Military hospitals like DC's Walter Reed could ease national ER overcrowding, save lives

President Barack Obama rides in the presidential limousine on the campus at Walter Reed National Military Medical Center, for a visit with wounded military personnel in Bethesda, Md., Wednesday, April 29, 2015. (AP Photo/Pablo Martinez Monsivais)

A disagreement between the state of Maryland and the federal government is preventing the use of Walter Reed National Military Medical Center as a Washington-area 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, a physician who is Walter Reed's director of surgery. So does the entire trauma team, which also deploys.

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 professor 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 currently 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 earlier this month.

Walter Reed already treats gravely injured service members after they get initial care overseas, but it wants to be officially designated as a trauma center so its surgeons keep their skills up by treating area residents and government officials.  

Emergency physician Arthur Kellermann, is a professor and dean of the medical school at the Uniform Services University of the Health Sciences.

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. Walter Reed is about eight miles from Washington Hospital Center.  

Washington Hospital Center — which has the city's busiest adult emergency room — 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 article also cited National Nurses United data showing the hospital had to replace up to 400 nurses last year, up from 300 the previous year. 

"If you take operating rooms offline at a trauma center, if you don’t have enough nurses, it's like a pipe (when) the flow gets compromised," says Kellermann, a nationally known emergency and disaster preparedness expert. "Care will be compromised."

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. 

"There’s a compelling mutual benefit to the patients and to us," says Bailey, also a surgery professor at the Uniformed Services medical school. 

The Maryland Institute for Emergency Medical Services Systems told Walter Reed it was concerned that adding another trauma center so close to an existing trauma center could hurt nearby 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, including 120 patients who are admitted to the hospital with serious injuries. Suburban Hospital had an average of about 1,500 trauma cases a year for the last three years, says spokesman Gary Stephenson. 

Told of the defense law's requirements, Pat Gainer, acting co-executive director of the Maryland institute, noted that "health care happens at the state level and is regulated at the state level." 

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 also couldn't help respond to a terrorist attack, which would "exceed the capacity of any facility," says Bailey. 

Washington Hospital Center has difficulty coping with a large — and predicted — snowfall, said Stephen Frum, now a labor representative for hospital employees. How can it deal with a mass casualty event? asked Frum, who worked at the hospital as a nurse for more than a decade until 2015.

"ERs are notorious for being understaffed," says John Kauchick, a longtime operating room nurse who works on contract in different hospitals. 

The most recent data on hospitals' capacity to deal with surges of patients is nearly 10 years old, but is believed to still be accurate, says Kellermann. At the time, Washington Hospital Center's ER was operating at 286% of capacity, making it the single most overcrowded hospital in the seven cities studied. One current and one former physician at the hospital who asked to remain anonymous due to legal concerns say patients are still regularly lined up in hallways on gurneys, sometimes for days waiting to get in a room. 

None of the hospitals surveyed had sufficient emergency care capacity to respond to an attack that caused the number of deaths in Madrid in 2004 — still the deadliest terror attack ever in Europe.  Nearly 200 people died and more than 1,800 were injured when several bombs detonated on Spanish commuter trains.  

Walter Reed also has a helipad — and helicopters — so non-military patients could be flown there quickly.

In May 17, 2017 file photo, House Majority Whip Steve Scalise, of La., speaks with the media on Capitol Hill in Washington.

Rep. Steve Scalise, R-La., was flown by helicopter to Washington Hospital Center after he was shot during a congressional baseball practice in Alexandria, Va., in June. The last operating room where he had surgery was shut down two days later for a sewage leak that one of the physicians described as including liquid feces on the floor. 

The hospital acknowledges five sewage leaks this calendar year and says only two occurred in operating rooms during surgeries. In a recent internal letter to employees, Washington Hospital Center President John Sullivan downplayed the sewage leak in Scalise's former operating room as "a minor plumbing leak."

Last week,  there was a large water leak in one of the surgical recovery rooms, according to the doctor who saw it shortly before Sullivan sent "talking points" to the hospital staff in case family, friends or patients were to ask about USA TODAY's coverage of its myriad safety problems and low ratings.

Former Centers for Medicare and Medicaid Services chief Donald Berwick called for the creation of a "joint, integrated network of military and civilian trauma centers" in an editorial last year in the Journal of the American Medical Association. The editorial was based on a National Academies report about how to get to "zero preventable deaths" after patients are injured. 

"It’s just a no brainer — particularly when you read about the challenges at Washington Hospital Center," says Kellermann,