Fisher House chief: Smash the bureaucracy
By Kelly Kennedy - Staff writer
Posted : Tuesday Oct 2, 2007 16:24:39 EDT

After helping heal hundreds of service members at Fisher House comfort homes across the nation, Ken Fisher said the failures in the health care system for wounded troops and veterans that have been revealed in the wake of the controversy at Walter Reed Army Medical Center have both surprised and angered him.

And he’s still mad: As the Pentagon and Department of Veterans Affairs search for solutions, Fisher said they keep stumbling over delays in staffing, technology and ingrained bureaucratic culture.

“I don’t understand why anything is held up anywhere,” he said. “We’ve lost a little momentum and we need to get that back.”

Fisher, chairman of the Fisher House Foundation that builds the comfort homes near military and VA medical facilities so families of the wounded can be near them while they recuperate, recently served on the President’s Commission on Care for America’s Returning Wounded Warriors, which ultimately recommended more than 40 changes, all but six of which require no congressional action.

One of the most significant recommendations was to provide each seriously injured service member a single case manager to stick with them through the entire process.

Pentagon officials went to Capitol Hill last week with a long list of changes they have already made. But the Government Accountability Office issued a report that said half of the Army’s new Wounded Warrior Brigade, a new organizational structure meant to guide men and women through the disability process — to include assigning case managers — is still only half-staffed.

On the VA side, officials are not even sure how many case managers are needed because no one has come up with a standard definition of “seriously injured.”

A group of lawmakers met with about three dozen troops at Walter Reed in September who said they are still spiraling through a convoluted system.

Moreover, both the Senate and the House have yet to pass “wounded warrior” legislation introduced months ago to address many of these issues.

“According to the GAO, nothing has changed drastically,” Fisher said. “We’ve got to make the process less cumbersome.”

In his world — a place where the private sector kicked in to help the troops once it became clear the wars in Iraq and Afghanistan would go on much longer than anticipated — administrators kept up with the unexpected influx of injured men and women.

There were no questions of how to make it happen, just a drive to make it happen, he said. But because he worked with troops in the early stages of their injuries, he did not become aware of shortfalls in the medical disability evaluation system — or the months or years it could take to get through the process.

When he did learn the true scope of the problems from his participation on the presidential commission, he said, “it took me by surprise. I had no idea.”

In fact, the private sector took advantage of the public’s zeal to support the troops to create a multitude of nonprofits offering everything from housing to medical care to equipment, he said. When the Pentagon made plans to build a new Center for the Intrepid in San Antonio for seriously wounded veterans, $50 million was raised from the private sector in a matter of months.

“The private sector is cheaper and quicker,” Fisher said, “and much less cumbersome. We don’t have the same bureaucratic red tape. We positioned the foundation to catch the wave.”

Fisher said the government could learn a few things form the way his foundation and other charitable groups operate, particularly in being more “transparent.”

“If you donate to us, you can see where the money goes,” he said. “The growth factor is off the charts.”

Six or seven new Fisher Houses will be built this year, and 22 to 23 within the next four years, which will bring the total to 60.

“After 9/11, we all knew this was coming,” he said. “Everything was done to gear up for coming action.”

For example, a new Fisher House was built near the military hospital at Landstuhl, Germany, which often serves as the first stop for troops wounded in the combat zones of Southwest and Central Asia. Then they worked with VA and the Pentagon to create more houses or beef up existing buildings.

He said the same sense of purpose existed among the members of the presidential commission.

“We were focused, we were motivated; we were ready to make a difference,” he said. “We were all angry and we were all energized.”

As the commission members went about their work, Fisher heard tales from injured service members of carrying medical paperwork “a foot deep” from appointment to appointment. The commission has recommended VA and the Pentagon immediately make changes to ensure that their databases are compatible —an effort that has been ongoing for a number of years, and could go on for many more, officials from the two departments have said.

Such talk frustrates Fisher to no end. “They have to get it figured out,” he said.

He also railed against a culture in which, over generations, significant stigma has wrapped itself around such issues as post-traumatic stress disorder and traumatic brain injuries.

The military culture also shies away from blowing the whistle when something’s wrong, he said.

“There’s a stigma associated with ... being specifically seen as a whistle blower,” he said. “I don’t think anyone wanted to get up and say, ‘This system has gone to hell in a hand basket.’ ”

But he holds out hope that the necessary changes will be made based on the recommendations of the commission, which was co-chaired by former Secretary of Health and Human Services Secretary Donna Shalala and former Kansas Sen. Bob Dole.

Fisher called Shalala the “most intelligent person I’ve ever met” and praised Dole for his wit and willingness to call people out when necessary.

“We did as much as we could given the time frame we had,” Fisher said. “We wanted to look at it from the eyes of the soldier: How can we simplify in a way that is easily implemented?”

The recommended changes, he said, could have an immediate impact:

* Require only one physical exam for each wounded service member, with the military determining fitness for continued service while VA determines the disability rating for potential benefits purposes.

* Overhaul the outdated VA disability ratings system to reflect today’s injuries and medicine.

* Create transition payments so injured veterans don’t lose their homes while waiting for the system to process their paperwork.

* Allow family members more time off from their jobs to take care of their service members.

“We estimated this would have cost about $500 million over two years, going to $1 billion over five years,” he said. “We did not feel that was unreasonable considering what we’ve already spent on this war.”

The family issues upset him the most, he said, particularly the tales of family members losing their own jobs because they had to take time to care for wounded loved ones.

“You want to talk about getting angry ... if these guys are heavily medicated or have brain injuries, they need a family member to advocate for them. But [family members] were coming back to no job. It was infuriating.”

The bottom line, he said, is the clear need for immediate action.

“Let’s do something,” he said. “Let’s not chip away at the bureaucracy; let’s smash this bureaucracy. These men and women deserve a hell of a lot more than this.”