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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Stoddert Assignment Berlin
Nigerian Banker's Corruption Surpassed by Army’s Hospitals

By Thom Stoddert

The Seattle Times published an article on Sunday, August 13th, 2011 by Hal Bernton which describes how a cardiologist was trashed professionally and personally by Madigan Army Medical Center in Tacoma, Washington. The cardiologist’s sin was to report major legal and ethical violations that he claimed to have observed. As you read, please remember two incidents: the Walter Reed Army Hospital scandal and the Fort Hood killings by an Army doctor. In each, the problems were ignored because that is the culture.

The Seattle Times writes how a cardiologist Col. Michael Eisenhauer went to the deputy commander of Madigan Col Robert Place with allegations of an unethical relationship between several other doctors in his department and a medical equipment manufacturer. He asked that this be investigated. Dr. Eisenhauer alleged that other cardiologists, a Dr.  Jason Davis, and Dr. David Schacter, were insisting on the purchase and use of only one supplier of surgery devices and for this Davis was receiving gratuities (kickbacks). 

  For his efforts, Dr. Eisenhauer was first offered help in getting transferred by Col. Ronald Place, who was the deputy commander. Later, when the position for Chief of Cardiology became vacant Colonel Eisenhauer was overlooked in favor of the much lesser ranked, Major Davis, who then became his job evaluator. Eisenhauer’s personal evaluations also dropped, which could have only added to his public humiliation. Repeated attempts by Eisenhaur to get the command’s attention were continuously ignored by many people in key positions.

  When this whole matter was finally exposed and brought to the Department of Justice it eventually came with allegations of patients receiving unneeded medical cardiac devices and possible harm to patients. At this time there may be such evidence coming forward to support these allegations, despite several of Madigan’s supervisors refusing to investigate these matters since 2008. To date, Dr. Davis has reached a plea deal  Boston Scientific was fined $600,000.

So what? another whistleblower beaten up and blamed for the problems!!!!

  But keep in mind the climate, the environment in which this all happened. Keep in mind the neglected wounded soldiers at Walter Reed and the dead at Fort Hood. What does the future hold? A deeper look into the Army’s Medical Department is demanded here to understand what Col. Eisenhauer was up against.

Whether it is the Ford Motor Corporation or a military hospital, there is always an agency or department that manages risk and quality. In this case there is at Madigan the Chief of Quality Services, and her subordinate the  Risk Manager. There is also the front line of services, the staff for the Patients’ Advocate/Representatives Office, all of whom, I have met. These are the people to whom is given the responsibility of ensuring the quality of patient care. They are the ones that must be aware of the events when the quality of medical care is threatened or compromised.

  The Chief of Patient Advocacy exposed and documented his superior’s lies and misbehavior to a deputy commander in 2008. What they had done may have gotten a senior NCO court-martialed. In this case the Deputy Commander first attempted to down play and then finally removed the Patient Advocacy’s office from under the Chief of Quality Services Department and the Risk Manager. Instead of being punished, the Risk Manager received a promotion afterwards. The Chief of Patient Advocacy had a computer data-base program, which was being developed to make his office more efficient, sunk by the Chief of Quality Services after the office was removed from under her supervision. (more to come of this in the next article)

  Another factor to consider when looking at Dr’s. Davis and Schacter; how were they able to get permission to sole-source purchases? Normally a request for sole–source purchases requires extensive justification for even the Logistic’s Department to be justified to go beyond federal and military guidelines. The need has to be clearly shown why the selected product is NEEDED, not just preferred, over a competing source. In this case there seems to have been a significant waste of tax-payer dollars. Other manufacturers were aware of the cozy deal between Madigan and Boston Scientific and made complaints, most likely to the Feds in Seattle.

  Is the Logistics Department corrupt? damn right!  

  I recall when a time when I was appointed to investigate the reason for the loss of missing medical equipment, worth hundreds of thousands of dollars, by the Gastroenterology Clinic. There was a Staff Sergeant who was legally responsible for the loss. However, the equipment was being stolen by physicians leaving the army after their military commitment was finished and the two officers in charge of the clinic were aware of the facts and did nothing. Madigan was willing to punish the junior NCO with massive fines until they found out I was going to document in favor of the sergeant and fault the two colonels. Then I was informed my investigation was over and it was to be written off as “just the cost of doing business.” The Logistics Department is primarily staffed and managed by civilians.

  This brings us to next issue that Dr. Eisenhauer was up against: civilian employees. If you read the comments made to Hal Bernton’s article, it’s clear that federal hiring practices are very often ignored and with full knowledge of the bases’ Civilian Personal Office. This can easily be verified by anyone who left Madigan and is familiar with the resume database system. Somebody wants to hire an employee; they are given a list of resumes from a database system from which a few are selected for interviews. The candidate is then selected and notified. However, in reality, the person the manager wants to hire, (usually a friend, even family member) is given key-words to put in their resume for the computer to select. Then the manager selects the person they want and the least likely to be qualified by a face-to face interview. So it all looks in line with federal law, when in reality some of the most incompetent and dishonest are hired and retained. The “good-ole-boy” system is well maintained. 

The machinations of the Civilian Personnel Office are well known by any soldier who ever supervised a civilian employee. They were of no help and even impeded me in disciplining a civilian nurse before she killed someone. I finally got rid of her when she remarried her husband and moved to San Antonio. Years later, Madigan rehired her after her divorce.  

Who are some of the other players that must be safe guarded by command staff of all the Army Medical Centers and agencies through routine cover-ups? In order for sales reps to enter the operating rooms, the OR staff would have to know it and ignore the medical ethics involved. Surely the nursing staff in the ICUs who reviewed patient medical histories would see if there were too many unneeded procedures being done.

The mistreatment and neglect of the wounded at Walter Reed, resulting in the scandal, continues. The Wounded Warrior Battalions is still managed by the Army’s Medical Department and as I have spoken to many of the soldiers in it, they are afraid to talk or complain for fear of reprisal and they told me so. Until the Army investigates and cleans out the oxygen thieves and promotes according to proven success things won’t change. People will die, like at Fort Hood, patients will be hurt and hard working professionals will work in a toxic environment - the miracles in Iraq and Afghanistan will provide honor to its medics and not a free ride to glory for the ethically challenged.

This was written because I witnessed women being intimidated and publically humiliated by senior male staff, simply because they could get away with it. I witnessed the dumping of hazardous materials each month into the water disposal system; me and others reported it and nothing was done till the EPA sued.  

I witnessed the 4077 M*A*S*H as a soldier and as a civilian in real life every day at Madigan till I sickened and left for good. 

Thom Stoddert, former VA Rating Specialist
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