USA Today ran a story on Friday, Nov 21 about substance abuse treatment problems at General Leonard Wood Army Community Hospital in Missouri.
For many first time readers, this may be a sobering story that one would wish was isolated. Unfortunately, as a 6-year veteran of the military health system as a surgeon in the Air Force, the article did not surprise me at all. The military is a place where ethics and integrity are sold as guiding principles, yet at times the opposite is the case. New military physicians quickly find themselves navigating complex ethical mindfields such as the scenario described below that result in disappointment, burnout and attrition.
Here is the synopsis: In a 2007 review, the Joint Commission found deficiencies of waiting lists and insufficient staff for drug and alcohol counseling and treatment at General Leonard Wood Army Community Hospital in Missouri. An apparent problem throughout the Army with increasing number of soldiers seeking this type of help, but the number of counselors has not kept up. A whistleblower, one of the counselors there, filed a complaint that one month after the review, there was no longer a waiting list because the hospital commander, a COL Theresa Sullivan had the Clinical director a CPT Melissa Lee, allegedly divert the patients away from treatment. The Inspector General, found that CPT Lee, had consistently incorrectly filled out forms that resulted in many soldiers erroneously appearing as if they had drug problems and needed counseling. The Captain is now a Major. The Hospital commander, now a DEPUTY DIRECTOR OF NURSING in an Army installation in Hawaii said she never told anyone to get rid of waiting lists. She also said she tried to hire counselors, but it was hard.
The IG findings were 168 who were sent, or voluntarily went for counseling for drug or alcohol problems did not get treatment. Twenty-eight were screened in August 07, none were enrolled in the program. Lee the Clinical Director filled out over 150 forms with "mistakes".
The counselor complained to congress after the IG apparently found the allegations unfounded. Further findings were that during the 9 months that Lee was the Clinical Director, only 20% of those seeking counseling were enrolled, compared to 52% since she left, which is closer to the Army-wide average.
After filing his complaint, the counselor went to another base in Germany where despite having had excellent job performance evaluations, the credentials committee received a negative evaluation of him from CPT Lee, the one who was making all the "mistakes" on the forms. The report said that he had poor interpersonal skills, and pointed a finger at someone during a discussion. His new boss and the Senator he contacted wrote to the Army secretary about this travesty, and now the records of the denied soldiers are going to be reviewed.
The story appears to suggest that the hospital commander and mental health provider acted together to cover up gaps in mental health capability at Fort Leonard Wood. It also suggests that an IG, a non-physician, arrived at conclusions that differed the joint commission's findings. Finally the article suggests that the COL and CPT were rewarded with promotions while the whistleblower was punished.
The article gives the reader a glimpse of military medical system darker side. What type of message does this send to junior physicians at the crossroads of their careers or prospective medical students interested in military medicine? How could the problems with access to care at Fort Leonard Wood have been handled with a better outcome?
Galo, that's a great article. I worked at an overseas military hospital that was the equivalent of a small community hospital when I served in the Navy. We ran into issues like this where we felt we needed more staff and tried to ask the senior members of our community for help. Our perception was there was a conflict of interest because the senior military medical leaders worked at the big stateside hospitals and would drag their feet on any issue that would result in realigning key personnel. For example, fixing the issue at Fort Leonard Wood might require moving a psychiatrist from Walter Reed. The leaders would say things like "it's bad everywhere" and "things are worse here". Our perception was things were much better off at the big hospitals because they had a number of GS physicians, contractor physicians and a strong Tricare network. On overseas and small rural bases like Fort Leonard Wood, there is little or no Tricare network and its difficult if not impossible to hire a contractor. Another thing is the detailers would put the most junior personnel at the small hospitals. Maybe if more senior, experienced personnel were placed into billets at small hospitals they could prevent this type of situation from occurring. I wonder what would have happened if CPT Lee would have been a COL?
Unfortunately, its been my bad experience that, (with few exceptions), by the time a "physician" stays long enough to become a Col, they have bought into the system lock stock and barrel. Very often they are part of the problem, and rarely the solution, as it well should be.