The Broken Soldier

Adding to what was already a bad mood, my wife shared a disquieting Fox News story regarding 19 deaths due to substandard health care - a combination of doctor inexperience and slow hospital administration reaction to the deficiencies of their doctors - at a southern Illinois VA Hospital. VA officials reacted with anger, heaving apologies on the dead patients’ families, promising them assistance in their push for compensation. Members of Congress echoed this sentiment, but also expressed feelings of shock that such things could happen. VA undersecretary for health Michael Kussman offered assurances these are aberrations in an otherwise quality health care system, and vows reform.

But those of us in the military health care system understand this brand of malpractice, while perhaps not representing the majority of medical outcomes, is hardly unusual. Poor treatment takes many forms. From poor bedside manner to the sort of egregious malpractice leading to the deaths of these 19 veterans. The serious shortcomings of military medicine are discussed more candidly now, but not candidly enough.

Whether members of Congress or VA/military medical facility administrators, no one wants to treat this matter with the honesty and frankness it deserves. Doing so isn’t expedient. For elected officials, the fear is angering and or alienating military members and those supporting them. For administrators, it’s angering or alienating their staff. But neither seem motivated to address what is possibly the single greatest challenge to national morality and honor of our time: Keeping our promise to service members and veterans to provide timely, quality health care.

The time to play tip-toe around the problem is over. The time to make excuses for negligent and incompetent doctors and health service staff is over. The time to prioritize our fears of ruffling the delicate plumage of VA/military officials and doctors with criticisms is over. The time of service members honoring long traditions of accepting whatever crap is thrown on their plates is over.

Until we stand together, Republicans and Democrats, service members, veterans, and citizens, and proclaim in one voice, “We aren’t going to accept this anymore!” nothing will be done. More service members and veterans will be harmed. More families will be without spouses, fathers, mothers, brothers, sisters, sons, and daughters. What is more important to us as a nation? The risk of offending incompetent and negligent medical professionals and the staff covering for their bad behaviors by calling them out and demanding they be accountable (possibly making them leave their posts), or the risk of not taking sufficient action to minimize the likelihood of more hurt and/or dead service members/veterans (harmed not on the battlefield, but by those ostensibly ‘on our side’)? Time to decide America.

The original story can be found here: http://www.foxnews.com/story/0,2933,326187,00.html

The word is getting out and into the ears of the right people.  More and more are getting involved everyday.  People of principle.  People of substance.  People with influence.  Now a man of the cloth is part of that crew.  He, a former priest in Washington, DC, is currently organizing his fellow clergymen to petition Congress (something he and his colleagues have the power to do) for formal hearings to address the problems many of my fellow service members and I experience.  Thank God for him.  If he and his friends can save one service member from the suffering my wife, family, friends, and I have endured, he is truly doing God’s work.

My new friend Jazz and I are working out the details of a remote radio interview to share my experience with her audience. She is extending her talk radio show by an hour, and will be promoting this interview for the next couple/few weeks. I know of a few of others in similar situations, like Eric, but am putting out a call to anyone else interested in getting their stories out to a wider audience. If interested, contact my wife (the site admin).

I have no particular political alignment. I have few political views I feel are unchangeable. I do not have a precipitous ideology. My approach to politics is more a matter of right and wrong than of right and left and center. I’m open to listening to different points of view, as I imagine are most people who recognize they aren’t omniscient. I spend time on each of the current crop of presidential candidates’ websites and blogs searching for entries regarding soldiers’ rights. I’ve been spending quite a lot of time recently on John Edwards’ site. To my complete surprise, it is his supporters who seem most sympathetic to the cause. And not in a patronizing, creating a new victim class, political football to throw at Republicans sort of way. They truly seem touched by my accounts, and have shared their own.

This post, to hurry up and get to it, is about one soldier, currently and for over a year residing at Walter Reed, and his experiences with Army medicine. He has had five surgeries in the past year, is pretty messed up, and nothing in the way of retribution is likely to happen to the doctor(s), Walter Reed, the Army, or the Federal Government in terms of equitable compensation or even punishment for their malpractice. The soldier in question had his colon attached backwards. Yep, you read that right. He is messed up because Army surgeons attached his colon backwards! Now I’m not a medical doctor, but I suspect if the Almighty had meant for the colon to be attached that way, He would have included that in His design.

It is high time to hold these people responsible for their actions. That will only happen after Feres is seriously revamped and soldiers and their families have the right to sue military doctors, military hospitals, branches of the military, and the Federal Government. To add to an idea broached in a previous post - doctors tend to try harder when there are consequences for carelessness and mistakes, but this isn’t about adding new ways to sue other people or other organizations. Though some will attempt to suggest otherwise, this a matter of justice. To ratchet up the rhetoric and drive the blatant injustice home, a convicted murderer and his/her family have more rights than soldiers and their families whose lives have been destroyed (or ended) by malpractice at the hands of military doctors.

The title assumes I’m going to Heaven, which, given the indiscretions and dalliances of my youth is not at all certain.

I overdosed on pain patch medication last night. With the combination of higher setting on the thermostat and unusual blanket coverage, the extra heat energy probably caused more pores in the patch to open, allowing for more of the medication to enter my bloodstream. Given the way the Army and the MIARNG have treated me over the past year, I was tempted to just roll with it. If not for my wife and my dog coming into my (rather sobering) peripheral view, I would have. At that moment, in spite of the pain, physical and emotional, I do have a lot to live for. But something has got to give. The Army and the MIARNG will not address my problems or those of other soldiers in similar situations unless they are forced to do so. They can only be forced by those outside the system. Media and congressional attention has the potential to embarrass them publicly, punish them in terms of funding (though, given the unpopularity of that sort of move, that result is doubtful), and/or rescinding or seriously altering Feres. But the media and congress have focused, as those who have followed media coverage (and to a lesser extent my posts here) understand, on veterans of the Iraq and Afghanistan wars. Those aren’t the only soldiers suffering from harm visited on them by this broken Army and VA medical system.

Please, write your senators and congressional reps. Make clear to them soldiers’ rights is a major issue to you. Also make clear the consequences of not meaningfully addressing that issue.

I had another conversation with Sheila Marolla last week. She told me the NCOIC of Health Services, SFC Patricia Weir, claims all requests for medical care from my doctor, my wife, and I have been authorized. Ms. Marolla sent along an attachment authorizing 12 visits to physical therapy dated December 10, 2007. This is odd. I’ve been in more or less weekly contact with my unit since September. This would mean I had at least two calls with my unit rep LT Van Hout between the time my physical therapy was approved and the unit left for the holiday break. During each call with LT Van Hout, she made certain to let me know she was hard at work and on the horn with Heath Services to get my medical care authorized. My conversation with Ms. Marolla was the first I had heard of approved physical therapy.

SFC Weir then went on to discuss my incapacitation pay. She claims the reason my request was disapproved was no medical records accept for the month of May, 2007. I submitted the request form (which includes a section filled out by my doctor) and medical records from May to September in September. I have since sent additional medical records to both my unit and Health Services from the months of October, November, and December.

SFC Weir also claims not to have received requests from anyone regarding my need for a neurosurgery consultation. My doctor, my wife, my unit, and I have all sent requests for referral to the neurosurgeon since May in the forms of actual referral slips, medical records, and hand and type-written requests along with conventional medical justifications for seeking this type of treatment. SFC Weir’s claims are obviously not true.

Weir then switches gears. Not approving incapacitation pay and neurosurgeon consultations wasn’t a matter of not having received the documents, it was a matter of ‘insufficient’ documentation. Language is fun isn’t it? Of course, in this context, insufficient can mean anything, to include referring to a level of documentation no person could ever reasonably hope to satisfy. Eric, my buddy whose story is also posted here, went through something very similar. This seems to be all too common with reserve components of the Army seeking the benefits to which they’re entitled. In attempt to remedy, I’m sending along every related document sent by every person involved during the past 9 months to Sheila Marolla later today. I’ll also be sending along email conversations between my unit and I speaking to the need (per conversations with my doctor) to see a neurosurgeon as early as the second week of May.

It’s tempting to blame my unit for this. Maybe my OIC isn’t doing what she claims to have been doing. Though I find this hard to accept. More plausible is that SFC Weir and the people in Health Services and at State JFHQ are lying in attempt to cover their asses. But denying having received a mountain of documentation, then changing stories to not having received sufficient documentation is bound to raise eyebrows during a formal inquiry conducted by a US Senator’s staff. We have receipts from our trips to Kinkos. We have email from my unit confirming they received faxed materials. My doctor and his staff have records of the materials they have sent to Health Services directly from their office. What makes a person deny things that are obvious to everyone? Well friends, these idiots are about get housed by the legal equivalent of Wittgenstein’s Poker.

If the formal inquiry doesn’t fix the problem, my attorney is talking about bringing a ‘mandamus’ suit against the Guard in Federal Court. For those of you not hip to the jargon, this is a legal action in which a judge orders the National Guard to do what it is legally obligated to do.

I received a letter from AMEDD this morning. In it a request to do a survey regarding my opinions of the medical care I received at Ireland Community Hospital with a one Robert Toon. The session timed-out, of course, after 3 minutes of typing. This is, from my experience, not unusual. Army rap sessions really aren’t designed to listen to criticisms. They’re designed to give the appearance of listening to criticisms. Most of this is old hat for those of you following my story. I never claimed to be original or creative. Please find what I wrote in email to the survey administrator below.

“I have serious doubts my comments and criticisms will be taken seriously. With each new Army experience my confidence in Army personnel to regulate themselves and the Army’s ability to regulate its people lessens. It is because of my visit with Dr. Toon my wife and I are in a position in which we must decide on whether to pay our bills (many of those in arrears given that I’ve not been able to work for close to a year because of this approved LOD injury for which I’ve not received adequate care) and paying to retain a semi-high profile soldiers’ rights attorney.

Dr. Toon clearly confused to whom it was he was talking during my physical evaluation. I find Dr. Toon’s confusion common in the Army. A very serious category mistake regarding what I, as a PFC, am, what I know, what I have accomplished in life, and what I am capable of doing. My rank not being commensurate to my time in grade, time in service, aptitude, and education, while insulting in and of itself, is a side issue. I have degrees in Physical Anthropology, Behavioral Neuroscience, and Analytic Philosophy with minors in Biology and History from the University of Michigan. I worked as a clinical researcher in the U of M Medical Center’s Department of Neurology/Neuropsychology Division. As such I know something about the human body, about the human nervous system, and about applied medical neuroscience. Toon’s mistake was in thinking I, as a PFC, wouldn’t be able to detect his shenanigans. He was wrong. With my attorney’s help, I’d like to begin the process of writing a formal request for an ethics violation inquiry to the AAOS. If not for broad interpretations of Feres I would probably sue him.

Dr. Toon claims in his medical report to have spent an hour with me. Closer to the truth, he spent about 20 minutes. He was almost 50 minutes late for our 11 a.m. appointment. In that 20 minutes, Dr. Toon spent most of his time having a laugh at my pain and physical impairments when attempting to heel and toe walk, etc. Given his report, he clearly didn’t listen to my list of symptoms or the severity of them. For example, when asked the question, “On a scale of 1 to 10 how would you rate your pain?” I responded, “That depends. When I’m inactive it’s between a 3-5. When I’m active, which for me can consist of as little activity as sitting up, it can be anywhere from a 5 to a 10.” In his report Dr. Toon states my self-pain rating is moderate, somewhere between a 3 and a 4. He then went on to suggest the symptoms I experience, which are not full accounts of my symptoms, are the result of my being fat and poorly conditioned. In my defense, however, not that I should need one, gaining 50 pounds during 8 months of almost complete inactivity and regiments of steroids and gabapentin belies the fact that I do have a rather serious, debilitating injury. He misconstrued my labored exhalations, without labored inhalations, sweating and rapid heart rate as signs confirming his belief of my being out of shape. It didn’t occur to the doctor, or perhaps, as I believe, his confusion was deliberate, that these may be signs of being in extreme pain. He suggested, “Get more active.” Easy to say when you’re not the one who experiences increased pain and neurological symptoms for days after doing as little as taking out the garbage.

Of the 8 months worth of medical records I had in my possession, paying for copies of those, as with almost all diagnostic and palliative medical care I’ve to date received, Dr. Toon saw fit to only look at my MRI and my MRI report. In looking at a sagittal plane MRI for 10 seconds (twice to give the appearance of thoroughness), he changed my diagnosis from an L5-S1 right side, broad-based lateral disc herniation effacing an exiting ipsilateral spinal nerve root to a small, central focal L5-S1 disc herniation. He then claimed to be confused about my symptoms, which, after review with my primary care and pain management doctors of primary neurology/neurosurgery medical sources (”Localization in Clinical Neurology,” for example), was unjustified. L5-S1 herniations can affect/compress/lesion S1 nerve roots. My symptoms, which include sensory and motor disturbances in my right leg, foot, and toes, and moderate to severe pain my lower back, buttocks and hip are perfectly consistent with my diagnosis, even his. When I asked why he had rejected the civilian MEDICAL TEAM’S diagnosis taken from 8 months of treating me compared to his 20 minutes of ham-handed evaluation, he said, “Civilian doctors tend to over-call.” He then sent me on an allopathic wild goose chase through Ireland to resolve what I believe to be feigned confusion. This too was at best irregular. He performed a test for patellar reflex. He made a big deal about the fact it was preserved. Of course, with S1 compression/lesion patellar reflexes are spared. Why do I know this but a retired COL and ortho specialist doesn’t? With a spinal disc injury and radiculopathy/neuropathy he sent me to lab. What does my blood have to do with my symptoms or my injuries? He then sent me for one visit with a physical therapist. What is accomplished by one visit to PT? He then sent me to Radiology for an X-ray. If he was confused by the MRI, which is doubtful but let’s give him the benefit, how would a less precise diagnostic image resolve it? Answer, it wouldn’t. He then sent me for another MRI. If one MRI doesn’t work why would two? I believe, as does my attorney, and as does US Senator Carl Levin, this doctor is purposely confusing my medical condition in attempt to assist the government in denying its legal obligations to care for and compensate me. In reviewing literature, lateral disc herniations are very difficult to find. But his approach would not help in clarifying matters. There are standard procedures to resolve confusion about the presence of lateral herniations. These involve careful documentation of symptoms, and appropriate diagnostic measures - contrast CT scans and or myelograms, for example. He didn’t do any of these and hasn’t ordered them either. Instead he sent me home with a script for Tylenol (which I didn’t bother picking up). My wife and I left Knox having accomplished nothing. By nature I am not given to painting with a broad brush. However, my experience with Army medicine, and with the Army in general, has been terrible. Never in my life have I experienced such blatant and audacious disregard for rules, laws, and morality. And I don’t believe I’m the only one of Dr. Toon’s customers to receive this treatment. At some point he and all of you will have to come to terms with the idea that rules and consequences for breeching them do apply to you. I am absolutely disgusted, and basically helpless to resolve this matter within the Army or the ARNG. You’re simply not interested in fixing the problem. You’re interested in deflecting blame and negative attention. This universe in which most of you live is quickly crumbling. There will be a reckoning, and that day is fastly approaching.”

Today I had a good discussion with Sheila Marolla. She’s a staffer for US Senator Carl Levin. Her advocacy has been helpful, but it’s about to become even more helpful. Upon learning the folks at MING HQ, including the AG of the MING, lied to her again in informal inquiries, we’re moving to full formal inquiries. These folks have put themselves in it. They will now have to account for their false statements, and if they are unable to do so in a meaningful way there will be consequences for them. This is something to which I’m sure they aren’t accustomed. But a reasonable person recognizes when a system that has simultaneously harmed so many and insulated them from having to answer for their actions and inactions is falling down around them. One would think even an unreasonable, even stupid person could act prudently. But this isn’t the case with the folks at MING HQ. They’re convinced allowing this miscarriage of justice to continue will have no affect on them. It hasn’t so far. My wife, family, friends, and I have suffered because of this. But that doesn’t affect them. Why should it? I’m under their heel. A pawn. And kings, bishops, and knights shed no tears at the suffering of a pawn or his associates. They’re in for a very rude awakening. Pawn promoted (with the help of a US Senator), check mate!

Among my many factory defects, being without an edit/censorship program is probably my favorite. My wife thinks it’s funny. My friends find it endearing. Most of my ’superiors’ find it intolerable. I’m given to talking about what’s on my mind without much attention to code switching or what’s appropriate in a given setting. Not that I’m socially retarded or insensitive, just honest, as direct as I can be, and not given to changing personalities as a hatter changes hats. That’s about all the warning I’m going to give for this and any other post. I should probably get to it, as the stage-setting is in danger of taking longer than the play.

I don’t care for Eastman, but I thought the quote made an apt title. Good to share a bit of painful humor about an experience I had today. I was taking a shower today. (I do that regularly, and while after 8 months of inactivity and weight gain my naked body may be funny in a nut-kicking Steve-O vomiting schadenfreude sort of way, that’s not the funny part.) I’m a bit limited in range of motion these days. Limited by pain and limited by partial paralysis in my right leg. Showering is always a challenge. I thought about getting one of those handi-capable shower chairs, but I’m not quite ready to admit I need one. Not yet. Anyway, I was turning to the side and leaning back as far as I could to apply the soapy wash cloth to my backside. This movement made me have a muscle spasm that lasted for about 10 minutes. It went from the right side of my lower back to the left side of my lower back, up my back on both sides to my shoulder blades, and around to my abdomen. Wocka, wocka, wocka. I thought it was funny.