Patients at Walter Reed National Military Medical Center and other premier military hospitals are being sent to private doctors and having surgery and other treatment delayed because of furloughs to medical personnel, according to interviews and internal documents.
"Please show (patients) the utmost understanding and care while we are asking them to accept longer wait times and in some cases, curtailed or limited services," Rear Adm. Alton Stocks, hospital commander, told staff in a July 12 message.
A "colleagues" memo issued in recent days says inpatient beds are in "critically short supply" because of furloughs of civilian staff triggered by federal spending cuts known as sequestration.
The memo encourages "dispositions/discharges as soon as possible." Hospital spokesperson Sandy Dean explained this direction, saying, "We are are encouraging health care providers to be more efficient when handling their paperwork instead of writing discharge orders later in the day ... no patient has been or will be discharged before it is medically appropriate."
With cases of post-traumatic stress disorder and other mental health problems at an all-time high, Dean says civilian caregivers in the hospital's in-patient mental health section are furloughed, reducing beds there from 28 to 22.
Most serious combat wounded and other medical cases are given priority as routine treatments are delayed, officials said.
Military families complain on the National Military Family Association website of waiting longer for medical appointments, immunizations for infants and getting someone to answer the phone at small medical clinics.
Similar cutbacks occurring across military medicine are "definitely impacting our ability to deliver health care," said Maj. Gen. Richard Thomas, commander of 11 Army hospitals in the western United States. Just in the first month of furloughs, 10,000 routine patient appointments in the western Army medical region been delayed because of staffing shortages, Thomas says.
The Pentagon's top medical official, Jonathan Woodson, assistant secretary of Defense for health affairs, called the cuts illogical and a significant threat.
"We simply cannot continue to sustain the burdens placed on the military medical system if sequester remains the law of the land," Woodson says. "The men and women who have fought tirelessly on the battlefields of Iraq and Afghanistan ... deserve much, much more than this."
Thomas said that by sending patients to a network of private doctors who contract with the government for services, the Pentagon will spend more money in order to compensate for the automatic spending cuts.
"As we curtail ... we will inevitably refer more care out to the network," he says. "We'll end up spending more money in the long run."
The automatic cuts, which many in Congress have vowed to keep in place through 2014, led the Pentagon to furlough more than 640,000 civilian workers for 11 days between July 8 and the end of the fiscal year on Sept. 30.
For the Army, which has the largest medical system within the military, all but 6,600 of its 44,000 civilian medical workers are being furloughed.
"The impact on morale is huge," says Thomas, adding that some caregivers have quit, lured to the Department of Veterans Affairs for jobs. "VA is parked right outside our installations and they're poaching our players."
For Erika Townes, a nurse at the Malcolm Grow Medical Center, an out-patient clinic at Andrews Air Force Base near Washington, D.C., furloughs mean canceling family vacation, cutting groceries and losing $200 per paycheck every two weeks.
"It frustrates me because I make less than $50,000 a year and, not to toot my own horn, but I'm a damn good nurse. ... I put a lot of passion into what I do. So you're going to punish me because you can't fix your own budget?" says the veteran nurse, a mother of four whose husband is disabled.
At Walter Reed, the primary care facility for troops wounded in Afghanistan, the number of operating rooms has been cut from 23 to 20 Monday through Thursday and to 10 on Friday, when most civilians take their weekly furlough day, according to a memo July 15 from Navy Capt. Philip Perdue, deputy chief of surgery.
"Sorry to be the bearer of bad news; this is being forced on all of us," he writes.
The sprawling Walter Reed campus in Bethesda outside Washington is a joint military operation that in 2011 combined the National Naval Medical Center and the Walter Reed Army Medical Center.
With the spending cuts, 10%-20% of beds are now left vacant in surgery, in-patient mental health, maternal child services and critical care. Surgeons are urged to finish operations by 3 p.m. each day, according to an internal memorandum.
Contributing: Tom Vanden Brook