Thomas W. Stoddert, US Army Retired, is right on every point and I applaud his courage to write a very exacting letter.  My tenure at Madigan Army Medical Center as the NCOIC of the Department of Medicine made me aware of mismanaged policies and management issues.  I worked with a wonderful staff of professionals and paraprofessionals who conducted themselves very appropriately and courteously, with politeness, knowledge, experience and timeliness.  However, all of our efforts were frequently clouded by the frustrations of personnel shortages, ancillary demands of personnel, frustrations secondary to multi-echelon mismanagement issues, and numerous other problems.

The Department of Medicine includes 13 separate sections, clinics, and sub-departments, each with specific medical missions comprised of doctors, PA's, nurses, medical technicians, and support personnel, including military and civilian staff.  Some clinics have direct access through central appointments while many others required a referral from the primary care provider.  All too often miscommunication between various services and ancillary personnel would complicate scheduling problems.  An appropriate example: Patient "A" might be scheduled to see doctor "Z" in a specific clinic, but Dr. Z had to cancel all appointments because he/she had to support another military mission somewhere else on post or deploy to another country.

Frequently, the appointment schedule confusion was not because of medical staffing, but due to Central Appointments or Tri-Care issues for providing less than appropriate information to the patient and the provider.  Regardless who was at fault, the senior enlisted member of each clinic, section or department always tried to resolve relevant matters at the lowest level before involving the members of the Patient Representative Office and Patient Affairs Office. 

As the NCOIC or the department, I coordinated with the Patient Representative Office and Patient Affairs Office and designed placard's which identified the OIC and NCOIC of each clinic, section and department with a current photograph and a customer service statement bent on resolving problems or complaints at the lowest level.  The commanding general at the time accepted the design and ordered that it be implemented throughout the hospital.  The implementation was done in 2000 and I hope it is still in place. I am confident that the NCO's and OIC's at each level are fully capable of resolving conflicts and complaints, providing they get support from the senior management of medical care at Madigan Army Medical Center.

On the other hand, I and many others have all too often witnessed many frustrated and dissatisfied patients and family members who lack the patience to allow the system to work as it is designed.  These patients complain every chance they get and they become very loud and ugly about it, making treats, breaching the chain of command, and writing letters and memos to anyone who will listen.  The members of the Patient Representative Office and Patient Affairs Office do everything possible to bring providers and patients to a equitable arrangement, resolve appointment conflicts and ultimately bend-over-backwards.  Still, the patient complains and will ultimately use the same tactic every time they feel the need, regardless of how well or how often they have been treated with the same professional level of care that all patients and family members are given.

I am not blind and I do not wear rose colored glasses.  I know there are problems with the management of care at Madigan Army Medical Center and other military medical facilities.  However, there is no single mission in the military service that is as resource intensive as the medical mission on a daily basis.  Then the medical facilities must comply with and satisfy military and civilian laws, protocols, standards, inspections, and funding agencies.  All of this while still supporting the military missions of deployments, training, education, reassignments, and command emphasis issues. 

So, yes, a problem exists, but it will take the collective initiative of the soldier's at each facility to make the improvements, with the support of the Army Medical Corp senior management and mass influence of money and personnel.

Alan B. Candia
U.S. Army (Ret.)   

Reader's Response Below
Thank you for your courage to tell it like it is!   The General is a good person but what can one person do?   Do you know who the members of her so-called command group are?   The Deputy Commander for Administration is ineffective, disinterested, weak and lame.   The Deputy Commander for Clinical Services is pretty smart but he is a poor leader, has no clue what his subordinates are supposed to do and he is leaving in a few weeks.   The Deputy Commander for Nursing is also lame and she is about to retire.   The Hospital Sergeant Major is also about to retire!    In addition to the problems you described, there are many others.   For example, I wish someone would approach Mr. and Ms. Horrell  and ask them what they know about nepotism and the merit system!   Madigan is a wonderful institution and has many great people but the fat, ineffective and overstaffed upper management needs to replaced and realigned now!  

Husband of a very concerned member of the Madigan Team  
I am rated 100% unemployability. My ratings are as follows.
30% for chlorache from Agent Orange exposure
30% for PTSD
40% for diabetes
It also says on my award letter, "No Future Exams."
My question is do you think they can re-examine me in the future and take away my benefits?
Thank You,
Bob Clark

Bob, Thanks for writing in to the "Veteran's Voice."

The VA can require a future exam at any time  if they feel there may be an issue of fraud or if a   gross mistake was made. But generally in cases like yours where they say no future exams,
they mean just that.

The VA can, if they have sufficient reason, propose to lower a rating percentage only if they        believe you may have gotten better or something has happened and they have to review
certain awards. This can happen as an example as the result of a mandate from Congress. The   issue of PTSD, was getting a lot of nasty attention by the national press and the VA went back   and started looking at this issue when it was awarded to  non-combat veterans.

However, the general rules are basically after five years, service connection can not rescinded,   but the rating percentage can be lowered; after ten years there can be no reduction in the rating percentage or severance of a service connected condition unless there was fraud.

All this to say, if you got a fair rating and they have said no future exams, just run with it. The  VA does not like to hassle vets when they do not need to.

Now, the down side, FYI. The VA does  routinely check up to see if you are working and so does    the Social Security Administration. They both allow you some grace in making some extra income because they know staying home vegetating is harmful. However, 100% unemployability is just that and both agencies frown on a veteran receiving benefits because they can not work and then go out and work full time. So check carefully and see what they allow you. I was told recently that these rules may have changed not too long ago.

Assuming you are not working you may want to consider doing volunteer work in the community and/or working with veterans. Here is where the fun starts. The VA, through the education department,  will sometimes purchase items to make a veteran's life more meaningful. In my case they helped me purchase computer equipment so that I can write like I am now and aid other veterans. Now that there is a war on, there are many opportunities to use your talents and experiences for others, particularly other vets.

So good luck and welcome home.
Thom Stoddert
The Veterans Voice
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Thom Stoddert

"You know, education, if you make the most of it, you study hard, you do your homework and you make an effort to be smart, you can do well. If you don't, you get stuck in Iraq."

Let’s take Senator John Kerry at his word–that the above quote was a "botched joke" about President Bush, and he never intended to insult United States troops. I can easily picture a scenario that supports that version of the incident.

Unemployed gag writers from the old Rosie O’Donnell show (now known as Democratic strategists) sit around a table at John Kerry’s office, hemmed in by snow boards, that camouflage duck hunting suit (practically new), a bin containing his Vietnam war medals marked "Take One,"a reproduction antique Heinz ketchup bottle turned into piggy bank, and two litres of unused "Tan in a Can." It’s the way the Oval Office would look now if Ohio had gone the other way.

John Kerry says he’d like to open his appearance at the California fundraiser with a few jokes, and, being an Ivy League graduate, is at least smart enough to know he can’t write his own material. The strategists toss out ideas, in the tradition of Buddy and Sally on the old Dick Van Dyke show. John Kerry sits in judgment, rejecting cute line after cute line. For him, there is a litmus test. The punch line has to say, "George Bush is stupid."

The strategists go back to their laptops, wracking their brains. In six years, they’ve come up with thousands of "George Bush is stupid" jokes. They’ve sold them to Rosie, Barbra, Howard Dean, Teddy Kennedy, Hillary Clinton, Nancy Pelosi, David Letterman, Keith Olbermann. Joe Biden is one of their best customers–but he likes ‘em folksy. They tried to sell a few to Harry Reid, but just looking at him, no one would believe he’d ever told a joke in his life.

Finally, one wag comes up with the education line, shown above. Kerry, who hasn’t had much to smile about since early November 2004, cracks up. That’s it. George Bush is stupid, because he’s stuck in Iraq.

Perhaps some or all of the gag men, er, strategists, wonder if the joke could be misconstrued. It could be interpreted as a zinger against the troops. There are over 100,000 American troops in Iraq–somebody could think that Kerry is talking about them being "stuck in Iraq," rather than Bush. But it’s late and fresh Bush shots are hard to come by. Kerry’s happy with the line, so why rock the boat? It’s time for the  strategists to get their evening briefing from Jon Stewart.

This scenario is plausible because it is a microcosm of the Democrat approach to this campaign and to politics in general since American forces removed Saddam. The Democrats are not at war with Islamic terrorists. Their enemy is George Bush. Getting rid of him is their primary mission. If zinging him at a fund raiser offends a few million members of the United States military, and their families, that’s what the Democrats call collateral damage. A small price to pay for making   Bush look stupid.

And if getting rid of Bush requires a constant barrage of criticism about the war, about the planning of the war, about the reasons for war, about the conduct of the war, about the tactics of the war, about the troop levels of the war, or about the food, equipment and weapons  of war, then so be it. If calls for withdrawal of our forces, resignation of our leaders, prosecution of our soldiers serve only to embolden and encourage our enemies, then the nation will have to bear it. If claiming  that half of America wants to give up before the job is done causes more casualties to our troops, that’s okay–because at least it gets rid of George Bush.

The Democrats are consumed with a hatred of Bush that blinds them to every other consideration, and makes them deaf to the sound of their own words. That’s why John Kerry went before the crowd at Pasadena City College and told a joke that a majority of reasonable people believe was a put-down of every man and woman in uniform. While America heard a moronic, insensitive and despicable quip, all Kerry could hear was "George Bush is stupid."

Thom Stoddert, former VA Rating Specialist
Bio Here

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