"Dr." Winkenwerder leaves the Pentagon: good riddance

There seems to be a recent article on Anthrax vaccines in JAMA, but I'm not a suscriber

Bioterror Vaccine Production: Take 2: New Biodefense R&D Agency Created; JAMA.2007; 297: 575-576. 13 Feb 2007
http://jama.ama-assn.org/cgi/content/full/297/6/575

Project Bioshield largest contract of $900M was to VaxGen, but they failed to come up with the improved Anthrax vaccine. They (apparently) were paid only $1.5M instead of the full amount, but fortunately VaxGen was also the recipient of a $100M research grant by the NIH ...

I keep reading that name as winkie wierder.

What I'd like to see are a bunch of examples of the letters, e-mails and phone call records that those affected military families made to their congressmen about this long-standing problem and the congressional responses, automated or lacking as they are. I'm betting that those congressmen who are now holding these hearings as if they didn't have any prior knowledge ignored a lot of evidence and would have continued ignoring it had it not been for the Washington Post. IMO, they are mostly a bunch of pious hypocrites that need to be held to account as well.

anon: I won't take that bet because I'm thinking the same thing. This was no secret. We wrote about it here several times over the last couple of years. The difference is no we have a two party government and oversight is possible.

Yes, most of them knew not all was well, even if they did not know the extent of it. I have contacted my own Senators and Representatives regarding the problems in the military medical system for three and a half years and have been ignored. Every member of Congress was delivered a copy of the February issue of Wired Magazine with Steve Silberman's investigative report on conditions in the military evacuation system from Iraq. The problems originate well before Walter Reed.
The media and all of our politicians are either ignoring these serious public health issues or abiding by an illegal gag order from the top. Either way it's deplorable.
Good Riddance to "Dr" Winkenwerder. He's been lying on behalf of his employer and on the backs of our service people and veterans for far too long.

Re: the medical treatment of veterans...

Those of us in healthcare have long known of problems in this regard. Revere, I am sure you have had first hand experience in the halls of a VA facility at some point in your career. Most of us have.

And while there are those VA facilities that shine in their delivery of care and in their physical plant, many times that is not the case. How many of us chose the VA as a work venue when presented with the often lower pay scales and less than aesthetically pleasing surroundings?

I have seen exposes on several VAs over the years. This complaint is NOT a new development. And it is also NOT a consequence of the current administration. This has been "the norm" since my neophyte days in medicine over three decades ago. I saw similar stories in the post-Vietnam era. Nothing has changed in the interim, except for a recent increase in volume. In fact, I would expect that that is one of the problems in funding VA medical centers: the funding must expand and contract in keeping with the number of veterans.

Don't get me wrong - I have seen some great VA medical centers. But, there are also those that are a travesty. (I know of two in the southeast alone). I have a relative that currently works in one and the juggling of monies for staffing and for sheer existence is never-ending. And the lamenting about bureaucratic paper "impactions" is just part of the typical scenario.

Ever since I saw the story reported about Walter Reed, I have wanted to comment about this "revelation." Revelation, hell. This is about as revealing as the nose on your face, and we all know it. Walter Reed is NOT an exception. And if I had a penny for every patient that had treatment delayed or injured or worse, secondary to the avalanche of required paperwork (government or otherwise), I'd have quit working a decade ago.

Who knows, perhaps the publicity will get a few more pennies in the coffers for the vets. This is a system problem that has been present for years/decades and will take years to improve.

And once we "fix" the VA's moldy, deteriorating physical structures, perhaps we can focus on those moldy, deteriorating physical structures we call public schools...of course, THAT will come as a great "surprise" also...

So many exposes, so little time.

nthesia: Indeed I have. I have been a genuine VA employee with admitting privileges in a (pretty good) VA hospital at one point in my career. I've known some terrific heatlh care workers in the VA (one is a close relative) but I have also seen it as one of the more dysfunctional agencies. The VA system is the usual mixture of terrific and horrific. The horrific needn't exist, however, and it breaks a social contract our government has with veterans. It is hard to escape the impression that wounded soldiers get the short end of the stick because they are just cannon fodder to the Generals and their civilian bosses, the Rumsfelds, Weinbergers, McNamaras, etc., and they have outlived their usefulness (literally).

reveres: Frankly, G-d help you if you are a patient in any hospital these days with no family member as a patient advocate. The staffs are so thin that all kinds of things (meds, therapy) fall through the cracks on a regular basis. I have a couple of friends who are nurses and couldn't wait to get out of some of the "best" hospitals in my area because they were so overworked that they knew they couldn't supply good care. Sure, GW has prettier rooms than Walter Reed, but the care isn't much different.

Lucky for me (well, not so lucky, I would have been hospitalized during this last illness if I had insurance) the last couple of times I needed to be in the hospital, even the pain meds didn't fog me out so bad that I couldn't track down a charge nurse when my meals didn't show up on time. And this was in the (then) best rated hospital in the area. I had to check the radiologist's work, just to make sure they were looking at the correct broken limb.

Yes, I'm an unholy terror in an ED. With good reason.

The system is fucking broken, even when you have insurance.

As a Captain in the Army Reserve, I was mobilized in 2003 and had the opportunity to serve as a "Holding Company Commander" from 2003 to 2004. During my tenure at one military base on the West Coast I had over 1500 soldiers process through my Command. These were just Army Reserve and National Guard soldiers wounded or injured in Iraq and Afghanistan that were in "outpatient" status. We met these soldiers at the evacuation plane, picked them up from the ER at the hospital and then took care of them. When I was given this responsiblity, the Army had no structure for handling these soldiers. On my first day I found the "unit" staff of six set up in a warehouse off the back of a loading dock. No proceedures, no resources. Over the course of 15 months we created processes and proceedures and fought everyday for attention, speed, and care.

The medical care itself was excellent, the system around it was not. We started with wounded soldiers waiting for 15 hours or more as the came off the plane from Germany or Walter Reed for evaluation at the hospital. Because they were reservists, they were put last in line for treatment and care. We changed that. In the beginning there were no case workers, no transportation, no mental health workers. In 2003 there was a similiar news frenzy about conditions at Fort Stewart and a similar round of interest and focus...but it faded. When I assumed responsibility, soldiers were lving in WWII barracks with no handicap ramps or services. We worked hard to get visibility and we made "deals" with army commands on the garrison to install ramps and handrails, to house these soldiers in a postive environment. We lobbied constantly for more staff to handle the case load and the processing of paperwork. I had to fight everyday all day to get past the complacency. We researched regulations for every possible way to speed up processing. Wounded NCO's helped supervise the hundreds of soldiers. Wounded soldiers manned 24 hour offices so that their commrades would have someone to talk to at 2am when they woke up with nightmares. I personally sat with many. It took relentless focus and daily supervison. We had to explain that putting Iraq vet in barracks next to a firing range was a bad idea. We made it up as we went along, but everyday we tried to make up for the system by treating these man and women with additioanl respect and a message that they were normal and still valued. We were visited by senators, the pentagon, the GAO and more ranking generals than I could count. Many of our "policies and proceedures" became Army policies and proceedures. But, when we returned to civilian life, we were replaced with contractors. The unit kept office hours from 8 to 4:30. THe soldiers were relocated to different and less optimal barracks. Case managers got fewer. And the attention waned...

There are literally hundreds of officers and VA types working desparately to serve this new population of veterans, but without consistent focus and resources that match the need, without constant guard against complacency, this situation will continue. It literally costs lives. Thank you for adding your voices to the issue.

Skye:

I salute you and your "Can Do" attitude. That is the glue that holds these situations and the psyches of a vulnerable patient population together. There are many dedicated workers that give all they have and then some, to ensure the dignity and optimal outcome of those in their care. Often, they do it while fighting an uphill battle. It is thus in the civilian sector as well as in the military.

In respect to the VA system, I would like to add an addendum. I have seen this medical system in operation over the course of many years, from various locations. Friends, colleagues and family members have shared their work experiences, in addition to my years spent training in the halls of a few VAs.

For many years post-Vietnam, the numbers of vets slowly diminished. As the distance between the end of Vietnam grew, I saw many facilities merge or close. People had to do more traveling and wait longer to get care.

In the meantime, I saw many examples of poor utilization of resources , including the ubiquitous, top-heavy administration. I saw computers that would sit in warehouses for a year after being shipped until they could decide where to place them. I saw supplies juggled for, while expensive, luxury items like a $30 toothbrush with attached suction device, was made part of every ICU admit kit!

I also saw some abuse of the system by vets. Medications would be prescribed, filled in mass quantities, and then distributed to friends and families. Little regulation or oversight took place. Some with substance abuse problems would get readmitted periodically to meet criteria to ensure financial compensation. It happened like clockwork - the money would run out, and they would get readmitted.

Then the current conflict started a resurgence (scared to use that word) in those needing access to services. In the interim, the services had been decreased. And that seems to be where we stand today.

It takes FOREVER to get a bureaucracy like the VA to make any significant change. Skye's comment about a center having attention focused on it for a while and then seeing it fade, is all too true. I believe that will happen here, also, unless...

Our military/vets deserve a first rate medical system from admission to discharge. Their experiences and needs are often unique to their profession requiring equally unique solutions. The price of war is multi-faceted. You do NOT cut corners by cutting services to those who most deserve them. But IMO, like a tactical mission, it must be well defined and well-executed.

We ALL deserve a firstrate health care system.

If we had even a secondrate system, vets would have a firstrate system, part of the general public system. Separating VA allowed them to leave a fourthrate system for the rest of us while gradually reducing vets to an adminstration-happy tenthrate care system.

Drug abuse, both using and sharing, flows naturally from a system which dispenses pills like gumballs, as substitute for nonexistent services.