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The New Walter Reed: Less Than 'World Class'?

By Stephen Schimpff
Columbia
Sunday, September 13, 2009

We Americans owe our servicemen and women, especially our wounded warriors, the very best in medical care. With the construction of a "new Walter Reed" in Bethesda, we have a unique opportunity to ensure that they get such world-class care. But for that to happen, much more needs to be done.

Care for military personnel in the Washington area has long been provided by Walter Reed Army Medical Center in Washington and National Naval Medical Center in Bethesda. But in 2005, the Base Realignment and Closure Commission (BRAC) mandated consolidating them into a new Walter Reed National Military Medical Center on the grounds of the naval hospital. This facility will provide primary and more complex care to all military personnel who live in the northern half of the Washington area, as well as tertiary care -- high-level specialty care -- to those from the entire region, including complete care for wounded service members.

About a year ago, after reports suggested that the new facility was not on track to meet a stated requirement of "world class" care, Congress passed legislation calling for a review by a subcommittee of the Defense Health Board. I was nominated to join this 15-member group by Sen. Benjamin L. Cardin (D-Md.).

There is much to commend in the work that has been done so far. For example, the view of the facility from Wisconsin Avenue will be very pleasing, with the iconic 1930s tower flanked by a new outpatient building and a revamped, extended inpatient building -- and these will provide not only good but excellent care. But a master facility plan has never been done for the campus, which serves multiple functions and includes many older buildings that, over time, should be replaced in an orderly manner. During our review, we were told that such a plan was not within the scope of the BRAC budget.

Similarly, no analysis has been performed to determine needs based on future local demographic changes (the number of retired military personnel in the area is increasing), changing types of wounds (such as from improvised explosive devices) or advances in the delivery of medical care. Instead, the consolidation was planned using a static approach, whereby the functions performed at Walter Reed were simply shifted to the future facilities. Again, the rationale we were given for this was that the BRAC law did not allow for any other approach.

This has led to other issues. For example, three operating rooms are being built for the new medical center. That's good; they will be up to modern size and technology standards. But seven older ones to be incorporated from the naval hospital will remain as they were constructed -- too small for all of today's operating room technologies -- and will depend on nearly 25-year-old air-handling systems. Logically, this is the moment to update those operating rooms. We also found that there would be no in-house simulation laboratories for learning and practicing operating room procedures and other hard-to-master technical skills, ostensibly because there is an excellent simulation facility a few miles away. These learning labs are critical to a modern hospital, but they must be immediately accessible to trainees to be useful.

One more issue: Most of the rooms at the naval hospital are semi-private. Today the standard is one patient per room, not just for privacy but for infection control and other medical imperatives. Only one floor of the new facility will be renovated to have private rooms. On the remaining floors are two-bed rooms and bathrooms that are too small for those with amputations or in wheelchairs. These should also be renovated, for obvious reasons.

Our report recently went to Congress. I hope it will encourage those in decision-making capacities to move ahead with a master facility plan, a true demand analysis and appropriate renovations to ensure that these issues and others are resolved before the new Walter Reed opens in a few years. It may require some rebudgeting, but our military personnel deserve no less than world-class facilities.

The writer is a retired chief executive of the University of Maryland Medical Center and author of "The Future of Medicine -- Megatrends in Healthcare." To read the Defense Health Board subcommittee's report, go to http://www.health.mil/dhb.

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