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A Congressional mandate to ensure the new Walter Reed National Medical Center will be a “world-class” medical center has turned into a war of words between the deputy secretary of defense and an independent review board charged with checking the military’s progress.

The new Walter Reed medical center is scheduled to open in 2011 at the campus of the Bethesda Naval Hospital in Bethesda, Md., under BRAC policy that will shutter Walter Reed Army Medical Center that is six miles away in Washington, D.C.

According to the Defense Health Board’s Base Realignment and Closing Health Systems Advisory Subcommittee, the Pentagon still needs:

• A master plan for the region’s medical centers as well as for the new Walter Reed facility itself.

• Continued budget funding for construction on the project.

• To determine who will be in charge of the joint facility.

• To make changes to fit the definition of “world class,” such as larger operating facilities and single-patient rooms.

Those findings come from a report submitted to the Defense Department on July 2 called “Achieving World Class: An Independent Review of the Design Plans for the Walter Reed National Medical Center and the Fort Belvoir Community Hospital.”

Pentagon officials overseeing the project “have to figure out who’s in charge; the authority issue has to be straightened out,” said Ken Kizer, chairman of the Base Realignment and Closing Health Systems Advisory Subcommittee, an advisory group for the Defense Health Board. “That and the budget and the master plan are the three paramount issues.”

On Oct. 15, Deputy Secretary of Defense William Lynn III wrote a letter to members of Congress stating that he concurred with the board’s findings. But, according to Defense Health Board members, Defense officials seemed to have misinterpreted the intent of the report.

“The key findings in the report indicate that construction should continue at both the Bethesda and Fort Belvoir sites while a comprehensive master plan for [Walter Reed] and a [National Capital Region] Integrated Delivery System is developed,” Lynn wrote.

Defense Health Board members say that’s not what the report means at all, and that they were “dismayed” that Defense Department officials felt the operations as they stand now are “sufficient” after seeing the report. They sent their own letter in response to Lynn’s letter to Congress:

“To be clear, the committee did not suggest that either the new construction or the total design plan as presently laid out would result in a world class medical facility,” states the letter from Kizer. “The committee clearly stated that the current plans were not those of a world class medical facility.”

According to the 2010 National Defense Authorization Act, the Secretary of Defense “shall develop and implement a comprehensive master plan to provide sufficient world class military medical facilities and an integrated system of health care delivery for the National Capital Region.”

But Lynn seemed to disagree that this is an immediate requirement.

“While Congress has specified that the new [Walter Reed] and [Fort Belvoir Community Hospital] should be designed as world-class military medical facilities, this is not an underlying requirement of the BRAC 2005 recommendations,” Lynn wrote. “Instead, the development of these facilities as world-class medical centers … will be an ongoing process, requiring continuous improvement and benchmarking to commercial best practices.”

Though the report was not officially released until July, Defense Department officials have known about the recommendations since late 2008, Kizer said. They responded in October.

Kizer expressed concerns that the Pentagon may have misunderstood his subcommittee’s recommendations in a letter to the vice president of the Defense Health Board, Wayne Lednar, on Nov. 13. The board endorsed the letter, which was been forwarded to Lynn.

“The committee appreciates the [Defense Department’s] general agreement with its findings and the department’s candor in acknowledging that the current plans for the [hospital] will not produce a world-class medical facility,” Kizer wrote. But the letter continues, stating that the Defense Department lacks the “sense of commitment to correcting the identified deficiencies and organizational problems that were identified by the committee.”

Congress asked the Defense Health Board, an independent advisory group to the Pentagon, to conduct the review of the new facility, which will combine existing buildings with new structures. The board also worked to determine what “world-class” means, including details of a facility above and beyond what’s available at a typical hospital. But part of the problem, Kizer said, is that BRAC money may only be used for new structures. However, the master plan must include the site as a whole.

“The two processes have to come together,” Kizer said. “It’s one facility. That’s not rocket science, but it hasn’t happened.”

Some of the report’s findings included that surgeons would be required to travel two floors through public areas from the operating room to gain access to tissue specimens — forcing patients to spend more time anesthetized and surgeons to have to scrub in twice.

Kizer said the 17 existing operating rooms are about half the size of what they need to be because they were built according to old standards, and that only the three new operating rooms could be considered not just “world class,” but reaching the “state-of-the-art” standards most hospitals require.

In part, Walter Reed Army Medical Center is moving from its current digs because of old infrastructure — everything from faulty heating and air conditioning to rough plumbing — and because of what the new facility can offer: a 354-bed center with equipment to treat brain injuries and post-traumatic stress disorder, as well as equipment to help service members with amputations recover.


Article: http://www.militarytimes.com/news/20...rreed_111709w/