docs are totally out of their leagues with the complexities of many of these patients, which means med boards don't get done in a timely manner, and the admin/case managers, while they may be good at case managing, aren't physicians, so they can't write up med boards to expedite the process. The soldier will sit around forever as subspecialty consult after subspecialty consult is generated, and all the docs wait for "someone else" to initiate the med board because none of them can see the overall "big picture." Meanwhile, some poor soldier is sitting in limbo 500 miles away from home not getting comprehensive treatment.

This is not a new problem, folks . . . it's been going on since 2001 and unless the system is totally revamped, it's not going away. The Army thought it had a solution to soldiers sitting indefinitely in med hold with something called "Community Based Health Care Organizations" (CBHCO), which allowed a soldier to go back home to get med care and ongoing eval to determine if they returned to fit for duty status or needed a board. Unfortunately, this system more or less collapsed because of a) the sheer numbers involved, b) the incompetence of the CBHCO people and c) a few "bad apple" soldiers who were put into CBHCO, went home and sat around forever collecting paychecks but never going to med or therapy appointments.

So, basically, none of this surprises me. It's just the cows coming home to roost. This is may turn out to be the "big jolt" that mil med has needed for a while, but I'm not so confident that much will change systemically after a couple of highly visible heads roll to show that "we're making changes."

X-RMD
 
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I'm just salty over a true patriot, GEN Weightman, getting axed over something like this. His 33 year career is over because of a politically inspired "piece" written in the Washington Post by an America hater. The man jumped into Panama for Christ's sake, he certainly cares for the troops as much as the rest of us do.

I don’t know how to quantify the patriotism of General Weightman, and it's obvious that he is a scapegoat, but one reason that a lot of these guys are going down is because two weeks ago they were vigorously denying that there was any problem. You’ve got photographic evidence of cockroaches and mold, congressmen posturing furiously, calls for immediate investigation, etc. and the military leadership is putting out letters like this:

This letter is to address the issues that were raised in the Washington Post articles this weekend concerning the treatment of patients at WRAMC, specifically their outpatient care and administration. First and foremost, I want to assure all of the staff that I do not believe that there is the "other" Walter Reed. I firmly believe that we deliver the same level of world class healthcare to all of our patients and their families, regardless of whether they are inpatients or outpatients. I see that same level of competence and compassion regardless of what clinic or ward that I visit. I see you taking the same pride and honor in caring for our Nation's sons and daughters day in and day out. We have treated over 6000 OIF/OEF patients at WRAMC since 2002 and the vast majority of them are delighted with our care. We get a lot of visitors daily at WRAMC and they have numerous interactions with our patients and families. They have many opportunities to express both their satisfaction and dissatisfaction, and therefore I feel confident that we, as a staff, have both accurate and frequent feedback from our patients which is overwhelmingly positive. Because of this, I do not believe it is accurate to portray our outpatient population as being "invisible" to the public.

Information for this article was covertly obtained over more than 2 years by reporters who did not wish to bring their findings to the leadership for action. Many of the issues that were raised in the articles have been resolved or mitigated. A survey of outpatients done in our Brigade last month showed that only 2.6% of them expressed dissatisfaction with the administrative aspect of their care; certainly not the picture painted by the recent articles. We have numerous forums to obtain feedback from all of our patients and their family members because it is important for us to know, at all times, how our customers perceive their treatment. They are the reason we exist; their care and satisfaction must remain our highest priorities
.

Same old crap…’world class healthcare’…’delighted’ patients…’competence and compassion’…blah…blah…blah. The sh** has hit the fan and the time for such platitudes has long past. No possible way to keep your job if you are going on the record with stuff like this.
 

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Amazing snippet from mitchconnie... So, in reality, the true bad guys are the WP reporters who "covertly" obtained information, and did their job: reporting it, rather than "bring their findings to the leadership for action".

Geez.. If that's the standard response from milmed leadership, no wonder that things are going the way they are. And little hope, that anything will change anytime soon. Scary stuff!

Shooting the messengers are certainly not going to solve the problem. But hey! I forgot: There IS no problem, what so ever! Everybody's happy, and those that aren't are simply unpatriotic...
 

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Latest from the newspapers:

(1) Lt. Gen. Kevin C. Kiley, Army surgeon general and former Walter Reed commander, tried to frame the situation as a failure of lower-ranking personnel and characterized an article in The Post as "yellow journalism."

(2) Lawmakers on the committee, who were visiting Walter Reed Army Medical Center for a field hearing yesterday, quickly tired of the general's I-don't-do-windows routine. Rep. Bruce Braley (D-Iowa) accused him of spouting "hogwash." Rep. Chris Shays (R-Conn.) called his position "dishonest." ... "I want you to know that I think this is a massive failure of competence in management and command," said Rep. Paul Hodes (D-N.H.), pointing his finger at Kiley.

(3) "I'm afraid this is just the tip of the iceberg, that when we got out into the field we may find more of this," said Rep. Tom Davis, R-Va., a member of the House Oversight and Government Reform subcommittee that held the session... "What you're saying though, under oath, is that you have all the resources necessary to you," said Shays, R-Conn. "And I honestly don't believe that. I don't believe that." ... Rep. Henry Waxman pointed to several investigative reports _ including assessments by the Rand Corp. and the Government Accountability Office _ dating back two years ago that sounded "alarm bells." ... "Despite all the work that went on before, top Pentagon officials reacted to the reports at Walter Reed two weeks ago by claiming surprise," said Waxman, D-Calif.

(4) Yes, there's a terrific new rehab facility just opened on the grounds of the Brooke Army Medical Center in Texas. But it was built with private contributions through the Intrepid Fallen Heroes Fund.
 

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I hope this will be the time to expose the poor state of medical readiness the reserve and guard was in when the war started.

WRAMC may be a mess, they're overwhelmed, but there was about a division's worth of activated reservists on medhold throughout CONUS before the first shot was fired. You pile that on top of the war and it's the perfect storm.

We just weren't ready, the NG and AR were reporting they were ready for a decade prior to OIF.

Funny how the combat arms officers always looked at medical as a pain in the ass side show.... now it seems to be the Achille's heel.
 

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News roundup for 6 Mar 07:

(1) "I think Secretary Gates's decision to force the resignation of the Army secretary was excessive and counterproductive," Loren Thompson, a defense expert at the Lexington Institute, said... Thompson said it would be difficult to find a good candidate to take the post when the administration had less than two years to run... "To essentially fire him for a single misstep, it sent a bad signal to anybody who might consider taking one of these jobs in the future," he said.


(2) Constrained resources during a war lasting longer and costing more than anyone in the administration had expected, along with a controversial privatization initiative at the hospital, also played a role... one key factor has come up during congressional testimony this week: The facility was due to be shuttered in coming years, raising the possibility that officials were reluctant to make large financial commitments to it... However, Lt. Gen. Kevin Kiley, a former commander at the hospital who is now the Army's surgeon general, testified Monday before members of an Oversight and Government Reform subcommittee to say that he had all the resources he needed

(3) Eleanor Holmes Norton (D-D.C.) will introduce legislation seeking to repeal the planned closure of Walter Reed Army Medical Center, saying the problems in outpatient care that have been revealed at the hospital have been exacerbated by the Defense Department's planned closure of the facility.

(4) Mr. Bush named Bob Dole, the former Kansas senator and G.O.P. presidential candidate, and Donna Shalala, the health and human services secretary during the Clinton administration, to head a panel to investigate the problems at Walter Reed.

(5) Army officials will visit 11 posts in seven states to study outpatient care, building conditions and the information provided to patients, the Army said Tuesday following revelations about problems at Walter Reed Army Medical Center.
 

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News roundup for 6 Mar 07:

(2) Constrained resources during a war lasting longer and costing more than anyone in the administration had expected, along with a controversial privatization initiative at the hospital, also played a role... one key factor has come up during congressional testimony this week: The facility was due to be shuttered in coming years, raising the possibility that officials were reluctant to make large financial commitments to it... However, Lt. Gen. Kevin Kiley, a former commander at the hospital who is now the Army's surgeon general, testified Monday before members of an Oversight and Government Reform subcommittee to say that he had all the resources he needed


Kiley is a POS. He returned tens of millions of our budget last fiscal year b/c we "didn't need it." Of course we could have used it though (there are several machines my dept has been waiting on). I can only assume that he turned the budget money back in order to makes himself look good for a promotion to surgeon general. Now he's trying to hide that fact.
 

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Although I am truly troubled by all this, it sucks, I can only hold on to a small hope that maybe they will look into the huge TRICARE fiasco, and what a burden it is on the military. We have nurses running the circus and not nursing, a gazillion gatekeepers in the referral chain and reimbursement route, doctors doing a LOT of paperwork that civilian docs don't do, plus all the madatory training. Hopefully they will finally see the huge shortage of docs, and what that has done to manning and useful productivity.

On the plus side, FOX news is running an article talking about how maybe we should rethink social medicine, because the author correctly realized that the model the goverment will implement will be based on TRICARE. If the military has to routinely refer out to civilians, what are civilians going to do, refer out to the military? Yeah, that's a vicious death cycle.
 

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News roundup for 7 March 07 (my new hobby when I'm not studying):

(1) Gates said he has also told acting Army Secretary Pete Geren to brief him by the end of the week on the Army's action plan for Walter Reed, and to provide timelines on changes in Walter Reed outpatient care... Gates said he expects progress reports "every two weeks."

(2) Shalala said Bush made it clear he wants the panel to examine conditions from the battlefield to hospitals and beyond... "He made it very clear that if one soldier doesn't get high-quality treatment and isn't transitioned back into civilian life or back into the military, that's unacceptable.

(3) Bush said the nine-member commission "will analyze our health care both at the Defense Department and at the Veterans [Affairs] Department, to ensure that not only our soldiers but their families have got complete confidence in the government's upholding its responsibility to treat those who have been wounded."

(4) Sen. Patty Murray demanded assurances that soldiers under treatment at Army hospitals would not be penalized for reporting substandard conditions or care... "Senator, you've got my word," Kiley replied. The Washington state Democrat also questioned, based from reports she had received from wounded service members at Madigan Hospital at Fort Lewis near Tacoma, whether the Army was deliberately downgrading the seriousness of soldiers' injuries so that it could avoid having to pay disability pensions... "I agree that the system is clearly perceived to be unfair," Kiley replied... "I have to tell you there is suspicion that medical and physical boards are giving artificially low disability ratings simply to save money for the Army," Murray charged... After the hearing, Murray seemed unsoothed by Kiley's responses.
 
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I can only hold on to a small hope that maybe they will look into the huge TRICARE fiasco, and what a burden it is on the military.

I can only hold on to a small hope that maybe they will look into the huge PGME training fiasco. Hopefully, the press will make public the fact that the military is using a bunch of doctors that don't have enough training to get licensed in some states. After seeing that 23% of 4th year medical students got thrown into transitional years with the latest match, I'm very scared about my own future.
 

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News roundup for 9 March 2007 (Does anyone find this summary useful?):


(1) Gen. Richard A. Cody, the Army's vice chief of staff, announced that Brig. Gen. Michael S. Tucker will come to Washington as part of a leadership restructuring at Walter Reed that will include the creation of a brigade focused on helping wounded outpatients navigate a treacherous bureaucracy... Kiley and a string of other senior Army and Pentagon officials reiterated their accountability for the problems at a hearing of the House Armed Services Committee yesterday, but their reassurances failed to satisfy some members... "You've got a management problem," Rep. Robin Hayes (R-N.C.) said to Army Chief of Staff Gen. Peter J. Schoomaker. "Should not General Kiley be relieved from duty because of what has happened here?"

(2) Veterans face serious inequities in compensation for disabilities depending on where they live and whether they were on active duty or were members of the National Guard or the Reserve

(3) The American Federation of Government Employees (AFGE), whose veteran membership is over 40 percent, today called for a full evaluation of the privatization process that has created a debacle at Department of Defense (DoD) medical facilities across the country... AFGE's review of Walter Reed's privatization records reveals a botched system in which costs have far exceeded the savings it was to produce.

(4) The Army's chief medical officer promised senators on Wednesday that soldiers who publicly criticize care and conditions at military hospitals would not face retaliation.

(5) Leon Krachyna has pleaded guilty to bribery conspiracy charges in connection with a plot to steer contracts at Walter Reed Army Medical Center to his companies.
 

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I wonder how many of the class of 2008 are going to rank WRAMC last because of all this. I think it will make other training locations even more competitive for certain specialties.
 

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News roundup for 10 March 2007:

(1) "Sadly, what is happening at Walter Reed is not an exception to the way this administration has treated our troops," said Rep. Harry Mitchell, D-Ariz... "What we now know is that the situation at Walter Reed cannot simply be fixed with drywall and paint. The problems at Walter Reed were not just about run-down buildings — the problem was a catastrophic failure of leadership." ... Mitchell said the Bush administration has tried to care for veterans "on the cheap." ... Democrats have provided about $3.5 billion above the president's budget request in the emergency war funding bill, which House members will vote on soon, to deal with the health care problems faced by veterans, he said.

(2) Some Democratic lawmakers have questioned the decision to hire IAP Worldwide Services, a contractor with connections to the Bush administration and to KBR, a Halliburton subsidiary... Last year, IAP won a $120 million contract to maintain and operate Walter Reed facilities. The decision reversed a 2004 finding by the Army that it would be more cost-effective to keep the work in-house. After IAP protested, Army auditors ruled that the cost estimates offered by in-house federal workers were too low. They had to submit a new bid, which added 23 employees and $16 million to their cost, according to the Army... The Army selected IAP for the five-year deal in January 2006, but IAP did not take over management until last month. During that period, the number of facilities management workers at Walter Reed dropped from about 180 to 100, and the hospital found it hard to hire replacements.

(3) Weeks after the scandal surrounding shoddy conditions at America's flagship military hospital, the Walter Reed Army Medical Center in Washington, the British government faces its own crisis over a hospital where hundreds of wounded service personnel have arrived since the Iraq invasion four years ago... An extraordinary sheaf of letters sent to the Ministry of Defence and the NHS and passed on by military sources to The Observer chronicles a series of alleged failings in basic care and services given to UK soldiers.

(4) Tammy Edwards, wife of an Army staff sergeant who was badly burned in Iraq, has been named to a presidential panel that will study health care issues facing wounded veterans.
 

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News roundup for 11 March 2007 (slow news day; most articles are commentary):

(1) Bob Dole, the former Kansas senator, said more money may not be the answer... "We want to take a look and see where the problems are and see if it can be fixed. It may not need more money," he said. "It just may need clarification or somehow better coordination between the Department of Defense and the Veterans Administration.

(2) At Walter Reed, news reports and congressional hearings have made it clear that lower-ranking and noncommissioned officers knew about the conditions under which hundreds of wounded and recovering U.S. soldiers lived until last month. It appears that those near the bottom of the chain of command found the squalor unspeakable, but word of it didn't move upward along the usual channels, and those at the top never "walked the barracks" to preempt trouble... "There's a need for anyone in a leadership post to walk around, to talk to people, to not rely on subordinates only," a predecessor of Kiley as Army surgeon general, retired Lt. Gen. Ronald Blanck, told me last week. Blanck did not criticize Kiley directly, but he spoke proudly of military medicine's tradition of outspokenness from below.

(3) Cardiologist S. Ward Casscells, nominated for a top Pentagon health post in the aftermath of the Walter Reed Army Medical Center scandal, saw the resilient, no-nonsense face of military medicine during a tour of duty in Iraq... Casscells said he would like to instill the disregard for bureaucracy and the interservice cooperation he saw in Iraq throughout the military health system.

(4) Brig. Gen. Michael S. Tucker has been named deputy commanding general at Walter Reed Army Medical Center to steer changes in patient care... "He's going to be the guy that we look to to be the soldiers' and families' advocate as they go through inpatient and outpatient (care) but also he's going to be the bureaucratic buster and take on this bureaucracy that at times frustrates our soldiers," Gen. Richard Cody, Army vice chief of staff, said of Tucker.

(5) Bob Dole wants Walter Reed to remain open... Dole said Walter Reed had too much history to close.
 

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Its the typical move to allow high ranking officials to leave with all their bennies, and take ZERO resposibility and ZERO accountability. If someone court martialed him for deriliction of duty, then maybe others in his position would actually say something about their jobs other than tow the line and wait for the next boss. Its a problem inherent in military service and not likely to change.

This is why MILITARY medicine will never change.
 

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Its the typical move to allow high ranking officials to leave with all their bennies, and take ZERO resposibility and ZERO accountability. If someone court martialed him for deriliction of duty, then maybe others in his position would actually say something about their jobs other than tow the line and wait for the next boss. Its a problem inherent in military service and not likely to change.

This is why MILITARY medicine will never change.

I don't know . . . I think this type of thing happens pretty frequently in the civilian world as well. CEOs come to mind with the whole golden parachute thing.

While I think Kiley is a piss poor leader I don't know if it would be possible or even a good idea to try and prove that he did something criminally wrong. In fact, he probably didn't. He's just a dirtbag. So your court martial thought probably wouldn't make it out the door. Much easier to just gid rid of him than drag out a tenuous case.

And I think that this sort of 'firing' of high ranking officers/civilian leadership does send a strong message to the flag officers of tomorrow.
 

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I don't know . . . I think this type of thing happens pretty frequently in the civilian world as well. CEOs come to mind with the whole golden parachute thing.

While I think Kiley is a piss poor leader I don't know if it would be possible or even a good idea to try and prove that he did something criminally wrong. In fact, he probably didn't. He's just a dirtbag. So your court martial thought probably wouldn't make it out the door. Much easier to just gid rid of him than drag out a tenuous case.

And I think that this sort of 'firing' of high ranking officers/civilian leadership does send a strong message to the flag officers of tomorrow.

You're right, we've seen in the last few years a large number of corporate scumbags get away with very nasty white collar crimes that have ruined thousands of people's lives. But at least there has been an attempt at justice with some of them. This guy gets off scott free, with all his benefits to show and a cushy job in the civilian world surely to come. If people know that be gross incompetence, or neglect , the most they can get is asked to leave a few years earlier than they planned, there will be no incentive to change.
 

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On the plus side, FOX news is running an article talking about how maybe we should rethink social medicine, because the author correctly realized that the model the goverment will implement will be based on TRICARE. If the military has to routinely refer out to civilians, what are civilians going to do, refer out to the military? Yeah, that's a vicious death cycle.

Although I haven't had the chance to see the feature referenced, it doesn't make any sense on the face of it. The massive, yawning difference between the concept of socialized medicine and TRICARE, as I understand it, is that there IS nowhere else to refer to. Canadian healthcare works pretty damned well, but part of the problem is the giant pot of gold for a doc just south of the border. Without the portal through which a brain drain could occur (where are docs going to go to find a privatized system, Mexico?), the medical population would stay in place, albeit somewhat less well compensated.
 

chopper

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You're right, we've seen in the last few years a large number of corporate scumbags get away with very nasty white collar crimes that have ruined thousands of people's lives. But at least there has been an attempt at justice with some of them. This guy gets off scott free, with all his benefits to show and a cushy job in the civilian world surely to come. If people know that be gross incompetence, or neglect , the most they can get is asked to leave a few years earlier than they planned, there will be no incentive to change.

I'm not talking about ENRON here or white collar crime. Those guys did something CRIMINAL - cooked the books, etc. I'm just talking about CEOs who do a poor job, and still get paid millions. Poor leadership.

If it came out that Kiley had recieved a personal kickback from a contracting company involved in this whole issue, then yes - send him before a court martial. Trust me, I would love to see this guy raked over the coals.

But a court martial is a CRIMINAL thing. What did he do that was patently ILLEGAL? Did he lie under oath? Did he take money under the table? Did he boink a subordinate? UCMJ here - is there a category for 'BAD LEADER'?

Maybe there should be . . . but then I'm sure we would have far fewer flag officers out there.
 

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Canadian healthcare works pretty damned well, quote]

Really? You have evidence of this? You can tell my grandfather who waited 6 years for his cataract surgery how well it works...oh wait, no you can't, he died before it happened.
Preface this by saying I lived in Canada for 18 years, so yeah, I have ample evidence.

But to mollify my comments, I'd say it works very well in the context of mass migrations of professionals out of the market. With the math working out that way, I'd say it works better than logic would suggest.

Plug the drain, and the labor market would stabilize. Mind you, not to the benefit of the labor, but probably a net gain for the society they serve.
 

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I'm not talking about ENRON here or white collar crime. Those guys did something CRIMINAL - cooked the books, etc. I'm just talking about CEOs who do a poor job, and still get paid millions. Poor leadership.

If it came out that Kiley had recieved a personal kickback from a contracting company involved in this whole issue, then yes - send him before a court martial. Trust me, I would love to see this guy raked over the coals.

But a court martial is a CRIMINAL thing. What did he do that was patently ILLEGAL? Did he lie under oath? Did he take money under the table? Did he boink a subordinate? UCMJ here - is there a category for 'BAD LEADER'?

Maybe there should be . . . but then I'm sure we would have far fewer flag officers out there.
Negligence can be a criminal offense.
 

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It would actually surprise me if he got a good job in the civilian world. Would you hire him right now to do anything related to medicine?
Consultant, lobbyist, networker. He's still well connected, and as such, will find more than comfortable means awaiting him.
 
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