'Change Is Hard': Army, Navy Hospitals Merge

Sep 2, 2011
Originally published on September 2, 2011 8:01 pm

There's a lot of good sense behind closing two famous and nearby military hospitals and merging them into the new Walter Reed National Military Medical Center. But just looking at the name reveals both what's good about this merger and what makes it so tricky.

Walter Reed was a famous Army doctor, and for more than a century his name was on the Army's iconic hospital in Washington, D.C. Now that hospital is shutting its doors, and Reed's name will go onto the new hospital built on the Navy's flagship medical campus in Bethesda, Md., 6 miles away.

It's a bit like merging the Yankees and the Red Sox and then making them play in "Derek Jeter Fenway Park." Yankees fans and Red Sox Nation would never go for it — but it might make a great baseball team.

That's the sort of potential behind the new, jointly operated Army and Navy hospital. With bright new buildings and the latest technology, the new hospital promises better care to service members, veterans and injured troops from the wars in Afghanistan and Iraq.

But the Army and Navy each have their own proud traditions. So bridging those separate, and often competing, cultures will be the key to truly offering better medical care.

A 'World-Class Standard' Of Care?

The possibilities of the merger are clear when Cmdr. Blair Miles gives a tour of one of the spacious new operating suits. The scanners and computers are attached to long booms that extend down from the ceiling.

"This is going to be the neuro room," Miles says. "It's a hybrid room, and it's a biplane room, so that's why you see the two C-arms." That's a lot of jargon for the new equipment here. The point is: This operating room has all of the latest technology.

All of the scanners and computers are attached to long booms that extend down from the ceiling. The booms make it easy to move in even more high-tech equipment on a moment's notice, and that's safer for a patient during surgery.

"It's merging all the technology in one operating room," says project manager David Olivera. "And when we have our great staff to take care of patients like we do, we are the world-class standard, right here."

But some think that assessment is a bit optimistic. Two years ago, when the military's own Defense Health Board looked at the design for the new hospital, it wrote a scathing report about its many shortcomings.

Dr. Dennis O'Leary, a member of the board, says one problem was that Army and Navy officials couldn't agree on even basic details.

"They have their own leadership and their own cultures," O'Leary says. "And so right off the top we're talking about merging leadership, resources and cultures, and that is a daunting challenge, and no one should believe that it is anything less than that."

Those spacious new operating rooms are a response to the criticism from the Defense Health Board. But there are only three of the large rooms, and the report called for even more. Other shortcomings include a lack of private rooms for patients. O'Leary says all of this leaves the new facility short of being able to claim the official designation of a world-class facility, like Congress demanded.

The Challenge Of Merging Cultures

It's not all the military's fault: It's never easy to retrofit an existing hospital. And Congress raised its expectations late in the game but didn't provide the needed money to meet those higher standards — like adding those private patient rooms.

"Change is hard, you know, for us as people," says Vice Adm. John Mateczun, who is in charge of the hospital merger. "Sometimes I think it's harder for medical people. Maybe we're a little bit more on the obsessive-compulsive side."

Mateczun knows about obsessive-compulsives because he's also a psychiatrist. In Vietnam, he was on the bomb disposal squad, so he learned to stay calm.

Those are good skills for his current job, and O'Leary credits Mateczun with getting a good start on making many of the changes the Defense Health Board sought.

Mateczun is working with admirals, generals and doctors — all are people with strong wills. They've got their own Army and Navy ways of doing things. And these ways are definitely different — from the way one makes an appointment to see a doctor to the kind of therapy a soldier or Marine with traumatic brain injury receives.

But Mateczun thinks that in the end, a shared professional background will trump the color of their uniforms.

"The fact is that everybody comes out of a medical background," he says, "and that the training for doctors and nurses and technicians in America is very much the same. And that is probably more a part of what we are than anything else."

Two Institutions, Each With Long, Proud Histories

Still, the proud histories of these separate hospitals go way back. The Walter Reed Army hospital was built in 1909. The origins of the Bethesda naval hospital trace back to President Franklin D. Roosevelt's pride in the Navy.

Roosevelt served as assistant secretary of the Navy during World War I. Later, as president, he picked out the location for the Navy hospital: a vegetable farm with a pond on it in the town of Bethesda, Md., outside Washington, D.C.

"Well, the president immediately fell in love with the location," says Jan Herman, a historian with the Navy's Bureau of Medicine and Surgery. "First of all, the word Bethesda: He was entranced with that because it had biblical meanings — the biblical pool of Bethesda. He saw that as a place of healing."

Roosevelt's legs had been paralyzed by polio, and he'd sought to cure himself in pools of water.

"And so he got very excited about the site," Herman says. "And he said, 'I want the hospital built here.' "

Roosevelt even sketched out the tall tower he wanted for the new Navy hospital on a piece of White House stationery. Roosevelt, in a white linen suit and white Panama hat, dedicated the new hospital on Aug. 31, 1942.

Today, multiple hospital buildings stand crowded alongside that small pool in Bethesda — including those that make up the new Walter Reed National Military Medical Center.

Last weekend, patients moved out of the Army's old Walter Reed hospital. Its storied care for amputees moved to the new, jointly operated Army-Navy hospital.

A Merger With Potentially Broader Implications

One criticism of the old Walter Reed was that some outpatient soldiers lived in rooms with mold, mice and cockroaches. The Washington Post revealed these conditions in an investigative series published in 2007. The new hospital and new living quarters sparkle.

Another criticism of the Army and Navy hospitals was that they failed to adequately treat troops with PTSD and traumatic brain injuries, so the new, merged hospital has specialized wards and extra staff.

If this new hospital does provide better quality of care, that could change one of the most heated debates in military medicine: Whether to combine the medical services of each military branch into one unified medical command. In June, the House of Representatives voted to do just that, but the legislation has been blocked in the Senate.

This is called the "purple suit" debate: A reference to mixing Army green with Navy and Air Force blues.

Congressional investigators say combining the military's medical operations could save taxpayers $460 million a year and improve medical care. But the Navy and the Air Force object, saying their individual medical staff best understand the needs of their own troops.

Meanwhile, some private groups have put up their own money to provide more care.

The National Intrepid Center of Excellence opened last fall, right next-door to the new hospital on the Bethesda campus. The center was built with $65 million in private funds and then turned over to the Department of Defense. It's a research and treatment facility for troops with PTSD and mild brain injuries.

"There is no place like this anywhere in the military or the civilian sector — nowhere," says Dr. James Kelly, a neurologist who runs the center.

In the first years of both the war in Afghanistan and the Iraq War, the Navy's hospital didn't screen the wounded for head injuries. This new center is another small step forward for military medicine. But the problems are big, and there's still much that needs to be done to help those injured troops.

Copyright 2018 NPR. To see more, visit http://www.npr.org/.

ROBERT SIEGEL, host: From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MELISSA BLOCK, host: And I'm Melissa Block.

For more than a century, Walter Reed Army Medical Center, here in Washington D.C., has cared for the nation's wounded soldiers. Now that it's closed its doors and begun the transition to a new campus, we've heard reports on the history and legacy of Walter Reed. Today, we hear about its future.

SIEGEL: Walter Reed has merged with other facilities, including the Navy's flagship hospital in nearby Bethesda, Maryland. There, the newly named Walter Reed National Military Medical Center is already open for business. The merge is not just of facilities and patients, but of two very different military cultures.

And as NPR's Joseph Shapiro reports, that makes the move both promising and problematic.

JOSEPH SHAPIRO: It was 69 years ago this week, in 1942, when President Franklin Roosevelt arrived wearing a white linen suit and white Panama hat to open the new Naval medical center.

(SOUNDBITE OF APPLAUSE)

President FRANKLIN ROOSEVELT: In this hospital that we are dedicating today in this green and peaceful Maryland countryside our Navy battles against disease and disability and death.

SHAPIRO: Talk about the start of the Bethesda Naval Hospital and it all goes back to FDR's pride in the Navy.

JAN HERMAN: His favorite service was the Navy. He loved the Navy. He loved everything about the Navy.

SHAPIRO: Jan Herman is a historian for the Navy's Bureau of Medicine.

During World War I, Roosevelt had been assistant secretary of the Navy. Then, as president, he even picked out the location for that new Navy hospital. He'd been driven into the countryside, outside Washington, D.C. And there he found a vegetable farm with a pond on it in the town of Bethesda.

HERMAN: Well, the president immediately fell in love with the location. First of all, the word Bethesda, he was entranced with that because it had biblical meanings: The biblical pool of Bethesda. He saw that as a place of healing.

SHAPIRO: Roosevelt's legs were paralyzed by polio and he'd sought cure himself in pools of water.

HERMAN: And so, he got very excited about the site and he said, I want the hospital built here.

SHAPIRO: Roosevelt even sketched out, on a piece of White House stationery, the tall tower he wanted for the new Navy hospital. Today, there are multiple hospital buildings crowded alongside that small pool in Bethesda, including those that make up the new Walter Reed National Military Medical Center.

Last weekend, patients moved out of the Army's old Walter Reed hospital. And its storied care for amputees moved to the new, jointly-operated Army-Navy hospital.

One criticism of the old Walter Reed was that some out-patient soldiers lived in rooms with mold, mice and cockroaches. The Washington Post reported this in 2007. The new hospital and new living quarters sparkle. Another criticism of the Army and Navy hospitals was that they failed to adequately treat troops with PTSD and traumatic brain injuries. The new merged hospital has specialized wards and extra staff.

But the Army and Navy have their own proud and often competing traditions. So, bridging those separate cultures will be the key to really offering better care to injured fighters.

Commander BLAIR MILES: (unintelligible)

SHAPIRO: Commander Blair Miles shows off one of the new operating rooms.

MILES: This is going to be the neuro room, it's a hybrid room. And it's a bi-plane room, so that's why you see the two C-arms...

SHAPIRO: Hybrid room, bi-plane room. C-arms - it's a huge surgical suite with the latest medical technology. All the scanners and computers are attached to long booms that extend down from the ceiling. It makes it easy to move in even more high-tech equipment on a moment's notice, and that's safer for a patient in surgery.

David Olivera is a project manager for the new hospital.

DAVID OLIVERA: So again, it's merging all the technology in one operating room. And when we have our great staff to take care of our patients like we do, we are the world class standard, right here.

SHAPIRO: Well, not everyone thinks so. Two years ago, the military's own Defense Health Board looked at the design for the new hospital and wrote a scathing report about its many shortcomings. Dr. Dennis O'Leary was a member of that board. He said one big problem was that Army and Navy officials just couldn't agree on basic details.

Dr. DENNIS O'LEARY: They have their own leadership and their own cultures. And so, right off the top, we're talking about merging leadership, resources and cultures. And that is a daunting challenge and no one should believe that it is anything less than that.

SHAPIRO: Those spacious new operating rooms are a response to the criticism from the Defense Health Board. But there are only three of the large rooms. The report called for even more. Other shortcomings include a lack of private rooms for patients.

O'Leary says all this leaves the new facility short of being able to claim the official designation of a world-class facility, as Congress demanded. It's not all the military's fault. It's never easy to retrofit an existing hospital. And Congress raised its expectations late in the game but then didn't provide the needed money to meet those higher standards, like adding those private patient rooms.

Vice Admiral JOHN MATECZUN: Change is hard, you know, for us as people. Sometimes I think it's harder for medical people. Maybe we're a little bit more on the obsessive-compulsive side.

SHAPIRO: That's Vice Admiral John Mateczun. He knows about obsessive-compulsives because he's also a psychiatrist. And in Vietnam, he was on the bomb disposal squad. He learned to stay calm. All that's good training because now he's in charge of this hospital merger.

Mateczun's dealing with admirals and generals and doctors. These are people with strong wills. They've got their own Army and Navy ways of doing things. They're different, from the way you make an appointment to see a doctor to what kind of therapy to give a soldier or Marine with traumatic brain injury.

Mateczun thinks, in the end, a shared professional background, will trump the color of their uniforms.

MATECZUN: The fact is that everybody comes out of a medical background, and that the training for doctors and nurses and technicians in America is very much the same. And that is probably more a part of what we are than anything else.

SHAPIRO: Whether this new hospital does provide better quality of care could change one of the most heated debates in military medicine. In May, the House of Representatives passed legislation that would combine the medical services of each military branch into one unified medical command. It's been blocked in the Senate.

This is called the Purple Suit Debate, a reference to mixing Army green with Navy and Air Force blues. Congressional investigators say combining the military's medical operations could save taxpayers $460 million a year and improve medical care. But the Navy and the Air Force object, saying their medical staffs best understand the needs of their own troops.

Meanwhile, some private groups have put up their own money to provide more care.

(SOUNDBITE OF FLUTE MUSIC)

SHAPIRO: In a light-filled room with skylights, green plants, and calming ambient chirps and flutes, patients at the National Intrepid Center of Excellence can get massage therapy.

Neurologist James Kelly runs the center.

Dr. JAMES KELLY: Massage therapy, acupuncture, Botox injections, sleep medications.

SHAPIRO: Botox injections relieve the headaches that are common with mild head injuries.

The National Intrepid Center was built with $65 million in private funds and then turned over to the Department of Defense. It's a research and treatment facility for troops with PTSD and mild brain injuries.

KELLY: There is no place like this anywhere in the military or in the civilian sector - nowhere.

SHAPIRO: In the first years of the wars in Afghanistan and Iraq, the Navy's hospital next door didn't even screen the wounded for head injuries. This new center is another small step forward for military medicine. But the problem is big and there's still much that needs to be done to help those injured troops.

Joseph Shapiro, NPR News. Transcript provided by NPR, Copyright NPR.