Compassionate Command

Steve Vogel reports in today's Post on the "Walter Reed Warrior Transition Brigade" -- a new kind of unit established at the Army medical center in the wake of criticism that it wasn't doing enough to take care of servicemembers. Prior to this, hospitalized servicemembers were assigned to a "medical hold" company -- described by friends of mine who have been through it as an administrative and organizational wasteland run by bureaucrats. But these new kinds of units are run by combat arms officers and organized along the lines of conventional units. They are designed to better take care of wounded troops and shepherd them through their appointments and struggles.

Commanders and senior sergeants set the tone for their units; their selection often determines success or failure. In the case The Post highlights, the Army chose Maj. Steve Gventer to lead Able Company, Walter Reed WTB. I know Steve from when we were lieutenants in South Korea together. We later served together at Fort Hood and again crossed paths in Iraq, where he served as aide to Lt. Gen. Peter Chiarelli.

He was an inspired choice at Walter Reed -- as the Post article makes clear -- because of his ability to see soldiers as individuals and understand their difficult struggles to overcome the wounds of war.

Gventer was preparing for room inspection when a platoon leader arrived to report an 18-year-old private from Arkansas missing. "I tried cell, I tried text messaging, nothing," Staff Sgt. John Guna said.

Guna offered one clue: "The kid ordered a set of tires for his car," delivered just the other day.

Gventer quickly grasped the point: "Once he got the new tires, he might have rolled."

"I'm going to try to call his mom," Guna said.

Gventer moved on to the weekly inspection, making sure the soldiers and their rooms were in good shape and checking for alcohol or improper medications.

In one room, he noticed Spec. Kain Schilling wearing a hero bracelet in honor of lost comrades.

"Who's on your bracelet?"

"Six of my buddies, killed," Schilling replied. "We were coming out of a village and got hit."

Gventer has his own bracelet, with the name of Spec. Carson Ramsey, a soldier from his tank company killed in Baghdad.

The next stop was Spec. Chad Spears's room. The soldier had been at Walter Reed more than a year, being treated for traumatic brain injury and post-traumatic stress disorder and coping with an alcohol problem. "I had a suicide attempt, went through divorce," Spears said. "I was a troubled soldier for the longest time."

Spears had done well enough in an Army substance abuse program that he is no longer considered high-risk. Even so, the major peered into his refrigerator.

"I've still got to check, man."

No beer.

There's a larger story here -- that of institutional learning in the Army. Lt. Col. John Nagl has made the argument that the organization or country best able to learn (in an institutional sense) is the one likely to win a counterinsurgency campaign -- or any war, for that matter. I accept this maxim in the area of warfighting, but I actually think it's even more relevant to those "administrative" areas that support the war effort -- like recruiting, procurement, and medical care for servicemembers and veterans.

On the battlefield, there is a Darwinian pressure to improvise, adapt and overcome (to use Clint Eastwood's memorable phrase from Heartbreak Ridge), and that pressure often helps to overcome institutional barriers and resistance. By contrast, in areas like recruiting and procurement, there is a peacetime atmosphere that enables institutional inertia and lethargy. Despite the fact that we are fighting wars in Iraq and Afghanistan, much of the Defense Department (to say nothing of other agencies) is not really at war. Its personnel work peacetime hours, follow peacetime procedures, and have a peacetime mentality -- and these stateside organizations have not adapted to the demands or changed environment of these conflicts.

The myriad problems at Walter Reed flowed, in part, from this mentality. Despite the heroic efforts of the hospital's medical staff, and an endless stream of combat wounded, the administrative side of the house failed. It took a Pulitzer Prize-winning series, several sackings, a ton of Congressional attention, and public outrage to spur actions that should have already been done. No combat leader worth his/her salt would have let the conditions in Mologne House or Building 18 fester, but the leaders at Walter Reed did so. In my opinion, they did so because they thought they were just doing a peacetime job, and didn't fully internalize the need to do things differently because we're at war.

I'm glad the Army has put a commander like Steve Gventer in charge. But as the article indicates, he's still got a fight on his hands with the Walter Reed bureaucracy. We have a long way to go before we can say that we're doing all we can for the men and women at Walter Reed.

By Phillip Carter |  April 10, 2008; 7:45 AM ET  | Category:  Veterans
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IRR, if you've made the transition over, I'd really like to hear your thoughts on this. You've made a strong and consistent case that the WTUs are undermining patient care and medical authority. ISTM, though, that the arrangement described above actually helps medical folks focus on patient care and getting the things done that need to happen within the medical bureaucracy. Or to put it another way, the green-tabbers focus on green tab business and the docs focus on doc business.

I can tell you that this is exactly what's happening at the WTU here at my post. We're able to accept a lot more wounded soldiers that we otherwise would have, because the WTU focuses on their day-to-day living stuff and soldier needs, and the hospital focuses on their care.

Posted by: Ray Kimball | April 10, 2008 8:53 AM

As a medic on active duty I had to fight constantly against line officers' pressure on their troops to get back to duty. If I d a nickel for every joe who cut off his own cast, violated his profile or injured himself doing something the Bn PA or the TMC docs told him not to I'd be Richard Mellon Scaife.

This officer is an outstandingly compassionate man. Anyone who believes that all - or most - or even many - combat arms officers are like this has obviously never met "Ravin' Dave" Mattes...

Medical holding companies did just fine from the Somme to Dak To. Blaming the average MSC officer for what was a colossal command failure at WRAMC is as unrealistic as blaming the average line platoon leader for the fact that GWB has no geostratecgic plan for the Middle East that could be printed in a family newspaper (published post-1945, anyway - colonialism doesn't play so well in the yellow press anymore outside Fox "News").

Posted by: FDChief | April 11, 2008 4:36 AM


You raise outstanding points. The "Walter Reed" crisis stemmed from a resourcing issue where the Medical Hold companies were not given the personnel or resources to get the job done. WRAMC was in the midst of an A-76 (fed employee to contractor) and Military-civilian conversion. The ranks of administrative personnel was shrinking precipitously. As a consequence, some subpar folks got sent to lead medical hold units.

There is a DANGEROUS, yet seductive narrative being developed here - that only combat arms "warriors" are capable of leading or understanding injured combat soldiers. This is dangerous and seems to me, another "trojan horse" used to undermine the independence and reputation of the Army Medical Department - as if taking away our branch insignia - the very symbol of healing - wasn't enough.

Stories like this perpetuate a myth and a dangerous post-2003 fiction. As I've stated previously, I vehemently disagree with the underlying inference that an MSC officer that commanded a medical platoon on the 101st or led a Medical Company in the 10th Mountain can't take care of a Medical Hold company.

The AMEDD wasn't given a chance to "fix" Walter Reed. The portly General Schoomaker swept in and made "fixes" as he saw fit: more camouflage, more Orwellian name changes using the word "warrior"; more desert boots on the patient wards. I disagree strongly with those changes. The Army is 54% strength on Branch qualified Captains and has a 98% selection rate to Major. Steve Gventer's talents and experience could be better used in about 50 places in the Army right now than where he's assigned. I have a novel idea - experienced combat arms leaders should be serving in our institutional Army training those Captains who will take companies to Iraq. Let the Medical Service Corps do the job it has done in WWII, Korea, Vietnam and through 2006 - "Conserve the Fighting Strength" and take care of medical patients.

Here is an earlier comment I made on this issue:

"Two things stand out:

1. The insertion of a shadow, combat arms chain-of-command in the Orwellian named "Warrior Transition Brigade". The Army Medical Department has been stripped of oversight/administration of seriously wounded patients. As the LT Whiteside case highlighted, this shadow chain of command can be in direct ideological conflict with healthcare providers and Walter Reed's Medical Leadership. When LT Whiteside's "Warrior" Commander dismissed the expert opinion of WRAMC's Chief of Psychiatry as "psychobabble", and the "Warrior Brigade Commander" - with NO Medical training - challenged the opinion of WRAMC's Commander (2 star General), I knew that this was just the tip of a larger issue.
If the Army simply wanted combat experienced leaders for Medical Hold units (like it claimed), it could have simply staffed them with MEDICAL personnel who had led combat arms medical platoons or commanded companies in Iraq. The idea that only Infantry officers can "get it" and need to "command" catastrophically injured soldiers is pure folly and ahistorical.
Given the well documented, systemic shortage of Army combat arms officers, we need to relook the wisdom of inserting a "combat focused" chain of command for the most grievously wounded returning veterans - most of whom will NEVER return to full service. We need to assist them with their transition to productive civilian lives and drop the "warrior" window dressing used as an attempt to "sell" the public on a war they have already turned against.
"Wounded Warrior" ... "Warrior Transition" ... "Warrior Care" ... this is the "newspeak" of the post-2003 Army and were unheard of in previous Army history. These glib terms were crafted by political appointees in Tori Clarke and Larry DiRita's Pentagon Public Affairs shop and are an effort to diminish the impact of the more appropriate term: Disabled Veteran.

2) The repackaging of Walter Reed as a "little slice of the Green Zone in NW." Seriously. This window dressing is a sham and diminishes WRAMC's proper place as the flagship of Army Medicine - a unique part of a larger PROFESSION - Medicine. The idea of dressing up Cardio-thoracic Surgeons and neurologists in Desert Boots in NW DC should be re-examined. Are we trying to create an environment for our wounded that they feel they are perpetually in Iraq? We're an Army at War. Got it. So is the Navy Medical Corps that supports our Marines - a ground force that has proportionally sustained more casualties then the Army, yet they have not implemented these Iraq-themed "fixes" at Bethesda. You walk in and it appears, well, like, a major medical center - not the Green Zone.

The Army Medical Department is feverishly damaging its "brand" to American Medicine and medical students and they don't even know it - that's the tragedy. Some day, when this all winds down, Army leadership will sit and look around, smugly self-confident in their "warrior" posture and wonder how they got so isolated from thier civilian peers.

The patients and our Army deserve better."

Posted by: IRR Soldier... | April 11, 2008 8:43 AM

IRR Soldier -
Outstanding post. The philosophy of "only a warrior can lead" is the same problem that the Air Force had under Merrill McPeak. He started the "dress like a warrior" syndrome so he could wear his flight suit to work. He told the officer corps that weren't fighter pilots that the Air Force didn't owe them a career, and that only the "war fighters," i.e. fighter pilots could be commanders. When he commanded PACAF in Hawaii, he wanted staff officers to carry side arms!

We had a saying - "If you look good, you feel good;if you feel good,you do good;if you do good,you are good. So let's all concentrate on looking good!"

Having line officers command med outfits sounds like the attitude still persists.

Posted by: RMarigny | April 11, 2008 1:04 PM

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