Thursday, March 01, 2007

Money for hospitals: never enough

I am reflecting on the scandal at Walter Reed Hospital while finishing up the annual report for our charity supporting Children's Hospital in St. Petersburg Russia.

There is never enough money for hospitals. I worked at Mass. General for 4 years before taking time off to raise my lovely children. Who knew it would be a 15 year maternity leave? I couldn't leave them to the care of anyone else. But while I was there I was first a financial analyst, then business manager. In Boston, at MGH---medical mecca---there wasn't enough money.

In Russia our hospital scrapes along as well as it can. Several years ago I saw the health budget for the whole city. Reaction: no way! Where's the rest of it? And that's not even counting the sums that never quite *cough* reach the hospitals. Twenty million in that offshore account would buy a lot of supplies. Just sayin'.

At Walter Reed, I imagine there are similar dynamics in play. The VA hospital system has been shrinking over the last several years, as the bulk of wounded World War Two veterans pass away. The system was totally unprepared for the influx of 30,000 seriously crippled young people from what was supposed to be a quicky war.

Shock and awe. Well, we are shocked at the results, and they are awful: the army's top hospital in a scandal for not caring for its most grievously wounded patients.

When there isn't enough money, it's necessary to be attentive to the necessary choices, as every family on a budget knows.

I think what happened with Walter Reed is that there was chronically not enough money as with every hospital in my experience, from rich to poor. Then thousands of severely injured people came pouring in. Then their plans for expansion and improvement were several years behind the urgent need.

In addition, there may be callous administrators and any number of nearly burned-out people who have been desperately carrying small buckets of water to put out this fire.

So where DID all that money go, the regular Congressional appropriations, the 'emergency' appropriations? Well, clearly not enough to this hospital.

But beyond that, in an era of scarcity and urgent need---which I know a little bit about from Russia---it is necessary to prioritize; to watch your funds like a hawk; and to manage your institution with diligence. It is entirely possible that Walter Reed Hospital failed on all three accounts.

It's easy to be a manger when there are plenty of resources. But in scarcity, you need top people to run things. This didn't happen, and our young men and women who have lost arms, legs, eyes, and sanity are the poorer for it. FOR SHAME.


egregious said...

How do you cope with scarcity?

egregious said...

Looks like I'm on court duty tomorrow. If you are a praying person, I ask for your prayers and/or positive energy.

I am mostly stumbling around in the darkness, but I hae found a lantern, and try to hold it high for others.

Suzanne said...

I see your lantern and raise you one candle for positive energy.

cbl said...

of course you have my prayers and I am grateful for the light your lantern provides

((((go egy go ))))

NZ Expat said...

Enjoy yourself, egregious! All is well and all manner of things will be well.

You'll be in my thoughts.

egregious said...

suz cbl and nz

i feel rather surrounded.
and now to sleep.
if i can, seeing how important tomorrow might be.

jane is alone in court and they asked me to come in to be w her. duh of course. a privilege. everything i am otherwise doing can be cancelled/postponed.

its good to be the president. nobody can second guess how i spend my time at our charity :)

LoudounLib said...

We haven't formally been introduced, but I read your comments on FDL and really love what you write. Sending you all positive vibes for tomorrow. You and Jane will be just fine! Oh, and we're sorta neighbors - I'm just over the border in Loudoun County. Hey neighbor!

egregious said...


thx. off to---I must hope---sleep before court tomorrow.

keep up the good work in the wild west [anything west of fairfax :)

egregious said...


i TOLD you i needed sleep

spelling = ??eeeek??

egregious said...

Trial notes:

Waiting for the jury. Getting to know others in the media room, truly a privilege.

Several people, including utter strangers, came up and said how great my shoes were.

Also several people came up and said, “You’re with…[whispering] THAT BLOG? I just wanted to you know that there are so many people who read you very carefully and support what you are doing. I am in profession X.” It got so that I could distinguish the shoe strangers from the Yay FDL people.

egregious said...

Btw on my way to court at dark thirty this morning the neighbor dog, of dog whisperer post fame, was standing by my driveway looking happy.

First time I saw him there. A good sign.

egregious said...

The right wing is gonna say this is Clinton's fault instead of their own egregious mismanagement and callous disregard for these precious wounded young men and women.

Don't get me started all over again.

We need to get the facts out there, including an acknowledgement that there is NEVER enough money for hospitals even in the best of times.

Altho just between you me and the wall I was once quietly taken into a place where there were No Shortages. Forget I said this.