RED TAPE SNARLS USE OF WALTER REED HOSPITAL
As combat decreases, facility could help ease overcrowding
A disagreement between the state of Maryland and the federal government is preventing the use of Walter Reed National Military Medical Center as a Washingtonarea trauma center, eliminating the potential for an alternative to the troubled MedStar Washington Hospital Center.
Maryland emergency services officials quietly rebuffed Walter Reed’s proposal in July to start treating civilian trauma patients, citing the needs of nearby civilian hospitals, although local emergency rooms are overcrowded and the area has a higher-than-usual risk of terrorist attacks.
The 2017 National Defense Authorization Act required the secretary of Defense to integrate military hospitals with civilian care and to require military hospitals to treat civilians if needed to maintain “military readiness skills.”
Walter Reed’s surgeons, who deploy from the hospital, need to be able to “exercise all the muscles” needed, including getting experience with trauma patients immediately after an incident, says Col. Jeffrey Bailey, who is Walter Reed’s director of surgery.
At a time of decreased U.S. combat activities in Afghanistan and Iraq, there are fewer combat injuries and deaths so military doctors handle less trauma care.
Trauma services are sorely strained in most of the country.
“We have an overwhelmed system,” says emergency physician David Marcozzi, an associate pro- fessor at the University of Maryland School of Medicine.
Besides, he says, “the truth is, there are probably no better surgeons in the U.S.” than in the military. The San Antonio Military Medical Center is the military’s only Level 1 trauma center and handled 40% of that city’s civilian trauma cases even during the wars in Iraq and Afghanistan.
The move would provide another option to any member of Congress and White House official who relies on trauma care at MedStar Washington Hospital Center, which has poor safety and quality ratings and is under investigation for sewage leaks in and around operating rooms, as USA TODAY reported this month.
Walter Reed wants to be officially designated as a trauma center so its surgeons keep their skills up by treating area residents and government officials.
Physician Arthur Kellermann, dean of the Uniform Services University’s medical school, says Washington Hospital Center’s problems underscore the need for a better trauma system around the nation’s capital. Walter Reed is the primary teaching hospital for the medical school, which is next door in Bethesda, Md. USU is the military’s medical school and is run by the Department of Defense.
Washington Hospital Center repeatedly had to close down operating rooms due to persistent sewage leaks that lasted for more than a year, USA TODAY reported. The D.C. health department is investigating. The story also cited National Nurses United data showing the hospital had to replace up to 400 nurses last year, up from 300 the previous year.
When there are more than five patients per emergency room nurse, the chance of death increases by 3% for each additional white patient and 10% person per black patient, a 2012 study by the University of Pennsylvania nursing school found. Washington Hospital Center’s patients are overwhelmingly black.
The Maryland Institute for Emergency Trauma Services Systems told Walter Reed it was concerned that adding a trauma center so close to an existing trauma center could hurt Suburban Hospitals’ ability to keep enough patients to maintain its trauma center designation.
A level 2 trauma center like Suburban must have at least 400 total trauma hospital admissions in a year. Suburban Hospital had an average of about 1,500 trauma cases a year for the last three years, says spokesman Gary Stephenson.
Without designation as a trauma center for civilians, Walter Reed can’t help alleviate overcrowding in D.C. or Northern Virginia’s emergency rooms either. Without this, Walter Reed couldn’t help respond to a terrorist attack, which would “exceed the capacity of any facility,” Bailey says.
“It’s just a no-brainer — particularly when you read about the challenges at Washington Hospital Center,” Kellermann says.