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Lessons Learned Walter Reed Army Medical Center Colonel Sam Smith Center Judge Advocate March 2008

Lessons Learned Walter Reed Army Medical Center Colonel Sam Smith Center Judge Advocate March 2008. Credits: Derived in part from “40 Days of Winter” by COL Chuck Callahan, DCCS, Walter Reed Army Medical Center.

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Lessons Learned Walter Reed Army Medical Center Colonel Sam Smith Center Judge Advocate March 2008

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  1. Lessons LearnedWalter Reed Army Medical CenterColonel Sam SmithCenter Judge AdvocateMarch 2008

  2. Credits:Derived in part from “40 Days of Winter” by COL Chuck Callahan, DCCS, Walter Reed Army Medical Center

  3. Setting the StageEmail - October 3, 2006”I'm at work on a long piece for the Washington Post Magazine about the process by which injured service members are retired, or aren't, via the Physical Evaluation Boards of the various services. I've been reading regulations and reports, talking to veterans' organizations and attorneys who specialize in military law, and I've interviewed a number of service members who have gone through the medical board and PEB process. Now I'd like to talk to the people within the Army who operate the PEB system.So I am hoping you can help me set up interviews with the following people… the three attorneys who represent soldiers before the formal PEB….” CJA responded through PAO Oct 27, 2006

  4. Walter Reed 2007February 12, 2007 – Washington Post Reporters contact Walter Reed’s PAO for interviewsFebruary 15, 2007 – Interview conducted with MG Weightman, senior staff presentFebruary 18, 2007 – First story in the Sunday Post: “The Other Walter Reed, Soldiers Face Neglect, Frustration At Army’s Top Medical Facility”

  5. Walter Reed 2007 (Cont.)February 18, 2007 (Cont.)– High level inspection visits begin for military and civilian officials throughout military and government service; Command EOC activated, February 19, 2007 - Battle Updates morning and night; Constant Data Calls, media inquiries, strategy sessionsFebruary 21, 2007 – Pentagon News Conference led by General Cody

  6. Walter Reed 2007 (Cont.)February 22, 2007 – Walter Reed Press Conference led by LTG Kiley, TSGFebruary 23, 2007 – Washington Post article “Walter Reed Stories Factual But Unfair, Medical Chief Says” February 23, 2007 – SECDEF Press Conference at Walter ReedFebruary 25, 2007 – Washington Post Magazine Article “Twice Wounded” by Paula Span

  7. Walter Reed 2007 (Cont.)February 26-27, 2007 – House and Senate Armed Services Committee TestimonyFebruary 28- March 2, 2007 – Unannounced For Cause JCAHO Survey Focused on Life Safety, Out-buildings, Infections, Mental HealthMarch 1, 2007 – MG Weightman relieved of command, LTG Kiley named CommanderMarch 3, 2007 – Secretary Harvey relieved; MG Eric Schoomaker assumed command

  8. Walter Reed 2007 (Cont.)March 5, 2007 – House Committee on Oversight and Government Reform Holds Hearing at Walter Reed; First of a Series of Voluminous Document Production Requests Is MadeMarch 5-6, 2007 – Initial Hearings DoD Independent Review Group; Testimony at House and Senate Appropriations CommitteesMarch 6, 2007 – Dole/Shalala Commission Announced

  9. Walter Reed 2007 (Cont.)March 12, 2007 – Acting SECARMY Geren holds press conference at Walter Reed, announces LTG Kiley’s retirementMarch 22, 2007 – Informed of Impending Presidential Visit

  10. Walter Reed 2007 (Cont.)March 30, 2007 – Lengthy multi-part Presidential VisitMay 4, 2007 – The Washington Post reports actions pending against the Commanders of the Walter Reed Healthcare System, the Medical Center Brigade, and the Garrison as a result of an internal investigation.May 26, 2007 – The Washington Post reports that Colonel Deal was returned to duty and permitted to change command as scheduled June 2007.

  11. Walter Reed 2007 (Cont.)June 2007 – Army Times article –Massive mail backlog found at Walter ReedSeptember 15, 2007 – Washington Post article “Almost Home, but Facing More Delays at Walter Reed”

  12. A Brewing Storm… • Casualty Receiving Hospital(s) • Deploying Providers • “Burning Platform” • Anthrax Scare • Six Command Changes • Smallpox Vaccination • BRAC Announcement • Integration with NNMC • AHLTA Fielding • Nursing Contract Change • Hiring Freeze: June 06 to February 07 • Three Joint Commission Surveys

  13. Brewing Storm… • Patients: • Volunteer Army • Severe injuries, multi-trauma • Increased survival • Continuous casualties: 5 ½ years • Complex TBI / PTSD issues

  14. Brewing Storm… • Place: • BRAC and Integration • Aging infrastructure • “Crisis Mode” since August 2001 • Insufficient Patient/Family Housing • Difficulties with VA Transition

  15. Brewing Storm… • People: • Staff Deployments / PROFIS • “Compassion Fatigue” • A-76 and Hiring Freeze (June 06 – Feb 07) • Wrong Mix of Case Managers • Insufficient Training of Case Managers • Conflicting Leadership Agendas • Integration • Public Relations (“Tours”) • Executive Medicine (Generals, Cabinet) • Complex Medical Organization • Wounded Warrior Care • Conflicting Commands

  16. “We were handcuffed by short-termism.”Erik PetersonCenter for Strategic and International StudiesJune 20, 2007

  17. “The strategic leader must communicate that one assumes risk when there are insufficient resources to accomplish the mission. Unfortunately, he may then lose sight of the risk when he focuses on accomplishing the mission.”General Erik ShinsekiJune 24, 2007

  18. Lesson #1The Donkey in the Well

  19. Lesson #2Plan Ahead for Crisis Management Staffing Plan Training PlanAugmentation Plan

  20. Lesson #3Monitor & Track Performance:“If you don’t know where you aregoing, any road will get you there.” Lewis CarrollStandards & Metrics, ComplaintsMedia Inquiries, Congressionals

  21. Lesson #4Accountability Management Suspension & Relief -Legal & Reality ChecksInternal Investigations & Inquiries

  22. Lesson #5PAO & the Media Priv Act/HIPAA/QA protectionsDoD Policies1st Amendment

  23. Lesson #6Requests for Information Congress, Commissions, DoD & HQDA

  24. Lesson #7Coordinate, Coordinate, Coordinate

  25. With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in, to bind up the nation's wounds, to care for him who shall have borne the battle and for his widow and his orphan, to do all which may achieve and cherish a just and lasting peaceamong ourselves and with all nations. Abraham Lincoln, March 4, 1865

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