Heads may roll

[NavyFP]

Advertisement - Members don't see this ad

I say they should start with the psych res PD at Walter Reed (what, an O-4, O-5?). How can you let someone get away with so many dings, never disciplining him, allowing him to graduate, then even placing him in a fellowship?! He should've been failed out of the program, given the boot, and force to payback both his USUHS and ROTC commitment. Yeah, I know the Army is in need of psychs, but I'd rather have the need and the shortfalls, than nutjobs like Hasan walking around.

You say that like there's only one person. There was probably 2 or 3, and they probably all did a deployment while he was a resident.

Besides, isn't that the norm in Psych? They all seem a bit odd to me.

The problem is that even if the PD thinks the resident is a dirtbag and should be out, if none of the rotation attendings fail him for the rotations, there is not a lot he or she can do. There has to be a mountain of documentation to remove a resident and I would guess a majority of attendings pass him to get him off of their service.

 

[a1qwerty55]

Looks like we got an update on this issue:

http://www.foxnews.com/story/0,2933,582732,00.html

WASHINGTON — A Defense Department review of the shooting rampage at Fort Hood, Texas, has found the doctors overseeing Maj. Nidal Hasan's medical training repeatedly voiced concerns over his strident views on Islam and his inappropriate behavior, yet continued to give him positive performance evaluations that kept him moving through the ranks.
into question long before he reported to Fort Hood."

What blows me away is it took him 6 years to graduate from USUHS - I mean come on can the guy already! In extenuating circumstances (someone who is academically strong but has a personal issue) I can see doing an extra year but 6 years is obscene. I hope that part isn't true because if really calls into question the judgement of the USUHS deans.

 

[faith2]

on the extreme side could it be scared that they were scared of a discrimination suit? I am not defending the arm services, but could it be that if they did anything it could have been viewed as that?

What blows me away is it took him 6 years to graduate from USUHS - I mean come on can the guy already! In extenuating circumstances (someone who is academically strong but has a personal issue) I can see doing an extra year but 6 years is obscene. I hope that part isn't true because if really calls into question the judgement of the USUHS deans.

 

[Gastrapathy]

What blows me away is it took him 6 years to graduate from USUHS - I mean come on can the guy already! In extenuating circumstances (someone who is academically strong but has a personal issue) I can see doing an extra year but 6 years is obscene. I hope that part isn't true because if really calls into question the judgement of the USUHS deans.

Its true. And they added to his obligation bonus year for bonus year.

 

[IgD]

My program director/department had a problem resident they had to release. It was a difficult decision but they were strong leaders and did it because they knew it was right for the patients, for psychiatry and the Navy as a whole. It is interesting that the Army PD is a MAJ where my program director was a senior CDR who is now a CAPT. Our program director was also supported by 2-3 CAPTs who were in unanimous agreement about the situation I described. I wonder if the different in experience had a lot to do with the decision making.

Everyone focuses on the program director because his written comments are like a smoking gun. It is important to keep in mind that the situation is complicated and has many layers.

 

[DrMetal]

What blows me away is it took him 6 years to graduate from USUHS - I mean come on can the guy already! In extenuating circumstances (someone who is academically strong but has a personal issue) I can see doing an extra year but 6 years is obscene. I hope that part isn't true because if really calls into question the judgement of the USUHS deans.

For the record, USUHS does axe students. There's many accounts (as recently as this past summer) of students getting the boot for academic shortfalls and/or personal behavior. In the case of Hasan, my guess is they granted him extra lineancy per his parents' death (as the article states). But, in any case, I do agree the right (and easier) time to have nipped him in the bud would've been at USUHS.

My program director/department had a problem resident they had to release. It was a difficult decision but they were strong leaders and did it

Exactly, that's what should've happened in the case of Hasan. Or at the very least, write him a mediocre letter of support, not a good one! Why did the PD boast him so much?

It is interesting that the Army PD is a MAJ

Yes, it is interesting, but that's about it. Rank should have nothing to do with this discussion. Unless things are different in the medical corp--bracing for punches--it's your job title (not your rank) that grants you authority. I may be a junior O-4 as a resident, my attending an O-3. He'd still be my boss, right? And if I tried to pull rank on him, he should give me a swift kick in the . . .

 

[IgD]

Yes, it is interesting, but that's about it. Rank should have nothing to do with this discussion. Unless things are different in the medical corp--bracing for punches--it's your job title (not your rank) that grants you authority. I may be a junior O-4 as a resident, my attending an O-3. He'd still be my boss, right? And if I tried to pull rank on him, he should give me a swift kick in the . . .

I disagree with that. What would you think if I suggested the CO or XO of a large Naval ship could be a LCDR? I would argue the program director of a military residency program, especially an interservice one in Washington, D.C. ought to be a CDR/CAPT. You need someone with lots of experience who knows how to handle difficult ethical minefields.

 

[DrMetal]

I disagree with that. What would you think if I suggested the CO or XO of a large Naval ship could be a LCDR? I would argue the program director of a military residency program, especially an interservice one in Washington, D.C. ought to be a CDR/CAPT. You need someone with lots of experience who knows how to handle difficult ethical minefields.

maybe not a large ship, but of a patrol craft, definitely, most are O-3s. And that O-3 really is in charge, could kick a visiting O-6 off if he wanted to (maybe not the best career decision, but he'd still have the authority).

Look, I agree with you, is better to have a higher ranking PD. But whatever the rank, the PD is still in charge, by virtue of his position. In this case, as you alluded to, the PD shouldve cracked th whip a little more (not that that would've prevented the tragedy, but at the very least it would've covered his rear). B/c he didn't, so now he's going to lose his job.

 

[AF M4]

maybe not a large ship, but of a patrol craft, definitely, most are O-3s. And that O-3 really is in charge, could kick a visiting O-6 off if he wanted to (maybe not the best career decision, but he'd still have the authority).

Look, I agree with you, is better to have a higher ranking PD. But whatever the rank, the PD is still in charge, by virtue of his position. In this case, as you alluded to, the PD shouldve cracked th whip a little more (not that that would've prevented the tragedy, but at the very least it would've covered his rear). B/c he didn't, so now he's going to lose his job.

Easy to say, tough to do. I'm sure that the PD had multiple discussions with and about Hasan, but as alluded to in previous posts on this thread, it takes a lot of top cover and agreement amongst various big-wigs to axe even a troublesome resident. As IgD said, it can take unanimous agreement amongst several O-6s to do something as big as boot out a resident, and if this lower-ranking PD didn't have that kind of support then he would have expended a lot of effort and exposed himself to significant litigation by trying to go it alone and Hasan would likely have still ended up in place.

A very tough spot to be in, and exacerbated by the fact that the PD didn't have the type of high-level rank and experience that would have enabled him to go it alone if he had to.

 

[pgg]

The problem is that even if the PD thinks the resident is a dirtbag and should be out, if none of the rotation attendings fail him for the rotations, there is not a lot he or she can do. There has to be a mountain of documentation to remove a resident and I would guess a majority of attendings pass him to get him off of their service.

You're right. It's funny how SDN can blow hot or cold on the same subject depending on who the protagonist is perceived to be.

A few minutes browsing the 'general residency issues' forum and the
- terminated! unfair!
- resident sues Johns Hopkins over firing
- my PD hates me!
- problem attending trying to get me canned!
threads are just all over the place. And nearly without exception the commentary is supportive of the resident.

I have no doubt that if Hasan had a SDN account and posted about his alleged harassment or threats to fire him there'd have been 100 SDN'ers urging him on to fight the good fight and go on.

I would argue the program director of a military residency program, especially an interservice one in Washington, D.C. ought to be a CDR/CAPT. You need someone with lots of experience who knows how to handle difficult ethical minefields.

The problem with sub-10% retention in the medical corps is that even at a ridiculously top-heavy place like DC the O5 & O6 ranks can be thin ... either in absolute numbers, or in capability, or in desire to do anything. For every stellar O6 physician I've known, I've known two whose primary objective since attaining O6 has been to do as little work as possible. My PD was a junior O5 when I started residency and he was outstanding in every regard. I can't believe how hard he worked for us. We had some O6 guys who - while fine clinicians - took those rank privileges and ran, I mean sat, with it.

So good for that O4 program director. I bet he's a superior physician. Too bad about the witch hunt.

 

[IgD]

I have no doubt that if Hasan had a SDN account and posted about his alleged harassment or threats to fire him there'd have been 100 SDN'ers urging him on to fight the good fight and go on.

I don't agree with that at all. To my knowledge, no one has as made those kind of posts in this forum. If they did I'm sure we would handle them in a responsible way.

 

[pgg]

I don't agree with that at all. To my knowledge, no one has as made those kind of posts in this forum. If they did I'm sure we would handle them in a responsible way.

Are you kidding me? 🙂

Are you reading the same forums I am? 😀

Fired Hopkins doctor seeks $24M
Terminated residents
List of Programs That Terminate Residents

These 3 are from the first page of the general residency forum. SDN is littered with posts about residents being terminated, and the threads are nearly always supportive of the resident. Occasionally someone will post something about how the resident might need to step back and take a more objective view of their own performance ... but often they're just 'get a lawyer, fight the Man' threads.

 

[IgD]

Are you kidding me? 🙂

Are you reading the same forums I am? 😀

I'm talking about here in the military medicine forums. Have you seen any posts like that here?

 

[NavyFP]

I disagree with that. What would you think if I suggested the CO or XO of a large Naval ship could be a LCDR? I would argue the program director of a military residency program, especially an interservice one in Washington, D.C. ought to be a CDR/CAPT. You need someone with lots of experience who knows how to handle difficult ethical minefields.

I agree. I always thought it odd that the PD was an O4 and the APD an O3, especially when there were O6s in the departments. Hard to say why they were not voluntold to perform the duties.

 

[NavyFP]

With punishment being the order of the day...........Here they come.


http://www.msnbc.msn.com/id/34872942/ns/us_news-tragedy_at_fort_hood

 

[ftrflyr29]

With punishment being the order of the day...........Here they come.


http://www.msnbc.msn.com/id/34872942/ns/us_news-tragedy_at_fort_hood

Let's hope they not use scapegoats, but I'm sure that's exactly what will happen. One thing that's frustrating is to have these media outlets try to explain comments in the OER (reporting on how positive they are), but most of which were probably not as great as the media makes them out to be.

I'd imagine most of them used commonly known, subtle ways to actually describe him as worthless. One that comes to mind at this late hour is a description of him reported as "adequate." If my fitrep described me as adequate, that would be it.

Unfortunately it seems, due to the shortage on physicians, particularly psychiatrists, I would imagine for his most recent promotion to O-4, his board was probably precepted (or whatever it's called in the Army) and the board members were probably told to promote everyone, unless they find some really bad paper.

 

[NavyFP]

Let's hope they not use scapegoats, but I'm sure that's exactly what will happen. One thing that's frustrating is to have these media outlets try to explain comments in the OER (reporting on how positive they are), but most of which were probably not as great as the media makes them out to be.

I'd imagine most of them used commonly known, subtle ways to actually describe him as worthless. One that comes to mind at this late hour is a description of him reported as "adequate." If my fitrep described me as adequate, that would be it.

Unfortunately it seems, due to the shortage on physicians, particularly psychiatrists, I would imagine for his most recent promotion to O-4, his board was probably precepted (or whatever it's called in the Army) and the board members were probably told to promote everyone, unless they find some really bad paper.

Promotion to O4 is essentially automatic. All in zone are allowed to be promoted. If you don't have anything negative in your record, you are promoted. Even "adequate" docs are promoted.

 

[orbitsurgMD]

With punishment being the order of the day...........Here they come.


http://www.msnbc.msn.com/id/34872942/ns/us_news-tragedy_at_fort_hood

The bitter irony is that this will come on the heads of those same people who probably privately wanted to choke the life out of Hasan at one time or another and who, had they actually tried to remove him by formal process would have been thwarted out of reasons of toxic political and cultural correctness.

 

[Mirror Form]

maybe not a large ship, but of a patrol craft, definitely, most are O-3s. And that O-3 really is in charge, could kick a visiting O-6 off if he wanted to (maybe not the best career decision, but he'd still have the authority).

That statement corroborates IgD's point. That is, a major is too low ranking within the medical corp to do anything without having to worry about his career.

 

[Mirror Form]

I agree. I always thought it odd that the PD was an O4 and the APD an O3, especially when there were O6s in the departments. Hard to say why they were not voluntold to perform the duties.

Well Program Director is a HUGE amount of work and responsibility. If we just assigned the job to someone who was not motivated to do it well, it would be a disaster for the the residency program.

 

[Mirror Form]

had they actually tried to remove him by formal process would have been thwarted out of reasons of toxic political and cultural correctness.

Maybe or maybe not. I agree that is probably a major factor as to why they never attempted to formally remove him. But you cannot excuse them for not trying.

 

[Gastrapathy]

Maybe or maybe not. I agree that is probably a major factor as to why they never attempted to formally remove him. But you cannot excuse them for not trying.

Really? Shall we separate every physician with a personality disorder? Pathology would be a quiet place😉.

Seriously, someone has to be in the bottom 10%. Grounds for failing him would have been subjective. He never threatened to kill anyone, had an inappropriate relationship, etc. Those same monday morning qbs that are blaming his supervisors now would have fried them, sent them to sensitivity training and all but called them racist if they had tried. No one thought he would be violent, they thought he would be a lazy pain in the ass. Its not like the PD was monitoring his emails with extremist groups (or was told about that).

I can and do excuse them for not trying.

If you don't think the military is obsessed with diversity, just look at our terminology. We quote the % of selectees for rank, specialty, etc that are "diverse." As if a single person can be diverse (we all have our own ethnicity and gender, right?). For a great example of this, read a little about the career of the recently fired CO of the COWPENS. She was protected over and over again. I had a brief bizarre interaction with her (in front of a flag, no less) almost 10 years ago and was told later that she was untouchable. You can be that Hasan would have been similarly untouchable.

 

[a1qwerty55]

Seriously, someone has to be in the bottom 10%. Grounds for failing him would have been subjective. He never threatened to kill anyone, had an inappropriate relationship, etc. Those same monday morning qbs that are blaming his supervisors now would have fried them, sent them to sensitivity training and all but called them racist if they had tried. No one thought he would be violent, they thought he would be a lazy pain in the ass. Its not like the PD was monitoring his emails with extremist groups (or was told about that).

I can and do excuse them for not trying.

If you don't think the military is obsessed with diversity, just look at our terminology. We quote the % of selectees for rank, specialty, etc that are "diverse." .

this post is right on. Diversity trumps all else in today's military. We strive to keep everyone regarless of lack of potential. Attendings fail to frankly evaluate students/residents making it impossible for the program director to can someone. Additionally, the program director can recommend termination but this is routinely trumped by the hospital level education committee. Lastly, having been involved in several terminations. I have never seen a minority resident or medical student not play or threaten to play the "racism card". If promotion boards don't have enough minorities board results can be held up and scrubbed to make the numbers look better.

Ultimately, we in healthcare - both military and civilian don't hold each other to high standards, only to minimal standards and we work in a legal environment where trying to expect more than marginal competence is roundly punished. I can only hope that Sec Gates understands this.

 

[ftrflyr29]

Here's some light reading for you all, if interested. It's a link to the publicly issues review of the incident.

http://www.defense.gov/pubs/pdfs/DOD-ProtectingTheForce-Web_Security_HR_13Jan10.pdf

 

[orbitsurgMD]

Here's some light reading for you all, if interested. It's a link to the publicly issues review of the incident.

http://www.defense.gov/pubs/pdfs/DOD-ProtectingTheForce-Web_Security_HR_13Jan10.pdf

Whitewash by committee. The "investigation" gives a total BZ/attaboy to base security for their timely response, totally ignoring that the shooter brought the weapons and ammunition right through the gate (they still have those, right?)

The suggestion that there was someone who could have 1. anticipated that Hasan was going to be trouble, 2. "connected the dots" (love that, always seen in retrospect as something that even an idiot could do) 3. written a de-railing OER that actually could have de-railed this one particular mediocre officer (who the Army wasn't able to replace, go figure) and 4. paid close enough attention to Hasan's "officership" (which appears to be everything about Hasan that wasn't part of his "medical studentship" and "psychiatry resident-ship" and "psychiatry fellow-ship.") The committee just didn't appreciate the fact that until Hasan arrived at Ft. Hood, he was in one form or another a medical corps trainee and was, as are most trainees, subject to the standards of institutions whose main mission is education. I didn't see too many medical corps people listed on the committee; it looked pretty much like the retired admirals' and generals' club.

The notion that this kind of thing, which so far seems to be nearly singular (except for the other Hasan who Islamic-ly self-radicalized and turned his weapons on his unit at Camp Pennsylvania, Kuwait.) and trying to draw some lesson from which to prevent these things from occurring in the future seems an exercise in futility. I suppose we could say "gotta watch out for those radical Muslims, now." But that sort of thing has got to be a problem for our "diversity," and you know how important that is, Admiral Mullen said so himself.

 

[IgD]

I can't see how you guys are trying to defend the Army on this. I don't see how this guy should have been allowed to be graduate his residency let alone be penciled in for a deployment. I don't think it is fair to everyone else when standards aren't enforced.

I'm actually surprised about the whole thing. If anything, Navy medicine had a reputation for going overboard with discipline. There was one case where a respected "provider" was doing a massive amount of clinical work at a large Navy MTF. He honestly forgot to do his random drug screen for the day. The Admiral took him to mast and gave him a career ending letter of reprimand.

I will say that there was some hippocracy in the author list of that report. Some of the big names were almost certainly involved in gutting military medicine resulting in the situation that created the Hasan nightmare.

 

[NavyFP]

According to this there are 9 heads on the chopping block.
My guess is they are all now headed towards assignment on the USS Backyard.

http://www.msnbc.msn.com/id/42017230/ns/us_news-security

 

[bogatyr]

According to this there are 9 heads on the chopping block.
My guess is they are all now headed towards assignment on the USS Backyard.

http://www.msnbc.msn.com/id/42017230/ns/us_news-security

My guess is that none of the officers who are receiving "non-judicial punishment" are the ones responsible for the entire army having to sit through quarterly EO training, which is probably a bigger clue as to why nothing was done about Dr Hasan.

I like where they criticize these people for making him sound better than he should on his OER. When was the last time you saw anything bad in anyones OER? My bet is this is not unique to the medical corps.

 

[AF M4]

My guess is that none of the officers who are receiving "non-judicial punishment" are the ones responsible for the entire army having to sit through quarterly EO training, which is probably a bigger clue as to why nothing was done about Dr Hasan.

I like where they criticize these people for making him sound better than he should on his OER. When was the last time you saw anything bad in anyones OER? My bet is this is not unique to the medical corps.

It's no different in the Air Force either, we just call them OPRs (Officer Performance Reports). All the docs and officers I know write their own, I wouldn't be surprised to learn that Hasan was actually the one who first characterized his radical Islamization as "counter-terrorism research", submitted the draft to his commander who then rubber stamped it and him as "excellent" and forwarded it up the chain.

And you're exactly right about the EO portion. If he had been confronted, Hasan could easily have gone directly to the law office and filed a complaint that he was being persecuted for his religious views. Nonjudicial punishment? Yeah...what's going to happen is that they are all going to be moved to some separate out of the way Backyard Bases, where they're going to quietly appeal their respective NJPs, which will be quietly removed from their personnel records afterwards. There is no way the Army is going to take the slightest chance of this thing flaring up in the media again.

 

[orbitsurgMD]

It's no different in the Air Force either, we just call them OPRs (Officer Performance Reports). All the docs and officers I know write their own, I wouldn't be surprised to learn that Hasan was actually the one who first characterized his radical Islamization as "counter-terrorism research", submitted the draft to his commander who then rubber stamped it and him as "excellent" and forwarded it up the chain.

And you're exactly right about the EO portion. If he had been confronted, Hasan could easily have gone directly to the law office and filed a complaint that he was being persecuted for his religious views. Nonjudicial punishment? Yeah...what's going to happen is that they are all going to be moved to some separate out of the way Backyard Bases, where they're going to quietly appeal their respective NJPs, which will be quietly removed from their personnel records afterwards. There is no way the Army is going to take the slightest chance of this thing flaring up in the media again.

The blamefest is in the rearview mirror and Hasan hasn't even gone to court martial, a year and a half later. To give you some perspective, Jared Loughner, the shooter in the Tucson murders that targeted Rep. Gabrielle Giffords is closer to trial.

This is a military institutional problem that won't be solved by any of this blame-laying. Notice no one mentioned an over-active EO policy that would be just as punitive had any one of these officers actually exhibited the kind of "officership" the investigation concludes they should have. So I call this charade a cynical whitewash.

Adm. Mike Mullen saying publicly after the shooting that the one thing he hopes is that these events don't hurt the military's "diversity" certainly shows nothing is really changing. Diversity trumps.

What it may result in is a bunch of untimely retirements by a demoralized and fed up clinical staff that will leave a hole in the Psychiatry service that will be difficult to repair, and it would serve the Army right.