The Walter Reed scandal is nothing new.The good news is that DanaPriest at the WAPO did an expose on Walter Reed’s decrepit condition.

The bad news is that this was general knowledge for years, and so in 2005 there was even talk of shutting the place down .
The linked article merely says the plan to shut WRAMC was part of a “consolidation” but this is government jargon that means it’s inefficient to fix the place, so shut the damn place down.

I don’t have personal knowledge about WRAMC, but I suspect the shutdown plan was why a lot of stuff only got a temporary fixing, and that some problems were ignored if they could be lived with.

But then the war in Iraq continued to cause casualties, so they decided to keep the place open. And alas, it was easier to tell the soldiers not to complain than to make waves and actually fix the place.

If I’m cynical about the matter, it’s because I’ve worked in city, state, and federal hospitals over the last 35 years, and gotten in trouble in all of them because of my big mouth.

You see, the idea is to “stay within budget” and “follow the paper guidelines” as being important. So ugly walls don’t matter, they’re painted, aren’t they? And if something leaks, well, the paper was submitted to the authorities last week to fix it, so stop complaining. If you complain too much, you find yourself getting bad evaluations for a negative attitude.

So although docs and nurses tend to be good hard working people, the idea is to “make do with what you have”.  And since to too many administrators, keeping within the budget is more important than making a nice livable person friendly place, you can see the result.

Usually the government institutions had concrete walls painted institutional grey/green or blue. (one place it was orange…enough said). Only “health” posters on the walls. In my office, I had a utilitarian steel grey desk with a utilitarian chipped examining table, with a utilitarian calender on the wall, with a utilitarian steel grey bookcase, with a utilitarian steel grey file cabinet.Stained carpet? well, if it was clean, it’s okay. Ditto for flaking walls and linoleum. If the bathroom is clogged, the nurse has to clean it, because the housekeeper is busy and only cleans once a day. And in the day before HIV was around, blood stained walls and ceilings and shoes were not uncommon in busy E.R’s.

The government does try to improve things, it’s just that it takes time to make plans and get approval and then wait for funding and then get a contract and then place the contract out for bidding, the then wait for the bids, and then….and then…
One of the best things that has happened for federal Indian Health Care facilities is…Indian Casinos. Once they got casinos, the tribes got money, and tribal officials made health care a priority. They took many IHS clinics over. So now you will see art on the walls and carpets on the floor…

Now, as a doctor, I back the idea of universal health care. But I shudder at single payer government health care… it’s bad enough to have a bureaucrat nix your treatment. What will happen if a bureaucrat discourages transfer to another facility because you can’t care for the patient? Or denies you specialized care until funding is available?

The problem is not for the bad cases, but the in between cases.

As a doc, I never had trouble getting a critically ill person seen.The delays usually were for the mildly sick. You broke your leg? Well, here’s a splint, and the secretary will make you an appointment on Monday…and you are seen Friday.

But if you have a bad knee, you might wait for months. No one ever died of a torn meniscus.

And so for me, the worst state scenerio is not 40 million without insurance (they end up getting seen anyway, and you bill medicaid retrospectively for major emergency care). My worst case scenerio is a government run universal health care, especially a Hillarycare type that forbids private alternatives. And then, you ration care to the elderly, the retarded, the handicapped…but you allow funding for assisted suicide. Don’t think it will happen here? Right.

So what should we do about the soldiers needing care? Well, I suggest the Frank Rizzo medical Plan.

Years ago, there was a newspaper expose on Philadelphia General Hospital, which was a dirty and chaotic place that cared for the indigent when I went to medical school. The reporters found deep structural and institutional problems. And so Mayor Rizzo, a man that made Attila the Hun look like Mr. Rogers, just shut the place down.

You can’t do that, cried the dogooders. Our people love going there (note: the dogooders lived in the Suburbs and wouldn’t be caught dead in PGH).

The mayor pointed out that with Medicaid the poor could go anywhere for their care., and often there were church or community hospitals in the poor neighborhoods that could care for them better than the old PGH. So he shut the place down, and….nothing bad happened. People just went to Germantown or Einstein or St. Agnes Hospital for their care, and did fine.
So maybe Bush should take a clue from Mayor Rizzo.

Once the soldiers are out of danger,give the soldiers insurance papers and a hot line, and let them be treated near their homes.

It would help my Okie patients if they could get treated in Tulsa instead of Walter Reed, and the hospital is probably a lot cleaner.

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Nancy Reyes is a retired physician living in the Philippines, Her webpage is Finest Kind Clinic and Fishmarket and she posts medical essays on Hey Doc Xanga Blog

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