Galo

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Not to beat what I think is a dying horse, but this is exactly one of the most infuriating experiences in military medicine today. In a place where ethics, and integrity are sold as guiding priciples, you see the complete opposite much too often, and that was one of the leading dissapointments about military medicine for me. These people should be flogged, and jailed.

This story was in the USA today Friday Nov 21, page 11A. Athough if really intersted you can read it for yourselves, the synopsis is: 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 MO. An apparent problem throughout the Army with increasing # 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 Capt Melissa Lee, diverte the patients away from treatment. The IG, found that Capt Lee, had consistently filled out the forms incorrectly having made it appear that the soldiers had drug problems, and needed counseling. She is now a Major. The Hospital commander, now 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 Aug 07, none were enrolled in the program. Lee the Clinical Director filled out over 150 forms with "mistakes".

Once the IG had vindicated them, this counselor, (who had spoken to Lee early in the process about the mistakes, but she did not seem concerned), then went to Congress. 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 Capt 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.


This is what killed it for me. ABSOLUTE [email protected]*[email protected] *****S who with power can absolutely do what they want with NO REPERCUSSIONS other than getting more power.

I wish this was an isolated thing that happened just for pure bad luck to me at both my bases, but ITS NOT. For whatever reason, and perhaps it has to do with the fact that over a decade ago the command structure of military medicine changed out of physicians hands, this is a widespread DoD problem. I think its lucky that some of the most positive posters here have not had experiences like this, but unfortunately most of us have. This is one of the reasons why I am so vocal, and "jaded". I had to deal with criminals like these two, and always came out frustrated and on the loosing end.

While in the civilian world this is a possibility, it is much less likely to happen, and if it does, there is a system for getting justice. Also, you can walk away. When on active duty, if you see this and act on it, your life becomes a misery.

This is clearly my opinion, and my experience.
 
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IgD

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Our regional Naval hospital had three psychiatrists to cover inpatient, both child and adult outpatient and emergency room/medicine consults. Basically one guy did full time child, the second did full time adult outpatient and the third ran the inpatient unit and managed consults. The problem was one of the psychiatrists was deployed leaving only two to cover all those responsibilities. The problem was compounded by the fact we didn't have a referral network or contractors.

Air Force and Marine Corps psychiatrists in the region stepped up to the plate and volunteered to help take call in the absence of any MOU. Even so things were pretty hectic.

We tried to be reasonable and worked to get the situation addressed but efforts always seemed to hit a brick wall.

At one point, a senior Navy medicine flag officer came to our region for a routine visit. I appreciated the opportunity to speak openly during a medical officer's call. I tried to explain why we needed three psychiatrists. He looked over at one of the hospital big whigs and accused him of paying me to speak. The admiral shot me down and told me we were the best staffed hospital in the Navy.

Galo, at least we tried:)
 
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Galo

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Sorry if this seems like a rant, but the more I thought about this today, the more it brought up old demons.

Are people not OUTRAGED that something like this happens? Unfortunately the majority of us here have had similar experiences and even though people point out that they are isolated, I would argue that this is not the case. What outrages me more is the fact that the military presents itself on the ethics of officership which are often clearly violated, and the violators often not only do not get punished, but ascend in power.

I think many of the arguments that I've gotten into here with A1, crazy, etc stem from the fact that I am denigrating the service based on my experiences, and in turn they denigrate me to protect the idea, the ethics of that service. I understand that. But I have to wonder based on their beliefs if faced with similar situations no matter how well or tactfull the attempt at rectifying it yielded results like the one in this Army case, or many of the one's that I faced, (absolute and clear malpractice of a higher rankind officer, LOR for jaywalking, serious waste in training/manning issues), would they not react with some measure of disbelief, anger, impatience, regret?

A new army lifetime commited primary care physician posted today on the pro/con thread, that has not had the experiences of alot of us. To that effect he makes the challenge that as "officers" we are there to solve problems. To act, and do when we see something wrong. What do you do when all that fails, and you end up being seen as sometype of villan who is not a team player, and are attacked while the attackers get away with criminal activities?

I do not understand the reason why ethics have become so maleable with higher ranking and some lower ranking officers, especially in the medical corps. I hope imagine these type of instances do not happen commonly in the line side of the military. But I remember when I had had it early on and I tried to communicate with the surgeon general of the air force, (A1 told me on an earlier post that maybe it was not a good idea to try to be his penpal, and he was right). After it got back to my command that I should not try to contact him, (one letter, two phone calls), the hosptial commander, a non-practicing pediatrician Col, gave me that metaphor of this guy flying at 50K feet, while I was on the ground, and that he could not concern himself with me, or my problems, which were actually problems facing all AF surgeons. That day was like an epiphany to me that the moral values of the AF were just words that although repeated and written often, were only just words that did not seem to have meaning, especially as you got higher in rank. Once again, some of these violations on the outside would be punishable by law.

What's happened to military medicine why has it gone so bad? Why are'nt more people outraged?
 
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crazybrancato

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Sorry if this seems like a rant, but the more I thought about this today, the more it brought up old demons.

Are people not OUTRAGED that something like this happens?

I'm sure people have made the same observations that you have and are just as outraged. Perhaps they decide not to be as vocal as you, or perhaps they're so busy in their own mil and/or civi lives, that they just don't have the time to speak up or take action. (I gotta admit, I am puzzled by how you, an attending civilian surgeon, has the time to log on here and post as much as you do. I would think you'd be quite busy).

I think many of the arguments that I've gotten into here with A1, crazy, etc stem from the fact that I am denigrating the service based on my experiences, and in turn they denigrate me to protect the idea, the ethics of that service.

Yeah, you're right here. You are generalizing a little too much based on your personal experiences.


A new army lifetime commited primary care physician posted today on the pro/con thread, that has not had the experiences of alot of us. To that effect he makes the challenge that as "officers" we are there to solve problems. To act, and do when we see something wrong. What do you do when all that fails, and you end up being seen as sometype of villan who is not a team player, and are attacked while the attackers get away with criminal activities?

Look, the bottom line is this. In the military (as in any large beuracratic organiziation, with a rank structure), you've gotta pick and choose your battles carefully. If you go toe-to-toe with some frickin MP about a J-walking rule, that might blow up in your face and result in an LOR. If you're going toe-to-toe with your dept. head about a patient's care, yeah that might blow up in your face too. But at least in this latter case, you fealt better b/c that was a fight worth fighting. i'm sure your complaints regarding AF surg. warranted many "good" fights. and at least you had the nads to put up a fight.

Just b/c you complain or point out something that's wrong, or try to exact change . . .does not nec. mean you're going to get "punished". In my SWO and engineering days, there were several times I suggest change. Some suggestions were used, some weren't. I was never punished . . in fact I was promoted. It's not the act of 'complaining' or 'suggesting' that gets you in trouble, it's how you deliver the message, your attitude, and how well you play the political game that matters.

I don't know you personally Galo, of course, but just based on your posts, you sound like the kind of guy that complains about the time of day, you're probably very vocal, and you probably complain to anyone within ear-shot (this is just my perception). If that's true, then it's no wonder you drew so much fire in the AF.

In the military, you have to be a 'calculated' complainer and suggester. And if you do that amongst the right people, in aesthetic tones, throw in some talk about football or beer, you'd be surprised how much change you can exact.

What's happened to military medicine why has it gone so bad? Why are'nt more people outraged?

other than posting here (which is fine, good place to vent, but doesn't result in any action), what else have you done to voice your concerns about milmed? You're a civilian now, no fear of retribution, so why not do something more meaningful (writing congressmen, lobbyists etc).
 

Galo

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I'm sure people have made the same observations that you have and are just as outraged. Perhaps they decide not to be as vocal as you, or perhaps they're so busy in their own mil and/or civi lives, that they just don't have the time to speak up or take action. (I gotta admit, I am puzzled by how you, an attending civilian surgeon, has the time to log on here and post as much as you do. I would think you'd be quite busy).


Your time is what you make of it and how you wish to spend it. I'm busy enough, but this is important enough for me to post.






Look, the bottom line is this. In the military (as in any large beuracratic organiziation, with a rank structure), you've gotta pick and choose your battles carefully. If you go toe-to-toe with some frickin MP about a J-walking rule, that might blow up in your face and result in an LOR. If you're going toe-to-toe with your dept. head about a patient's care, yeah that might blow up in your face too. But at least in this latter case, you fealt better b/c that was a fight worth fighting. i'm sure your complaints regarding AF surg. warranted many "good" fights. and at least you had the nads to put up a fight.

Mine jaywalking had nothing to do with arguing with an MP it had to do with a vindictive nurse who had nothing but contemp for physicians, and with whom patient care was not her primary concenrn. To me fighting for patient rights was always a fight I had to take on. Depending on how you develop as a physician in the military, you may or may not want to take on those fights, we'll have to see.

Just b/c you complain or point out something that's wrong, or try to exact change . . .does not nec. mean you're going to get "punished". In my SWO and engineering days, there were several times I suggest change. Some suggestions were used, some weren't. I was never punished . . in fact I was promoted. It's not the act of 'complaining' or 'suggesting' that gets you in trouble, it's how you deliver the message, your attitude, and how well you play the political game that matters.

Once again, you are comparing your military job to mine which you yet have no experience in. As I've said before, milmed, especially in the AF has become a haven for mediocre leaders who care nothing more than about their advancement. The MO instance is just another clear example. Do you think that's a generalization? How do you show attitude when you file a complaint for the IG to investigate? I'm afraid if you may soon find out the line and the hospital side of the military are not the same.



In the military, you have to be a 'calculated' complainer and suggester. And if you do that amongst the right people, in aesthetic tones, throw in some talk about football or beer, you'd be surprised how much change you can exact.

Good luck with that. Let's see what kind of positive change you can enact by talking football over beers with the nurse hospital commander.


other than posting here (which is fine, good place to vent, but doesn't result in any action), what else have you done to voice your concerns about milmed? You're a civilian now, no fear of retribution, so why not do something more meaningful (writing congressmen, lobbyists etc).
[/QUOTE]

I wrote to a member of congress during my AF level IG complaint about cstars, and I've spoken to reporters a number of times. I guess neither was hot enough to run with. But having given prospective recruits the ability to learn other than from a recruiter, a medical student, or some line guy who thinks he knows just how milmed runs, is where I've had the most influence. Even if I stop posting today, there are plenty of physicians to warn others of what's going on in milmed today. In the mean time, continued stories of how bad milmed will continue to trickle out. Perhaps our efforts will end up in an easier life for you and your patients. At the very least, is seems because of the deplorable recruiting efforts, the majority of physicians leaving at first chance, and the critical manning needs this has created, you will at least make more money than before. You can buy me a beer with your extra change if your not too busy.
 

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I once convinced an admiral to re-route his entire battle group, by talking to him for 25 minutes about the Detroit RedWings! :laugh: , and then for 5 minutes about my recommendation. I hung up the phone, made a head call, came back to my desk to find his new MOVREP, abiding by every coordinate that I gave him. I felt pretty powerful for an Ensign!

anyway, I've spent my time in a restricted line community. never a swo, nor an engineer, nor a doc. But I can see what you guys are talking about. There are a lot of commonalities amongst these communities . . .personalities in the military tend to follow a common trajectory, no matter what the job.

anyway, you're both right--crazyb in the sense that change takes a little socializing/politiking, Galo in the sense that you could be really sticking your neck out there and asking for it . . . my two cents.
 

crazybrancato

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Good luck with that. Let's see what kind of positive change you can enact by talking football over beers with the nurse hospital commander.

Will do so, hopefully she'll be a cutie . . . :love:

You can buy me a beer with your extra change if your not too busy.

You got it, anytime! Despite me busting your balls so much on this forum, I don't think you're a bad guy, quite the contrary. And I don't mean to denigrate your service, just some of your comments, I wouldn't consider that "denigration", I'm just commenting on what you post. That's what this forum is all about. You demonstrate a great passion for medicine (even if you are a complainer), that I wish more physicians had. I'd be first in line to see you at your clinic, although you'd probably give me the boot. And I admire you for at least signing the dotted line and serving in some capacity . . . no matter how bad your experience. I have much more admiration for you, than say for the dweeb that's never left his comfort shell, having gone to high school, college, med school, residency, all within a 15 mile radius of where he was born, and can't place Washington DC on a map. At least you had the courage and conviction to serve. So yes, I'd love to buy you a beer and pick your brain about medicine and military life, PM if you're ever in the San Diego area.

Enough mushy talk . . .now, back to busting your balls: I missed something in your post above. Did you say you tried to complain to the AF Surgeon General?! That's hilarious:laugh:, I wish I could've seen the face of your hosp. CO when he found out!? "He did what!?" You jumped the chain-of-command by only--chee, I dunno--10 paygrades!? You got some cajones my friend. If they ever make a medal for having huge ones (what would such a medal look like, maybe a ribbon with two medal balls?!), you should be the first recipient. In a way, I wish you had stayed in. It takes people with that kind of courage and action to make change.
 
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crazybrancato

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I once convinced an admiral to re-route his entire battle group, by talking to him for 25 minutes about the Detroit RedWings! :laugh: , and then for 5 minutes about my recommendation. I hung up the phone, made a head call, came back to my desk to find his new MOVREP, abiding by every coordinate that I gave him. I felt pretty powerful for an Ensign!

anyway, I've spent my time in a restricted line community. never a swo, nor an engineer, nor a doc. But I can see what you guys are talking about. There are a lot of commonalities amongst these communities . . .personalities in the military tend to follow a common trajectory, no matter what the job.

anyway, you're both right--crazyb in the sense that change takes a little socializing/politiking, Galo in the sense that you could be really sticking your neck out there and asking for it . . . my two cents.

Exactamundo!!! That's what I'm taking about! And you probably felt silly b/c you spent 12 hours prepping that recommendation, only to sell it based on the merits of your hockey knowledge! but that's how this business goes sometimes. It's not enough to be an expert at your profession (that much is expected). You also have to know how to tickle people's personalities. You have to know how to bond with people. Good doctors know how to do just that. How else are you going to convince your patients to change their lifestyles (stop smoking, exercise more). All the facts/numbers in the world wont help you, but if you can connect with them on some other level (as you did with the admiral), the process of persuation can become a lot easier.
 

IgD

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I'm speechless:) My friend said once, "it's so obvious why even discuss it".
 

IgD

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I suppose its obvious but the issue I described was worked over the course of 6 months to a year. It started at the lowest levels and gradually worked its way up higher and higher. If you take the position that "the Navy just doesn't have the bodies" you could rationalize that there was no other outcome. I didn't see it that way and wasn't pleased with the outcome. Despite that, my colleagues and I did everything possible to put our patients first and make best of the situation that we had no control over.
 

IgD

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Exactamundo!!! That's what I'm taking about! And you probably felt silly b/c you spent 12 hours prepping that recommendation, only to sell it based on the merits of your hockey knowledge! but that's how this business goes sometimes. It's not enough to be an expert at your profession (that much is expected). You also have to know how to tickle people's personalities. You have to know how to bond with people. Good doctors know how to do just that. How else are you going to convince your patients to change their lifestyles (stop smoking, exercise more). All the facts/numbers in the world wont help you, but if you can connect with them on some other level (as you did with the admiral), the process of persuation can become a lot easier.

I think this is incredible advice. Surely the issue I described boiled down to an issue of diplomacy and poor interpersonal communication skills. I would recommend immediately that the DoD replace its top brass with pre-med(?) students so more can benefit from this type of advice.
 

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Ok, getting back on topic.

I read the article Galo references and that (like Galo) is all the information I have available to me.

I would say that the one has to take an article in USAToday with a bit of skepticism. I definitely believe that there could have been falsification of records to elminate a waitlist, but the article does not prove this. I would argue that the IG unless a total idiot would be able to differentiate a mistake from intentional falsification.

The negative letter on the whistleblower seems pretty concerning, but again maybe more to the story.

Having not seen the forms, and not understanding where the consults were coming from or even the stats presented in the article, I can't conclude that a criminal act or even an unprofessional act occured here.

With the focus on post deployment SRP's a zillion bogus consults are generated by medics, nurses and others which innundate the system. Sometimes we sit down, triage and realize that there either isn't a problem or the problem resolved. I can't tell you how many soldiers I call who tell me their whole unit put down a complaint under the guidance of a Pl SGT or a misinformed screener. Or denied ever having the complaint.

All I am saying is that you are ready to act as judge, jury and executioner without a full data set.

Scary.
 

IgD

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I would say that the one has to take an article in USAToday with a bit of skepticism.

What did you think of the joint commission report that was listed in the article? I thought that carried a lot of weight.

Appointment wait time and referral numbers are not that useful. I would like to know how many soldiers and their families are stationed at Ft. Leonard Wood and how many physicians there are. I wonder if Lee was the only psychiatrist(?) for the whole base.

My overall impression of the military medical system is that we barely had enough psychiatrists (and physicians across the board?) to meet the peacetime mission. In the situation I described, there were only 3 psychiatrists to handle all inpatient, outpatient (child and adult) and emergency/medical consults. All of the sudden someone gets deployed and with those levels of staffing service delivery is impacted. The idea that there is a shortage of psychiatrists at Ft. Leonard Wood is highly probable and not surprising at all to me. In the future I think the DoD has to build up some more redundancy in staffing to better handle this scenario in the future.
 
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IgD

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Fair enough.

But I will tell you that right now (at your former base) psych is one of my fastest referrals, beaten only by General Surgery. From referral until they are seen (routine) is averaging about 2 weeks right now. I am never turned down or put off for urgent referrals.

For SARP referrals, initial eval is done within a week for routine referrals. There's quite a wait time for the intensive outpatient program (1-2 months) but that's not too far out of line with what I saw in the civilian world.

I have a lot of complaints about things down here, but getting people to psych is not one of them.

I'm confused about your post. Are you suggesting that there are not staffing problems in psychiatry and surgery across the military medical system?
 

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Our base has a grand total of 1 psychiatrist for the whole base, so when he went on leave, we had no psychiatry coverage (no fault on him - I mean, you have to let him take off with his family at least 1 or 2 weeks a year...!). So during that week I was sitting in clinic and I got a referral FROM life skills on two new suicidal ideations, one with attempt, to see and start treatment on in clinic. And they were in 20 minute appointment slots.

...needless to say I was running a little late those two days...
 

IgD

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Our base has a grand total of 1 psychiatrist for the whole base, so when he went on leave, we had no psychiatry coverage (no fault on him - I mean, you have to let him take off with his family at least 1 or 2 weeks a year...!). So during that week I was sitting in clinic and I got a referral FROM life skills on two new suicidal ideations, one with attempt, to see and start treatment on in clinic. And they were in 20 minute appointment slots.

...needless to say I was running a little late those two days...

That is more in line with what my experience was. Was the psychiatrist on call 24/7? I'm sure it was frustrating for him too. Red flags were probably going off in his head but he found himself powerless to do anythign about it. He was likely counseled nothing could be done about the situation.
 

a1qwerty55

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What did you think of the joint commission report that was listed in the article? I thought that carried a lot of weight.

Appointment wait time and referral numbers are not that useful. I would like to know how many soldiers and their families are stationed at Ft. Leonard Wood and how many physicians there are. I wonder if Lee was the only psychiatrist(?) for the whole base.

My overall impression of the military medical system is that we barely had enough psychiatrists (and physicians across the board?) to meet the peacetime mission. In the situation I described, there were only 3 psychiatrists to handle all inpatient, outpatient (child and adult) and emergency/medical consults. All of the sudden someone gets deployed and with those levels of staffing service delivery is impacted. The idea that there is a shortage of psychiatrists at Ft. Leonard Wood is highly probable and not surprising at all to me. In the future I think the DoD has to build up some more redundancy in staffing to better handle this scenario in the future.

All good points... The military will NEVER have enough psychiatrists, and psychologist to deal with the volume of PTSD, mood disorders etc, coming out of this war.

The JCAHO report pointed out waitlists and delays - I don't think there is any arguing that point, but the point of the story was the recategorizing people as not needing treatment as I understand it.
 

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I don't know about the call situation for him but likely yes; when I first got here I didn't know how bad it was, so when I had someone already on a med and it wasn't working I referred them to life skills figuring, hey you probably need counseling and some more expertise than I can give you in 20 minutes! After the first three or four he let me know - nicely, heh heh - that for med management they have to fail max therapy on two or three different meds before referring to psychiatry. I do still refer them to psychology because I think we have three psychologists/social workers but I specify "for counseling only" and they try and see them all, but it's still a 1-2 month wait so I end up also recommending they talk to the chaplain service which has worked for a few of them. He always tells us to give him a call during clinic if we need some help with meds or concerns about SI, but they're in a bad way over there... of course apparently the whole air force is at 80% manning of what we're rated for...

...I'm sure the chaplain service is thrilled at the abrupt upswing in service though! :laugh:
 
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