The ones I noticed less than stellar performance, rudeness, losing your medical records, etc are civilians - and seem not to fear any disciplinary action.
If they are government employees it is almost impossible to fire them. DC has had quite a problem with less than efficient and/or pleasant government service employees. I can recall newspaper articles about various mayors trying to encourage more appropriate behavior in their public service people. Perhaps they have never gotten it from all too many. This is very sad for our wounded warriors.
I'll just say I had my run ins with some non medical staffers there at WRAMC a couple of times. It shouldn't be that way. I was already stressed enough as it was and the treatment I received ticked me off. I did, however, let them know I was angry. I didn't let them get by with it. That's unusual for me because I'm a pretty laid back person and it takes a lot to really get me angry. I could go into a lot more detail or talk about how screwed up the system is and provide examples, but it would take up too much space. :) And I (we) was/were only there for 3 weeks. I really feel for those soldiers and their families who have been there for months.