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.
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