Recent events at Walter Reed Army Medical Center, once thought of as the premier U.S. government health care delivery facility, illustrates better than anything in recent memory exactly how government bureaucracies really work. If it were not for the pain inflicted on wounded servicemen, it would be “medical care as delivered by the Keystone Cops.”
First, let us begin with the inescapable truth: medical care in the adjacent Building 18 facility was below standards, even by standards in a local Veterans Administration hospital.
Second, the Army had known about this for over three years.
Steve Robinson, director of veterans affairs at Veterans for America, said he ran into Kiley in the foyer of the command headquarters at Walter Reed shortly after the Iraq war began and told him that “there are people in the barracks who are drinking themselves to death and people who are sharing drugs and people not getting the care they need.”
“I met guys who weren’t going to appointments because the hospital didn’t even know they were there,” Robinson said. Kiley told him to speak to a sergeant major, a top enlisted officer. (MSNBC. March 1)
Third, the Army did nothing about it.
More than a year ago, Chief Warrant Officer Jayson Kendrick, an outpatient, attended a sensing session, the Army’s version of a town hall meeting where concerns are raised in front of the chain of command. Kendrick spoke about the deterioration and crowded conditions of the outpatient administrative building, which had secondhand computers and office furniture shoved into cubicles, creating chaos for family members. An inspector general attending the meeting “chuckled and said, ‘What do you want, pool tables and Ping-Pong tables in there?’ ” Kendrick recalled. (MSNBC. March 1)
Fourth, the Army immediately imposed sanctions and a silence ban against the residents of Building 18. (Air Force Times, Feb. 28)
Fifth, the Army immediately sanctioned some nameless non-commissioned officers.
Sixth, the Army replaced the general in charge with the general who had run Walter Reed until 2004, who lives across the street from Building 18, and who had recently dismissed the criticisms as exaggerated.
General Kiley, commander of Walter Reed from 2002 to 2004, left when he was appointed Army surgeon general. On a tour of the outpatient facilities for reporters last month, he took issue with the way the conditions were portrayed in some accounts.
“While we have some issues here, this is not a horrific, catastrophic failure at Walter Reed,” he said. “I mean these are not good, but you saw rooms that look perfectly acceptable, you saw the day rooms with the pool tables and plasma screen TVs, and we’re working every day to make those rooms better.” (New York Times, March 3)
Seventh, the Army replaced Kiley at Walter Reed with another general the next day.
Eighth, the Secretary of the Army resigned under heavy pressure from the Secretary of Defense.
In a visit to the outpatient facility last month before it was fixed up, Mr. Harvey called the conditions inexcusable. But he went on to place the blame for the situation on noncommissioned officers.
“We had some N.C.O.’s who weren’t doing their job, period,” Mr. Harvey said. (New York Times, March 3)
THE BASIC LAWS OF BUREAUCRACY
A bureaucracy is regarded by its senior officials as having three primary functions: (1) to increase next year’s budget; (2) to provide promotion opportunities for existing heads of departments; (3) to avoid public awareness of anything inside the bureaucracy that might threaten #1 and #2.
A bureaucracy changes policy in response to only two sanctions: (1) the threat of budget stabilization or a budget cut; (2) public exposure that reveals the bureaucracy as incompetent, and therefore threatens the careers of existing managers.
A bureaucracy will do anything, including violating the law, in order to keep embarrassing information from surfacing.
When caught red-handed by the media, the senior bureaucrat accepts full responsibility and then fires one or more low-level employees.
When probed about the cause of the failure, the senior bureaucrat blames a host of causes, none of which could possibly have been his fault, and most of which were outside the jurisdiction of his area of responsibility.
FROM ABU GHRAIB TO WALTER REED
The greatest threat to any modern bureaucracy is a videotape of something blatantly illegal or incompetent. The second greatest threat is a photograph. These can be put on television or YouTube and may be seen by millions of people. They are also difficult to explain. As Groucho Marx once put it: “What do you believe: me or your own eyes?”
The reaction of senior officials to every videotape or photograph before it is released to the public is to destroy it or threaten its owner with a career dead end — with specifics left unsaid. “What do you mean, dead?”
The reaction after it is released is to blame a low-level perpetrator who was acting on his own outside of channels and in opposition to written guidelines. In military bureaucracies, this is the responsibility ceiling: it rarely extends above sergeant.
The response of commissioned officers is the Sergeant Schultz response on Hogan’s Heroes: “I know nothing! Nothing!”
In contrast, a spreadsheet is institutionally harmless. No matter what phony figures are in it, or how many zeroes, a spreadsheet cannot be seen clearly on TV or YouTube. The digits are too small. The public mentally turns off all numbers that cannot fit onto a scorecard. A spreadsheet therefore will not lead to firings at the top.
THE PRESIDENT’S RESPONSE
Let us assume that the President, as Commander in Chief, really wants to make sure that the buck stops well below him.
He calls in Major General Weightman and Lieutenant General Kiley. The President says:
Corporal Weightman, I want you to explain to Sergeant Kiley exactly what went wrong under your command.
That would be all that he would need to say.
He would then hand Weightman a corporal’s stripes and Kiley three stripes. Not three-up, three down. Just three. He would ask each of them to file his report after he had removed his stars and sewn on his stripes.
Being a helpful man, the President would hand each of them a needle and some Army green thread.
Each man would immediately offer to resign. The President would reach into his desk, pull out two letters of resignation, and hand each of them an official White House ballpoint pen.
That afternoon, he would release the videotape of the entire session. He would authorize it for YouTube.
This message would get down the chain of command so fast and so deep that there would be nothing else like it in the history of the American military. It would go into the textbooks. Maybe even high school textbooks. High school textbooks in Turkmenistan.
There is nothing institutionally unique about the Walter Reed snafu. When it comes to the military — any military — snafu and fubar are how things mostly are.
What was unique about this scandal is the incomparable foolishness of Weightman to let a camera crew into Building 18. That revealed his utter incompetence. No bureaucrat is allowed a second chance when he violates the bureaucratic code of self-defense on a scale like that. Make no mistake about it. This was why he was relieved of command.
He and Colonel — formerly General — Janice Karpinski will now disappear into the place where old soldiers just fade away. They can spend the remainder of their careers watching re-runs of F-Troop.
March 5, 2007