Lawmakers question plans for new Walter Reed

Pentagon officials said Wednesday that plans are on track to complete the new Walter Reed National Military Medical Center on the grounds of the National Naval Medical Center, as required by the 2005 Base Realignment and Closure Commission. But an independent review board disputes that claim.

BRAC directed the Defense Department to close the Walter Reed Army Medical Center in Washington and rename and expand the naval facility in Bethesda, Md., stipulating that it be a "world-class" medical center for troops from all services.

In May, the health systems advisory panel of the Defense Health Board reported that the department's plans for the new medical center were not even state of the art, much less worthy of being considered world class. Among the problems the panel identified were inadequate surgical and laboratory facilities and substandard patient rooms.

Defense's response to the report has not been reassuring, said Dr. Kenneth Kizer, chairman of the advisory committee, during a joint hearing by two House Armed Services subcommittees.

"The department has not presented a meaningful plan for addressing those findings and recommendations, nor a cost estimate for the needed corrective action," Kizer told lawmakers in written testimony.

For example, single patient rooms are considered standard in modern hospital design, in part to help control the spread of infections. But at the new Walter Reed, most patient rooms are to be shared by two people, the advisory committee found. Only three operating rooms will meet current size and infrastructure requirements; 17 others will not. In addition, a clinical pathology area will be far away from operating rooms, requiring surgical staff to carry tissue specimens from sterile operating rooms through public spaces before entering the pathology area on another floor. That poses increased risk to patients, who must be kept under anesthesia for longer periods, and serious hassles for surgeons who will have to take extra precautions for moving in and out of sterile space to examine specimens.

Allen Middleton, acting principal deputy assistant secretary of Defense for health affairs, told lawmakers that executing the BRAC recommendations has been "one of the most difficult undertakings in the history of the [military health service]." Nonetheless, he said: "With less than two years remaining until the BRAC deadline, we have a comprehensive plan to meet the deadline with minimal risk to patient safety."

Dorothy Robyn, deputy undersecretary of Defense for installations and environment, said the Bethesda facility expansion is proceeding under challenging circumstances: "We have had to continue to operate that superb facility even as we carried out the expansion and renovation effort. Thus, we face a very real limit to the amount of construction that we can undertake there at one time.

"Moreover, in our view, the kinds of beyond-BRAC improvements being discussed can be addressed separately and subsequently," she said.

Kizer and the advisory board vehemently disagree with that assessment. "We believe that failure to very quickly address the identified deficiencies that have been publicly discussed for over a year will result in substantial additional and avoidable expense, unnecessary future disruption of services, untoward effects on personnel morale, and possible harm to patients," Kizer said.

Rep. Susan Davis, D-Calif., chairwoman of the House Armed Services Military Personnel Subcommittee, said she remains worried about progress. "We have had concerns about the plans for the Walter Reed National Military Medical Center at Bethesda from the beginning," she said. "In hearings and meetings we have had [Defense leaders] tell us in effect, 'Don't worry, everything is on track.' We have yet to be convinced that is true. In fact, we have yet to be convinced that the department takes our concerns seriously."