Q&A: Major General Carla G. Hawley-Bowland
Written by Ted McKenna
MMT 2009 Volume: 13 Issue: 7 (October)
Commanding General
U.S. Army North Atlantic Regional
Medical Command and Walter Reed
Army Medical Center
Born in Casper, Wyo., Hawley-Bowland earned her Bachelor of Science from Colorado State University. She received her medical degree in 1978 from Creighton University.
In 1998, she took command of the General Leonard Wood Army Community Hospital at Fort Leonard Wood, Mo. She assumed command of William Beaumont Army Medical Center in July 2000. In July 2002, she transferred to San Antonio, Texas, becoming the chief consultant, chief of the Clinical Services Division and deputy chief of health policy and services at U.S. Army Medical Command. In July 2004, she took command of Europe Regional Medical Command and also served as the Command Surgeon for U.S. Army Europe and 7th Army in Heidelberg, Germany.
Certified by the American Board of Obstetrics and Gynecology, she is a fellow of the American College of Obstetricians and Gynecologists (ACOG), and has served as the Army section vicechairman and the Army section chairman, and is currently the chairman of the Armed Forces District of ACOG. She is a fellow of the American College of Surgeons and a member of the Association of Professors of Gynecology and Obstetrics, the American Medical Association and the Association of Military Surgeons of the United States. Hawley-Bowland’s awards include the Distinguished Service Medal, Legion of Merit (three Oak Leaf Clusters), Meritorious Service Medal (five Oak Leaf Clusters), Army Commendation Medal (one Oak Leaf Cluster), Army Achievement Medal (two Oak Leaf Clusters), Humanitarian Service Medal, Overseas Service Ribbon, Armed Forces Reserve Medal with bronze device, the surgeon general’s Physician Recognition Award and the surgeon general’s Award for Military Academic Excellence (the Lewis Aspey Mologne Award).
Hawley-Bowland was interviewed by MMT Editor Ted McKenna.
Q: What programs or activities would you particularly note as successes at the center?
A: Walter Reed has a tremendous history of service to the nation. Having just celebrated our 100th anniversary on May 1 highlights the fact that Walter Reed has been the home of warrior care through two major world wars, Korea, Vietnam, Desert Storm and now OIF and OEF, not to mention numerous other smaller military actions over the years, and for the past 50 years has also been the home of world-class beneficiary care, graduate medical education and research. Currently Walter Reed counts among its great successes its various centers of excellence, which include prostate cancer, breast care, gynecologic disease, integrative cardiac health, regional anesthesia and acute pain, diabetes, vaccine health, gastroenterology and liver disease, the Deployment Health Clinical Center and a branch of the Defense Veterans Brain Injury Center. We also are home to the U.S. Military Cancer Institute and the 3D Medical Applications Center.
Q: What does the 3-D center do?
A: [This] is the only one in the Department of Defense and serves military treatment facilities worldwide with bio-modeling, 3-D photo-modeling, digital custom anaplastology models and custom titanium and acrylic implants as well as custom titanium fixation. These 3-D services have helped make highly complex restorative surgeries significantly more efficient in reducing the average time of a case from six hours to two. We [also] have the Military Advanced Training Center, which houses our rehabilitation program for our amputees, and we even have a new center of excellence on the horizon called the Combat Wound Initiative Program. This newest program is designed to perform research into the healing of complex wounds and eventually not only identify markers of inflammation that can either impede or assist in the timing of wound healing, but also to get to the genetic level, whereby the gene for those markers is not only identified but can be manipulated to guarantee complex wound closure, and graft or flap survival, thus yielding tremendous outcomes for our wounded, ill and injured servicemembers, and new scientific methods for the greater medical community at large. Walter Reed has a legacy of providing world class health care to America’s heroes and their beneficiaries, and this legacy will continue as we transition to the new Walter Reed National Military Medical Center at Bethesda, Md.
Walter Reed Army Medical Center [WRAMC] is leading a customer service transformation to address the needs and expectations of our patients, the staff and the nation. As the face of Army medicine and one of the Army’s premiere patient reception stations, Walter Reed is uniquely positioned to influence the first impression and set the tone of the Army health care experience for returning warfighters and their families.
Q: What do you mean by customer service transformation?
A: Customer service initiatives include health care hospitality training for staff; appointment of a deputy commander for cultural transformation; a hospitality and guest service that provides concierge, hospital greeters, patient transporter and wheelchair escorts; and the “quest for excellence” customer service program that recognizes employee contributions to quality, understanding, excellence, safety and teamwork. We have made the Walter Reed campus much more accessible for patients and visitors with disabilities. A children’s playground and a barbecue patio have been installed at the Mologne House to help families cope with extended stays to support their warriors in recovery and rehabilitation.
Q: What’s your view on efforts to improve electronic record keeping throughout the military medical system, from initial treatment on or near the battlefield to the transition of patient from the DoD system to the VA system? Is the software as it is pretty good? Do you see the need for a lot of improvement?
A: The electronic health record is certainly something that is constantly being improved, and constantly in a state of change as we discover what applications do and do not work, which ones can be done better, and discover what new applications need to be developed to meet specific data needs of our health care providers. This is true for applications for use in theater, on the battlefield, or all the way back at home at our CONUS-based treatment facilities.
Right now a major project is in the works between DoD [the AHLTA system] and the Veterans Administration [the VistA system] in terms of the seamless transfer of information on patients being cared for in both systems. We have a narrow bridge that connects the two in the application of the electronic patient transfer note, whereby a VA medical team will receive a transfer summary on a military patient prior to his or her arrival at the VA hospital, and vice versa. We are also developing windows into the VistA system to allow providers to pull up laboratory data, test results, et cetera, on patients recently seen at the VA.
Eventually the systems will merge into one fully functional bidirectional system. The future, of course, lies in the creation of the electronic virtual personal medical record, one that can be securely accessed by any physician, military or civilian, who is treating a military beneficiary, from any treatment site around the world.
Q: How goes the Warriors in Transition program? Does it appear to be popular with the soldiers—and families—participating in it?
A: The Warrior Transition program is going extremely well. Our average length of stay in the Warrior Transition Brigade is 195 days for fiscal year 2009, down from 281 days in 2007—a 30 percent decrease. Patient satisfaction with their case managers, their primary care managers and the Warrior Transition program as a whole remains high. Ninety percent of the warriors surveyed were satisfied with the program during the second quarter of this fiscal year. Individual primary care manager, squad leader and case manager satisfaction rates were all over 90 percent on the same survey. Anecdotal comments from surveyed warriors indicate they are very pleased with the comprehensive transition plan and feel it has been extremely helpful in organizing their transition process.
Q: Why is the average length of stay down? How is the care provided through the new program different or better than it was previously organized and administered?
A: The average length of stay is down because we have a dedicated “triad” focused on warrior care and we have been constantly refining our systems. We’ve got case managers actively engaged in assessing patient care needs and appropriately referring patients to providers in a timely manner. We’ve got primary care managers who are focused on the total patient and not just a specific specialty, so all patient needs are rapidly and thoroughly addressed. Finally, we’ve got squad leaders who are dedicated to getting patients to appointments routinely and on time.
Q: What do you think of the prosthetics programs currently available to soldiers? Are the technologies and services about as advanced as could be expected?
A: Historically, significant advances in patient care come during times of military conflict, and that has been evident in the changes in prosthetics over the past seven years. There have been many advances in prosthetic components that I will discuss in a minute, but it must be realized that it is a combination of all of the health care services working together that has enabled us to return servicemembers to the highest levels of activity, including over 40 returning to theater with prosthetic devices. Over the past seven years our prosthetics service has developed strong connections with prosthetic manufacturers, which has enabled the development of new prosthetic components, many of these specific to military requirements.
Q: What are some of the advances?
A: Among these advances are field hardened microprocessor knees, power knees with the capability to propel the user, and significant advances in upper extremity prosthetic devices, increasing function and adding advanced mind-machine control mechanisms. While these advances have been revolutionary, gaps remain between the current capabilities and fully integrated, fully functional prosthetic limbs. Government agencies continue to play an important role by either funding research for advanced prosthetic systems or participating in level one research, expanding the technologies to address these gaps. Similar to past conflicts, the advances in health care for the wounded servicemember transition to the private sector and enhance the lives of the general population with limb loss due to injury or disease.
Q: Can you elaborate on what you mean by gaps in current capabilities and fully integrated prosthetic limbs? What is it that’s lacking, basically speaking?
A: The gaps are numerous—the technologies of neuroconnectivity as a control mechanism are not yet scientifically proven nor are they commercially available. Socket interfaces are still predominately limited to rigid materials as compared to auto-adaptive [shape shifting] technologies. Terminal devices for upper extremity are still very limited in function—you still cannot play a piano or guitar, nor do they have sensation. Power prosthetics for lower extremities, which permit running and agility motions with minimal increase in energy expenditure, [similar to] able-bodied individuals, are still conceptual or in early levels of research. We still have a long way to go to get to “I Robot.”
Q: How goes the effort so far to move Walter Reed services to Bethesda, as part of the BRAC realignment?
A: Planning efforts with JTF CAPMED [Joint Task Force Capital Region Medical], NNMC [National Naval Medical Center], DeWitt ACH [Army Community Hospital], and WRAMC are going well. There is great cooperation and collaboration between all involved. We are planning for an orderly, time-compressed movement of Walter Reed’s services to both Bethesda and Belvoir between July and September 2011. Our patients and stakeholders will be informed, well in advance, of the actual movement dates—and our appointment clerks will ensure our customers know exactly where access to services will be accomplished. We have jointly selected integrated department and service chiefs as well as program directors. We only have two residency programs out of 53 left to integrate: internal medicine in 2010 and general surgery in 2011.
Q: How would you sum up the benefits to servicemembers and the staff caring for them in moving the Walter Reed facilities to Bethesda? Would they be basically the sorts of benefits one would expect from newer facilities, more staff in one place that can collaborate, et cetera?
A: The military health care system’s tertiary care capabilities in the National Capital Area [NCR] are currently split between WRAMC and NNMC. For instance, gynecology is mostly done at Walter Reed, while obstetrics is performed at NNMC. Similarly, almost all neurosurgery is performed at NNMC, while most amputee care and amputee rehabilitation is done at WRAMC. Once the merger of WRAMC with NNMC is complete, WRNMMC will become the principal hub for military tertiary care capabilities in the NCR, while also serving as a major primary care enrollment site for DoD beneficiaries. The new and newly renovated health care buildings on the Bethesda campus will allow this expansion of capabilities and the continued delivery of world class health care.
Q: Does the transition appear to be going as smoothly as could be expected?
A: There will be no substantive transition until the summer of 2011 due to the construction schedules that will not allow major transitional movements until the summer of 2011. Small movements of equipment and people will occur prior to the summer of 2011, but they will be mostly transparent to our customers. Planning is going quite smoothly. As long as there are no surprise delays in the construction schedules, then we will be able to meet the BRAC deadline of September 15, 2011.
Q: Any final points you’d note?
A: In closing, my husband and I trained at Walter Reed over 25 years ago, graduating in 1983. I trained in OB/GYN; he trained in general surgery. As an intern, he moved patients from Building 1, the original Walter Reed, into Building 2, the current Walter Reed. He retired after 30 years of service. My call room is still present in Building 2, and I will transfer patients to the new Walter Reed National Military Medical Center in Bethesda. The legacy of Walter Reed continues as it moves again. And the memories will continue to grow, for it is our warriors and our patients who create the precious memories for all of our staff. ♦