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DoD Press Briefing On Outpatient Care And Administrative Processes At Walter Reed Army Medical Center And The National Naval Medical Center

Presenters: Dr. William Winkenwerder, Assistant Secretary Of Defense For Health Affairs; General Richard A. Cody, Vice Chief Of Staff Of The Army, Accompanied By Lt. General Kevin Kiley, Army Surgeon General
February 21, 2007
            BRYAN WHITMAN (Pentagon spokesman): Good morning, and thank you for joining us. Today we have some individuals that are here that can talk to you about the department's efforts with respect to the rehabilitative care and administrative -- meeting the administrative needs of our wounded service members. I know it's a story that many of you have been following, some of you have written on. But today we have some of our key people in the department that can address this issue for you. Dr. Bill Winkenwerder is the assistant secretary of Defense for Health Affairs. General Richard Cody, of course, is the vice chief of staff of the Army, and with him today he also has Lt. General Kevin Kiley, the Army surgeon general. Both Dr. Winkenwerder and General Cody are going to give you a brief overview and then are prepared to take some questions. 
 
            So with that, let me turn it over to Dr. Winkenwerder. 
 
            DR. WINKENWERDER: Thanks, Bryan. 
 
 
 
 
 
            Good morning. I'm glad to be with you today. General Cody and General Kiley and I are here to speak about the concerns raised in recent news media reports relating to the experience of service members at Walter Reed Army Medical Center while they are receiving outpatient care and rehabilitative care as a result of their wounds in military service. This service is valiant, and it deserves the respect and thanks of all of us and all Americans.   
 
            Let me begin by making an important point, and that is that the concerns that have been raised are not about the quality of the medical care or about the care and professionalism of the medical staff at Walter Reed. That is not the issue. Concerns have been raised, however, about the life experience, the quality of life experience of service members as they receive their outpatient care, which may take place over the course of many weeks and many months -- things like bureaucratic hassles, delays, problems with personnel systems and decisions moving through the disability determination process, lack of clear and timely communications, and for some soldiers, their housing. 
 
            Now, having said that the issues are not medical care issues by the strict definition, they are issues about caring for and supporting the whole person and his or her family. So they are equally important as the matters that the doctors and nurses and medical support staff are directly responsible for. And caring for the whole person is a matter of concern for the Army and for the service members of the Navy and the Marines and the Air Force and the Coast Guard, which is, again, caring for the whole person. 
 
            So let me just say, I know that General Cody and General Kiley will speak further regarding the reported issues and assertions and shortcomings that have been identified, but speaking for the Department of Defense, I want to say that several matters reported in the news media are serious matters, they deserve immediate attention, and they are getting immediate attention. They're problems that must be fixed and fixed immediately. Other assertions that have been made may not provide, at least in our view, a full and accurate picture, or they may not be totally correct. But that's not the issue. The issue is that our clear objective here and now is to not debate about any item or shortcoming, but to fix whatever problem exists and to fix it immediately. 
            Let me just say that whatever problems exist, they have to be corrected and the processes and procedures that need to be put into place to ensure that things happen properly, whatever the problem or condition of the service member for the entire time during their healing process or recovering from their wounds, that's what needs to be done. 
 
 
 
 
 
 
 
            I'm sure this is what the Army will do, and General Cody and General Kiley will talk about that. 
 
            I would like to speak briefly about just three matters before I turn the podium over to General Cody. First is the concerns of various other individuals and the knowledge of certain individuals about the situation described, or better stated, their lack of knowledge about some of these matters. Second is with respect to an independent review group that the department is establishing immediately or as soon as possible that will report back to the secretary of the Army, the secretary of the Navy and to my office in a short time period. And finally, just some personal observations based on my visit there yesterday to the Walter Reed facilities. 
 
            First with regard to the concerns and knowledge of my own, because I'm sure you'll ask me about that, so let me just go ahead and address it.
 
            This is my sixth year at my responsibility. I think most people know me as a very engaged and probing person in terms of asking about and knowing what's going on and visiting. This news caught me, as it did many other people, completely by surprise. I visit Walter Reed regularly. Before yesterday, I was just there three weeks ago. We regularly ask the question, "Do you need help? What do you need? If you need anything, we want to make sure that you have it." And I think that we were surprised.  
 
            I will also say, based on what I'm aware of, others in sort of the senior line of command were not aware of these issues, and certainly General Cody can speak to that as well within the Army. 
 
            Secondly, let me talk about the independent review group. This will be established as soon as possible. It will be a small number of people who can begin their work quickly, that will be a representative, independent group that can look carefully at the issues and report back on them in a short time frame. 
 
            Thirdly, just let me comment about my personal observations yesterday. I'll just say that my observation is that people are working hard. They care. They care about the service members. But clearly, in some areas the processes need to be improved.   
 
            And with respect to the facilities, they're very nice facilities for the vast majority of the service members there. If any of you have visited the Mologne House and other of the facilities, the Fisher houses are very nice facilities.   
 
            With respect to Building 18, there are some issues there. That housed about 80 to 90 servicemembers, and again, I'll let General Cody talk about this. 
 
            Let me just say in conclusion that we all share in the responsibility and accountability. There are those that are responsible on a day-to-day basis, and then others of us who have accountability up the line. We accept that accountability. 
 
 
 
            One of the matters I hope to learn about is why the problems and concerns were not raised up. I think that's an important issue, to identify why. I've talked to staff members in Congress, members of Congress, other people. I think it is fair to say that people -- Walter Reed -- it's a very open place. There's a lot of people out there visiting, and there certainly is every opportunity for people to voice concerns. I never received a concern from a soldier, a family member -- and we get concerns all the time directed to us, but we never got a concern sent our way about this issue, which is a little surprising. I'm not sure why that is. 
 
            And finally, let me just say, this is not a resource issue. There are resources to do all the things we need to do to take care of people. 
 
            So at the end of the day, I think this matter is about trust and the trust that we all have with the servicemembers and their families. The trust has been -- taken a hit here, and I think it's our job to repair that trust and to re-earn that trust, and that's what we're going to do. 
 
            So with that, I'm confident that will happen. And with this, let me turn it over to General Cody. 
 
            GEN. CODY: Thank you, Dr. Winkenwerder. 
 
            Many of you have read and heard reports this past weekend concerning the outpatient care of our wounded warriors at Walter Reed Army Medical Center. The secretary of the Army, Dr. Francis Harvey, and myself visited one outpatient care building mentioned in those reports yesterday, Building 18, and we were absolutely disappointed in the status of the rooms and found the delays and lack of attention to detail to the building's repairs inexcusable. 
 
            I am disappointed that I had to learn about the conditions of that building through media reports. Despite frequent visits to Walter Reed facilities, informal and formal discussions with patients and their families and the medical staff, I have never been made aware of Building 18, its condition or complaints by any of our wounded warriors over the last five years. That is not an excuse by any shape or form. Clearly, we've had a breakdown in leadership and have bureaucratic medical and contractual processes bog down a speedy solution to these problems. I can assure you that the appropriate vigor and leadership is being applied to this issue, and we will correct any problems immediately. 
 
 
 
 
 
            I will personally oversee the plan to upgrade Building 18, and we'll soon change the name of it. Referring to a place where our soldiers stay as "Building 18" is not appropriate. We own that building, and we're going to take charge of it and other facilities. I will oversee and ensure that our soldiers and their families, who have sacrificed so much, receive the care and the housing they so deserve as they go on their road to recovery. 
 
            Army medical care is the best in the world. Each day selfless and dedicated doctors, nurses and support staff perform miracles to save lives and limbs, and provide the best possible care for our wounded warriors and their families. What has been discovered at Walter Reed in Building 18 and dealing with our outpatient care must not overshadow the incredible work of our medical professionals throughout the world. 
 
            We will do what's right for our soldiers and their families, and our soldiers and their families need to know that the Army leadership is committed and dedicated to ensure that the quality of life and the quality of their medical care is equal to their quality of service and sacrifice. 
 
            With that, I'll take your questions. And Bill, I don't know if you want to join me.   
 
            Yeah? 
 
            Q     General Cody, you said that you were unaware of this until media reports. Aren't buildings like Building 18 inspected regularly? And if so, how could that happen? And you said there was a breakdown in leadership.   
 
            GEN. CODY: Sure. 
 
            Q     Where did that breakdown in leadership occur? 
 
            GEN. CODY: First off, this is a building of 54 rooms, across, as you know, from one of the gates right there on Georgia Avenue. The Army took possession of it in 1999 or 2000. I can't remember the date that we took total possession of it.   
 
            Any building that we own and any barracks that we put our soldiers in, we have standards. And those standards go from every -- from the type of furniture we have in it, the climate control, the upkeep and housecleaning of that facility, as well as, in a case where we have soldiers living that are provided medications, health and welfare inspections to make sure that our soldiers are properly being taken care of. 
 
            None of these types of inspections or the rigor of these inspections, I'm convinced, were done in an appropriate manner.   
 
 
 
            The building has been upgraded several times. I've reviewed some of the upgrades that they've had. And as Dr. Winkenwerder said, this is not an issue about funding. It's not an issue of resources. This is an issue about -- we have a very high standard for the care of where we put our soldiers, especially those that are recovering and on the road to recovery, and we were not meeting that standard.  
 
            And appropriate actions are being taken care of to hold the leadership at every level accountable, as well as to ensure that they understand the standard. And we put the right people in charge at the right level of rank and the right level of responsibility to -- one, to immediately correct it, but also to make sure this doesn't happen again. 
 
            Q     Well, do you believe that leadership breakdown occurred? 
 
            GEN. CODY: I'd rather not say. I'll take responsibility. I'm the vice chief of staff of the Army. I'll take responsibility for this, and I'll make sure that it's fixed. But I'm not here today to lay out at what level. We know what level. I've had meetings with those people, and the appropriate actions have been taken. 
 
            Yes. 
 
            Q     How many patients do you have in Building 18? 
 
            GEN. CODY: Building 18 has 54 rooms, they're double rooms. Right now, we have 69 soldiers that are on medical hold-over and medical hold, as well as another nine -- excuse me -- another seven soldiers. So we have 76 soldiers in those rooms right now. We have two empty rooms. Dr. Harvey and I went through the two empty rooms that were being renovated. When I talk about renovations, taking care of the mildew on the walls, as well as some of the ceiling and some of the molding around the bathrooms. These rooms are typical of some of our two-man rooms that you see in our barracks that some of you have gone through. They have a private bath and shower and sink, refrigerator and very nice furniture. I was happy with the quality of the furniture that we have put in there. 
 
            But the upkeep of the infrastructure, the walls and stuff, wasn't up to speed. We went through some other rooms that soldiers were living in, and they went from everywhere from being very good to not being good, and that's the leadership issue that we've got to address. 
 
            Q     Just to follow up, can we say that in the Walter Reed Hospital there is only 76 soldiers in bad condition? 
 
            GEN. CODY: I believe that is a true statement. As you know, many of you have been to the Walter Reed wings. I just -- I go up there quite a bit, more than once a month. And in our wards, those rooms and the upkeep there are excellent. The Malone House, the Fisher Houses, where we house our amputees and soldiers and other soldiers that are seriously wounded, the upkeep of those are in great shape. 
 
            This is an anomaly that's going to be fixed and addressed. 
 
            Yes, sir.  
 
            Q     As part of your review of medical facilities, does the Defense Department plan on looking on facilities beyond Bethesda and Walter Reed -- specifically, any facilities in Europe and Asia?   
 
            DR. WINKENWERDER: As you know, the facilities, the two main facilities that take care of the large majority of the returning service members are Walter Reed and Bethesda. So those two sites take care of the major volume of the workload. And the independent group will look at both sites, obviously probably focusing more on Walter Reed, but will look carefully at both sites. I'm also informed by the chief of Naval Operations that he has directed an inspector general just review to make sure that there are no other issues at any Navy facilities. We don't have any indication of that; no concerns, no complaints, no data that would suggest that.   
 
            Q     So all naval facilities will be looked at?   
 
            DR. WINKENWERDER: He -- I'm not going to -- it was a very brief conversation, but my understanding was it was focused on Bethesda. If there are any other issues at other sites, any indication of that, we'll look at it. But we don't have any indication of that.   
 
            Q     Dr. Winkenwerder?   
 
            DR. WINKENWERDER: Yes.   
 
            Q     Why Bethesda? I know it's near --  
 
            DR. WINKENWERDER: I think candidly it was just because there were a couple of anecdotes in the stories that related to experiences that people had at Bethesda. And you know, there are Marines that are there that go to Walter Reed and back, I mean, and we're in the process of bringing those two facilities together over the next few years. So I think the fact that it is a receiving site for a large number of servicemembers, we wanted to make sure that everything was checked out fine there.   
 
            Q     But you are considering looking at other facilities where wounded vets are being treated, such as --  
 
            DR. WINKENWERDER: If we need to, but that will not be the focus of the review group that will be on those two main sites.   
 
 
            Q     General, does the review include practices and procedures used at the hospitals, both Reed and Bethesda? One of the complaints you hear from the troops particularly is about formations, daily formations and some of the difficulties that they have complying with that, and some say it borders on harassment.   
 
            GEN. CODY: We are looking at -- I'll speak for Walter Reed. We are looking at all procedures in terms of handling of our soldiers as well as their families.   
 
 
 
            The Family Assistance Center, the Army Wounded Warrior Program that we stood up to take care of our 1,600 seriously wounded soldiers -- those procedures, the medical evaluation board procedures, the physical evaluation board procedures, as well as how we account for our soldiers that are outpatient soldiers. We have some 176 outpatient soldiers that are for long care outpatient care that have -- we have changed the permanent change of station to Walter Reed, and they're living on the economy. We've got them in apartments and houses, and we did that so that we could continue their long-term care. 
 
            Also I think it's important to know that for the last three and a half to four years we have conducted several after-action reviews not with just the medical people that run Walter Reed, but with the Army staff, our personnel staff, our staff over at the Army Wounded Warrior Program. And we include family members, former soldiers that have gone through these different procedures, and they're part of our action group that provide us information. So we're constantly tweaking and trying to fix the bureaucracies so that we do not frustrate the family members and soldiers. 
 
            I will not be satisfied until we have a Family Assistance Center at Walter Reed where it's one-stop, it has an easy button, and the families and the soldiers all can take care of their financial issues, their scheduling issues, their follow-up care issues, as well as any other issues that they or their family members have. Right now we're close to that, but it's not to -- it does not meet my standard nor the leadership standard. And I've directed General Weightman and General Kiley and the Army staff to fix that, and you'll see that being fixed very quickly. 
 
            But we include Army-wounded warrior soldiers and their families as part of our after-action review, and these are ongoing. 
 
            Yes. 
 
            Q     General, you said appropriate action has been taken. Has anyone been relieved of command or fired? 
 
 
 
            GEN. CODY: No. We will do the right thing across the board as we continue to assess where the leadership failure and breakdowns were. In some cases -- I'll just say it as plainly as I can -- we had people that were put in charge that did not have, in my mind, in my experience, the right rank and the right experience to be -- and the authority to be able to execute some of the missions that was required. 
 
            In some cases we have some of our own wounded soldiers that have volunteered to be -- have charge of quarters duties. I think that's appropriate because that helps in the rehabilitative process, and who knows better how to answer some of the issues than our wounded warriors taking care of wounded warriors.   
 
            But at certain levels, we should have had higher level non- commissioned officers, and we should have had higher level officers overseeing Building 18 in the outpatient care, and that's what we're correcting right now. 
 
            Q     This is not necessarily a new issue. We saw similar things when it came to the Vietnam War. At the outset of hostilities, did anybody say, within the leadership, what are we going to do to make sure this doesn't happen again? If not, why not? 
 
            GEN. CODY: Well, I think the comparison is not a good one. I mean, when you take into account that we've had over 6,000 patients go through Walter Reed, over 2,000 of them with battle injuries, 31,000 soldiers evacuated during this five-year war, 4,000 of them having battle injuries, we have constantly reviewed, since 2002, as an Army, under General Kiley's leadership and now General Weightman's, how we will handle our outpatient care. Quite frankly, we are doing much, much better in terms of holding soldiers in active duty status, National Guard and reservists, so that we can fix all their medical care and not discharge them and put them on the civilian system. And so we are holding on to soldiers a lot longer so that we can take care of them.   
 
            What we have not done a good job in Building 18 is the quality of life of where we put these 69 soldiers, and we're going to fix that. 
 
            Q     General, in addition to the infrastructure fixes, which are ongoing as we see, any other sort of quick fixes that you see immediately in terms of, A, the physical and mental evaluation boards; B, getting these guys -- just basically some of them across the street so they can -- (inaudible) -- in cold weather, instead of being afraid of (slipping ?) -- 
 
            GEN. CODY: All of these soldiers -- I sat and talked to several of them. All the soldiers that are in this building right now are ambulatory. 
 
            Some have arthritis, some have -- recovering from knee surgery but they're ambulatory. Others have other medical conditions that I really don't want to get into. But again, we're looking at making sure some of the things you saw -- read in the paper, we'll correct those things.   
 
            I did not see those when I talked to all the soldiers. In fact, I asked several of them, I said, "What other problems are you having?" and they brought up other things that, quite frankly, weren't brought up. And we'll go ahead and address them. And that speaks to their candor and their willingness to address the issues. 
 
            Dr. Kiley and Dr. Weightman are going to fix the appointment process. That has been a frustrating thing for these 69 soldiers. And they're going to streamline that. That's part of this family assistance group, as well as a one-stop operation that I've directed to put in place at Walter Reed. That will speed up some of the process. 
 
            But as you know, in some of the types injuries that we have, we have to be very, very careful to go through and do -- we have a very, very high bar that we hold our Army medical care to. And in some cases it is frustrating to the soldier, but we want to make absolutely sure that we have absolutely taken care of all the things that we need to do to either return him to his unit or return him to his civilian life. And it is frustrating sometimes, but I'm convinced that the care we're giving him is the best. What we need to do is a better job of streamlining the bureaucracy. 
 
            MR. WHITMAN: We have time for one or two more. 
 
            Q     General, you have said that you don't want to lay blame or talk about where the chain of command broke down, but the troops have a right to know what happened. So can you say who is at fault here and what actions have been taken? 
 
            GEN. CODY: I'm not going to address who's at fault. The senior Army leadership takes full responsibility for the lack of quality of life at Building 18, and we're going to fix it. And what our soldiers and family members need to know is that we will make all the corrective actions and put the right leadership in place and the right caring leadership in place so that this does not happen again. 
 
            Yes? 
 
            Q     General -- 
 
            MR. WHITMAN: We'll make yours the last one. 
 
            Q     You mentioned that none of the wounded soldiers had complained to you or come to you and brought up any of their concerns. Specifically with the structural -- the building problems at Building 18, do you have any indications that the wounded soldiers complained to people at Walter Reed, that they complained to some of the lower- level leadership there, and that then there was a breakdown from there on?   
 
            And do you know where that breakdown in communications occurred? 
 
 
            GEN. CODY: In some cases, the soldiers did complain, and they talked to me about it. And then when you start chasing and seeing where the breakdown was, it gets back to we didn't have the right rank structure, the right experience and in some cases, people were not holding themselves and holding the quality of life of Building 18 to the standards that we want for our soldiers, and that's where the breakdown was. 
 
            Q     But even before the article came out, was there -- do you have indications that there were complaints to people at Walter Reed from the wounded who were -- 
 
            GEN. CODY: That's part of the review we're doing right now. 
 
            MR. WHITMAN: Thank you.
 
 
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