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DoD Press Briefing with Secretary Gates, Mr. West, and Mr. Marsh on the Report of the Independent Review Group Care at Walter Reed and the National Naval Medical Center

Presenters: Secretary of Defense Robert M. Gates, Former Army Secretary Togo West, Independent Review Group Co-Chair, Former Army Secretary John Marsh
May 02, 2007
            SEC. GATES: Good afternoon everyone, and thank you for coming. 
 
            With me this afternoon are former secretaries of the Army Togo West and Jack Marsh, co-chairs of the Independent Review Group, a panel I named after learning of unacceptable outpatient conditions at Walter Reed Medical Center. I want to thank all of the men and women of the review group for their service.   
 
            I just met with the group, which consisted of nine distinguished military, medical and political leaders. They all agreed to drop pretty much everything else in their lives and address this serious problem. They took a broad look at all of our rehabilitative care and administrative processes at both Walter Reed and the National Naval Medical Center. They were also allowed access to any other facilities they felt needed to be included. 
 
            I asked them to complete their report in 45 days and to report on the conditions they found and create an action plan to fix any problems that they uncovered. They've done just that, and the department's Health Affairs Division and the Army have already begun implementing some of their recommendations. Again, I'm grateful for their willingness to take on this challenge, for the quality of their recommendations and for meeting a very short deadline. 
 
            Today I'm also announcing the formation of an oversight committee of senior military and civilian officials that will be chaired by Deputy Secretary Gordon England. This strategy and oversight group will ensure that the recommendations of this review group, the President's Commission on Care for Returning Wounded Warriors, and the Interagency Task Force are promptly and properly integrated and implemented, coordinated and resourced. 
 
            The committee will meet weekly and will consist of the service chiefs, or the vice chiefs, the chairman and vice chairman of the Joint Chiefs of Staff, as well as the senior civilian leadership from Personnel and Readiness, Health Affairs and other relevant divisions of the Department of Defense. 
 
            As I said when the Walter Reed problems first emerged, our nation is truly blessed that so many talented and patriotic young people have stepped forward to serve. They deserve the very best facilities and care to recuperate from their injuries and ample assistance to navigate the next step in their lives, and that is what we intend to give them. Apart from the war itself, this department and I have no higher priority. 
 
            I look forward to seeing some of these extraordinary men and women at Brooke Army Medical Center in San Antonio later this week. During that trip, I also will meet with Secretary Dole and Secretary -- with Senator Dole and Secretary Shalala, the co-chairs of the President's Commission. 
 
            I'll now turn this over to the co-chairs of the independent review group, Togo West and Jack Marsh, for a few comments. After their remarks, we will take some questions. I'd appreciate it if you all could ask your questions on the review group first, and then I'll hang around and take a few questions on unrelated matters. 
 
            MR. WEST: Thank you, Mr. Secretary. 
 
            First off, thank you very much for your announcement of a new group that's been appointed to help you oversee the implementation on the review of the recommendations we made. If I could say there was a fondest hope and a greatest concern for any review group such as this, it is what happens to the report, where does it go, who does anything about it. 
 
            I think we've just heard about your intention to see that it goes front and center and that very responsible people in the department will be focused on seeing that it is reviewed and implemented. 
 
            Four questions in our work pretty much summarize what we've looked at and what we've seen and what we've concluded.   
 
            First -- Who are we as a society? We say a lot about ourselves about how we -- in the manner that we treat those who have been wounded in their service to the nation. And so, though we perceive ourselves as a nation that is grateful, that is honored by the service of its wounded veterans and service members, and that shows its support, our review suggests that our service members and their families who are wounded have not always seen it that way. And thus, our report contains recommendations for more case workers, the assignment of physicians who will coordinate the work of others working on a particular case, an improvement in attitude in general how we show our gratitude to our wounded service members. 
 
            Second question -- Where are we going? The BRAC process, the A- 76 process, have taken an institution, a distinguished one like Walter Reed, and made its personnel uncertain as to the future of the institution, perhaps a little fragile. We need to improve that. We need to review how those two processes apply to medical centers. And our report contains recommendations to that effect. We do not recommend that Walter Reed be taken off the BRAC list but, rather, that the process, since it is now under way, be expedited in whatever way is possible, that the preparation at Bethesda and at Belvoir to receive those functions get under way quickly and be advanced.   
 
            Thirdly -- What's happening to our service members in this wartime context? The advent of IEDs, their concussive impacts on the brains and they psyches of our service members means that of the four signature wounds, injuries, that we identify in our report, one is having a most profound impact: traumatic brain injury.  
 
            In our report are recommendations with respect to how we might respond to that as a society and within the Department of Defense and in VA as well. The major recommendation, of course, is for a center of excellence to be established, not one that already exists, a new one that can bring together all the aspects of both understanding this and dealing with it for our service members. And we encourage the Department of Defense and the Department of Veterans Affairs to cooperate in this endeavor and to be willing to accept outside support and participation as well. 
 
            And the fourth question is: How long? The physical disability review process, the medical evaluation process is lengthy and segmented and has many different parts. To those of us within the departments who understand how it works, it all seems logical; but to vulnerable service members and their families, it seems a contradictory mass of several sequential reviews of several sequential decisions, compounded by confusing regulations, at a time when they are most vulnerable and least able to follow them. Our recommendation among several in our report, of course, is that every effort be made to make that into one process that involves both departments within the Department of Defense -- the military departments as well as the two Cabinet-level departments. 
 
            This has been an extraordinary experience for every one of the nine members that have been part of the IRG. Of it, this quick, almost life-changing 45 days, one experience was largest for me, and that is when I and several of our members went out to the airport at Andrews Air Force Base to see the daily plane -- well, except for Thursdays -- that brings our wounded service members back from Landstuhl here to Andrews sometimes within 36 hours of their having been wounded on the battlefield, with a complicated surgery and attention that they will require either at Walter Reed or at the National Naval Medical Center at Bethesda or at one of the other medical centers. 
 
            There on that plane, as part of that marvelous system that has brought them back from the battlefield, brought them into a steady state, transported them by the United States Air Force back on those palettes, on those stretchers are what America regards as their heroes. They are more than that. They are parts of America herself. 
 
            I, my colleagues on the IRG have been pleased, along with those who served them in our medical centers, to have served them. 
 
            Thank you. 
 
            MR. MARSH: Well, thank you, Togo, and also thanks to our secretary of Defense, who made every service and agency of the Department of Defense available to us, complete cooperation, has directed the Department of Defense and the medical community and others to assist us in this very important project. 
 
            You know, the care of the wounded soldier is a part of our national ethic and had been damaged somewhat by these reports in reference to things that had happened at the military hospitals, particularly in one phase of the stay at Walter Reed. And we want to reestablish that.   
 
            And members of our committee -- and incidentally, some of the members of the committee are here. A number of them are. And they have the expertise on many subjects that relate to medicine -- airlift, and questions -- we may want to call on them to give you an answer. 
 
            But if you look at what we were seeking to do -- and the secretary gave us a deadline of 45 days -- actually we were -- had completed slightly before that.   
 
            But it was broad, but it was limited. It was limited principally to Walter Reed and collaterally, in a more incidental way, to the National Medical Center at Bethesda, the Naval Medical Center at Bethesda. Those were the principal objects of our attention. 
 
            The perfect storm that Secretary West mentioned was very apparent at Walter Reed. 
 
            But I think it's also important that we realize that there are two phases to this medical delivery service. The first of that is the one that was referred to as the trauma situation, the wounding, attention and care on the battlefield events, through evacuation stations to Landstuhl, Germany, and then airlifted back in the United States and there a period of hospitalization.  
 
            That dimension of our medical program is superb. Everywhere we went, whether it were patients or other members of other services, all gave high marks to that.   
 
            Where it fell down was what might be termed the second phase at Walter Reed, where the individual completes the hospitalization, is then placed in outcare or outpatient status, and there goes into a title called either a holdover or a medical holdover, depending whether they're Guard and Reserve or active. And that is a very substantial population. The population of that group today at Walter Reed's probably around 640, 650 outpatients who are necessary -- that they stay in the area in order to obtain the medical attention. There it was breaking down and broke down very, very severely. And this is an area that we want to correct and we feel is being corrected.   
 
            And I would call the press's attention to the fact that the Army did an IG report that confirmed many of the things that I have said about that post-hospital treatment. And that is the area that we need to address.   
 
            Some of these things can be addressed by the Department of the Army. Some can be addressed by the Department of Defense. Some will have to be address by the executive branch of government -- for example, questions that relate to A-76 or Office of Personnel Management records.   
 
            Others will have to be addressed by the Congress of the United States. They will require legislation to reconcile areas of jurisdiction and responsibility between the Department of Defense and the Veterans Affairs Department of our national government. There is a place here for Congress to exert its leadership, which will be essential for successful resolution of this.   
 
            We're prepared to try and respond to your questions.   
 
            Q     There has been reporting on some of these problems in the military medical system, and including at Walter Reed going back to 2003. Do either of you or did the IRG at all develop any insight at all as to why it took so long, and why it took an expose from The Washington Post to get action on these problems?   
 
            MR. WEST: Let me put it this way.  We are engaged in a shooting war in two combat theaters. The numbers that result from that of the wounded, combined with the extraordinary advances in medical care from our military medical personnel, means that we have, for want of a better term, a kind of ongoing surge of patients through our flagship medical institution, Walter Reed. That kind of a stressor, that kind of a push, will always show the weaknesses in the system much more clearly than the more ordinary period of peace, where a system is able to function even when there are little cracks that are developing there. I think that is the reason we see it now.   
 
            I don't have the answer for the original question you asked, for, why didn't we see it sooner? I think a system which is producing extraordinary medical care, and where you can do what I did during one afternoon and go sit in the reception area at Walter Reed Medical Center and just talk to whoever happened to come in -- true outpatients, outpatients who were not at the medical center but who were living outside -- and say, well, how's it going; what do you think? Not a one said anything other than, so glad it's here -- best medical care, best treatment. Well, if you're getting that on a regular basis, then you miss what may be happening with, oh, you know, electrical wiring, or what you might see if we were asked to open up for billetting places we haven't had before, or if we've just had a much larger number, 650, at one time 800, in a medical hold facility that didn't have nearly that many before.   
 
            MR. MARSH: Additionally, we in the report noted that there was a breakdown in the system or methodology of reporting complaints and concerns. We -- there were some soldiers who had indicated that they tried to complain about it, but nobody listened. One of the things we were recommending is that there would be established an oversight system whereby you can make those complaints and they'll move immediately to the senior levels of the command.   
 
            MR. WEST: I guess the other thing I -- correct the record, too. Actually, the complaints were heard. Remember that Secretary Marsh referred to a very detailed inspector general's report of the Department of the Army. That was commissioned more than a year ago, and took a year to go through. And that was based on concerns that had been developed. So all of those factors come into play.  
 
            Q     Did you come up to a conclusion or a sense of why the Disability Board seemed to have such a hostile opinion in giving out their evaluations, the physical evaluations to the out patients? Because that's where so much of the complaint seemed to be, that these validators were giving low percentages whereby they just couldn't go forward -- (off mike). 
 
            MR. WEST: Let's let Dr. Roadman, if we could, Mr. Secretary, talk about that. We all have some ideas, and you have our report, but he's spent a lot on time on this. 
 
            MR. MARSH: Dr. Roadman -- he's the former surgeon general of the United States Air Force. 
 
            CHARLES (CHIP) ROADMAN: (retired surgeon general, United States Air Force) I think that's an excellent question, and it looks as though systems were in place to limit benefits awarded rather than try to make decisions that benefited the soldier, sailor or airman. And our concern is that that system needs to be relooked at and the leadership and culture of that needs to be completely reworked, and that was part of our report. 
 
            It was the feeling of the IRG that if we take a young male or female out of their community and they serve in the services, and we return them back to their community not in the same shape that they were, that we need to either fix that or compensate them. And that's a different mind-set than what has evolved. 
 
            My view -- and it's my own personal view, Mr. Secretary, as I give this -- is that the PDES system is a draft era, 20th-century bureaucratic system that we're trying to adapt to an all-volunteer force in the 21st century, and, quite frankly, they don't quite mesh, and the soldiers, sailors and airmen are -- and Marines -- are actually getting caught in that trap. As you know, in our report we recommended a very thorough review retrospectively to assure consistency, thoroughness and fairness of those decisions. 
 
            Q     And if I can just follow up, when you mentioned there was a 30-year lag time between the draft and the all-volunteer force, that -- all of a sudden this came up to the public knowledge? 
 
            DR. ROADMAN: Well, you know, as you frame that with public knowledge, I think the real issue is this is a system that has evolved over time, that, quite frankly, as we deal with new diseases -- and Secretary West and Secretary Marsh referred to traumatic brain injury, as an example -- that would be a poster child disease of conditions that actually we don't believe the PDES has prospectively been able to take care of. 
 
            So we're seeing different injuries. We're seeing a scale that is different in the number of people that are coming back. That always stresses a system, but we also believe that there are a culture of a system that needs to be changed. Does that answer your question? Okay. 
 
            Q     Mr. Secretary, do you support the IRG's recommendation that Walter Reed stay on the BRAC list and that the Environmental Impact Study for Bethesda be accelerated or waived? 
 
            SEC. GATES: I won't speak to the acceleration or the waive. I think the general view of people that I'm talking to here in the department and as well as the IRG is that Walter Reed is still at this point a very old facility, no matter how much money you put into it, and far better to make an investment in brand-new 21st century facilities at Fort Belvoir and at Bethesda, and how can we accelerate getting those facilities in place, and how can you keep high-quality staff at Walter Reed right up until the day that people transfer to one of the other hospitals. 
 
            So that's a roundabout answer to your question. I haven't -- you know, right now the status is it is on the BRAC list. My own view is that based on what I know at this point, it probably ought to stay, but we ought to have the flexibility to make sure that it stays open until Bethesda and Fort Belvoir are completely ready to take on the responsibilities of the patients and the staff that are at Walter Reed now. So there shouldn't be -- Walter Reed should not be closed unless those other facilities are ready to go, in my opinion. 
 
            Q     Mr. Secretary, in the report there are several recommendations that specifically mention changes to Walter Reed, like assigning a single physician to a returning casualty. I wonder why you didn't apply that, even though the scope was meant to be Walter Reed and the National Naval Medical Center, to other facilities that are treating returning casualties. 
 
            MR.
 
             : (Off mike.) 
 
            Q     I wonder why you didn't include the verbiage to -- or extend that to other facilities that are treating returning veterans, such as -- wounded veterans, such as Brooke Army Medical Center and so forth. And was that the intent, to see DOD do that? 
 
            MR. MARSH
 
             : That related to the charter that we were given.   
 
            We were directly tasked to address the situation at Walter Reed and in a collateral way as that impacted on Bethesda. 
 
            Now, the surgeon general who just spoke to -- is very aware of the situation at -- (inaudible) -- I mean, Brooke Army Medical Center, and I'm sure he can speak to that because he raised issues about it to the -- 
 
            DR. ROADMAN: Yes, sir. We -- as the secretary said, we actually went to several other facilities in order to be able to get a feel for the issues that we were seeing at Walter Reed and at Bethesda. Specifically, we went to San Diego Naval Medical Center in Balboa. We went to Wilfred Hall USAF Medical Center in San Antonio and Brooke Army Medical Center in San Antonio. 
 
            The important thing to keep in mind -- and I'm -- I'll get around to your question -- but the important thing to keep in mind is the scale of the number of returning casualties at Walter Reed, in military terms, overran the systems, and so they became apparent. The level of care being delivered at the other facilities is, quite frankly, much smaller, and therefore, much more manageable. 
 
            The -- your question about having a primary physician assigned to -- philosophically, that's the issue of health care in America, and one of the things that we have in our report, not stated explicitly, but in-patients are really in and outpatients are really out. And that's true whether you look at civilian health care or military health care. It's particularly acute if you have people that are in rehab care on a campus. 
 
            So as you're reporting, you also need to point out the difference between acute care and rehabilitative care, and those are fundamentally different issues in delivering care. And so you have to be able to differentiate those. 
 
            We did think -- we do think that everybody should have a physician period, and -- but what we saw at Walter Reed and at Bethesda was Bethesda had actually cracked the code. They had a holistic approach so that one trauma surgeon was responsible for the care of every one of the patient and all the care they were getting. It's what we call very holistic care for the patient. Quite frankly, at Walter Reed, the scale was so high that they could not do that. We did point out that Bethesda is a model to be emulated, and quite frankly, that's expandable over a great deal more even than military health care.   
 
            SEC. GATES: Can I just add one thing to that?   
 
            Although the charter of the group was to focus on Walter Reed and to a lesser extent Bethesda, I think I can assure you that all of the services, including the Army, are looking at this report in terms of, how does it affect the other facilities in those services, and what of these recommendations need to be applied elsewhere beyond Walter Reed and Bethesda? And frankly that's one of the issues that this oversight group that I mentioned that Gordon England will chair is going to be looking at.   
 
            MR. WEST: On your specific question, I think the view of the IRG is that the concept is a good one everywhere, okay?   
 
            Q     The release we have here says that the Army has accomplished or is addressing 24 of the findings of the group out of the 26 recommendations. What are the two recommendations that they aren't pursuing yet? And why aren't they pursuing them?   
 
            MR. WEST: I have no idea. Do you --  
 
            DR. CHU: (Off mike) -- issues the Army cannot by itself take action on, so legislation is required -- (off mike) -- for what the Army can't do by itself. And I would emphasize, the Army has addressed a portion.   
 
            MR.
 
             : Could you use the mikes please?   
 
            DR. Chu.
 
             : Sure.   
 
            The Army is addressing portions of the 24. I don't think I want to pretend that every issue that's raised in each of the 24 is something the Army has decisively dealt with. But they have addressed themselves to each of those 24 areas in some fashion.   
 
            Q     Mr. Secretary, can I ask you a question off-topic here?   
 
            SEC. GATES: Are we done with the secretaries? I don't want to subject them to -- (laughter.)   
 
            (Cross talk.)   
 
            SEC. GATES: Thanks. Yeah.   
 
            Q     Mr. Secretary, Secretary Rice is in the Sharm el-Sheikh, and she's not ruling out meeting with the Iranians off to the side of the meeting there. Is this -- is that an indication that the Iraq Study Group's recommendation of meeting multilaterally in the region with Iraq -- Iran and Syria is coming to fruition?   
 
            SEC. GATES: Well, I think that first of all, the -- Secretary Rice would be the first to tell you that she's always been willing -- first of all, we've always been willing to talk with the Iranians at the ambassadorial level in Baghdad.   
 
            Second, she's always been willing to meet with the Iranian foreign minister in -- as long as they were willing to forgo -- on a broad range of issues if they were willing to forgo enrichment. 
 
            I think what is different than what the Iraq Study Group had in mind is that, as I understand it -- and I haven't read her talking points, so I don't really know for sure, but as I understand it, whatever dialogue there is on substantive matters, if she were to have a conversation with the Iranian foreign minister, would be focused on trying to get the Iranians to stop destabilizing Iraq and to stop taking actions that result in the deaths of our servicemen. 
 
            So it will be -- my impression is that the dialogue -- any dialogue that takes place will be focused on Iraq. 
 
            Q     Mr. Secretary, could I ask you about the current process involving Congress and the White House with regards to the supplemental? Is it your view that a bill which could include benchmarks which could apply pressure to the Iraqi government would be helpful? You yourself have encouraged them to move swiftly with reconciliation legislation. Could a supplemental bill which includes those goals with benchmarks explicitly be helpful? 
 
            SEC. GATES: I think that the real issue -- and I don't want to -- I really shouldn't say very much about this, because the fact is, the president's meeting with the bipartisan leadership right now -- I think one of the issues will be to what degree are there consequences involved if one or another benchmark isn't met. But I would defer, frankly, to the dialogue that's going on at the White House right now. That's probably well beyond what I just said and probably makes what I said irrelevant. 
 
            Q     Mr. Secretary, during the debate over the supplemental, many members of Congress had argued that the U.S. military operations, at least in Iraq, could continue at the same level without being hampered at all by a lack of funding well into July. What is the time frame at which the U.S. military would start to feel the pinch of not having this supplemental passed? 
 
            SEC. GATES: Well, first of all, we will take every action necessary to -- for as long as possible, that the troops in Iraq not be impacted by the failure to get the supplemental. 
 
            The impact that we've been talking about, if the supplementals were not to be passed by April 15th, were not to be passed by May 15th, and so on, has really been on the disruptive impact on the Army here at home in terms of -- and on the other services as monies are transferred to cash accounts, and so on, to try and keep the flow of money supporting the war in Iraq flowing. So the consequences that we've been talking about on the Hill and internally really are focused on what happens here at home in terms of delaying construction, delaying some kinds of training, delaying hiring, delaying travel, delaying those kinds of things. So it's really more focused on the situation here at home. 
 
            Q     Sir, the administration has staked so much on this issue of timelines and inserting them into the operational picture that would completely and fundamentally, apparently, undermine the effort in Iraq. Certainly there are those who believe that timelines are not going to undermine the effort. Can you just talk a little bit more here now again about why telegraphing this intention to the enemy really changes the fight in Iraq? 
 
            SEC. GATES: I think it's -- I think it's -- you know, as was pointed out, I've talked about how I thought that the debate on the Hill was useful in terms of letting the Iraqis fully understand the impatience here at home and the importance of their getting on with their domestic reconciliation, and the importance of the political reconciliation to the success of the enterprise in Iraq.   
 
            But I think it's actually a pretty straightforward matter. If you pick a certain date and say the troops are coming out on a certain date, everybody basically just gets to sit back and say, okay, we got 90 or 100 days that we've got to wait. All we have to do -- all that al Qaeda and Jaish al-Mahdi and all the rest have to do is say, you know, "We've got X days until these guys are gone. So husband your resources. All we have to do is make the run for the money in a specific period of time."   
 
            As long as there's some uncertainty about that, it seems to me that they don't have that luxury. 
 
            Q     But if you can put a timeline out into next year, is there not enough time for the Iraqis to build up? And also, doesn't that have a value to defuse the situation here to some degree, and the debate the other way, to some degree, and you can -- (inaudible) -- kind of move forward? 
 
            SEC. GATES: Well, I don't think any of the -- as far as I know, none of the timelines -- I mean the front end of the specific timelines were not next year, they're this year. 
 
            Q     Thank you. 
 
            Q     Mr. Secretary, if I could just ask one last question, have you been talking to members of Congress about your meetings with the Iraqi government in the recent weeks and talking to them about sort of what effect their debate has had on Iraq? And is there a role for you, seeing as you're one of the administration's figures with the most credibility on the Hill at this point, in terms of working out a compromise between the White House and Congress? 
 
            SEC. GATES: No. I mean, my talks -- my most recent talks with the Iraqis and the ones that were probably the most candid were just two weeks ago, and I ended up having to turn around and make another trip last week. So I have not had an opportunity to sit down with anybody from the Hill. 
 
            Q     (Off mike) -- to meet with members of Congress on this? 
 
            SEC. GATES: I'm happy to meet any time they want. 
 
            Thank you all. 
 
            Q     Thank you.
 
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