A Sea Change for Military Medicine: Walter Reed Joins Navy Medical Center in Bethesda

by U.S. Medicine

September 7, 2011

WASHINGTON — A new chapter in military medicine is set to begin this month with the opening of the new Walter Reed National Military Medical Center in Bethesda, MD.

Therapy-Pool-at-FBCH.jpgThe completion of the new medical center comes after six years of a carefully-orchestrated plan to integrate staff, patients and equipment from two major medical centers in the military health system–National Naval Medical Center (NNMC) in Bethesda and the Walter Reed Army Medical Center (WRAMC) in Washington.

“I can think, truly, of no better way to ensure the continued compassionate care of our wounded soldiers, sailors, airmen, marines and coast guardsmen and women, than by bringing together, uniting the best, the brightest, the most caring people to treat our men and women in uniform, regardless of the color of that uniform,” Army Secretary John McHugh said about the integration of the facilities at the closing ceremony this summer.

The Navy and Army medical facilities had been separated by about five miles. The location of new medical center — on the campus of the former NNMC — was viewed as advantageous because medical care and research would be located on the same campus as the National Intrepid Center of Excellence (NICoE) and just across the street from the National Institutes of Health (NIH).

Officials have boasted that the new facility at Bethesda includes more than two million square feet of new construction and renovations and has 345 medical-surgical beds, 50 intensive-care unit beds and 20 operating rooms. Improvements also were expected in various centers at the new facility, such as the one for amputee care.

The Joint Task Force National Capital Region Medical said in a statement that, when it moves from WRAMC to the new joint medical center, new and improved technologies will be available at the Military Advanced Training Center (MATC), which cares for amputees and others with limb damage. Another feature of the new medical center is a Comprehensive Cancer Center that will combine all the cancer centers of excellence at WRAMC and NNMC. (see sidebar)

Bldg-B_-Nursing-Station-WRNMMC.jpgWhile most of the staff from WRAMC expected to move to the Bethesda facility, some will be reassigned to a new 120-bed Fort Belvoir Community Hospital in Virginia. That facility is three times larger than the hospital it replaces. It is hoped that the expanded inpatient and outpatient services located at Fort Belvoir will improve access to primary and specialty care in the Northern Virginia area.

Closure

WRAMC’s journey to closure began when the DoD’s Base Realignment and Closure Commission placed it on the list of installations to be closed in May of 2005, recommending that NNMC and WRAMC combine to form a joint military medical facility. In the time since Congress approved the recommendation, the medical facilities have been preparing to integrate by the mandated Sept. 15, 2011, deadline.

Undertaking integration of the two medical centers has not been without its challenges. In 2007, less than two years after the BRAC recommendation, the Washington Post reported substandard living conditions in outpatient housing at WRAMC and bureaucratic hindrances to the support of injured and ill troops as they transitioned to civilian life or the VA. Some congressional members questioned at that time whether the planned closure was exacerbating problems at the facility and whether closing the facility in the midst of a war was a good idea.

Another snag was in 2009 when an independent review of the plans for the new medical center at Bethesda was blunt in its assertion that the new medical center at Bethesda was not on track for being “world-class.” Members of a congressional committee expressed concerns about that to DoD officials at a House Armed Services subcommittee in December of 2009.

“This inability to obtain a world-class medical center seems to hide the fact that four years have passed since the BRAC Commission reported its findings, and yet we still have a disorganized medical command, a disjointed funding authority, and an inconsistent construction design in support of a $2.5 billion effort,” said former Rep. Solomon Ortiz, D-TX, who was then the chairman of the Readiness Subcommittee.

Navy Vice Adm. John M. Mateczun, MD, commander of Joint Task Force National Capital Region Medical, assured the subcommittee that military leaders did not disagree with the recommendations made by the Defense Health Board and were committed to achieving “world-class standards” at the new Walter Reed National Military Medical Center and the Fort Belvoir Community Hospital.

Last month, plans were in place to move every patient still at WRAMC to the new facility in just one day.

A Sea Change for Military Medicine: Walter Reed Joins Navy Medical Center in Bethesda Cont.

Friends, Patients and Medical Personnel Say Goodbye to WRAMC

 Over its 102-year history, WRAMC has not only cared for troops but also presidents such as Dwight Eisenhower, Harry Truman, Richard Nixon, Ronald Reagan, George H.W. Bush and George W. Bush. Celebrities such as Bill Cosby, Tom Hanks and Oprah Winfrey have paid visits to troops there.

Army leaders, patients and staff gathered on the grounds of WRAMC in July to celebrate its rich history and mark the closure of the medical facility.

“These doors may close, the address may change but the name, legacy and most importantly the work and the healing will endure,” McHugh said at the closing ceremony in  July.

During the ceremony, WRAMC flags were folded and symbolically placed in black cases signifying the end of the unit. Army Surgeon General Lt. Gen. Eric Schoomaker, MD, who recounted beginning his active duty career on the WRAMC campus, told the audience he had full faith and trust that the new Walter Reed National Military Medical Center “will proudly build upon the Walter Reed legacy.”

Walter Reed Health Care System’s commander, Col. Norvell Coots, told reporters at that ceremony that the move to build the new medical center was about what was best for the patients.

“When you look at Walter Reed, we are 113 acres here in the middle of Washington DC, with 72 buildings, many dating back to the beginning of the 20th century,” he said. “There is no room to expand to meet the changing demands of the complexity of the warriors we have now and the equipment needs as medical science changes, but over at Bethesda there was land to build on.”

Sidebar: A new feature of the Walter Reed National Military Medical Center is the Comprehensive Cancer Center. Located on the third floor of one of the new buildings of the medical center, its services include infusion therapy, medical oncology, surgical oncology, prostate, gynecology, breast care and breast imaging, among others.

This one-of-its-kind center in DoD houses all cancer services together, so that patients do not have to go to different buildings or facilities for care, Col. Craig Shriver, WRNMMC interim director of the Comprehensive Cancer Center and chief of Breast Center told U.S. Medicine.

“If you have one unit of medical oncology over there on the campus and surgical oncology over here on the campus, and the breast center is here, and down there is radiology, and the patient is traveling around getting various consultations, [then] treatment really is not patient-centered care,” he said.

The center combines the Cancer Centers of Excellence at WRAMC and NNMC.

“It is sort of one of those situations where two plus two equals more than four because it now frees up people to provide much more delivery of care, while also gaining a lot of efficiencies for DoD, in terms for reducing duplication of effort on administrative and other events,” added Shriver.

Acting Deputy Director of the Comprehensive Cancer Center Army Lt. Col. Christopher Gallagher said, now that the WRAMC clinical trials research program has moved to the new medical center, patients who may have been initially seen, treated or evaluated at NNMC will no longer have to travel back and forth for a research trial that was offered at WRAMC. In addition, the hematology and oncology stem cell transplant service at WRAMC is in the new cancer center.

Shriver said the center also includes the only breast-specific MRI in the DoD, he said.

“The positives to that is that it is configured much better for patient safety and comfort,” he said. “You don’t have to change out the mechanics of the machine. If you have an MRI machine looking at knees, spines, brains and breasts, you have to change the coil and the configuration of the machine and the software. This is configured only for breasts.”

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