WASHINGTON, DC—Members of a House committee voiced their skepticism to DoD leaders last month that the new Walter Reed National Military Medical Center is on track to becoming a world-class medical facility. The new facility is currently under construction on the grounds of the National Naval Medical Center in Bethesda, MD, and is supposed to open in September of 2011. It is being built as a result of the 2005 BRAC Commission Report that directed DoD to shut down Walter Reed Army Medical Center and realign the facility with the National Naval Medical Center.

Members of Congress told DoD leaders they were concerned that an independent review presented to DoD in the summer of 2009 found that the plans for the new facility are not those of a “world class medical facility.” “One of our key concerns is that the current plan and organizational structure are simply inadequate, and the patient care and wounded warrior care will suffer as a result,” said House Armed Services Committee Military Personnel Subcommittee Chair Rep Susan Davis, D-CA, at a joint hearing held with the Readiness Subcommittee.

Military Personnel Subcommittee Chairman Rep Solomon Ortiz, D-TX, said it was “unacceptable” that the independent review determined that the facility would not be “world class.” He noted that it has been 4 years since the BRAC report required the creation of the new facility and that “we still have a disorganized medical command, a disjointed funding authority, and an inconsistent construction design in support of a $2.5 million effort.”

Rep Solomon said he was also disturbed that DoD stated in a written response to the independent review findings that the “development of a world-class medical facility is not a destination, but rather a journey of continuous improvement.” “World class is most decidedly a destination—one that Congress expects a new facility to arrive at before the new center opens its doors,” Soloman told DoD witnesses testifying.

Facility Progress Reviewed

Congress had asked for the independent review and a subcommittee of the Defense Health Board, an independent advisory panel to DoD, performed it. The purpose of the review was to determine whether the design and construction of the new facility was “world class.”

In the executive summary of its report, the panel stated that, “the current plans for the WRNMMC are not those of a world class medical facility.” The independent review recommended multiple changes in how the new facility could meet its goal.

The report stated that it did not appear that there is a comprehensive “master plan” for the WRNMMC that includes WRAMC, NNMC, and the other entities that are on the grounds of the new medical facility. The panel also stated in the executive summary that “significant input from frontline clinicians and other stakeholders does not appear to have been incorporated in the current plans” for the new center.

The report also stated that there are “circumstances” that impede the efforts of those working to achieve the integration of the combined facilities. “Among these are Service-specific and facility-centric military health care cultures, a confusing and redundant chain of command, and ambiguity about the vision, goals, and expectation…”

Specific issues that the report stated needed to be addressed in the plans included that postconstruction and renovation, there will be too few operating rooms, and that the ORs will be too small to accommodate current and expected future surgical technologies. In addition, plans for information management and information technology appear to be “incomplete,” the report stated.

The report also stated that the current bed plan of the facility does not provide for “broad conversion to single-patient rooms.” The facility would not be world class, according to the panel, if the majority of rooms are not single patient rooms rather than double patient rooms. Single patient rooms are believed to be important for infection control.

Dr Ken Kizer, chairman of the Defense Health Board subcommittee that issued the report, said at the hearing that while DoD had no significant disagreement with the report detailing the deficiencies and needed corrective actions, it was unclear to him whether the corrective actions are on the “right track.” He noted that the reviewers would feel more confident that plans were on the right track if DoD’s statements of commitment “were accompanied by detailed plans for fixing the problems with clear milestones and deadlines, and if it were clear that someone had the necessary authority and control to execute those plans,” he said.

On Track

Al Middleton, acting principal deputy assistant secretary of defense for DoD Health Affairs, told the committee that DoD is committed to making the facility world class, and that DoD does not disagree with the recommendations made by the independent review. He said that it “will have to go beyond the BRAC deadline,” to do some of the needed renovations to the facility.

In response to a question about what the additional cost would be for some of the additional renovations, Dorothy Robyn, DoD deputy under secretary of defense for Installations and Environment, said that “funding outside of the BRAC process” will need to be used. DoD anticipates knowing how much additional funding will be needed once a master plan is built, she said.

Members of the committee also voiced concern about who was responsible for what in the Walter Reed project. Middleton conceded that issues of jurisdiction must also still be worked out among the different Services and entities involved. “It is a complicated issue that is not yet resolved. I think that is what we are about to do in the next several months...to work through these thorny issues of authorities,” he said.” I think the concern is that we are so far down the line and yet these issues exist,” Rep Davis responded.

Dr Kizer told the committee members that the independent review panel was “a little perplexed that this foundational issue of authority is problematic to resolve in a hierarchical organization like the Armed Forces.” He said that what it boils down to is that “someone has to be in charge.”

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