The Walter Reed Scandal Revisited

When “Walter Reed” hit newspapers in February, it was said that healthcare shortcomings needn’t be debated but that whatever problems were discovered needed to be fixed immediately and at all costs. It was said that a system seeking to protect itself from future breakdowns would do whatever was required. Change was inevitable, as one Defense Department official noted, “Our greatest attention will be to introduce change to the processes by which we support our service members and families… Sustaining a medically ready military force and providing world class healthcare to those injured and wounded in combat remains our primary mission.” And at the time no mission had higher priority. The war took a back seat for at least a week, domestic healthcare occupied all attention. Still, the existence of war injuries was never actually appreciated.

Dissidents were quick to berate the Administration for failing to plan and prepare, and for abusing the sacrifice soldiers had made. Indeed, the President’s military support base was severely shaken. Trust in the system was lost and needed revitalization. On this point there was no debate. The issue was a “rare unifier,” and as one Congressman stated, “the war in Iraq has divided our nation, but the cause of supporting our troops unities us.” It was “political suicide” in those days not to “support our troops,” and although the evident problems were complicated and complex, nothing was said to be complicated about supporting injured soldiers.

The changes first involved cleaning house of incompetent personnel responsible for the problem. Defense Secretary Robert Gates said, “The care of our wounded men and women in uniform demand the highest standard of excellence and commitment we can muster as a government… and when this standard is not met, I will demand swift and directive corrective action, and where appropriate, accountability up the chain of command.” Despite the desperate efforts of those caught in the emotional fallout, at least three high-level military and civilian medical officials left the service shortly after the reports appeared, including the General in charge of Walter Reed. Gates said, “I am disappointed that some in the military have not adequately appreciated the seriousness of the situation . . . Some have shown too much defensiveness and have not shown enough focus on digging into and addressing the problems.”

But there was no degree of action that could have been taken at the time that would have been “appropriate” enough to appease the Secretary, or the public. Indeed, every effort was made to portray the military healthcare system in the worst possible light. The immediate repairs to Walter Reed were deemed a “whitewash,” and there was no shortage of accusations of widespread systemic and financial failures. The Washington Post, where the problems were first exposed, took to citing littered beer cans on hospital grounds as indications of the problem’s scale. The language adopted by reformers was noticeably militant. There would be a “surge plan,” and “bureaucracy busters.” Veterans were said to have deserved more than to face another battle upon returning home. In short, military healthcare would be “attacked” with the disposition and desperation one might “attack” a formidable enemy with.

The media presentation was one of shock and awe. After “Walter Reed” began, “It’s Not Just Walter Reed” quickly followed, plaguing headlines for a week. The traditionally malfunctioning and under-funded VA system was quickly used as a rallying point for reformers of military healthcare. A thorough review of all VA facilities ordered by VA Secretary R. James Nicholson ( who stated that “negative responses are required”) found only a small portion of problems were serious, and most of these were already well-known. Still, the witch-hunt needed fuel, and the broken VA system offered opportunity.

The stories were said to have “sparked an important dialogue about the state of the services’ medical care,” but there was no shortage of literature and reporting on injured soldiers prior to either “scandal” and the developments at Walter Reed were certainly unsurprising to many in the healthcare community. For four years the wounded were chronicled and many comments were made, but they were also “invisible,” “hidden,” “unknown,” and “less well known,” until February 2007. One authority on military healthcare described the system in 2003 as, “a public disaster waiting to happen,” and the VA Secretary at the time of invasion stated that the VA had no capacity to handle expected casualties. And this was before the Iraq war proved itself particularly adept at generating mass American injuries. The stories actually sparked dialogue that originated in inattention, which played to the advantage of the military and allowed them to downplay an important problem they were facing.

Traditionally, the dead are the gauge by which military conflicts have been decided, but Iraq has been called a “war of disabilities,” as opposed to a war of death. Relentless violence, improvements in body armor, advances in battlefield medicine, unprecedented medical stabilization and evacuation capabilities, and long-term treatment capabilities have collectively contributed to a historically high number of American soldiers surviving what would have killed them in earlier wars but suffering horrific injuries that require expensive and complicated long-term domestic healthcare. The miracle of modern medicine has been called the hardship of injured soldiers. The “gruesome success” of battlefield medicine explains a great deal behind “Walter Reed” and the subsequent reforms.*

There are many indications that the Pentagon knew of problems before the Post series appeared, but they feigned ignorance once the scandal hit. By February, the military had already heavily invested in programs designed to deal with the injuries of the war. One Congressman stated that, “the DOD is never shy about asking for supplemental funds for operations and equipment, I cannot imagine why housing for recuperating wounded would not be a similarly high priority.” Indeed, at least three top military medical officials acknowledged that problems were well known before February, and an October 2006 Pentagon survey found several problems with military healthcare as well.

Until the Post series appeared, DOD kept information on injured soldiers clandestine. The week before “Walter Reed,” DOD created an outrage at VA by attempting to restrict data sharing on injured soldiers. The decision was quickly reversed, but it is curious that information-technology and data sharing was a key aspect of the reforms DOD proposed after the scandal, while a week prior to it they did everything possible not to pursue such a course.

The lesson of “Walter Reed” is that war injuries were, and are, a liability for the military, but that the military used the scandal to advance its own agenda. DOD acknowledged after the Post series appeared that they were struggling to cope with the complex and numerous injuries coming home. The system had been overwhelmed by historically unprecedented survival rates that left soldiers in need of expensive long-term care, which DOD could not adequately provide. Once public attention had been grabbed, the military Medical Corps maintained that they needed comprehensive and “total” reconfiguration to keep up with a modernized military. In “Walter Reed,” DOD found opportunity to expand healthcare according to the demands of the new “long war,” not just the problems generated by Iraq . One DOD official complained during the storm of outrage that, “I have concerns as we go through this long war about taking down capacity that may be needed.” “Huge investments” were deemed essential; no time could be lost debating responsibility or impact.

Essentially, “Walter Reed” established war injuries as tolerable in American public imagination, despite their being the proper gauge by which to assess the Iraq conflict, which the scandal should have demonstrated. Peter Pace, Chairman of the Joint Chiefs of Staff, once referred to lost limbs as “gifts.” The Post was just as eager and distasteful, saying that it was “fine” to be wounded overseas. Time magazine remarked that “today’s soldiers might not be able to stop roadside bombs from blowing off their limbs, but they’ll walk out of Walter Reed with bionic arms and legs,” as if the one was better than the other. Now, after a number of months and fundamental changes to military healthcare that will allow the “long war” and Iraq to continue indefinitely, wounded are still coming home. They are accepted by the public, they are absorbed into the bosom of military culture, kept from public view, and they are overloading the system that their existence has already once destroyed.

* The terms “war of disabilities” and “gruesome success” were coined by Ronald Glasser, this paragraph owes much to Glasser’s work.

Joseph Szczekoski is a writer from Bucks County, PA Read other articles by Joseph.