A CASE STUDY  (Read the latest events in the case)

 

HEADLINE: January 27, 2000 Washington State Medical Quality Assurance Commission grants Dr. Smith a full medical license under whistle-blower protection provisions of state law. The Commission does not require Brigadier General Mack Hill’s signature. Hill continues to refuse to answer the letters from Quality Assurance Commission about Dr. Smith,  a physician who works for him.

                                                         

 

 

Why is this Army Doctor under reprisal for reporting JCAHO standards violations?

Who are the Army Medical Generals accused by Stephen Whitlock Smith, MD, of violating JCAHO standards?

Could Brigadier General Kevin Kiley influence Dr Smith's credentials and influence any investigations?

Who is the one Army Medical General who can resolve the situation?

What Dr. Stephen Whitlock Smith reported:

The Reported Reprisal Involved the following:

 

World Wide Web Report updated 14 February 2000 after presentation at 11:45 AM on 18 October 1999 at Madigan Army Medical Center to the following:

·         Joint Commission on Accreditation of Healthcare Organizations Physician Surveyor Dr. Charles Blewett for Dr Dennis O’Leary, President of JCAHO telephone (630) 792-5000, JCAHO Case #134, and

·         Department of Defense Inspector General Investigator Debby Gibson for Donald Mancuso, Acting Inspector General telephone (800) 424-9098 DODIG Case #67218/372088, via COL Peterson;

·         COL Peterson, Inspector General, I Corps and Fort Lewis, telephone (253) 967-5181 was consulted in person on Monday 18 October and requested to assure safe transfer of protected documents to the JCAHO Physician Surveyor Dr Charles Blewett, and to Department of Defense Inspector General Investigator Debby Gibson for Donald Mancuso. COL Peterson accepted the computer disk of protected documents and agreed to transfer it to DODIG.

 

 

 Return to Beginning

Current Situation

Investigations

Contact Information                                                  

E-mail address

stevewsmith@pol.net, stevewsmith@ephysician.md

Telephone

253-576-6746

 

Biographical Information

·          Stephen Whitlock Smith, MD, completed all of his medical training in the  Army, and served in Desert Storm in the Saudi desert near Kuwait

·          Stanford University, Palo Alto, California, 1970 (Biology)

·          George Washington University School of Medicine 1980 (MD, Army Scholarship)

·          Eisenhower Army Medical Center, Internal Medicine Residency, 1983

·          Madigan Army Medical Center, Emergency Medicine Residency, 1987

·          Elected Fellow, American College of Physicians, 1994

·          Elected Fellow, American College of Emergency Physicians, 1991

 

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JCAHO and DODIG Summary Letter to Dr Dennis O’Leary and Donald Mancuso

Attention: Dennis O’Leary, MD, and Donald Mancuso

 

Gentlemen:


My complaint is contained in this Web site, with confidential documents passed to you under separate cover on 18 October 1999, anticipatory of assistance from COL Peterson, Inspector General of I Corps and Fort Lewis. Because of the complexity of the case and the huge number of documents, I am writing this outline to point out the key problems and to signal the key documents.

 

My complaint (JCAHO #134 and DODIG #67218) can be divided up into several areas:

 

 

“Inspector General, Department of Defense, 400 Army Navy Drive, Arlington, VA 22202-2884

Honorable Strom Thurmond

United States Senate

Washington, DC 20510-4001

Dear Senator Thurmond:

This is in response to your letter of June 22, 1999, regarding Lieutenant Colonel (LTC) Stephen W. Smith, US Army Medical Corps (case number 372088.) LTC Smith alleged that he is continuing to suffer reprisals for his 1996 reports of mismanagement at the Landstuhl Regional Medical Center, Landstuhl, Germany.

 

“This office has reviewed a report of investigation from the Inspector General (IG), Department of the Army, regarding reprisal allegations made by LTC Smith. More recently, the Army IG has completed its investigation of the allegations of mismanagement at Landstuhl. Our review of these investigations determined that additional review and analysis is necessary before we can conclude that all issues raised by LTC Smith have been adequately addressed. In that regard, we have recently interviewed LTC Smith and anticipate interviewing other US Army Medical Corps personnel in the near future. The results of our review of this matter will be provided to you as soon as possible.

 

“Please accept our regrets for the delay in providing you with a more timely interim response. If we may be of further assistance, please contact me or Mr. John R. Crane, Office of Congressional Liaison, at (703) 604-8324.

 

“Sincerely,

Donald Mancuso

Acting Inspector General”

 

Finally, Gentlemen, I remind you that the allegations that I am making herein are extremely serious because they appear to involve deliberate violations of Army Regulations and Joint Commission guidelines at Landstuhl 1994-1996 by officers reporting to then COL Kevin Kiley, and reprisal against me and other witnesses at Madigan at the apparent direction of Brigadier General Mack Hill, a former close associate of Brigadier General Kevin Kiley. I do not dispute that I myself became delinquent in medical records in early September 1998, after the episode of reprisal detention which followed shortly after an episode of harassing behavior by BG Hill himself. I reported that I was falling behind in records and would need additional assistance in order to complete them. However, Brigadier General Mack Hill and his command utilized both the Impaired Provider Committee and the Credentials Committee in an apparent reprisal mode against a whistleblower, and not in the way that Army Regulation 40-68 and JCAHO guidelines stipulate. Various DOD Directives were also apparently disregarded:

  1. The Directive issued in February 1991 by DOD IG Susan J. Crawford to Army Medical Facilities (Madigan was named specifically) not to place adverse documentation unrelated to medical credentials into a provider’s credentials file, and
  2. DOD Directives protecting whistleblowers from retaliation (DOD directives 6490-4 and 6490-1 and their antecedents)

Furthermore, both JCAHO and the DOD IG have an opportunity to investigate irregularities not previously investigated by the responsible agencies. If uncompleted Army  investigations are  reactivated by your efforts, that will bring back respect to the organization that was lost when MG David Hale, an Assistant Army Inspector General, during the time my complaints were being investigated, was investigated for Court-Martial. Some of the criticisms of the Joint Commission that it is too lenient might be answered to the organization’s credit if the irregularities which I report do actually force Madigan to follow established due process Regulations and guidelines, especially in a whistleblower case.

 

I can provide whatever additional material which you require for your investigation.

 

My item-by-item appeal to you follows later in this document. (hyperlink to JCAHO/DOD IG appeal)

 

Stephen Whitlock Smith, MD

 

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THE FOLLOWING CONSISTS OF A TIMELINE INCLUDING ALLEGATIONS TO BE INVESTIGATED:

 

Feb 1991 Following the initial leadership of Senator John Glenn to investigate the medical administration of the Army in Germany, in Feb 1991, Department of Defense Inspector General Susan Crawford issues report to then Sen. William Cohen telephone (703) 697-5737, Sen. Cranston, and other members of the Senate Armed Services Committee, ordering Army Physician Commanders to stop utilizing credentials libel to discipline Army Physicians. The Secretary of the Army is directed to comply. Madigan Army Medical Center is one of those listed in the report. Two current leaders with personal knowledge of these events: Secretary of Defense William Cohen (703) 697-5737, and Brigadier General John Parker, telephone (703) 681-3000 currently an Assistant Army Surgeon General reporting to LTG Ron Blanck.

 

July-August 1993 REPRISAL FOR JOINT COMMISSION COMPLAINT: Landstuhl Deputy Commander COL David Lipsi and Quality Manager Cliff Wagner allegedly tape record testimony provided to Joint Commission Physician Inspector Bert Hurowitz, MD. One Landstuhl physician is ordered to an involuntary psychiatric evaluation one day after he had made his report to Dr Hurowitz. Two other physicians received threats from COL Lipsi. Charges against COL Lipsi for alleged credentials libel and intimidation of witnesses by the physicians' defense attorney are mysteriously dropped. Into this command environment, COL Kevin Kiley assumed command of Landstuhl in Summer 1994.

 

May 1994 LTC David Gillingham, a Madigan Family Practice physician, leaves Madigan for Landstuhl. What is his credentials standing at this time? (Read the account of reported reprisals against one of the MAMC medical claims attorneys knowledgeable of this situation.)

 

June 1994 As reported by Dr Smith, LTC Gillingham and COL Lipsi order LTC Stephen Whitlock Smith to falsify a credentials file evaluation, a violation of AR 40-68 and JCAHO standards, in Dr Gillingham's favor; Dr Smith refuses and comes under reprisal by Landstuhl Command.

 

June 17 and 19, 1994 As reported by Dr Smith, LTC Gillingham orders a command-directed mental health evaluation of Dr Smith.

 

1994-95 As reported by numerous direct witnesses, COL Lipsi and LTC Gillingham quote direct orders from COL Kiley to ER staff to abandon care of unstable patients. ER refuses. COL Lipsi and LTC Gillingham inform Dr. Smith that he will forfeit the dollar amount of a patient’s hospital bill by order of COL Kiley.

 

May 1995 As memoranda document, Dr Smith and ER Staff warn Colonel (Promotable) Kevin Kiley about Joint Commission deficiencies likely to cause harm to patients.

 

June 3, 1995 Reportedly, LTC Gillingham sends a teenage boy home with written diagnosis of abrasions; the boy had sustained prolonged loss of consciousness, had a severe headache, and had no memory of the event (retrograde amnesia.)

 

June 4, 1995 Teenage boy returns unconscious, herniating, posturing; Dr Smith and ER staff stabilize him (via intubation, hyperventilation, corticosteroids); LARMC neurosurgeon is not reported not reachable by beeper or phone. Dr Smith transfers boy to Kaiserslautern for lifesaving surgery.

 

June 6 1995 The Newspaper Stars and Stripes makes inquiries about the boy with the brain injury. COL (Promotable) Kevin Kiley orders through Ms Marie Shaw, his Public Affairs Chief, that no one talk to the press about the case. The boy’s father visits LARMC asking questions about the boy’s management. Dr Smith refers him to LTC Gillingham and COL Lipsi, and calls COL Lipsi to let him know the boy’s father is on the way to see him. The boy’s father refuses to see LTC Gillingham, and goes to see COL Lipsi, whose office turns the man away quoting Quality Assurance confidentiality regulations. The same day, LARMC ER personnel report that they suspect that the clinical record of the boy’s first day of treatment at LARMC may have been reconstructed after the fact, with the original record unaccounted for.

 

Feb 12, 1996 Dr Smith reports Joint Commission violations to COL Kiley; 2 hours later, Dr Smith is ordered into "Impaired Provider" program; COL Russell Hicks is the psychiatrist. Dr. Smith is ordered transferred 7,000 miles to Madigan for in-patient confinement. Alleged lack of due process in both credentialing and in reevaluating psychiatric detention are deviations from DOD directive on improper mental health evaluations, Army Regulation 40-68, and JCAHO standards of due process for Medical Staff.

 

Spring, 1996 Landstuhl passes Joint Commission inspection. Subordinates of COL (P) Kiley allegedly suppressed the cases reported by Emergency Services, including Quality Assurance documents.

 

March 1996 Dr. Smith requests cooperation with investigation by MAMC Inspector General LTC Collins.

 

April 1996 Dr Smith returns to medical practice.

 

Oct 1996 Dr Smith reports violation of Whistleblower Protection to Department of Defense Inspector General with assistance of then MAMC Inspector General LTC Darrell Stafford.

 

Nov 1996 Baby V is allowed to die by the LARMC Ethics Committee with mild meningomyelocele. The Ethics Committee may have been given incomplete information.

 

Nov 1996 Joint Commission Inspection returns to Landstuhl. Is not reportedly informed of the Baby V death, continues to be unaware of sentinel cases unreported, as well as reprisals to Landstuhl physicians, including to those who reported problems previously to Joint Commission Physician inspector Bert Hurowitz, MD.

 

Feb 1997 Department of the Army Inspector General investigation begins.

 

March 1997 Dr Smith takes psychometric test; examiner Gordy Winslow tells Dr Smith that the test was within normal limits; Psychologist Brad Powell writes summary of psychometric test in the presence of Dr Smith and places his clinic record in the clinic chart. Details of the complaint against BG Kevin Kiley is contained in the written report. (Brigadier General Mack Hill, responding to a Freedom of Information Act request, says that the document never existed, and names the Army Surgeon General as the Denial Authority. (Read Dr. Hickey’s letter)

 

April 2, 1997 OFFICIAL NOTIFICATION TO MADIGAN BY MEDCOM THAT DR. SMITH IS A WHISTLEBLOWER

Madigan Public Affairs Director Mike Meines (husband of Carole Meines who is custodian of Dr Smith's Credential's file) informs Madigan Commander BG Brown by the forwarded memorandum of Ms Cynthia Vaughn of MEDCOM, that Dr Smith is a whistleblower with complaints against General Kiley, and that Army Times is investigating, as follows:

 

“Author: Michael Meines at MEDCEN1_MAMC

Date:     4/3/97 12:31 PM

Priority: Normal

TO:        COL William Cahill

TO:        BG George Brown

Subject:  Media Inquiry/Congressional Issue

----------Message Contents--

 

“Head's up.

Mike

----------Forward Header----

“Subject:   Media Inquiry/Congressional Issue

Author:    Cynthia Vaughn at MEDCOM4_FSHTX

Date:        04/03/97 01:06 PM

 

“Army Times reporter Grant Willis alerted me yesterday that he is beginning to look into a situation that may have occurred at Landstuhl RMC, involving BG Kiley (then a COL) and LTC Stephen Whitlock Smith. Smith is now assigned to MAMC.

 

“Willis will likely be contacting the appropriate PAOs after he has obtained copies of correspondence on this issue (13-page letter dated 26 Feb 97: from Smith to Senators Boxer and Feinstein.

 

“According to the reporter, Smith alleges the following:

Kiley gave an order not to treat any ER patients that were not entitled to military ER care, no matter what the medical condition, and that the staff was turning people away who were in life-threatening positions (actually putting them back in their cars). Smith considered this an illegal order, treated some non-entitled patients, and as a result, there was some form of retaliation or reprisal

 

“FYI: This information has only been provided to MEDCOM SJA, MEDCOM IG, and those of you included in this correspondence.

 

“C. Vaughn

MEDCOM Public Affairs”

 

 

Note: One of the MAMC Command personnel who obtained this memorandum said the following words to Dr. Smith:  “LTC SMITH, WATCH YOUR BACK!”

 

April 16 1997 the Credentials Committee routinely renews Dr Smith’s credentials.  However, Brigadier General George Brown does not sign the credentials renewal per routine.

 

April 17 1997 CREDENTIALS REPRISAL AGAINST THE IDENTIFIED WHISTLEBLOWER BEGINS

Suddenly, Nancy Greenfield, RN, Madigan Joint Commission and Quality Management Director, calls an emergency “ad hoc” credentials meeting to reduce Dr Smith's credentials,  presents psychometric test as "abnormal." Discrepancy ensues in the credentials minutes whether these actions by Ms Greenfield are in conformity with JCAHO requirements. Dr Smith’s credentials are placed “under supervision.”

 

Sept 1997 Dr. Smith continues to insist on investigation of wrongdoing and alleged JCAHO violations at Landstuhl. LTG Blanck orders Dr Smith to travel to MEDCOM San Antonio; Dr Smith reports Joint Commission violations at Landstuhl as "reckless endangerment" of patients by COL Lipsi and LTC Gillingham who claimed that they were following explicit orders by then COL (Promotable) Kevin Kiley, the Commander.

 

Oct 1997 LTG Blanck's Quality Management Directorate recommends urgent investigation of Landstuhl.

 

Jan 1998 LTG Blanck belatedly accepts the decision of his Quality Management Directorate to investigate BG Kiley’s management of Landstuhl. Only the officers below the rgrade of General Officer are to investigated first.

 

June 20 1998 Ms Kelly Theriot, MAMC Medical Claims attorney wins $500,000 settlement from MAMC.

 

Aug 1998 General Kussman of European Regional Command receives direction by Department of the Army and MEDCOM to investigate Landstuhl. Dr. Smith notifies both MAJ Richard Jordan and COL Lester Reed of Department of Medicine by memorandum that the Landstuhl investigations are beginning to escalate and may affect his ability to concentrate fully on his work. (The memorandum consisted of the McClatchy Letter to the Editor plus signed witness statements.)

 

Sept 1, 1998 BG Hill allegedly instigates angry confrontation with Dr Smith, after Dr Smith had chatted with Dr Sue Bailey at a public receiving line; Mr. James Cleaver pushes Dr Smith into an elevator, interrogates him in the Provost Marshall's Office, accused him of carriying a concealed weapon, and pushes him down an escalator, and orders him not to approach Dr Bailey again by order of the MAMC Command.

 

Sept 6 and 10, 1998 Dr. Smith reports officially to his Department via Ms Earnestine Russell and Ms Donna Hewitt that he is delinquent in records and requires extra administrative time in order to bring them into compliance. He reports the harassment of September 1 which precipitated the difficulty in concentrating on record keeping to Provost Marshall MAJ Murphy and to Department of Medicine.

 

Sept 1998 Dr. Smith reports these harassment actions, and reports his consequent difficulty in concentrating on record keeping to his assigned MAMC psychiatrist COL Russell Hicks (on 2 occasions) and to his private physician. Dr Hicks expresses fear in reporting the events, makes no mention in his official evaluations of Dr. Smith for the Impaired Provider Committee for September, October, and November. Dr. Hicks is specifically excluded from participation in the credentials hearing of 3 March, by order of LTC Pearson, Fort Lewis JAG Legal Officer presiding: LTC Pearson says that he is directed to say that Dr Hicks is NOT Dr. Smith’s psychiatrist under the Impaired Provider Program.

 

October 9, 1998 Dr Smith reports BG Mack Hill's actions of 1 Sept 1998 as reprisal in violation of whistleblower protection. (Read the official report made to Criminal Investigation Division at Fort Lewis.)

 

October 1998 A Medical Service Corps Lieutenant, apparently not at the direction of the Department Chief, directs assignment of the large number telephone triage patients (over 300); assigns some directly to appointments, some with Dr. Smith. Nursing staff complain, and an RN Maria Turner is allowed to take charge of telephone triage under the Department Chief’s authority.  Meanwhile, correspondence with both DA IG  and with COL Joseph Smith of Heidelberg consume large amounts of  Dr. Smith’s time to prepare testimony.

 

October 1998 Department Chief COL Les Reed and RN Maria Turner and SPC Jones “rescue” Dr. Smith from increasing depressive symptoms by assigning him more assistance with record keeping and patient flow under COL Reed’s direction. (See Supervisory Plan #1)

 

Nov 2, 1998 Allegedly, COL Howard Cushner, not Dr Smith's supervisor, meets with Nancy Greenfield, RN, under Command direction, in order to remove Dr Smith's credentials, while Dr. Smith is assigned out of town for LTG Blanck’s Telemedicine Conference in San Antonio. COL Reed, the Department Chief, is not consulted in this action. There is no mention of Supervisory Plan #1, and why it was being abandoned.

 

Nov 6 1998 COL Cushner allegedly allows announcement at clinic meeting that "Dr Smith will not be returning, because of credentials problems."

 

Nov 9 1998 Dr Smith returns from San Antonio. COL Cushner orders Dr Smith not to see any patients indefinitely, orders him to move all of his possessions out of his office, orders him in writing to report to GS4 clerk Elizabeth Henderson as his supervisor.

 

Nov 1998 As part of the investigation which MEDCOM authorized, Dr. Smith received an alarming report originating from 2 medical personnel currently assigned to Landstuhl. In November of 1998, they reported incomplete maintenance records for 10 years previously on instrumentation used by LARMC Ethics Committee for brain death determinations. The inability to predict the baseline readings implied that it is possible to declare a person brain-dead when that person is alive. This was reported to the investigator in Heidelberg.

 

Nov 20, 1998 LTC Johnston, orthopedist, diagnoses Dr Smith as having paranoid delusions. Dr. Russell Hicks, Dr. Smith’s assigned Army psychiatrist, appears to disassociate himself from this controversy. Nancy Greenfield maintains LTC Johnstone's memo in Dr Smith's credentials file. Army Times later reports the incident.

 

Nov 1998 COL Joseph Smith from Heidelberg, under orders of Brigadier General Kussman, arranges a secret visit to MAMC, requests LTC Smith prepare witness list.

 

Dec 2 1998 BG Mack Hill, not himself a physician, summarily suspends Dr Smith's credentials to practice medicine.

 

Dec 4, 1998 Dr Peter Nielsen, close associate of BG Kiley's and key witness for the Landstuhl investigation, reports by memo Dr Smith's involvement in the secret investigation to BG Mack Hill's legal officer. Ms Greenfield maintains the memo in Dr Smith's credentials records.

 

Dec 6, 1998 COL Smith arrives from Heidelberg. Key witnesses become suddenly unavailable.

 

Dec 15, 1998 LTG Crocker assigns MAJ Cusker as Dr Smith's lawyer to file charges against BG Mack Hill, including Article 138 of the Uniform Code of Military Justice. The charges to be included: harassment in violation of whistleblower protection on the day of Dr Sue Bailey's visit and Dr Smith's reported detention and assault by MAMC security guard, and credentials reprisal.

 

Feb 4, 1999 BG Hill requisitions MAJ Cusker as HIS own lawyer. COL Woodling, LTG Crocker's JAG attorney, justifies the sudden change by memorandum.

 

February 8, 1999 Ms Greenfield, RN, threatens punitive action against Dr Smith if Dr Smith allows his witnesses or outside agencies to see credentials documents under Ms Greenfield's purview. Ms Greenfield has Acting Commander COL Bauman sign the memorandum and has CPT Geib, MAMC Medical Claims Attorney, read Dr Smith his rights regarding the punitive action. COL Woodling, LTG Crocker's JAG Attorney writes a memorandum to Dr Smith justifying Ms Greenfield's actions. Dr Smith ceases preparing witnesses for fear of precipitating reprisals against his witnesses also.

 

February 15, 1999 (approximately) Incoming MAMC Deputy Commander COL Gilman reportedly arrives at Madigan for several days of briefings with COL Casey Jones and others. Gilman reportedly obtains detailed information about the case of Dr. Smith. Also, reportedly Gilman receives a briefing from another whistle-blower who allegedly refused unlawful and unsafe orders to cut corners during a nuclear cleanup at a previous assignment. The whistle-blower reportedly tells COL Gilman that he is under reprisal by Brigadier General Mack Hill’s command. COL Gilman replies that he (Gilman) is on a fast track toward becoming a general officer, and therefore cannot assist the whistle-blower. Denied assistance by the new Deputy Commander COL Gilman, the whistle-blower then files retirement papers.

 

March 3, 1999 Credentials Committee votes to restore Dr Smith's credentials. As summarized in the credentials minutes of 3 March, Nancy Greenfield, RN, refuses to correct numerous false data and memoranda contained in Dr Smith's credentials records. LTG Crocker's JAG officer LTC Pearson officiates at the meeting, but does not sign the minutes.

 

March 22, 1999 Credentials minutes are not transcribed until now; language recommending investigation of Dr Smith for "conduct unbecoming" and "unprofessional conduct" is inserted into the credentials record. Attendees at the 3 March hearing do not remember such language being present. BG Hill signs the hearing record. The record is forwarded to MEDCOM under control of BG Kevin Kiley, without opportunity of local appeal being afforded to Dr Smith. Local appeal is guaranteed under Army Regulation 40-68.

 

April 8, 1999 Dr Smith signs the memo of understanding, restoring credentials via Dr Patrick Kelly, Acting Deputy Commander.

 

May 10, 1999 University of Washington medical evaluation recommends Dr Smith be returned to duty.

 

May 13, 1999 LTG Blanck agrees to accept Dr Smith's appeal and request for retirement through mediation by COL Sid Atkinson, of MEDCOM’s Quality Management Directorate

 

May 14, 1999 Dr Smith informs COL Gilman, new MAMC Deputy Commander, of Dr Smith's desperate family and financial crisis, based on the prolonged legal expenses in excess of $20,000.

 

May 25, 1999 Dr Smith sends request for retirement and full credentials to LTG Blanck.

 

June 16, 1999 BG Hill per memorandum signed by new Deputy Commander COL Gilman orders a new obstacle to Dr Smith's returning to patient care: still another meeting requiring a lawyer, or alternatively, a tape-recorded reconvening of a credentials hearing. COL Gilman reports to the new Troop Commander LTC Turner that Dr Smith "is not being cooperative." COL Gilman’s memorandum does not mention Dr. Smith’s appeal to him of 14 May for restoration of credentials because of the numerous due process violation reported, and the desperate financial situation precluding bringing legal counsel to more hearings.

 

June 18, 1999 Dr Smith protests the new obstacle and delay. Repeats request in writing for immediate retirement and clean credentials.

 

June 22, 1999 Dr Smith forwards formal appeal of credential actions to LTG Blanck, with oversight of Dr Sue Bailey's office. Appeal of credentials actions was based upon reported numerous departures from JCAHO standards of due process; and refusal by Nancy Greenfield, RN, and Brigadier General Mack Hill to remove false data from Dr Smith's credentials file.

 

June 1999 Dr. Smith’s financial and family situation deteriorates. He separates temporarily from family under medical direction from his physicians. He is ordered by Dr. Hickey to rest 3 days in order to catch up on lost sleep; Dr. Smith reports to MAMC Emergency Room, is medicated for sleep, and is taken by ambulance to temporary barracks on Fort Lewis, as documented in the Emergency Room documents. Nevertheless, MAMC Command begins an investigation against him for not reporting to duty. (Absent Without Leave). Dr Smith is also notified belately that he had failed the Army PT Test which he had taken in April. Exactly why the test taken in April was judged a failure in June was not fully explained.

 

July 7 1999 Dr. Smith gives his retirement request to Ms Sharon Dahl, secretary to COL Gilman. The request does not reach Fort Lewis Retirement Office (one mile away from MAMC) until July 29.

 

July 12 1999 Army Times article (#2) by Karen Jowers is published, reporting the continuing delay by BG Hill in restoring Dr. Smith’s credentials, as voted by the 3 March credentials hearing.

 

July 16 1999 BG Mack Hill suddenly restores Dr Smith’s credentials “under supervision.” COL Gilman orders the plan to begin on Monday 19 July, before Dr. Smith’s living situation away from family is stabilized and during a week in which Dr. Smith’s Chief Dr. Reed is assigned to be on call for the in-patient service of students, interns, and residents.

 

August 13, 1999 Dr. Smith passes Army retirement physical exam at Madigan Consolidated Troop Medical Clinic.

 

August 16, 1999 Dr Smith appeals directly to LTC Kaleen Curtis, Deputy, Career Activities, to expedite retirement and credentials to make up for delays and obstacles placed by BG Hill.

 

Sep 1999 Dr. Smith accepts Army Emergency Relief loan of $1900, and uses all available leave in order to stabilize family and financial emergency. COL Gilman refuses to extend Dr. Smith advanced leave for the purpose of retirement and family emergency.

 

October 5 1999 COL Gilman takes over micro-management of “supervisory plan”; gives adverse evaluation to Dr Smith which the designated supervisors COL Reed and LTC Root had not given to Dr. Smith, excludes COL Reed the Department Chief from meeting, schedules meeting to conflict with Department of Medicine meeting when Dr Smith is scheduled to present his informatics project to the Department, tells Dr Smith that emergency loans are not approved per Troop Commander LTC Steve Turner, that nothing more could be done to secure the loans. However, later review shows that loan application #2 for Army Emergency Relief had never reached the AER office.

 

October 14 1999 Dr. Smith receives second Army Emergency Relief loan after Troop Commander LTC Steve Turner signs verification of need. This was the application which COL Gilman said had been disapproved on 4 October, but which in fact had never reached the AER office until Dr. Smith hand carried a copy on October 13. LTC Turner expresses surprise that his name was used by COL Gilman as verifying the inability of AER to give the loan, and is very helpful in signing the verification of need as required by the AER office. LTC Turner expresses concern that LTC Smith was forced by worsening financial circumstances to move out of the Fort Lewis Guest House (Lodge) and demonstrates willingness to explore all housing options. Dr. Smith has a full patient care day on Thursday, but LTC Turner agrees to call back after 1530 on Friday to discuss housing.

 

October 15 1999 There is still no official explanation for the “limbo” status of Dr. Smith’s retirement request which had been hand carried to Ms Sharon Dahl, COL Gilman’s secretary on 7 July, the same date that it had originated.

 

October 15 1999 1530 to 1600 hours: Dr. Smith in counseling session with his supervisor COL Crowe continues to receive favorable reviews on documentation of medical charts. There is no mention of any of the adverse feedback which COL Gilman had earlier cited (5 October.)

 

October 18 1999 Dr Smith, accompanied by his attorney Mr. Ivan Johnson meets with COL Peterson, I Corps and Fort Lewis Inspector General at 1145 hours. COL Peterson accepts computer disk of protected communication for delivery to DOD IG. COL Peterson declines to accompany Dr Smith to see the JCAHO surveyor, explaining that the presence of Dr.Smith’s attorney is sufficient. Dr. Charles Blewett accepts the computer disk with Dr. Smith’s protected communication to JCAHO, documentation of alleged due process violations by Madigan Commander Brigadier General Mack Hill, and a 30 minute discussion ensued, before interruption by MAMC personnel. Dr. Blewett agreed to read the case and discuss this with JCAHO for a decision on the matter.

 

October 26 1999 Dr Smith receives favorable written evaluations from Department Chief COL Les Reed. There is no documentation to support the unfavorable reviews mentioned by COL Gilman, representing BG Hill, on October 4. There is still no news on the retirement request now pending since July 7 1999.

 

November 2, 1999 COL Gilman fields questions from 2 journalists regarding Dr Smith’s case: Ed Offley of the Seattle Post-Intelligencer and Larry Miller of The Olympian. Ms Nancy Greenfield suddenly resigns.

 

November 10, 1999 COL Gilman advances Dr. Smith’s re-credentialing and notifies him that the retirement is being arranged to coincide with full recredentialing; that this is a “precedent-setting action.”

 

December 7, 1999 Dr. Smith requests that Secretary of the Army Louis Caldera expunge the false and misleading information in the credentials records, and reports to the Secretary the stolen Madigan medical records pertaining to the case.

 

December 16, 1999 COL Gilman is notified by Ed Offley of the imminent publication of the Seattle Post-Intelligencer article, and calls Dr. Smith to an emergency meeting. COL Gilman says the retirement is denied, that Dr. Smith will have to be medically separated from the Army, that Dr. Smith must move out of his current office in the Adult Primary Care Clinic. The angry meeting is documented by tape recording by Dr. Smith, as agreed on previously by the participants.

 

December 17, 1999 Ed Offley of Seattle POST-INTELLIGENCER publishes a front page article about the case: “An Army whistle-blower's private war”

 

December 30, 1999 John Simpson’s article of the case appears on the front page of the Fort Lewis RANGER: “Dr. Smith’s War: Madigan Physician Alleges Reprisals for Whistle-blowing” COL Gilman tells the RANGER that he did not know about the case of Dr. Smith before May 1999, in contrast to what was reported about his (Gilman’s) trip to Madigan on or about February 15, 1999.

 

January 27, 2000 Washington State Medical Quality Assurance Commission grants Dr. Smith a full medical license under whistle-blower protection provisions of state law. The Commission does not require Brigadier General Mack Hill’s signature. Hill continues to refuse to answer the letters from Quality Assurance Commission about Dr. Smith.

 

January 27, 2000 COL Gilman requests by memorandum that Dr. Smith end the “90-day supervisory plan” (which has lasted almost 11 months) so that he (Gilman) can appear to be “helping” Dr. Smith. COL Gilman sends a correction the next day of a serious error in the key sentence; however, no document suitable for final signature ever follows that correction. The memo promises to shorten the “90-day plan” by 30 days; however, 20 days of that time have already passed. Gilman’s motivation may be to cast himself as the “good guy” and the Credentials Committee as villain.

 

February 9, 2000 Dr. Smith ignores COL Gilman and appeals directly to the Members of the Madigan Credentials to restore his full credentials.

 

February 10, 2000 COL Gilman answers Dr. Smith’s letter to the Committee, and promises restoration of credentials;  however, he mentions a “special” credentials meeting.

 

 

 

 

 

 

 

An Army whistle-blower's private war 

Friday, December 17, 1999 

By ED OFFLEY  

SEATTLE POST-INTELLIGENCER MILITARY REPORTER 

 

When Army Dr. Stephen Whitlock Smith took over the emergency room at the Landstuhl Regional Medical Center in Germany six years ago, he found a facility in deep crisis.  The U.S. military hospital's emergency room was suffering from acute staff shortages, aging equipment and inadequate supplies -- so much so that Smith feared for the safety of patients and medical staff alike.  "It was the scariest professional experience that any of us had ever thought we'd be involved in," Smith said.  Smith and his emergency room staff pleaded for more physicians and supplies. Personnel were working up to 60 hours a week for prolonged periods. At one point, a psychiatric nurse was assigned to the ER to monitor symptoms of suicidal behavior among staff members as a result of work-related stresses.  After two years of fruitless requests, Smith took a harder approach: He filed an official complaint against his Army superiors for failing to correct the problems.  This time, Smith saw immediate results.  He was fired as head of the emergency room. The hospital commander revoked his medical credentials. Smith was shipped 7,000 miles from his family to Madigan Army Medical Center at Fort Lewis, where he was held in a psychiatric ward for three weeks without a hearing.  Today, three years later, the 54-year-old lieutenant colonel remains at Fort Lewis, still engaged in guerrilla warfare with the brass, still working in the uncertain twilight of a military medical career gone sour. And still, he says, suffering illegal reprisals for his whistle-blowing.  "This was done intentionally to muffle me, destroy my career and family," said Smith, a soft-spoken but intense man. "I think they are trying to wear me out and they don't care if my family is destroyed in the process."  He is more than $30,000 in debt from lawyers' bills. For the past two months, he has been living in a tent at a Fort Lewis recreational campsite.  What Smith wants now is vindication, the opportunity to retire early from the Army, and to get a civilian medical license in Washington state.  Army officials won't talk about Smith's accusations, citing the privileged nature of most of the material involved, including Smith's own medical records.  An investigation into Smith's original complaint filed with the inspector general at Landstuhl and a review of working conditions at Landstuhl by the Army's European Medical Command found no evidence to support his allegations, officials said.  But the Pentagon acknowledges that the Defense Department is investigating allegations of mismanagement at Landstuhl, as well as Smith's complaints of reprisals from officials there and at Madigan.  Smith remains optimistic that the investigation will clear his name and reputation. He sees his battle as a war of attrition, and so far, Smith says, "I have survived." 

 

An emergency room in crisis 

Smith reported to the Landstuhl Regional Medical Center as chief of emergency medical services in July 1993. It was his third stint as the head of an ER facility. He had the same job at a civilian hospital in Rhode Island, then was ER chief at an Army hospital in Denver before the transfer to Germany.  Smith and his family were excited about moving to Landstuhl.  "We enjoyed it for the day trips and weekend tours," Smith recalled. "It's the very best part of Europe to go touring from because everything is so close, whether France or the Bavarian Alps or the rest of Germany."  But work quickly began to crowd out family life, Smith said.  The medical facility in southwest Germany is the trauma center for all U.S. military forces in Europe, including troops deployed to crisis areas such as Somalia, Bosnia and Kosovo. It is open 24 hours a day, seven days a week.  Under Army policies, Smith's emergency room was supposed to have at least seven full-time certified ER physicians. But during the summer of his arrival at Landstuhl, the number dropped to four when departing physicians were not replaced.  In May 1994, Lt. Col. David Gillingham arrived at Landstuhl as the new chief of ambulatory care and Smith's immediate superior.  "I thought we would get along fine," said Smith, who was assigned to be Gillingham's sponsor to help with his processing and moving needs. "I picked him up at the airport and introduced him to the community."  The cordiality vanished about a week later.  Smith said Gillingham rejected his request for additional ER staffing even after being told the physicians were being forced to work 50-60 hours per week, and Smith was forced to work 60-70 hours a week to cover both ER shifts and his administrative duties.  At a meeting to discuss the ER staffing shortage, Gillingham's reaction stunned and angered Smith.  "Gillingham presided over the meeting and ordered me 'to work the ER doctors into the ground,'" Smith said. He quoted Gillingham as saying of the young doctors, "They are cannon fodder and have to pay back (for) their training." The stress took a toll on everyone working in the emergency room, including Smith.  "I was marooned at work," Smith said. "My family had to go on tours alone."  Smith, who has battled clinical depression for most of his life, said at one point he was hospitalized for nervous exhaustion.  "I don't dispute the fact that I became depressed as a result of the situation," he said.  In July that year, the number of available ER physicians dropped from four to three after a junior physician suffered a nervous breakdown, Smith said. Landstuhl officials eased the crisis by rotating other doctors into the ER for several months.  Smith's senior non-commissioned officer at Landstuhl, now-retired Sgt. 1st Class Stanley Gaines, said in an interview that hospital commanders refused to take steps to find qualified physicians for the emergency room. He also said they attempted to pressure doctors to minimize medical care to non-military patients.  "We didn't have the amount of staff to adequately take care of our patients," said Gaines, who now lives in Tyler, Texas. "I don't know the real reason, but we weren't getting supported and people didn't care."  By mid-1994, Landstuhl was treating more than 23,000 emergency cases a year -- an average of 63 per day -- but receiving administrative credit for less than half that number, Smith said.  Smith has accused Gillingham, his supervisor who also ran the hospital's family clinic, of diverting budget money and staffing positions from the emergency room by falsely claiming that more than 11,000 of the ER cases had actually been treated at the family clinic. Smith said this enabled Gillingham to obtain money and staffing support his facility otherwise would not have received.  "They were weak leaders and in a bad situation (with overall budget cuts)," Smith said of his bosses. "They didn't mind endangering patients to advance their careers."  That winter, Smith tried repeatedly to obtain support from his commanders to prevent another ER staffing crisis in the summer months when many physicians on temporary assignment to Landstuhl normally returned to their home bases. Smith said he was promised in February 1995 that the number of certified ER physicians would be kept at a minimum of five -- still two below the Army minimum of seven. 

 

Confrontation 

In May and June 1995, two events occurred at Landstuhl that set Smith on a course of confrontation with his senior officers.  On May 8, Smith reported that the beeper system for contacting on-call ER doctors had failed the day before at a time the emergency room experienced several major trauma cases.  "We couldn't call in the specialists we needed to save lives," Smith said. "In the spring, Germany is a beautiful place, and the specialists are going to be out . . . depending on their beepers if there is an emergency."  Smith requested an immediate replacement of the system. It didn't happen.  Instead, his superiors became angry with him for pressing the issue, Smith said.  Less than a month later, while on duty as an ER physician, Gillingham treated a 17-year-old civilian, the son of an Army contract employee, who had suffered a head injury, Smith said.  Smith and Gaines say Gillingham sent the boy home with a written diagnosis of abrasions even though the youth had sustained prolonged loss of consciousness, had a severe headache and had no memory of the event.  The next day, the youth was rushed back to Smith's emergency room in a coma.  Smith says the emergency room beeper system failed again and the on-call neurosurgeon could not be located. In desperation, staff members rushed the unconscious patient to another medical facility about 50 miles away for emergency brain surgery.  The youth suffered permanent brain damage as a result of the incident, according to the Hilton Head Island, S.C., Packet, the newspaper in the young man's hometown.  According to the newspaper, the boy's family last year filed a $7.5 million claim against the Army, alleging malpractice. The Army judge advocate general's office ruled the hospital had not acted improperly. The Army has final review of claims filed against the service's overseas facilities.  After the office of Sen. Strom Thurmond, R-S.C., intervened, the family was offered a settlement, a spokeswoman for Thurmond said. Details of the settlement were not released.  Back in Germany, things continued to get worse for Smith and his emergency room staff. In September 1995, NATO carried out a fierce air campaign in Bosnia that paved the way for the deployment of 40,000 U.S. and NATO troops into Bosnia. Landstuhl was earmarked to handle any seriously injured peacekeepers. In a memo to one of his supervisors, Col. Kevin Kiley, Smith said U.S. casualties would overwhelm his emergency room.  The dispute between Smith and his staff on one side, and higher-ups at Landstuhl on the other, continued to simmer. On Feb. 12, 1996, Smith formally submitted his complaint to the inspector general at Landstuhl accusing Kiley of tolerating violations of standards established by the Joint Commission on Accreditation of Healthcare Organizations. The independent commission evaluates both civilian and military hospitals for correct standards of practice and administration.  Smith alleged hospital officials were endangering patients by purposely understaffing the emergency room and that his requests for additional doctors were repeatedly ignored.  Two hours later, Kiley stripped Smith of his medical credentials and ordered his immediate transfer to Madigan. Smith said different officials at Landstuhl told him different things. At first, he believed he would remain at Madigan for a brief medical checkup before returning to Germany. Other Landstuhl officials indicated Kiley had ordered a permanent transfer.  "The paperwork was pretty confusing, as well," Smith said.  One assistant to Smith said the transfer was a reprisal.  "It was done very viciously," said Gaines, the senior sergeant in Smith's emergency room. "He (Smith) wasn't being supported by his superiors and made some calls they didn't like, so they struck out at him instead of solving the problem."  Smith packed his bags. 

 

Incarcerated at Madigan 

Twelve days after the confrontation with Kiley, Smith arrived for duty at Madigan on Feb. 24, 1996, and to his shock was locked up in the hospital psychiatric wing.  "They handed me the pajamas that patients wear who are not allowed out, and they told me I had to hand over all of my possessions except for my uniform," Smith recounted. "I was stunned."  He has records from his trip that indicate he stopped at Army Medical Command offices in Washington, D.C., en route to Madigan, where he met with officials and conducted routine business. He said there was no indication on his travel orders that he was to be placed under medical supervision or constraint.  Smith was released from the Madigan psychiatric unit in three weeks, and was surprised when Madigan's ER director invited him to join the ER staff. He had his medical credentials restored in full after several weeks. "It was as if the whole episode had not even happened," Smith said.  Smith said the incarceration violated numerous Army regulations because there was neither a formal hearing or any written orders committing him to the secure ward. He believes Kiley made a telephone call to Madigan officials that led to his incarceration.  Madigan officials declined comment on any specifics of Smith's complaints, including the hospitalization, but insisted that no patients are locked up without due process.  "We don't confine people in a hospital as a rule," said Col. Jim Gilman, Madigan's chief of medical staff and Smith's current superior.  But when Smith continued in the following months to press for Army and Pentagon investigations into Landstuhl, he said, officials at the Pierce County facility began engaging in reprisals against him.  In 1997, Smith said his medical credentials were restricted again for a brief time after officials learned the independent newspaper Army Times was investigating his case. And in September 1998, during a visit to Madigan by Dr. Sue Bailey, assistant secretary of defense for health affairs, Smith said he was forcibly detained by a security guard and dragged out of the area when he approached Bailey, an acquaintance from medical school.  Smith filed a criminal complaint with the Fort Lewis criminal investigative detachment as a result of the dragging incident. Several weeks later, he said, Maj. Gen. Mack Hill, commander of Madigan Army Medical Center, again restricted his medical practice rights. Hill, like other Army officials, declined to comment.  Smith said this complaint has been in limbo for more than a year. In March, the credentials committee at Madigan voted to restore his authority to practice medicine. He is currently fully active in the hospital's adult primary care clinic. 

 

The price of whistle-blowing 

Married with two sons, one of whom still lives at home, Smith said the stresses of the past year had become so great that he took his family therapist's suggestion and temporarily moved out of his home. "We decided to separate until the stress of this business was less," Smith said. "I'm trying to protect her from all of this," he said of his wife, Virginia.  Deeply in debt from legal expenses, Smith said the only temporary housing he could afford was a tent staked at a campsite at North Fort Lewis, where Smith goes every day at the end of his medical shift at Madigan.  Smith said he finally decided to request early retirement from the Army but his application remains bogged down in the bureaucracy. Smith also is at the mercy of Madigan officials -- the same officials whom he said have engaged in reprisals against him -- to complete the routine paperwork that would allow him to apply for his state medical license.  Smith remains in what he calls "suspended animation," waiting for the Army to respond to his retirement request. He wants to get on with his life and work as an emergency room doctor in the civilian community.  Smith looks forward to rejoining his family. He visits them on weekends.  Two of the three Army officials Smith accuses of improper actions at Landstuhl remain on active duty.  Kiley, the former Landstuhl commander, is a two-star general serving as assistant Army surgeon general and deputy chief of staff for force projection. He supervises all Army physicians. Kiley declined a request to be interviewed.  An Army Medical Command spokeswoman said Kiley has recused himself from any personnel decisions involving Smith. "He has declined to comment on this issue," said spokeswoman Cynthia Vaughan.  Gillingham, Smith's direct superior at Landstuhl, is now a student at the U.S. Army War College in Carlisle, Pa. He also declined comment on Smith's allegations.  Lipsi, the former deputy commander for clinical support at Landstuhl, has retired from the Army and could not be located for comment.   P-I reporter Ed Offley can be reached at 206-448-8179 or edoffley@seattle-pi.com

 

 

 

 

Dr. Smith’s War: Madigan Physician Alleges Reprisals for Whistle-blowing

J. M. Simpson of the FORT LEWIS RANGER December 30, 1999

 

In February of 1996, Dr. Stephen Smith became a whistleblower; As a result, his life has changed.

 

An intense man with an affection for technology, Smith was assigned to the emergency room at Landstuhl Regional Medical Center, Germany. While there, the lieutenant colonel complained to the inspector general that his superior, COL Kevin Kiley, tolerated the violation of standards established by the Joint Commission on Accreditation of Healthcare Organizations. The commission is an independent body that evaluates civilian and military hospitals for correct standards of practice and administration.

 

Smith complained that hospital officials were deliberately understaffing the emergency room, ignoring his requests for more doctors, and thereby endangering both the staff and patients.

 

"I filed the complaint because of the lack of due process in championing the welfare of patients and staff in Germany," Smith said.

 

Within hours of filing the complaint, Kiley stripped Smith of his medical credentials and ordered his immediate transfer to Madigan Army Medical Center.

 

When Smith arrived at Madigan on February 24, 1996, he was locked up in the hospital's psychiatric wing. Three weeks later, he was released and asked to join the hospital's emergency room staff.

 

Smith contends that his incarceration in the psychiatric wing violated Army regulations.  He points out that there was no formal hearing and no written orders placing him in the secure unit.

 

"It was all done as a cover-up for Kiley," Smith said.  Kiley, the former Landstuhl commander, is now a major general serving as assistant Army surgeon general and deputy chief of staff for force projection.

 

In a recent interview with the Seattle Post-Intelligencer, COL James Gilman, deputy commander for clinical services at Madigan and Smith's current superior, was asked about Smith's incarceration. "We don't confine people in a hospital as a rule," he said.

 

But when Smith continued to press Army and Pentagon officials about his allegations concerning Landstuhl, he contends that his superiors began to take reprisals against him.

 

Smith states that in March of 1997 he was "forced" to take a psychometric test. He believes the test was used as means to get back at him.

 

"MAMC command said the test results were abnormal and that they allow it to place me under supervision," Smith said. "I saw those scores; they are normal." Smith also went on to say that data from his medical records is missing and that the results of the psychometric test are part of the missing data. Smith also contends that data from his medical files vanished only after Gilman took over as deputy commander earlier this year.

 

"All of this stuff vanished when Gilman took over," Smith stated. "Things have been in a free fall, with no one in charge."

 

Madigan officials declined to comment on any aspect about the test.

 

Smith says his medical credentials were renewed on April 15, 1997, but that the following day they were revoked. On April 17 a meeting was held; Smith was placed under the supervision of COL Les Rice, chief of the department of medicine, and his credentials were restored.

 

Smith alleges that his credentials were pulled because hospital officials learned that the independent newspaper Army Times was investigating his whistle-blowing activities.

 

In December 1998, Smith said that Brigadier General Mack Hill, MAMC commander, suspended his medical credentials. "I didn't see any patients for eight and a half months," Smith said.

 

He did, however, see a psychiatrist.

 

On May 10, 1999, Smith was evaluated by Dr. David Dunner, Assistant Chief of Psychiatry at the University Of Washington. According to Smith, he does not know why he was sent to the evaluation; however, he believes his credentials' committee, which is chaired by Gilman, arranged the evaluation and that Hill ordered the evaluation.

 

Madigan officials deny that Hill and Gilman had anything to do with the evaluation. Moreover, hospital public affairs personnel stated that Gilman arrived at Madigan after Smith saw Dunner. Gilman, however, arrived in April 1999.

 

According to Smith, it is at this point that data from his medical records turned up missing.

 

"Some crucial medical records turned up missing. They are my psychiatric clinical records, my psychology clinical records, and my psychometric test results," Smith said.

 

As for the psychiatric evaluation conducted by Dunner, Smith contends that his test results show him to be "well-grounded."

 

"Dr. Smith had proven that he has done good clinical work; that he is in remission from major clinical depression; and that he receive his credentials and be put back to work," Smith said of Dunner's report. "Dr. Dunner also added that Madigan might not be the best place to stay because of the perception of reprisals," Smith added.

 

Smith does not deny that he has suffered from depression. "I've been up front about it since coming to medical school on an Army medical school scholarship," he said.

 

Married with two sons, one of whom lives at home, Smith said that the stresses of the past year had become so great that he took his family therapist’s suggestion and temporarily moved out of his home.

 

"I did not want to bring undue stress to my wife," he said. Smith does, however, see family members regularly.

 

Smith is more than $30,000 in debt from legal bills; he has used some of the money set aside for his children's college to pay some costs. He allots himself $500 per month on which to live. Since he could not afford separate housing, he has lived in a tent for the past two and a half months at a campground on North Fort Lewis.

 

"What's been done to me has been to destroy me and my family," Smith said.

 

Hoping to continue his career in the civilian community, Smith requested early retirement from the Army in July 1999 and that Madigan officials complete the paperwork that would allow him to apply for his state medical license. In his request, Smith asked that the full restoration of his credentials be a part of his retirement papers.

 

"That would be rare," said a source who requested anonymity. "If the Army did that, it would set a precedent, and that is unlikely to happen. But I will tell you this, there are people there out to squash him."

 

Smith says his request for early retirement was denied on December 16, 1999. Mike Meines, public affairs officer for Madigan, says he has not seen an official denial for the retirement request.

 

In the meantime, Smith will witness the new millennium in a tent on Fort Lewis, waiting for an answer.

 

 

 

 

Gilman’s memorandum to Dr. Smith requesting an end to the “90-day plan”

 

 

 

 

COL Gilman’s correction of the key sentence in his memorandum

 

 

 

 

 

Dr. Smith’s answer to the Members of the Credentials Committee

 

9 February 2000

 

 

Members of the Madigan Credentials Committee:

 

Thank you very much for seeing me through the 90-day supervisory plan, the last day of which is today, as the enclosed CHCS printout verifies. Special thanks are due to Ms. Sharon Hehn and LTC Curtis Hobbs of the Endocrine Service who have carefully documented the reviews of the medical charts during the full 90-day supervisory period. COL Reed, COL Crowe, and LTC Root have been outstanding supervisors, while Ms. Helen Pierce’s kindness knows no bounds.

 

Your draft letter of 27 January, as well as the edited paragraph received several days later, mentioned the Committee’s intention to offer a waiver for the last 30 days of the plan. Although I appreciate the Committee’s thoughtfulness in considering a waiver, most of the 30 days of the intended waiver had already been worked under the supervisory plan, making the waiver invitation moot. I followed wise counsel in finishing the supervisory plan today as originally written, in order to secure what the Committee promised me according to the top of page three of the Supervision Plan, revised 25 March 1999:  “After 90 days of successful proctorship and supervision, privileges for internal medicine will be recommended without supervision.”

 

For consideration during tomorrow’s Credentials Committee Meeting of 10 February 2000, I respectfully request the full Internal Medicine privileges promised by the Committee.

 

 

Sincerely,

           

Stephen Whitlock Smith, MD

FACP, FACEP

LTC, MC

 

Cc:             DCCS, DCN, Chief, Department of Anesthesia and Operative Services, Chief, Department of Emergency Medicine, Chief, Department of Family Practice, Chief, Department of Medicine, Chief, Department of OB/GYN, Chief, Department of Pathology, Chief, Department of Pediatrics, Chief, Department of Psychiatry, Chief, Department of Radiology, Chief, Department of Surgery, Chief, Physical Medicine and Rehabilitation Service, Chief, Preventive Medicine Service, Troop Commander, Ms. Sharon Hehn, LTC Curtis Hobbs, MAJ Burgoa, Ms. Deborah Gibson, Mr. Ivan Johnson, Mr. Mike Gaffney

                   

Attached:  CHCS documentation

(Names and details of the patients are omitted for reasons of patient confidentiality.)

 

 

 

COL Gilman answers Dr. Smith’s letter to the Credentials Committee. He mentions a “special” meeting.

 

---------------------------------------------------------------

"Inbox" Msg: 6 of 682

From: "Gilman, James K COL MAMC" <James.Gilman@nw.amedd.army.mil>

To: "'Stephen Smith'" <stevewsmith@pol.net>

Subject: RE: Fwd: Members of the Madigan Credentials Committee

Date: 02/10/2000 05:22pm

      ---------------------------------------------------------------

LTC Smith:

 

LTC Hobbs is collating the results of your last 30 days of charts for final presentation to the Credentials Committee. That information was not available for today's meeting. I hope to be able to call a special meeting next week and will do so as soon as LTC Hobbs and COL Reed indicate that they have checked all the charts and collated all the results. Assuming that

the last month's charts are as good as those provided previously, I see no issues for the Credentials Committee. However, I do need them to meet formally, hear the results of the last month's charts, and have their actions restoring your credentials recorded in official minutes. With regard to exactly what privileges are being restored without supervision, I refer you to the delineation of privileges requested by you on 28 April 1999. These are the privileges for which you have applied and which were granted under supervision. These are the privileges which are under consideration by the Credentials Committee.You do not have to submit any additional charts between now and the time the Credentials Committee next meets. Please contact me at 968-1190 if you have any questions.

 

COL Gilman

 

 

 

 

Dr. Smith’s new medical license from the State of Washington, issued on January 27, 2000, even without the signature of Brigadier General Mack Hill. Hill continues to refuse to answer the letters from Quality Assurance Commission about Dr. Smith.

 

 

 

 

 

 

DRAFT Letter To The New Physician

 

20 August 1999

To the Editor, NEW PHYSICIAN:

I am grateful for the opportunity to give your medical student and resident readership my perspective regarding my Army Scholarship to George Washington University Medical School (MD, 1980), and my Army residencies in Medicine (Eisenhower Army Medical Center, 1983) and Emergency Medicine (Madigan Army Medical Center, 1987).

My training prepared me for a busy career in both Army and civilian emergency medicine. I served in Saudi Arabia during Desert Storm, and I felt confident of the medical centers and support personnel wherever I practiced.

An abrupt change occurred while I was Chief of Emergency Services under then COL Kevin Kiley, who was Commander of Landstuhl Army Medical Center. Two of his subordinates, quoting direct orders from COL Kiley himself, began to issue inappropriate and recklessly dangerous orders to myself and other emergency care personnel. The orders included abandonment of unstable patients, who could not produce ID cards,

My staff and I refused those orders as unlawful and dangerous; we came under reprisal for our courage. There were several very serious incidences of harm to patient. Consequently, I filed charges against now-Brigadier General Kiley and his former subordinates. All resultant investigations have been slow in being prosecuted, and are not finalized.

 

The Medical Center to which I am currently assigned is Madigan Army Medical Center. Madigan is where I trained in Emergency Medicine. Last September 1, I was attending a public ceremony for the inauguration of Madigan's Medicare Program. I was at that time assigned to Acute Care Internal Medicine; a large part of my practice consisted of Medicare-age patients.

 

After I had had a pleasant chat with Dr Sue Bailey, Assistant Secretary of Defense for Health Affairs, Brigadier General Mack Hill approached me rapidly, and in apparent extreme anger. Later, a hospital security guard approached me, pushed me into an elevator, accused me of carrying a concealed weapon, and ordered me not to approach Dr Bailey's group again. He then shoved me down the escalator heading toward my clinic.

 

I reported the incident as reprisal for my part in the escalating investigations against Brigadier General Kiley. General Hill is a close associate of General Kiley's, and 2 weeks after the incident became Madigan's new Commander. He is the only non-physician ever to occupy that position.

 

A staggering number of adverse credentialing actions were then imposed upon me, in general instrumented by the Joint Commission RN Representative of Madigan Ms Nancy Greenfield. Because neither Army Regulation nor Joint Commission guidelines of due process in credentialing were followed, I have been obligated to accuse Ms Greenfield of acting under the unlawful orders of BG Hill to deny me due process in reprisal for my whistleblower activities against General Kiley.

 

This has now gone on to direct appeal to LTG Blanck, Surgeon General of the Army. It remains to be seen if there is ever an adequate investigation of danger to patients under then COL Kiley's leadership at Landstuhl.

 

I am hopeful that I will obtain both retirement and clean credentials. However, the sad thing is that both Landstuhl and Madigan Commanders have been so fearful of outside scrutiny of their actions that they have stooped to utilize very obvious reprisal actions in order to deflect any attempt to investigate.

 

I am aware that civilian HMO's have similar pressures on their leadership. However, the Army places unusual degrees of autonomy and power upon its commanders, this for faster response during wartime.

 

My opinion is that until the tendency for weak leaders who fear any investigation to overreact, even past the point of criminal wrongdoing, is minimized by greater scrutiny and oversight, I would not advise medical students and residents to accept any obligated time in the Army Medical Corps.

 

This is sad, for the Army Medical Corps largely contains well-trained and compassionate physicians.

 

Stephen Whitlock Smith, MD

 

***************************************************************************

 

Letter to  Dr Bailey, Assistant Secretary of Defense for Health Affairs

 

18 October 1999

 

RE: Freedom of Information Act Request

 

Dr Sue Bailey:

 

I am grateful for your salutary influence upon my request to obtain due process in credentialing as provided for my Army Regulation and Joint Commission and HCFA guidelines.

 

Because my appeal of the adverse credentials actions against me at Madigan, as carried out by Ms Nancy Greenfield on orders of BG Hill, has already gone to LTG Blanck personally, I am asking your oversight of this process.

 

BG Hill has refused to provide the majority of the critically important documents under Freedom of Information Act. The FOIA Office at MEDCOM San Antonio has answered for BG Hill, naming the Army Surgeon General as "denial authority."

 

Your role in this process proceeds from several sources, as follows. I will therefore categorize my request for groups of documents through your office, following the same categories corresponding with your oversight over the total situation:

 

1. DOD Directive for Improper Mental Health Referrals:

a. The Assistant Secretary of Defense for Health Affairs is the oversight authority for Improper Mental Health Referrals as provided for in DOD Directive....

b. Your training in Neuropsychiatry qualifies you admirably to judge such Improper Mental Health referrals from a medical and compassionate basis, rather than a purely administrative one.

FOIA REQUEST REGARDING IMPROPER MENTAL HEALTH EVALUATIONS: I request a full set of documents exchanged between Madigan Command, Landstuhl Command, and OTSG/MEDCOM corroborating that then-COL Kiley's denial of due process to me was outside of Directive.

2. Your Neuropsychiatry training allows your greater understanding of the allegedly substandard care given the teenage boy with prolonged loss of consciousness on 3 June 1995, by one of then-COL Kiley's subordinates.

FOIA REQUEST REGARDING THE JUNE 1995 BRAIN-DAMAGE CASE: I request corroboration that the family of the patient will be given every consideration for their medical claim, irrespective of the fact that a payment in the case would reflect poorly on then-COL Kiley's leadership.

3. The same background also allows your professional insight into the Landstuhl Ethics Committee decision, allegedly Command-directed by then-COL Kiley, to allow Baby Victoria to die with only mild meningomyelocele.

FOIA REQUEST REGARDING THE UNFORTUNATE DEATH OF BABY V: What assurance does the documentary record reveal to reassure Army patients and their families that INFANTICIDE has no place legally in the armamentarium of a Commander, and that it will not be condoned?

4. Your presence at the 1 September 1998 Inauguration of TriCare Senior Prime and your discussion with me, immediately after which I reported alleged harassment by BG Hill, has allowed you to be my best witness in my report of the incident.

FOIA REQUEST REGARDING MY REPORT OF DETENTION AND PHYSICAL ASSAULT: What documents can you provide of BG Hill's personal involvement in the reprisal action. Are you in receipt of BG Hill's written memorandum explaining his own personal role in this lamentable and shameful episode?

5. Your oversight of HCFA regulations would allow you to recognize that Madigan is held to standards of Joint Commission guidelines of due process in medical credentialing. Typically, Army Medical Centers utilize Army Regulations to show compliance with JCAHO and HCFA standards. If they do not do so, they jeopardize loss of considerable amounts of Medicare financing.

FOIA REQUEST REGARDING ALLEGED JCAHO AND ARMY REGULATION VIOLATIONS OF DUE PROCESS AT MAMC: My counsel and I require documentary evidence of ANY JAG legal review of the many months of credential actions against me. By memoranda produced by COL Dale Woodling, LTG Crocker's JAG, he is presumed to be the officiating lawyer. However, why did the JAG officer, also reporting to LTG Crocker, LTC Pearson, who actually was present at the hearings, not sign even one of the hearing minutes?

 

Thank you,

 

Stephen Whitlock Smith, MD

 

***************************************************************************

 

18 October 1999

 

Letter to American Association of Retired Persons AARP:

 

While I was Chief of Emergency Services at Landstuhl Army Medical Center, I reported an abrupt erosion of standards of care, especially as dispensed to dependents of retirees, as well as to children.

 

The main risk to dependents of retirees appeared to be denial of care while in the midst of a medical emergency, if they could not immediately prove eligibility.

 

Two subordinates of then COL Kevin Kiley ordered myself and other emergency personnel to turn away certain patients whom we considered at high risk of serious illness and injury if not monitored.

 

I reported these events so that other patients would not be endangered, then found myself under reprisal by BG Mack Hill for doing so. In a particularly dramatic event, after I spoke briefly to Dr Sue Bailey, Assistant Secretary of Defense for Health Affairs (Medicare), I reported that BG Hill personally approached me in anger; thereafter, I experienced detention and physical assault by the hospital security guard.

 

The hearing, which addressed these strange happenings, revealed that MAMC Command was worried about a violent protest by Army retirees who had not been selected for the Medicare project. Would the security guard have also detained and roughly handled the retirees if they had become any kind of danger in the perspective of the Command?

 

I am grateful to the retired patients of Madigan, having much accumulated wisdom from their own military careers, who have been my local experts in how to write up and request investigation of these events.

 

 

 

Thank you,

 

Stephen Whitlock Smith, MD

 

 

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Tacoma, Washington, 18 October 1999

 

Dear Editor:

 

I am an Army doctor with board certification in 2 specialties, Emergency Medicine and Internal Medicine. When I was Chief of Emergency Medicine at Landstuhl Army Medical Center in 1996, I complained in writing to my Commander, Dr Kevin Kiley, about my supervisors' orders for emergency staff to send patients away without treatment, and about the deteriorating beeper system and ambulance systems which were not operating according to safe guidelines. I reported one case of brain injury in a child who had been turned away without complete treatment. 2 hours after filing my report, Dr Kiley ordered to be sent 7,000 miles to Madigan Army Medical Center for psychiatric evaluation and spend 3 weeks in a locked psychiatric ward. I returned to medical practice at Madigan Army Medical Center; however, I continued to request full investigation, so that others would not be harmed. Meanwhile, Dr Kiley became Brigadier General Kiley, Assistant Surgeon General with authority over medical credentialing matters, and his close associate Brigadier General Mack Hill was sent to be Commander of Madigan starting in September 1998, just when the investigations of Landstuhl were due to begin. On 1 September 1998, I waited with dozens of other Madigan staff in a public, receiving line, and chatted briefly with visiting dignitary Dr Sue Bailey who had trained at the same medical center as I. Suddenly, Brigadier General Mack Hill rushed toward me with his anger apparently directed toward me. A hospital security guard approached me and pushed me into an elevator, interrogated me, and pushed me down the escalator toward my clinic, ordering me not to participate further in the meetings with Dr Bailey.  I protested such treatment as reprisal for the Landstuhl complaint against General Kiley. My official sworn statement was then placed into my medical credentials file, and General Hill has refused to allow me to practice medicine at Madigan for 8 ˝ months. My appeal has gone to Army Surgeon General Ronald Blanck. However, there has been an inordinate delay in the progress of the appeal paperwork between San Antonio where General Kiley is in overall charge of credentials, and Washington, DC, where General Blanck is. I and my legal counsel believe that this is the first time that an Army trained physician has been left without medical credentials for 8 ˝ months in reprisal for an Inspector General complaint of danger to patients.  What does this mean to Madigan Army Medical Center, which is embarking upon a new Medicare project? Will other doctors at Madigan be under reprisal if they refuse to follow dangerously inadequate medical standards for cost reasons?  What does this mean for Army medicine? Will doctors and nurses continue to serve in our Army if the standards are deliberately lowered, and if there are reprisals for requesting to stay within safe guidelines of patient care?  Army Times (Gannett) and Hilton Head Island Packet (McClatchy) have published reports of these happenings, which I attach to this letter. The situation is very unstable: General Hill has continued to refuse my full restoration of credentials, and has refused to verify my status for my Washington State license. I believe that Army patients and especially retirees should worry if one of their doctors can be punished for speaking out in favor of safe standards of care.

 

Stephen Whitlock Smith, MD

Lieutenant Colonel, US Army

FACEP, FACP

Stephen Whitlock Smith, MD

8103 Steilacoom Blvd SW PMB #28

Lakewood, WA 98498-6102

Tel 253-576-6746

E-Mail stevewsmith@pol.net

 

Senator Thurmond (202) 224-1300, Dr Sue Bailey, Assistant Secretary of Defense

for Health Affairs (703) 614-3537, Gannett (703) 558-3902, McClatchy (916)

321-1109, AARP 206-517-9350, American Medical Student Association (703) 620-

6445

 

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(Extract from HILTON HEAD ISLAND PACKET, McClatchy Company)

See WWW.islandpacket.com

Header: Category: Local News, Creator: Mike Ramsey, Paper Date: 7/28/98,

Paper Page/Section: 1A, End of Header.

BY MIKE RAMSEY Packet staff writer

Bobby Wood was an experienced off-road cyclist, an "A" student and computer whiz when a bicycle wreck three years ago sent him into a coma and changed his life. Wood, now 20 and living on Hilton Head Island, still rides his bike every day and has been taking design courses at Savannah College of Art and Design. But itąs not the life he planned. He suffered brain damage, as well as loss of vision and some mobility, and he canceled his plans to attend Rochester University on a $32,000 scholarship. Worse, Wood and his family contend the damage might have been prevented had he received proper care at a U.S. military hospital in Germany, where Wood was living when the accident happened. "Iąm angry, but what can I do?" Wood said. "They know they have done something wrong, but wonąt do anything about it." Wood has filed a claim against the U.S. Army for malpractice, but he and his family arenąt optimistic. The Armyąs Office of the Judge Advocate General in March turned down Woodąs initial claim for $7.5 million. Woodąs attorney filed an appeal and the results of the appeal should be back in a few weeks. If the appeal is denied, Wood has no recourse, said Pamela Brem, an attorney working for Wood. The case has attracted the attention of U.S. Sen. Strom Thurmond, R-S.C., chairman of the Senate Armed Services Committee. Thurmond has ordered an inquiry into whether the Armyąs review of the case was thorough and above-board.  John De Crosta, Thurmondąs press secretary, said it probably would take several months before any investigation results would be available. Wood was 17 years old in June 1995 when he fell off his bike and hit his head. He knows he was knocked unconscious, but does not know for how long. Wood's mother, Nohy Wood, took him to the closest hospital, Landstuhl Regional Medical Center, a military hospital.  It was a holiday weekend in Germany, and no local doctors were available, she said. Landstuhląs emergency-room doctor sent Wood home after treating him for scrapes and bruises, according to Woodąs claim. The doctor didnąt admit Wood for observation or perform a CT scan.  The next day, Wood started bleeding inside his skull, cutting off oxygen to his brain, according to the claim. When Woodąs parents took him back to the hospital, there was no neurosurgeon at the hospital to perform surgery. Wood had to be taken to another hospital, delaying surgery by 70 minutes, the claim states. He stayed in a coma for two weeks and suffered brain damage.  Wood maintains that the emergency room doctor the first day should have admitted him to the hospital for observation and performed a CT scan. That would be standard procedure for anyone who lost consciousness for more than 30 seconds.  Legal hurdles, i.e. Woodąs legal battle with the Army is made even more difficult because claims against the military are handled differently than other types of civil claims. Brem said a division of the Army, called the Office of the Inspector General, investigates claims against the Army.  In addition, Army officers investigate and decide the claims. If they deny a claim, a victim can appeal the decision to federal court and go before an independent judge and jury. But if the incident occurs overseas, the process stops with the Army.  "Itąs a good faith system," Brem said. "Potentially, the Army could come back and say, Yes, we were negligent, but we still arenąt going to award you damages." Another lawyer working on Woodąs case, Richard Weiss of Boston, said he may file a lawsuit in federal court accusing the Army investigators of "not acting in good faith." He said facts had been ignored or unaddressed in the Armyąs denial. "Self-regulation doesnąt work on any level," Brem said. "One of the reasons doctors here work so hard to maintain high standards is the fear of malpractice. Doctors at the (military) hospitals overseas donąt worry because they know people canąt touch them." The lawsuit could end up in the U.S. Supreme Court, Brem said. Similar lawsuits, which attack the law governing this case have been challenged, but upheld by the Supreme Court. Dr. Stephen Smith, the former emergency room chief who saw Wood on his second visit to the hospital, has filed a series of complaints against the leadership at Landstuhl, citing Woodąs treatment as one example of a number of problems.  Despite what Brem calls "extremely substantial" evidence supporting Woodąs claim, neither she nor Weiss are optimistic about winning the appeal. Weiss claimed in the appeal that the Army investigator, Maj. Douglas Dribben, "misstated or distorted facts" in the case. Neither Dribben nor any other official in the Army Claims Service could be reached for comment.  In turning down the claim, the Army investigators said his parents should have brought him back to the hospital earlier, when Wood experienced shooting pain in his head. And the denial states that a CT scan the first day would not have revealed the bleeding in Woodąs head because it didnąt start until the next day. But Smith said that wasnąt necessarily true, and the doctor should have held the boy overnight anyway for observation because Wood had lost consciousness during the fall.

 

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Extract from Army Times 19 July 1999

See www.armytimes.com

Newslines: The Army

Doc: Whistle blowing cost him medical privileges

By Karen Jowers Times Staff Writer

 

A doctor has accused officials at Madigan Army Medical Center at Fort Lewis, Wash., of withholding his medical privileges as retribution for his whistle-blowing activities, and he is calling for an investigation. Meanwhile, Army Lt Col Stephen Whitlock Smith, 51, has asked permission to retire from the Army, with restoration of his medical credentials. In March, the medical credentials committee held a hearing on whether to restore or permanently pull Smith's medical privileges, which had been revoked for alleged lax record keeping. He was told the committee recommended his credentials be restored, but no action has been taken. On April 2, he agreed to a psychiatric evaluation, which he submitted to, and to resume practicing medicine under supervision. The evaluation cleared him to work, his credentials are still being held. Smith has asked for retirement and has been told he can leave by Sept. 1. But that offer hasn't addressed his credentials. 'My credentials are more important to me than retirement,' he said. They affect his livelihood, and he said he won't retire without them.  Sharon Ayala, spokeswoman for Madigan, said that, to protect the privacy of all involved, she couldn't comment on the credentials issue. However, she said, 'All of the proper protocols were adhered to in the case of Dr. Smith.'  Smith's problems began in February 1996 when he filed a complaint with the inspector general at Landstuhl Army Medical Center, alleging hospital officials were endangering patients by purposefully understaffing the emergency room. Smith, who was chief of emergency medical services at the time, said his repeated requests for assistance were ignored.  Eight days later, he was medically evacuated to Madigan for psychiatric evaluation and spent three weeks in a locked psychiatric ward. He was allowed to slowly return to medical practice at Madigan but continued to press for investigations of Landstuhl. He believes his credentials problem began after the Army launched a probe in 1998 and is the result of close ties between some Madigan doctors and the former Landstuhl officials mentioned in his allegations. Smith was told his credentials were pulled because he had not kept his records up to date. In an earlier interview with the Army Times, Smith's psychiatrist, Dr. Deborah Hickey, said she believed Madigan officials overreacted. 'The information was there, but just not in the format they wanted,' she said. There was no reason to believe Smith couldn't function fully as a physician, she said. Smith has asked for investigations of Madigan by the Army surgeon general, the assistant secretary of defense for health affairs, the Defense Department

inspector general, and a national organization responsible for accreditation of

military hospitals.

 

***************************************************************************

 

Extract, Army Times 15 Feb 1999

www.armytimes.com

Newslines-The Army

Fit for duty?

Army says he's mentally ill:  doctor, a whistleblower, says it's a case of retribution

By Karen Jowers Times Staff Writer

 

Lt. Col. Stephen Whitlock is living a nightmare. An Army doctor for 15 years, he faces a hearing Feb. 10 on whether his medical credentials should be revoked. He has been held in confinement for psychiatric evaluation, removed forcibly from contact with top military medical officials and branded as behaving in a 'bizarre' manner. To Smith, 51, it's a case of retribution. He says his troubles started when he blew the whistle on understaffing at an Army hospital in Germany two years ago. To the Army, it's a simple matter of whether Smith is fit for duty. Officials at Madigan Army Medical Center, Fort Lewis, Wash., aren't saying much about the case because it's under investigation. But documents obtained by Army Times point to allegations of inadequate record keeping and concerns that Smith may be experiencing 'paranoid delusions.' Whichever side is right, Smith's story is a case study of how an individual can get tangled up in a web of bureaucratic, legal, and medical confusion that can threaten both a military career and a future civilian one, as well. A former Army investigator describes Smith's case as a classic example of what can happen to whistleblowers. 'They pay a heavy price,' he said. 'They get so angry, so frustrated, so depressed. They think it's the whole Army against them. And they're right,' said Jeff Lynch, who retired in 1991 as a Colonel in the Medical Service Corps. In his last two assignments, he worked as an inspector general. He has seen medical officers thrown into psychiatric wards and face hearings to remove their credentials, he said. Although he hasn't investigated Smith's case, he has reviewed it. 'I don't think that Smith was on the planet if he weren't a whistleblower,' Lynch said. He describes Smith as 'courageous and tenacious.'

From medical chief to patient

Smith's story is a long and complicated one, beginning when he was chief of emergency medical services at Landstuhl Regional Medical Center in Germany from July 1993 through early 1996. The joint Army-Air Force medical facility is the only military hospital in central Europe, with doctors and patients from all services.  In February 1996 he alleged hospital officials were purposely understaffing the emergency room, putting patients and staff at risk, despite his repeated requests for more assistance.  That's when Smith's world began to fall apart. Eight days after filing a formal complaint with the hospital inspector general, Smith was medically evacuated for a psychiatric evaluation. Sent to Madigan, he spent three weeks in a locked psychiatric ward. Then, he was allowed to slowly return to medical practice, but at Madigan, not Landstuhl. However, he has not been allowed to return full time to his specialty, emergency medicine. Still concerned about his original complaint, Smith pressed on, this time with the Army inspector general. That complaint, lodged in October 1996 is still being investigated, Army officials say. Meanwhile, Army officials ordered an investigation by European Regional Medical

Command officials, too. And when those investigators began interviewing people in the case last fall, reprisals began, Smith contends. On Nov. 9, 1998, Smith was ordered to stop seeing patients and told to move out of his office at Madigan. He refused to leave his office, but with his medical privileges temporarily suspended, he has ceased seeing patients. 'This is a cover-up of events that transpired to hurt patients,' Smith said. 'They're trying to get me out of here.'

'Paranoid' or not

Such statements play into the Army's case that Smith has 'paranoid delusions.' But Smith's psychiatrist disagrees.

'There's no reason to believe he can't function fully as a physician,' said Dr. Deborah Hickey, a retired Army colonel and Smith's psychiatrist since early 1996. 'He's very logical in his thinking and very bright.'  Hickey, who was chief of psychiatry at Madigan for two years before she retired in 1996, shoots holes in the Army's charges, which include allegations that Smith's record keeping was incomplete, that he did not sufficiently document his actions and treatments on patients' records. Those allegations seem to be an overreaction,' Hickey said.  'The information was there, but not in the format they wanted.  'In his case, they found his records to be lacking in the format desired and have used that to steamroll him without due process or the opportunity to bring them up to standards,' Hickey said.

THE ARMY'S SIDE

Cynthia Vaughan, spokeswoman for the Army Medical Command, said the Army has little to say right now, since the investigations aren't complete. 'Some investigations are still ongoing, but in the parts of the investigations that have been completed, there has been no evidence of wrongdoing' by the Army, she said.  Brig. Gen. Kevin C. Kiley, commander of Landstuhl Regional Medical Center during the time of Smith's complaint, declined to be interviewed. He is now an assistant surgeon general.  Madigan's credentials committee began reviewing Smith's case in October, based on allegations that he had not kept his patients' records up to date, Smith said.  He contends he keeps his records in his computer and has been lax in transferring them to the printed form. 'And I did get depressed and slowed down,' he said. 'Intimidation works.' Hospital officials also expressed concern last fall about Smith's psychiatric condition.  On Nov. 20, 1998, Lt. Col. Frederic Johnstone, Chairman of the Madigan Provider Health Program, wrote to Smith's psychiatrist, Hickey, asking if there had been an 'acute change' in Smith's mental status.  'I am concerned that he may be currently experiencing paranoid delusion,' Johnstone wrote. 'I am concerned that his underlying psychiatric condition may be more severe than we suspected. We have had multiple reports of fairly bizarre behavior.'

Hickey didn't respond. 'I felt the whole thing was totally irregular,' she said. 'They haven't gone by any procedure I've seen in reviewing the competency of a health care provider.'  Hickey said 'there has been no set policy or procedure for dealing with Dr. Smith. All of the allegations have come from those who are not professionals in the area of mental health.'  Smith said there have been other incidents that show he is the victim of reprisal. He filed a complaint alleging he was harassed Sept. 1, during a visit to Madigan by Dr. Sue Bailey, assistant secretary o defense for health affairs. He said he spoke to Bailey, an ex-medical school classmate, for about 3 minutes. Shortly afterward, a Madigan official confronted him angrily. 'There were witnesses that he ordered my arrest after seeing me talk to Dr. Bailey,' A security officer approached him, took him to another room, and said that he had been accused of carrying a gun, Smith said. He then forced Smith to return to his duty area. Smith alleges that the security officer forced him to walk to the escalator, holding his arm behind his back. 'He pushed me down the escalator,'

Smith said. 'It's clearly not something the security person did on his own.'  But Sharon Ayala, spokeswoman for Madigan Army Medical Center, dismissed those claims. 'He was not arrested, not handcuffed, detained, nothing,' she said. 'He was just escorted from the Command suite. We were ready to move (Dr Bailey) from one briefing room to the next, and Dr. Smith was not part of the group. He was not invited.'

'NO CONNECTION'

Ayala said there's 'no truth' to Smith's allegations that the review of his credentials is connected to any complaints he has filed. 'Madigan is committed to upholding the regulations against reprisal,' Ayala said. Smith admits he has had a history of depression, dating back to the time he was 18 years old. The Army admitted him into its medical scholarship program with full knowledge of his medical history. His depression grew worse at Landstuhl, he said, as a result of the grueling hours and poor working conditions. Although he and others repeatedly asked for assistance, it was denied, he said. Other medical professionals who worked in the emergency room at Landstuhl support that contention.  'We were very much understaffed and were very proactive about saying what we needed,' said one military nurse.  'We had three doctors and Steve (Smith) to work a 24-hour-a-day schedule.  'At the end, we felt no one would pay attention until we killed somebody...Anything we tried to do to fix the problem, was stopped,' the nurse said. 'Steve would do anything for us. He did his best, but in the end, it broke him. It was awful to see what they did to him.  'I've never seen anything like it,' she said. In late 1995, Smith's supervisors were replaced, she said, and the emergency room was put 'on track. But why did they allow the situation to continue for two years?' The answer to that question remains elusive, subject to the Army's ongoing investigation. The answer to what will become of Smith, however, should come sooner-perhaps directly after his Feb. 10 board appearance.

(PHOTOGRAPH CAPTION:

'Dr. Stephen W. Smith blew the whistle on understaffing at an Army hospital. Now

The Army wants to revoke his medical credentials.’)

 

 

 

EXCERPTS FROM CORRESPONDENTS INCLUDING MS JULIE APPLEBY

CURRENTLY CORRESPONDENT FOR GANNETT'S USA TODAY

Published on October 23, 1998

Kaiser receives a surprise visit from inspectors

Officials conduct an intensive investigation into new complaints about the Walnut Creek hospital

By Julie Appleby TIMES STAFF WRITER

Kaiser Bargaining Alert

10/12/97

RETURN TO BARGAINING

To: Kaiser Permanente

From: California Nurses Association

Re: CNA/Kaiser Permanente Contract

Negotiations

In the best interests of our patients, our members and all employees please immediately:

RETURN TO BARGAINING

We believe that before more damage is done to your reputation in California and nationally that you should:

Drop Your Unnecessary, Massive Concessions (13)

Provide RNs/N.S. A Therapeutic and Enforceable Voice In Patient Care Join With CNA To Resolve Current Regulatory Patient Care Issues

If you refuse because Kaiser Corp's attention is focused on a mission of expansion and cost cutting rather than patient care, Kaiser patients will read more of the following:

SAN FRANCISCO CHRONICLE

October 10, 1997

East Bay Kaiser Hospitals Face Loss of Certification Health regulators say problems need to be fixed soon

By Michael Hytha, Chronicle Staff Writer (excerpts)

Kaiser Permanente hospitals in Walnut Creek and Martinez once again face the loss of their federal certification -- unless they can correct problems with medical care by November 14, health regulators warned yesterday. The new threat comes after months of bad news for Kaiser, the country's largest nonprofit health maintenance organization. Earlier this year, its Richmond and Oakland hospitals narrowly avoided the loss of their Medicare certification after the deaths of patients transferred from the Richmond emergency room. Kaiser's registered nurses, working without a contract since January, have staged short-term strikes throughout the region and are waging a campaign to force Kaiser to reverse a series of cost- and staff-cutting efforts.

CONTRA COSTA TIMES

October 10, 1997

2 KAISER HOSPITALS STILL UNDER FEDS' FIRE

By Julie Appleby, Times Staff Writer (excerpts)

Kaiser Permanente has failed to correct some of the serious problems uncovered at its Walnut Creek and Martinez hospitals, prompting an ultimatum from federal officials. The HMO was told Thursday that unless it boosts nurse staffing in its intensive care units and improves quality assurance programs by November 14, it will lose Medicare funding at the two facilities.  CNA members voted overwhelmingly to hold a region wide one (1) day strike in late October unless Kaiser returns to the table and resolves this dispute.

Hospitals & HMOs cut care, make record profit & patients pay the price. If you feel your health care or that of your loved ones has suffered,

Please write or call CNA's Patient Watch Program: 1145 Market Street, Suite 1100 Market Street, Suite 1100, San Francisco, CA 94103, 1-800-440-6877, email: patientwatch@igc.org

For the second time in 16 months, federal officials have conducted a wide-ranging surprise inspection of Kaiser Permanente's Walnut Creek Medical Center after receiving a number of complaints, the Times has learned. The complaints included concerns over delays in patient care, both in the emergency room and elsewhere in the hospital, according to Gil Martinez, district manager for the state's Department of Health Services. A team of investigators authorized by the federal Health Care Financing Administration arrived at the hospital Oct. 6 and spent three days looking into recent events that led to the complaints. Kaiser officials said they cooperated fully with investigators and are optimistic that the findings will show no serious problems. "The primary person that reviewed us said the findings are not serious and are

Easily corrected," said Joseph Macaluso, Kaiser's director of regulatory compliance. The problems uncovered included occasional delays in transferring patients by ambulance to other hospitals and in admitting patients to the hospital, Macaluso said. The investigators' findings are being prepared for submission to the federal agency. If the financing administration determines that serious problems exist, Kaiser could be threatened with the loss of its Medicare funding at the hospital. A similar funding threat was made by federal officials in June 1997 when inspectors swept into Kaiser's Walnut Creek and Martinez hospitals after receiving complaints about patient care. The team cited the hospital for inadequate staffing, long delays in emergency room care, unlocked drug storage cabinets, sloppy record keeping and a quality assurance program that failed to uncover the problems. After initially failing a follow-up inspection, the hospitals eventually corrected the deficiencies to the federal agency's satisfaction. The funding threat was withdrawn. This month's inspection is related to deficiencies the state found in September when it looked into the deaths of two patients, 7-year-old Gregory McCan of San Ramon and 37-year-old Honorio Darauay of Walnut Creek. After reviewing those cases, state investigators sought additional review from the federal agency for a backlog of other complaints, Martinez said. Earlier this month, Kaiser's plan to correct the problems brought up in the McCan case was accepted by state officials. McCan died of a virulent blood infection after spending hours being treated and monitored in Kaiser's emergency room and pediatric ward. Inspectors said Kaiser violated its own protocols by taking more than an hour to have a pediatrician assess the boy. It also had adult patients in a pediatric ward, causing a delay in admitting the boy to that unit. Kaiser said it will make it clear to its doctors that they must report to the emergency room within 60 minutes of being called for a consultation. It will also never completely fill the pediatric ward with adult patients, Macaluso said. In the Darauay case, inspectors said Kaiser failed to pump the man's stomach, misinterpreted a blood test and failed to admit him to an intensive care unit. Kaiser officials have disputed those findings and are seeking a third-party review of its efforts. The man, who had injected himself with a pesticide, died at the county's psychiatric ward after being transferred there from Kaiser.

 Edition: CCT,  Section: A,  Page: 3

 (c) 1998 Contra Costa Times

 

*****************************************************************************************

 

Hospital oversight criticized System is too lenient, report says

By Julie Appleby

Wed., July 21, 1999

FINAL EDITION

Section: NEWS Page 1A

Federal investigators criticized the way U.S. hospitals are inspected Tuesday, saying the process is too lenient and often misses poor care.  The system responsible for ensuring safety is ''unlikely to detect substandard patterns of care'' such as inappropriate surgery or high complication rates, their report says. The strongly worded report from the Office of the Inspector General says the government should require:

* More surprise inspections. Hospitals currently have plenty of warning before inspections, which occur every three years. They often spiff up the facilities, train staff on answering inspectors' questions and even hold ''practice'' inspections.

* Review of randomly selected patient records. Now hospitals handpick patient records for inspectors.

* More background information for inspectors rather than reliance on hospitals to acknowledge major problems. Currently, inspectors often don't have even media reports about troubles such as medical errors, chronic understaffing or financial difficulties.  ''If a hospital had something it didn't want you to find, it could keep you from finding it,'' said George Grob, deputy inspector general.  The current inspection program does help educe risk, the report says, but doesn't do enough to spot problems. The inspector general spent two years investigating the hospital oversight system, prompted by advocacy group complaints and high-profile media reports about serious problems such as patients who had the wrong limbs amputated. The report's findings didn't surprise critics of the oversight system, who have been calling for changes for years.  ''The question is, how many more people will have to die before we do something?'' said Sidney Wolfe, director of the Public Citizen Health Research Group, a health care advocacy group.  Public Citizen wants the Health Care Financing Administration (HCFA) to scrap its current method of ensuring that hospitals meet standards for participating in Medicare.  That system relies on a private, nonprofit group to inspect 80% of the nation's hospitals to see whether they meet safety standards required by Medicare. The other 20% are inspected by states. Critics say the private group, the Joint Commission on the Accreditation of Healthcare Organizations, is too close to the hospital industry and wants a public agency to take over.  The commission earns 71% of its annual revenue from the organizations it inspects, including hospitals, home health agencies and labs. Only 1% of the hospitals reviewed fail to pass, although 85% are told to make improvements, according to the commission.  The commission said it welcomed the report and pointed out areas in which the inspector general praised its work. It said it is already making changes

including a consumer complaint hot line. The report also chastises HCFA for not having enough oversight of the inspection program. In a statement, HCFA administrator Nancy-Ann DeParle said the agency would adopt many of the recommendations. Those include calling for more unannounced inspections and setting additional performance standards.

 

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Hale Cuts A Deal

Fort Lewis, Washington, Posted 2:24 p.m. March 16, 1999. Retired Army Major General David Hale is pleading guilty to some of the charges against him. His attorney announced today that Hale has cut a deal with military prosecutors in Washington State. Hale was accused of having sexual relationships with some of his subordinates' wives.

Copyright 1999 by The Associated Press

 

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1998 IN A NUTSHELL

By The Associated Press

A MONTH-BY-MONTH LOOK AT NOTABLE NEWS IN 1998:

June 20 - Civilian lawyer Kelly Theriot accepts $500,000 settlement for claims an Army colonel sexually harassed her

Mistrial Declared in Army Sexual

Harassment Retaliation Case

Army civilian lawyer Kelly Theriot claimed that Col. Darrel Porr sexually harassed her and then conspired with other top officers to retaliate against her when she complained. Her case was declared a mistrial Saturday.  The judge in the case declared the mistrial after jurors said that they could not reach agreement after four days of deliberations. Theriot said that she would pursue a new trial. "I'm not going to quit. Absolutely not," she said. Darrel Porr, who was deputy commander of Madigan Army Medical Center at the time of the alleged harassment, has denied all wrongdoing.

Feminist News Stories on Sexual Harassment, Assault and Discrimination in the Military  [Source: AP - May 23, 1998]

 

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11 May 1998

        

        

Editor

McClatchy News Service

Tacoma, Washington

        

Dear Editor:

        

I am an U.S. Army physician now stationed at Madigan Army Medical Center, Tacoma, Washington. I graduated medical school and completed two residencies as part of my Army Medical Corps training. I am board certified in both emergency medicine and internal medicine. I will complete 15 years of service as an Army doctor later this year.

 

During my previous assignment, I was Chief of Emergency Medicine at Landstuhl Army Regional Medical Center (LARMC) in Germany from 1993 to 1996. As a result of the draw down of U.S. forces in Europe, Landstuhl became the only U.S. military medical center in Central Europe. In my capacity as Chief of Emergency Medicine at LARMC, I sought to insure that we had the resources necessary to render the high standard of medical care expected.

 

Beginning in approximately mid-1994, however, the former LARMC Deputy Commander for Clinical Services (DCCS), Colonel (COL) David Lipsi, and the former Chief of Ambulatory Care, Lieutenant Colonel (LTC) David Gillingham, began to issue some orders that I knew would endanger the lives of certain emergency patients. Both doctors referred to COL (Promotable (P)) Kevin Kiley, the Commander of LARMC at that time, as the source of those orders. In this setting, they gave me orders that would have required me to abandon care of a number of civilian patients who were unstable, and to utilize ambulances with inadequate brakes and inadequate airway management equipment as Advanced Life Support Vehicles. Furthermore, they both ordered me not to report deficiencies in writing. As Chief of Emergency Medicine, I refused to carry out these orders because our patients' welfare would be endangered. Moreover, I documented problems in the Quality Assurance minutes of my department; LTC Gillingham suppressed distribution of these official documents, saying that COL (P) Kiley had ordered him to do so.

 

Emergency care personnel at LARMC became subject to actions that we considered to be reprisals, including understaffing in the emergency room and orders for certain personnel to work in violation of medically ordered restrictions (medical profiles). Both COL Lipsi and LTC Gillingham indicated that these orders had come from COL (P) Kiley, now Brigadier General (BG) Kiley.

 

In June 1995, while I was Chief of Emergency medicine at LARMC, a tragic case of brain injury occurred in a now mentally impaired teenager currently living in Hilton Head, South Carolina. During his initial visit to LARMC on a Saturday, shortly after sustaining an extended loss of consciousness, he was seen by LTC Gillingham, the Chief of Ambulatory Care, who sent him home with a listed diagnosis of abrasions.

 

I was called on the child's second visit to the LARMC emergency room the next day, Sunday, and was able to save his life by trauma resuscitation and stabilization and immediate transfer to nearby Kaiserslautern Neurosurgical Center for immediate surgery. I followed the emergency trauma standard of care, based on "worst case scenario." Our standard practice at LARMC Emergency Room had always been to assure the highest level of specialty care available in the vicinity. The usual practice for high-risk neurosurgical patients at LARMC ER during the weekend was to transfer them by Advanced Life Support ambulance to either Homburg or Kaiserslautern where an immediate operation could be performed.

 

Because the tragic situation clearly revealed that such "worst case scenario" thinking had not been utilized by LTC Gillingham on the youth's first visit to the ER, both COL Lipsi and LTC Gillingham focused criticism on my lifesaving stabilization and speedy transfer of the boy on the second day. COL Lipsi asserted, without my receiving due process or peer review, that the brain damage which ultimately resulted was because I transferred the boy to immediate neurosurgical care without waiting the (inordinate) time required to wait for our one neurosurgeon, who was "on call" 24 hours daily for all of Central Europe and the surrounding vicinity (an unreasonable responsibility to require of any specialist), and a surgical team to be called in.

 

Both COL Lipsi and LTC Gillingham intensified reprisals against other emergency personnel, and me in order to minimize any adverse exposure of LTC Gillingham's care of the boy. On Monday June 12, 1995, COL Lipsi ordered me to his office and issued me an angry reprimand regarding my decision to transfer the moribund child to the nearest brain injury surgical center. He wrote out an order for me to convey to the ER nursing staff which directed them to call in our LARMC consultants via telephone and beeper, which was of course already our method of calling in specialists.

 

At the end of the one hour reprimand session, COL Lipsi issued me the following threat, which I quote verbatim: "LTC Smith, we do not shoot Army physicians who are uncooperative; however, there are other things that we can do. You do not want to end up like Dr. T, do you?" (referring by name to the OB-GYN chief whom the previous year COL Lipsi forced to work at a high risk labor and delivery unit with inadequate physician staffing. Dr. T suffered a situational major depression as a result of COL Lipsi's deliberate understaffing; COL Lipsi then issued reprisal orders for Dr. T to work in violation of his medically ordered work restriction (medical profile).)

 

LTC Gillingham continued to order me to force a seriously depressed young captain to work as a full-time emergency physician, even though that captain's military psychiatrist had issued strict orders (which I reported in detail to both COL Lipsi and LTC Gillingham) for him not to work in the LARMC ER. I refused LTC Gillingham's dangerous order multiple times, and insisted on an immediate replacement for the young captain.

 

In July 1995, the senior RN's and senior medics of LARMC's ER told LTC Gillingham that they would stage an immediate work stoppage if LTC Gillingham did not immediately agree to replace the young impaired physician, and if he did not cease his reckless endangerment of ER patients. I informed COL Carolyn Bulliner, LARMC Chief Nurse, and COL Jewett, Chief of Psychiatry, of the reckless endangerment of LARMC emergency patients by LTC Gillingham and COL Lipsi. COL Bulliner had already become alarmed at the risk that the deliberate understaffing of Emergency Services was causing toward patients and staff. She wisely kept the best trauma and resuscitation nursing staff in the critical care areas, although they were due for rotation to other services. Earlier in the summer, she had ordered Major Michael Kusek, psychiatric RN, to institute a suicide watch to protect LARMC Emergency Room staff from major depression induced by the reprisals of LTC Gillingham and COL Lipsi. Psychiatry Chief COL Jewett said in the presence of witnesses he would intervene with COL (P) Kiley, and directed me at the same time to write a Memorandum for Record through COL Lipsi to COL (P) Kiley requesting immediate written guidance from COL (P) Kiley about how  to proceed.

 

COL Lipsi then called me to his office, reprimanded me, and refused to forward my Memorandum to COL (P) Kiley.  LTC Gillingham issued angry reprimands to myself and other ER staff, then asked COL (P) Kiley to reprimand me, when I complained in the presence of the LARMC ER Quality Assurance RN and LTC Gillingham that he (LTC Gillingham) was intentionally staffing the ER in a way that was dangerous to patients. In fact, COL (P) Kiley himself reprimanded me for my refusal to follow LTC Gillingham's orders which would have endangered patients; I informed COL (P) Kiley that such understaffing ignored guidelines for safe staffing published by the Office of the Army Surgeon General's (OTSG) Consultant for Emergency Medicine. In addition, COL Kiley allowed a work schedule to be imposed on emergency personnel that violated certain medical profiles (work restrictions), thereby endangering both patients and staff.

        

In February 1996, I reported these and other problems to the LARMC Inspector General (IG) and then informed COL (P) Kiley that I had done so. Approximately 2 hours after I informed COL (P) Kiley of my IG complaint, COL Ney Gore, cousin of Vice-President Al Gore, indicated that COL (P) Kiley had ordered him to suspend my credentials to practice medicine. COL (P) Kiley ordered me to be sent to Madigan for psychiatric evaluation. My psychiatrists, who were treating me for depression, told me that, when they asked COL Kiley whether I would receive due process to protect my career and my medical credentials, he said something to the effect of, "Just get him out of here as fast as possible!"

 

At Madigan, an Army psychiatrist, Major (MAJ) Scott McDonald, assigned as my physician, obeyed telephone orders from COL (P) Kiley to keep me hospitalized for 3 weeks on a locked ward and at Level I (the highest) restriction, when neither the intensity nor the length of restriction was medically indicated.

 

At that time, the Deputy Commander for Clinical Services supervising all Madigan physicians was COL (P) Darrel Porr, now Brigadier General Porr. Then COL Porr was presumably aware that a senior Army doctor from Germany had suddenly been ordered confined to a psychiatric ward in his hospital. COL Porr, however, later left Madigan and has yet to explain what role, if any, he played in the abrupt psychiatric imprisonment of an Army doctor shortly after he reported real problems with the quality of patient care to an Army Inspector General.

 

I was eventually released from the psychiatric ward and allowed to stay at Madigan and practice medicine again, but concern about retaliation for continuing to insist that all these matters be thoroughly and honestly investigated has not gone away. In October1996, I submitted a formal complaint to the Department of the Army Inspector General (IG) about the endangerment of emergency patients at Landstuhl by senior Army medical officers. I also informed certain Senators and Representatives and requested congressional action to prevent recurrence of such matters. I reported endangerment of LARMC emergency patients and staff by COL Lipsi and LTC Gillingham who said they were responding to orders from COL (P) Kiley.

 

Approximately one year previously, a LARMC OB-GYN physician had made a similar complaint against COL Lipsi. That complaint charged COL Lipsi with issuing orders to reduce staffing below safe limits in a high-risk labor and delivery unit. Moreover, there is documentation of COL Lipsi's reprisal orders to the same OB-GYN physician to work in violation of his medically ordered work restriction (medical profile). Furthermore, COL Lipsi had reportedly enforced dangerously low staffing on the labor and delivery unit as reprisal against its Chief. These events happened while COL (P) Kiley, an Obstetrician-Gynecologist like the OB-GYN Department Chief, was Commander of LARMC and COL Lipsi's boss.

 

In September 1997, LTG Ronald Blanck, Surgeon General of the Army, invited me to the Army Medical Command (MEDCOM) in San Antonio, TX to provide information about my allegations. This trip was arranged as official paid travel (TDY) orders. At LTG Blanck's request, I briefed Quality Management (QM) personnel at MEDCOM about these matters.  Those present included 2 QM physicians, one Registered Nurse (RN), and an Army lawyer representing MEDCOM. I subsequently met with a representative from the Army's Criminal Investigation Division (CID) and provided related information and documentation. In the several months since I went to MEDCOM, I have received no report from LTG Blanck's office about what action is being taken to address the problems I exposed. I have recently learned that BG Kiley, the former LARMC Commander, is now assigned to LTG Blanck's office in a leadership position. If the Army Surgeon General's Office is going to investigate, the investigation will have to include past actions of a General Officer now assigned to that Office.

 

The Department of the Army Inspector General and MEDCOM have yet to produce a Report of Investigation (ROI) about these matters.  Furthermore, last year I was informed that the Department of the Army Inspector General assigned in overall supervision of my case was Major General (MG) David Hale. I have recently learned that MG Hale precipitously left active duty under a cloud earlier this year.

        

Several months after my abrupt departure from LARMC in 1996, another LARMC case, the "death of Baby V case," was reported as a complaint to the offices of LTG Blanck and Congressman Henry Hyde. The complaint and related information, which I have seen, describe a situation at LARMC in which Baby V's father, who was a military doctor, did not want to have a child with a birth defect and sought LARMC permission to allow his yet unborn child to die without treatment. According to the complaint, the baby's father gave a LARMC ethics committee misleading prenatal information and, when the ethics committee was unable to reach a unanimous decision, COL (P) Kiley reportedly made a command decision, before the child was even born, to allow the father, a military doctor, to withhold treatment once the child was born.

 

When born, Baby V had a condition (meningomyelocele) that is easily repairable by remedial surgery, but often fatal if not repaired. The baby was allowed to leave the hospital without corrective surgery and died of meningitis within 2 weeks. Two families had reportedly offered to adopt the infant in order to save her life, but this offer was reportedly refused. COL (P) Kiley's decision, made before Baby V's birth, created a situation that apparently permitted Baby V's death. The circumstances surrounding Baby V's birth and death need to be investigated.

 

The three cases (Dr. T, the February 1996 LARMC Inspector General case, and Baby V) show repeated endangerment of patient welfare under one Army Medical Center Commander, who should be required to account for his own role in the events described. Both of my Army Medical Corps Residencies-Emergency Medicine at Madigan Army Medical Center (where I have returned) and Internal Medicine at Eisenhower Army Medical Center-have taught me to uphold the standard of care for the patient's welfare. Neither of these centers would tolerate retaliatory actions against physicians and nurses that endangered patient care.

 

I notified my chain of command last year that the request for investigation had gone to LTG Blanck, and that it would become public knowledge eventually. On Monday, 4 May 1998, I notified my superior officer, the Chief of Emergency Medicine at Madigan, that I would soon be contacting the press about these matters.

 

Before other patients are harmed, I request an immediate congressional investigation regarding the now long-reported orders of BG Kiley, COL Lipsi, and LTC Gillingham at LARMC. In accordance with Section 846 (Safeguarding of military whistleblowers) of Public Law No. 100-456, otherwise known as the Boxer-McDermott Whistleblower Protection Law, I continue to request career protection from appropriate Members of Congress in keeping with the law's intent to protect military whistleblowers from retaliation.

 

Over two years have passed since I originally reported these problems and was confined to a psychiatric ward after doing so. The quality and integrity of the Army medical system are vital to the taxpayers who support it, to the parents who entrust their sons and daughters to it, and to the men and women in uniform who must rely on it. Congress must act if the Army is unwilling or unable to do so.

 

Thank you for your attention.

     

Respectfully,

 

        

Stephen Whitlock Smith, MD

Fellow,  American College of Emergency Physicians

Fellow, American College of Physicians                                                                                                        

Lieutenant Colonel, US Army Medical Corps                                                                                 

Steilacoom, WA 98388

                  

Cc:   Lieutenant General Ronald Blanck, Army Surgeon General

            Brigadier General George Brown, MAMC Commander

            Madigan Army Medical Center Public Affairs Office

            Representatives Dicks, McDermott, Pelosi, Spence

            Senators Boxer, Feinstein, Thurmond

            For Record

 

***************************************************************************

 

Friday 9 October 1998 0830 CID Agent Navarro, Fort Lewis, Washington 98433

Spell corrected copy submitted Friday 23 Oct 1998 1230

 

I, Stephen Whitlock Smith MD (LTC, USA MC) 024-38-5114, report what I believe to be criminal wrongdoing by high-ranking US Army Medical Corps Officers and others at Madigan Army Medical Center and other locations. I believe that the intent is a cover-up to protect Brigadier General Kevin Kiley and others from charges of reckless endangerment of emergency patients and medical staff at Landstuhl Army Medical Center.

 

I met Dr. Sue Bailey, Assistant Secretary of Defense for Health Affairs, at 1130 hours on 1 September 1998, on the occasion of the inauguration of TriCare Senior Prime (Medicare) Subvention by Madigan, directly in front of the Reception Desk of the Adult Primary Care Clinic where I am assigned as Acute Care Physician for TriCare Senior Prime. Sue Bailey is a classmate at George Washington University Medical School, Washington, DC, and we reminisced about our medical school.

 

Three minutes after our short meeting, I was approached by a very angry officer whom I had never met, who left the Madigan Command Group at high speed after exchanging words with COL Casey Jones, Madigan Deputy Commander, and others of the Command Group. This officer demanded to know my place of duty, and I replied that my duty station was immediately in front of us at the Adult Primary Care Clinic where I am Acute Care Physician for TriCare Senior Prime patients.  The angry officer still did not formally identify himself. I noticed his name plate "Hill" and grade of Brigadier General, and asked him if he was to be our new Madigan Commander. He did not directly reply. I said good-bye and told him that I would be rejoining Dr. Sue Bailey at 1300 for her scheduled tour of our clinic. The officer then rejoined the Madigan Command Group and exchanged words with COL Casey Jones, Deputy Commander, and others.

 

At 1305 hours on 1 September 1998 I was waiting outside the Commander's Conference Room in the vicinity of Mr. Mike Meines and Ms Sharon Ayala of Madigan Public Affairs, in discussion with LTC Steve Carter, Madigan Troop Commander. LTC Carter called my attention to someone waiting to speak to me directly behind me, and I turned to see who it was.

 

I recognized Mr. Cleaver, Brigadier General Brown's security agent. Mr. Cleaver called me by name. "LTC Smith, I need to speak with you."  He began to ask me a question, then stopped in mid-sentence when he noticed that my name badge was missing.

 

Mr. Cleaver then spoke to me angrily, "Do you know that you are not wearing a name badge?" I replied that, because I was wearing my Class A uniform for the occasion, I must have forgotten to transfer my name badge from my duty uniform. I asked Mr. Cleaver if he would issue me a replacement badge. He then escorted me hastily up one floor to the Provost Marshal's Office with one arm behind me pulling me. We entered his office;  he ordered me to remain seated. Mr. Cleaver sat at his desk facing me, and said, "What are your intentions regarding Dr. Sue Bailey?" I replied that Dr. Bailey and I had attended George Washington University School of Medicine in Washington, DC.

 

Mr. Cleaver said that the Commander, or the Command,  (I did not hear clearly which word he used) accused me of carrying a concealed weapon. He said, "I might have to pad you down for concealed weapons!"

 

I replied that he could certainly search me. I said that I was being accused falsely. I said, "I am a physician known to you and to the Command. I believe that I will need to report this incident."

 

Mr. Cleaver asked me sternly, "Why are you helping to lead the tour for Dr. Sue Bailey? You are not a chief;  you are ordered to return to your duty station and stay there. You are directed to ask your chief to lead the tour."

 

Mr. Cleaver then allowed me to leave his office, and with an arm pushing me from behind my back and right hip, forced me to walk down the escalator toward the Information Desk of the Medical Mall. At that point, I tried to stop on the first floor and request clarification of Mr. Cleaver's orders. He then pushed me down the escalator leading to the Adult Primary Care Clinic, ordering me to stay on that level.

 

I returned to my Clinic, and asked my Clinic Chief MAJ Richard Jordan to lead the tour in my place, telling him and Clinic Administrator MAJ Rumph that I had been ordered by the Command to do so. All three of us waited one hour, and then Ms Sharon Ayala notified us that the tour through our clinic had been canceled.

 

I sought legal counsel and reported these happenings via memoranda to Dr. Sue Bailey, as well as to Secretary of the Army Caldera and Secretary of Defense William Cohen. I requested an investigation in the nature of an Article 138 investigation.

 

On 1 October 1998, I received an urgent e-mail message from LTG Ron Blanck's MEDCOM Quality Management Office in San Antonio, Texas, that an investigation which I and others had requested into reckless endangerment of emergency patients and staff at Landstuhl Army Medical Center, was suddenly being moved to Germany. (I observe here that the principals of the investigation, including Brigadier General Kevin Kiley, COL Ney Gore, COL David Lipsi, and LTC David Gillingham, are no longer in Germany; in fact, BG Kiley is in San Antonio, Texas, and COL Gore is in El Paso, Texas. Nor are any of the principal 65 witnesses to the investigation any longer in Germany. Nor are any of the medical records of the reckless endangerment cases available in Germany, since many Medical Treatment Facilities there keep emergency records for only one year after the day of treatment. It has been over 2 years since I initiated my request for investigation.)

 

On 1 October 1998 at 1400 hours, my Clinic Chief MAJ Richard Jordan informed me that COL Casey Jones, Madigan Deputy Commander, had given him an angry direct order for me to submit all of my medical records for review by close of business that day.

 

On 5 October 1998, I was called by Ms Lissette Ortiz into the office of MAJ Richard Jordan. MAJ Jordan did not start the meeting until 2 minutes later when MAJ Rumph arrived as a witness to the meeting. MAJ Rumph took detailed notes throughout.

 

MAJ Jordan handed me a counseling statement signed by himself which informed me that my credentials file was at risk of being subjected to adverse action. I then reported the detention by Brigadier General Brown's security agent of 1 September 1998 as reprisal for my having spoken to Dr. Sue Bailey, Assistant Secretary of Defense for Health Affairs.

 

At 1300 hours on 5 October 1998, I reported the foregoing events to my Department Chief COL Lester Reed, and to my former Department Chief COL Matthew Rice.

 

At 0800 on 8 October 1998, MAJ Richard Jordan informed me that there were "no issues," and that I could send him 2 charts per day for his review, instead of the previous 100%.

 

 

I believe that recent events as described above relate to my report to Brigadier General Kevin Kiley on 12 February 1996 in the presence of Ms Michelle Jung, of reckless endangerment of emergency patients and staff, and the intentional orders for medical personnel to work in excess of medical work restrictions ("profiles," ordered by Landstuhl physicians, to protect personnel from serious illness.)

 

I reported in detail Brigadier General Kiley's prompt orders to suspend my credentials,  and to transfer me out of his command, with no recourse to the due process  required by Regulation and Statute. The specific steps which are in violation of established Regulations and standards have been reported in detail by myself and by COL Robert Tabachnikoff. I referred LTG Blanck's Quality Management Division to my attorney, Mr Mike Gaffney,  and to Dr. Tabachnikoff's attorney, Mr Barry Steinberg, both of Washington, DC.  To my knowledge, neither LTG Blanck's Office nor LTC Ed Bodling of the Department of the Army Inspector General ever contacted either attorney's office for a complete listing of violations and unlawful orders.

 

At the time of my suspension from medical duties as Emergency Medicine Chief on 12 February 1996, I was also the Medical Staff Joint Commission Representative, and I was reporting directly to LTC Debra Spittler and to COL Ney Gore, Deputy Commander.

 

BG Kiley's orders to remove me from his Command, and his orders to COL Gore to order removal of extra copies of my Inspector General Complaint, served to accomplish the following:

To prevent my report of significant deviations from Joint Commission Guidelines, to include the following.

 

1.(JCAHO Standards 1996)

RI.1.1 The patient's right to treatment or service is respected and supported.

RI.1.3.1 Confidentiality

RI.4 The hospital operates according to a code of ethical behavior

PF.1.7 Patients are informed about access to additional resources in the community.

CC.1 Patients have access to the appropriate type of care

CC.8 An established procedure is used to resolve denial-of-care conflicts over care, services, or payment

LD.2.4Directors recommend a sufficient number of qualified & competent persons to provide care

HR.2The hospital provides an adequate number of staff members whose qualifications are consistent with job responsibilities

MS.1.1.3 All medical staff member and all other with delineated clinical privileges are subject to medical staff and departmental bylaws, rules, and regulations, and policies and are subject to review as part of the organization's performance-improvement activities.

MS.3.1.6.1.7 The mechanism for fair-hearing procedures

MS.5.2 There are mechanisms, includinq a fair hearing and appeal process, for addressing adverse decision for existing medical staff members and other individuals holding clinical privileges for renewal revocation, or revision of clinical privileges .

MS.8.1.6 Significant departures from established patterns of clinical practice.

MS.2.3.4.1.3 The conditions and mechanisms for removing officers from their positions:

MS.3.1.6.1.6 The mechanism by which medical staff membership may be terminated:

MS.3.1.6.1.7 The mechanism for fair-hearing procedures.

TX.M.6.1.1 Seclusion or restraint is use only to prevent the individual from injuring himself or herself or others, or to prevent serious disruption of the therapeutic environment.

MS.2.3.2 Fair-hearing and appellate review mechanisms for medical staff members and other individuals holding clinical privileges:

 

2. In addition, I had knowledge of serious deviations from Nuclear Regulatory Standards for shielding and removal of used radioisotopes at Landstuhl.

 

3. Deviation from standards to include Department of Transportation, DOD, German, regarding operation of Advanced Life Support Ambulances.

 

4. Evidence of Black Market activities involving US Government Ambulances in the Landstuhl-Kaiserslautern area: as reported by Landstuhl Paramedic SSG Robert Barrett to "Waste Fraud and Abuse Hotline" via protected communication; by SSG Charles Marmann and SGT Mark Major and MAJ Laurie Sandstrom via our Departmental Minutes and directly through the Nursing Chain of Command. Agent Zangerine of Fort Sam Houston CID confirmed to me in September 1997 that such a Black Market was present. I believe that the existence of such black market operations prevented BG Kiley from granting our requests for acceptable Advance Cardiac Life Support Ambulances.

 

5. Evidence of Continued Credentials Libel by COL David Lipsi, as well as his direct orders to me to falsify a credentials document in favor of LTC David Gillingham. (Sources at Medical Claims, Madigan, where Gillingham had been assigned immediately before Landstuhl, have informed me that Gillingham had left Madigan for Landstuhl under some form of credentials restriction because of several unresolved medical claims against him.) COL Lipsi had been reported previously for intimidation of witnesses in regard to credentials files, in line with the report by DOD Inspector General to William Cohen, as well as to other members of the Senate Armed Services Committee.

 

6. Reckless endangerment and cover-up of marked deviation from standards of care in numerous cases of emergency conditions at Landstuhl. One case, as reported publicly in the Hilton Head Island Packet, July 1998, involved a denied claim for $7.5 million in a case of brain injury in a child. Some witnesses for some cases have told me that they have already suffered reprisal.

 

7. I have already reported evidence of the involvement of high-ranking officers at Madigan in reprisal against myself and others, seemingly to prevent investigation of the charges against Brigadier General Kevin Kiley and those who said that they were following BG Kiley's orders.

 

8. My report to LTG Blanck and to the McClatchy News Service of 11 May 1998 occurred during the same time period as the $500,000 settlement from Department of the Army, to Ms Kelly Theriot, former JAG Chief of Madigan, who had reported alleged wrongdoing by high ranking officers at Madigan. Previous to my 11 May report (released through the Madigan Chain of Command) COL Casey Jones, Deputy Commander, had informed my chief COL Matthew Rice that LTC Smith will NEVER receive full credentialing at Madigan. However, on 13 May 1998, the Credentials Committee under Chairmanship of COL Jones granted me Internal Medicine Credentials, and left my Emergency Medicine Credentials intact.

 

Other documentation will be sent as required.

 

I request career protection under PL 100-456 and all applicable regulations and statutes per Members of Congress. I believe that a cover-up of immense proportions is underway to protect high-ranking officers from charges of wrongdoing. The accusations which I and others have made involve specific reckless endangerment of US Army emergency patients, and reprisals against those reporting such problems.

 

              

Stephen Whitlock Smith, MD

Graduate, George Washington University School of Medicine US ARMY Health Professions Scholarship Program

Graduate, US Army Internal Medicine Residency, DDEAMC, 1983

Graduate, US Army Emergency Medicine Residency, MAMC, 1987

Acute Care Physician, TriCare Senior Prime (Medicare) Adult Primary Care Clinic, MAMC

 

cc:

Senators Thurmond, Feinstein, Boxer

Representatives Dicks, McDermott, Pelosi

General Accounting Office

Joint Commission (JCAHO)

Memorandum for Record

 

***************************************************************************

 

UNDER FREEDOM OF INFORMATION AND PRIVACY ACTS

 

Brigadier General Mack Hill

Commander

Madigan Army Medical Center

Tacoma, WA 98431

2 January 1999

 

Dear General Hill,

 

Pursuant to provisions of Article 138 of the Uniform Code of Military Justice I am requesting of you the following:

O Cessation of any adverse career actions against me; and

O Your consideration of providing documents to me as detailed below; and

O Your facilitation of my request, sent last week via personal correspondence to COL Casey Jones, Chairman, Credentials, for specifics related to a Credentials Hearing.

 

I request the copies of the following documents or files pertaining to me which are either maintained at MAMC or reside in files at MAMC:

O A complete copy of my individual Clinical Credentials File

O Any DOD, DOD (HA), HQDA, Army, AMEDD, MEDCOM, MAMC correspondence, documentation, notes, letters, email record or other records, or other documents (hard copy or electronic) received, maintained, retained or on file in the Credentials Office or in the files of Credentials Committee, or in the personal file of its Chairperson or in the personal file of the DCCS or Commander regarding my credentialing and privileging since February 1996 which are not already included in my individual Clinical Credentials File

O A complete copy of my individual Provider Activity File

O A complete copy of my individual Madigan Health Provider Program file

O Minutes of any and all Credential Committee meetings, regular, special and or ad hoc in which actions or discussions regarding me, my credentials and privileges appear

O Minutes of all Hospital/Center Morning Reports, Teaching Chiefs, Center and or other command meetings, conferences or briefings which reference me or in which there are actions or discussions regarding me, beginning from February 1996

O Copies of each published and approved the MAMC Officer Evaluation Reports rating scheme from Feb 1996 through today

O Official copies of the Order detaching me or reassigning me from permanent party status at LARMC to patient status with MHC LARMC

O Official copies of the Order placing me in medical evacuation status from LARMC to CONUS with ASMRO bed designation details

O Official copies of the Order attaching me or assigning me to patient status with MHC MAMC

O Official copies of the Order detaching me or reassigning me from patient status with MHC MAMC to permanent party at MAMC

O Official extracts of morning reports (DA Form 1) and Command Interest summaries reflecting my status as depicted in the orders above

O E-mail messages received by MAMC Public Affairs or any official in the Command Group referencing me and my protected communications associated with any and all detailed Inspectors General or DOD officials, AR 15-6 Investigating Officers, CID Agents or any other body conducting or having interest in Official Investigations in which I am named as a subject, suspect or witness

O Records, memoranda, and written summaries of any conversations between yourself and other Department of Defense or Government Employee, Public Affairs Officers or any official referencing me and my protected communications associated with any and all detailed Inspectors General or DOD officials, AR 15-6 Investigating Officers, CID Agents or any other body conducting or having interest in Official Investigations in which I am named as a subject, suspect or witness

O A copy of the most recent JCAHO report for MAMC, to include observations and findings regarding medical records. What is requested is the detailed report with deficiencies issued by the Commission by mail a few weeks after the survey, not the score matrix issued on the last day of the visit.

O the DAC job description of the Physical Security Agent, Mr. James Cleaver, that was current as of 1 Sep 98.

O Extracts of the DAC Civilian Personnel file for Mr. James Cleaver, demonstrating the training he received in preparation for his current job position as Physical Security Agent.

O Copies of any records and or files bearing my name appearing in or referenced in Congressional Correspondence regarding alleged reckless endangerment of emergency patients at Landstuhl and/or any alleged cover-up thereto.

Sincerely,

 

 

 

Stephen Whitlock Smith, MD

Cc: Legal Counsel

 

NOTHING FOLLOWS

 

 

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APPEAL TO DR O’LEARY AND MR MANCUSO 18 October 1999

 

Dr O’Leary and Mr Mancuso,                                                 

 

The following is my  Appeal:  Corresponding to specific documents to be forwarded----------------

 

The following questions relate to each credentials document mentioned:

 

#Notification of restoration of clinical privileges by DCCS COL Pat Kelly 2 april 99.

 

Why was there such a prolonged delay until COL Gilman partially restored my clinical privileges 4 days after the Army Times article in July? Since the psychometric test which imposed supervision on my credentials originally is still missing, should not the provision for supervision be waived?

 

Credentials Hearing Minutes 10 February 1999

 

#2 (page)

 

What is your opinion of the effect of the rapid turnover of JAG officers (Army attorneys) in this credentialling action?

 

Are all legal questions the province of LTC Pearson, LTG Crocker's JAG who presided over much of the hearing proceedings? Alternately, is COL Woodling, LTG Crocker's Chief JAG Officer, the responsible legal authority?

 

Why did BG Hill not provide me a Trial Defense Lawyer in conjunction with his memorandum to me of 2 February 1999 delivered in person by CPT Geib. Could your office provide me with a Trial Defense Attorney in case BG Hill is still unable to do so? How am I to determine if I require a Trial Defense Attorney, if LTG Crocker's JAG officers all seem to have divergent opinions on this matter?

 

#3

 

If the Impaired Provider Committee reports by MAJ Jordan (August, September, and October 1998) were considered in these 10 February minutes, why did I not receive my own copy of these until 1200 noon on 3 March from Ms Carole Meines. These evaluations written by MAJ Jordan, my supervisor, were important in the Credentials Committee actions during the months of August, September, October, and November, 1998. What was BG Hill's reason for withholding this feedback from me during my patient care time in the Department of Medicine? Did BG Hill make such a decision before or after the conversation which he had with me on 1 September 1998 immediately after Dr Bailey and I chatted. What was the reason for allowing me to see my supervisor's evaluations of August-October 1998, for the first time on 3 March 1999, and only in response to my request to BG Hill under the Freedon of Information Act?

 

#4

 

Each of the JAG officers associated with this hearing offers a different opinion regarding the question of whether witnesses can see credentials documents about which they are asked to testify. All of my witnesses asked me for specific written guidance in order to prepare them for the hearing. The discrepant opinions of CPT Geib, LTC Pearson, COL Woodling, and MAJ Cusker on this point were impossible to resolve to my witnesses' satisfaction. Consequently, only 2 witnesses were willing to testify on behalf without any written guidance. Moreover, Dr.Bailey testified by letter without hesitation. When will I be allowed to bring forward the other witnesses' testimony?   Dr O’Leary and Mr Mancuso,  what is your opinion in this regard?

 

MAJ Cusker is my JAG officer assigned by LTG Crocker for the still-pending complaint against BG Hill for his role in my detention by Mr. Cleaver on 1 September 1998 after my conversation with Dr. Sue Bailey. Why then, did LTC Pearson prohibit MAJ Cusker from advising me regarding witness preparation for the Credentials hearing? Dr O’Leary and Mr Mancuso,  I would like your opinion of this point because the witnesses for both proceedings are the same witnesses, and the evidenciary documents in question are the same documents.

 

#5

         

I reported that there was erroneous information in the credentials records relating to me.  I asked several times that these errors be corrected at time of the hearing. LTC Pearson's judgment was that these errors should not be corrected during the hearing itself. Since the information relates to my own medical record on file at MAMC which does not support the erroneous information in the minutes, when will such errors be corrected?

 

One obvious error describes my medical condition as "catatonic." Another error is the wording "manic depressive." Both my official MAMC records and Dr. Dunner's report from 10 May 1999 fail to support these diagnoses. When will these errors be corrected within the credentials records?

 

The following crucial MAMC medical files relating to me were reported missing between 1 and 10 May, the day of the Independent Medical Examination at University of Washington: 1) MAMC Outpatient Psychiatry Record; 2) MAMC Outpatient Psychology Record; 3) Psychometric Test and Report. These records are critical in supporting my witnesses' account of events. COL Victor Bell, former Chief of Psychiatry at MAMC, was the member of the Credentials Committee who discussed BG Hill's referral of me to Dr Dunner of UW, and arranged the transfer of medical information to Dr. Dunner. However, BG Hill has now reassigned COL Bell to Alaska. How can the information in the missing files be obtained or reconstructed?

 

In particular, Dr O’Leary and Mr Mancuso,  COL Gilmore arrived as new Deputy Commander at approximately the same time the records were discovered missing. Could you please investigate what his role is or will be in finding the missing records?

 

#6

 

MAJ Cusker is the JAG officer assigned to me by LTG Crocker in order for me to defend against BG Hill's personal involvement the events of 1 September 1998. MAJ Cusker and I had extensive discussions regarding our case during December and January. I transferred large numbers of files and e-mail to her in order to help her to develop our case. Why did BG Hill requisition MAJ Cusker to be the MAMC Center Judge Advocate just as our case was being developed in January?  Dr O’Leary and Mr Mancuso,  this question was presented to LTC Pearson and COL Woodling as a question of conflict of interest. What is your opinion on this matter, and how can it be resolved, so that the allegations which I have made regarding the events of 1 September 1998 can be directed into the proper channel?

         

LTC Pearson said that the Article 138 charges against BG Hill and the credentials hearing are 2 separate matters. Since this involves the same exact witnesses and the same exact allegations, why are they being treated separately? Do you intend to rule on the events of 1 September 1998, or should the matter ultimately stay within its original venue, Secretary of the Army Caldera with the assistance of Dr. Sue Bailey?

 

The Army Times article of 15 February 1999 referring to the events of 1 September 1998 at MAMC was constrained by the fact that MEDCOM Public Affairs seemed not to know any details of the event. Has MEDCOM Public Affairs been informed of the events of 1 September 1998, and of my FOIA request for MEDCOM-funded surveillance videotapes which I believe would substantiate the testimony of my witnesses? When will the MAMC witnesses from within the MAMC Command Group who corroborate my account of events be allowed to testify?

 

Dr. Bailey kindly provided documentary evidence in support of my witnesses. Should the case then be transferred to her office for administrative decision in order to save the time required to initiate another hearing within MAMC or MEDCOM only for the events of 1 September 1998?

 

With the exception of Dr. Bailey, my other witnesses of the events of that day have declined to testify, because they are currently members of the Command Group at MAMC. As such, they might find themselves as witnesses against other members of the Command, namely BG Hill and Mr. Cleaver. Could Dr. Bailey's office intervene informally in this matter, since Dr. Bailey was present also?

 

Specifically, when will the witnesses of the reported harassment by BG Hill and the detention by the security agent be allowed to testify about the events of Sep 1 1999. These events are crucial to the case.

 

#7

 

 What is your opinion whether I may utilize my credentials documents containing information about me, in the preparation of witnesses on my behalf? Why were the Freedom of Information Act documents which we requested in January not supplied before the credentials hearing?

 

#8

 

Specifically, the missing psychometric test result of 25 March 1997 has not been received under FOIA. The test is the determinant for the supervision of my medical privileges. Does not the recently-obtained FOIA document from Dr Marc Williams (my physician who ordered the psychometric test) dispute the Credentials Committee decision to impose supervised credentials as opposed to unsupervised?

 

What is the meaning of the memorandum received from MAJ Cusker on 10 February in which she attempts to justify her representation of MAMC and the simultaneous Article 138 associated allegation against BG Hill? Since COL Woodling's cover memorandum of the same date appears to support MAJ Cusker's opinion in this regard, what is your opinion of how to resolve the dilemma?

 

#9

 

Why does COL Woodling offer a new JAG officer to my service because of the discrepancy, if there is no discrepancy? However, why is a Trial Defense Attorney not provided?

 

Should I now resume working with MAJ Cusker  so that the Fort Lewis JAG office has the opportunity to provide an investigative response to the events of 1 September, particularly in regard to BG Hill's personal involvement? Apparently, LTG Blanck’s JAG officer COL Phil Savoie has not intervened in this regard.

 

If you are able to offer me MEDCOM JAG support in this matter, may I request the assignment of CPT Jeannette Stone of COL Savoie's office at MEDCOM? CPT Stone was present during the briefing which LTG Blanck kindly enabled (via TDY orders for me) which I gave to MEDCOM Quality Management team in September 1997 with respect to the reckless endangerment allegations regarding Landstuhl, under then-COL (P) Kevin Kiley's command.

 

#10

 

What was the intent of BG Hill's memorandum of 2 February threatening punitive action if QA documents were used in preparing witnesses? Why did BG Hill ask COL Bauman the Chief of Radiology to sign the memorandum of 2 February? Dr O’Leary and Mr Mancuso,  am I required to respond to such a memorandum specifically in writing, since no Trial Defense Attorney was provided for me to do so?

 

 

What is MAJ Cusker's role in this matter. Could MAJ Cusker be assigned to me as my Trial Defense Attorney, if such assignment is required at MAMC?

 

Was LTC Pearson requesting that a member of the committee read me my rights?

 

Why did CPT Geib advise me of my right to Trial Defense Attorney, but without official charges having been filed? I believe that CPT Geib is assigned to BG Hill's Command directly. Why then would COL Woodling, who is LTG Crocker's Chief JAG Officer be able to speak officially for CPT Geib not of his own command? What is your opinion regarding COL Woodling's memorandum?

 

Are my witnesses in the credentials hearing the persons which BG Hill means are at risk of punitive action, or am I at risk of this?

 

#11

 

Why did COL Woodling address both hearing and the article 138 in his letter? Is there confusion over disclosure of hearing minutes to attorneys vs members of DOD vs members of AMEDD? What are JCAHO guidelines regarding disclosure of credentials documents to credentials hearing witnesses during a credentials proceeding? What is your opinion about which guidelines to follow, so that I can appoint proper witnesses for both settings?

 

#12

 

Dr O’Leary and Mr Mancuso,  would the safest way be to have the documents released through the  Commander directly to witnesses? My witnesses were intimidated by lack of clarity on this issue and decided not to testify. Is BG Hill the authority who will determine if QA documents can be released to witnesses? If he does not agree with respect to certain key documents, are you then the authority who will decide this issue?

 

#13

 

BG Hill did not provide guidance regarding the witness list. When will I receive official written guidance regarding witnesses? Specifically, should witnesses worry that participating in a credentials hearing might place them in any legal jeopardy?

 

#14 

 

I presented no witnesses on 10 February because of BG Hill's direction that punitive action was possible if I allowed them to read credentials documents. Shall I send the proposed witness list to you in order to authorize release of certain documents to certain witnesses for the purpose of the hearing? Or should I keep such a list of names confidential until you can guarantee their rights under Whistleblower Protection provisions.

 

#15

 

Why did BG Hill direct that the time frame to be addressed by the credentials hearing be 1 July to 3 November? Should witnesses be prepared only for that time period? Can documents be provided to them for their hearing preparation which were created ONLY within that time frame, or are you going to allow previously-created documents to be provided?

 

#16

 

LTC Pearson allowed me to consult with MAJ Cusker once during the hearing for  five minutes, as a brief recess; however, why could she simply not be brought into the hearing room when this issue is presented to JCAHO and DODIG for resolution? What Army Regulation or JCAHO guideline covers the exclusion of a respondent's counsel from the hearing room? What is your opinion, Dr O’Leary and Mr Mancuso,  whether there is conflict of interest of the various JAG offficers involved in the case?

 

What is your opinion regarding the decision by BG Hill not to assign me a Trial Defense Attorney to be present during the credential hearing?

 

#17, 18 

 

I contested  COL Jones impartiality because COL Jones is a subject  of the Article 138 for my detention and physical assault on 1 September. Since BG Hill is personally mentioned in these Article 138 allegations, why was BG Hill not allowed to recuse himself from final judgment over the hearing findings?

 

The MAMC and Fort Lewis JAG officers allowed the proceeding to continue under such conflicting opinions? If such a conflict recurs at any time before BG Hill restores my credentials, is there any provision for such controversies to be resolved before any other proceedings begin?

 

What provision can you now afford me that this apparent conflict in interest can be resolved, at least before a final decision is made on my credentials?

 

#19

 

The allegations stated in the hearing minutes regarding behavioral issues are linked with the events of 1 September 1998. Specifically, after my short conversation with Dr. Bailey in the receiving line, BG Hill approached me with his anger seemingly directed toward me; the detention and physical assault by Mr Cleaver, MAMC Security Officer followed shortly thereafter. Is there still no official statement from BG Hill regarding what he might have said or done in the minutes after he and I spoke, which might relate to Mr Cleaver's treatment of me at the time of the detention? Specifically, Mr. Cleaver indicated to me that I was accused by the Command of threatening Dr Bailey in some manner. Where did such an allegation originate?

 

Dr Bailey has specifically corroborated for me in writing that she was aware of no threat to herself or her traveling party on 1 September 1998.  During the outbriefing at Fort Lewis that day, what was the report furnished to LTG Crocker regarding the detention and physical assault of that day. Did others in the outbriefing furnish a statement for LTG Crocker that you could assist me in obtaining for my defense?

 

Another reason that BG Hill's sworn statement would be helpful is that he identified me my name "LTC Smith," then shouted to me his demand that I identify my full name and place of business. Since I had never made his acquaintance previously (he was not yet officially MAMC's Commander), how had he identified me by name? The rest of my chronology of the event is summarized in my sworn statement to CID of 8 October 1998. This was made after a 5 week period of time elapsed with no official explanation to me from BG Hill or MAMC Command Group about why such events had transpired. Dr O’Leary and Mr Mancuso,  would you please assist me in obtaining a sworn statement from BG Hill? I believe that he deserves to provide his own official statement of that day's events.

 

Because the detention and physical assault and the behavioral issues related to the official written complaint to Dr. Bailey, Assistant Secretary of Defense, are linked, LTC Pearson asked COL Jones to recuse himself. Am I correct in assuming that BG Hill would likewise have been asked to forgo officiation at such proceedings, if he had been present at the hearing; however, his signature is required for me to renew my MAMC credentials. Has Fort Lewis JAG office made a ruling yet regarding BG Hill's signing my credentials record? What is your opinion regarding how such a dilemna could be resolved?

 

LTG Crocker's JAG officer LTC Pearson asked COL Jones to recuse himself. As COL Jones left the room precipitously, there ensued some visible confusion about what would then be the next step. After a declared 5 minute recess, which truthfully lasted 30 minutes, COL Kelley reconvened the hearing for one minute in order to declare a three week recess. Dr O’Leary and Mr Mancuso,  what was the legal basis for continuing the proceedings without requesting that BG Hill not be similarly recused from participation in the credentials action?

 

#19, 20

 

The hearing minutes for 10 February are signed by COL Kelley only. There is no signature by COL Jones (who presided over almost the entire session). There is no signature by Ms Meines, Recorder, nor did either BG Hill or LTC Pearson, LTG Crocker's JAG, provide their signatures.

 

Dr O’Leary and Mr Mancuso,  do you believe that the portion of the hearing on 10 February has had a review by any JAG officer, as required by AR 40-68?

 

Does COL Woodling's cover memorandum then substitute for any required signature from LTC Pearson, CPT Geib, MAJ Cusker, or LTC Olmsted?

 

Enclosures:

 

#4 January 1999 letter from COL Jones

 

Did BG Hill's letter of instruction as signed by COL Jones have the benefit of legal review by LTC Pearson, MAJ Cusker, CPT Geib, LTC Olmsted, or COL Woodling?

 

Were the instructions reviewed for adherence to AR 40-68  15-6?  Why were denials made regarding my request for tape recording and verbatim transcript? Dr O’Leary and Mr Mancuso,  the Freedom of Information Act denial from MEDCOM states such a denial was made because neither form of hearing record was requested by me beforehand. However, BG Hill's letter of instruction, signed by COL Jones, verifies that I indeed DID make that request. Dr O’Leary and Mr Mancuso,  I do now request your assistance in obtaining the full tape recording of all hearing proceedings; such a recording would help me and my counsel to respond to marked discrepancies which we have found in the record so far.

 

#8 February 1999 letter from SWS to COL Jones

 

What was the implication of  MAJ Cusker's exclusion from the hearing by BG Hill? MAJ Cusker was at the time of the hearing simultaneously representing me and BG Hill. How does this relate to the wording of COL Woodling's reply?

 

#9 February 1999 COL Woodling's letter

 

Is COL Woodling replying for LTG Crocker, or only for the JAG officers under his direction. In COL Woodling's analysis of the role and intent of CPT Geib, is COL Woodling speaking for BG Hill or only for Fort Lewis? (in regard to whether CPT Geib was reading me my rights or not.)

 

#2 February 1999 memorandum signed by COL Bauman

 

At the 10 February 1999 hearing, Ms Nancy Greenfield, RN, BG Hill's Quality Manager, clarified the meaning of the memorandum and why it was delivered to me by a JAG officer (CPT Geib.) Since COL Bauman deferred to Ms Greenfield for this explanation, did Ms Greenfield actually write the memorandum, or did COL Bauman? Did either of them intend for CPT Geib to read me my rights? Were Ms Greenfield or COL Bauman aware that by limiting my ability to prepare witnesses, this might diminish the validity of the proceedings? Was BG aware of this potential?

 

Have Joint Commission guidelines regarding due process in credentialling matters, as well as right of appeal, been considered fully in my case? Have JCAHO Offices of Quality Monitoring,  rendered a judgment yet whether or not the proceedings met their criteria?

 

Ms Greenfield, is MAMC's JCAHO expert. Was her apparent direct involvement in preparation of the 2 February memorandum to prevent me from transferring any of the hearing minutes to the Offices of Quality Monitoring.  Under AR 40-68, JCAHO and other accreditation organizations are specifically allowed to see QA files under certain circumstances?

 

Has MAMC asked  JCAHO to review my case during the current accreditation phase?

 

#3 March Credentials Hearing

 

Attendance

 

Dr O’Leary and Mr Mancuso,  why was a credentials clerk as well as the Recorder Ms Meines allowed to participate? Was not one clerical person enough. Why did BG Hill not allow correspondents of the media to attend, since published reports had already appeared in advance of the 10 February hearing? These correspondents would be able to verify whether due process had been achieved. Would requests for media representation be again denied in any future credentials proceedings? What is the correct way to apply for media representation to occur?

 

#6 (page)

 

Dr O’Leary and Mr Mancuso,  I can establish beyond reasonable doubt that I arranged properly with MAMC Command and Dr Bailey to accompany her tour with respect to my responsibilities as Tricare Senior Prime Acute Care Physician.  I request that you hear the witnesses who can verify this. Those specific witnesses were not afforded the opportunity to testify for me on 3 March.

 

#8

 

Dr O’Leary and Mr Mancuso,  a sworn statement from BG Hill is missing from this hearing record. What were his actions on 1 September 1998? What communication, official or unofficial might he have had with Mr. James Cleaver, MAMC Security Guard?

 

#9

 

Dr O’Leary and Mr Mancuso,  even a brief examination of LTC Foster's typewritten statement will show that it is not a properly sworn statement. It is rendered on a "sworn statement" standard form; however, it is not accompanied by a witness signature.  Without ANY STATEMENT at all from BG Mack Hill to explain his own actions that day, we are left only with Mr Cleaver's statements under oath. Mr Cleaver is accused in my testimony to CID of 9 October 1998, with physically assaulting me by shoving me down the Medical Mall escalator.  It is necessary to expand the quantity of sworn statements to include persons without self interest.

 

NO consistent rules of evidence were applied in this case (e.g, incomplete statement from LTC Foster, NO STATEMENT FROM BG HILL about his confrontational approach to me after I chatted with Dr Bailey); moreover, one MAMC witness in the Provost Marshall Office who directly contradicts Mr Cleaver's testimony, was not allowed to testify. The Command did not allow my other witnesses to testify. These witnesses will require guarantees from you that their careers will not be endangered if they become known by name as my witnesses. Can you allow them to come forward with their own testimony? This should probably not be done at MAMC. Why did BG Hill deny my original request for change in venue to the Fort Lewis JAG Office?

 

#11-19

 

Dr O’Leary and Mr Mancuso,  I can provide evidence that I did appear on the surveillance videotapes of that day, 1 September, along with the Command Group and the visiting dignitaries.  This contradicts Mr Cleaver's assertion that the tapes did not show any of the persons mentioned in the hearing.

 

Mr Cleaver has said that he erased the surveillance tapes of that day's events 7 days later. However, he also stated that there were other events to be monitored that day, apart from the circumstances covered in the hearing, requiring careful surveillance and reporting.  Dr O’Leary and Mr Mancuso,  I would like to ask your assistance in retrieving ANY of the surveillance tapes for that day. If there are none, who ordered their erasure? MEDCOM money is used to purchase and maintain this system according to published reports from MAMC Public Affairs Office ("The Mountaineer")

 

#21

 

I reported BG Hill's remarks and actions towards me and the threatening behavior of Mr Cleaver, as reprisal for my short discussion with Dr Bailey. I reported this event in a sworn statement to Fort Lewis CID. I also reported the same to MAJ Leah Cusker, the JAG officer assigned to me by LTG Crocker.

 

The CID investigator told me in December that CID did not investigate. He said that his report was forwarded to MEDCOM for action. However, a full copy of the CID report is present within my credentials materials at MAMC. My sworn statement predated both the statement of Mr Cleaver and the non-signature-bearing affidavit of LTC Foster by several months.  Would this situation bear up under usual rules of evidence?

 

Dr O’Leary and Mr Mancuso,  which MEDCOM official  did the CID report reach, and how and why was it returned to MAMC for placement in my credentials documents?

Dr Peter Nielsen, a key witness for the investigation of  reckless endangerment of patients at Landstuhl (1994-1996), wrote a memorandum to BG Hill's Center Judge Advocate LTC Olmsted dated 4 December 1998. This document warned MAMC of the impending visit of BG Kussman's investigative officer to MAMC. The officer arrived on 6 December on a flight from Heidelberg at US Government expense to interview me and the other witnesses regarding death and permanent injury at Landstuhl (1994-1996).

 

Dr O’Leary and Mr Mancuso,  quite simply stated, when I attempted to recontact the witnesses, they were suddenly not available for questioning. Was the investigating colonel's trip then a waste of US taxpayers' money? The letter to BG Hill's lawyer LTC Olmsted is in my credentials records as evidence against me. Who if anyone within  the MAMC Command prevented the witnesses from speaking with the investigating colonel from Heidelberg? If BG Hill did not want any witnesses interviewed at that time, could he simply not have requested a delay in the interviews from BG Kussman? The interviews could then have been rescheduled, so that money would not have been expended on the investigator's trip from Heidelberg to MAMC.

 

The credentials records under my name appears to be a sequestering place for documents related to the Federal investigation in Germany. This investigation was recommended in October 1997 by LTG Blanck’s Quality Management Office in San Antonio. LTG Blanc’s travel orders for me to brief them were instrumental in allowing the investigation to begin.

 

In February of 1996, I was JCAHO representative for Medical Staff issues reporting to COL Ney Gore, Vice President Gore's cousin, and then COL (P) Kevin Kiley's Deputy Commander at Landstuhl.  On 12 February 1996 at 1300 hours , in the presence of Ms Michel Jung COL (P) Kiley's secretary, I reported COL David Lipsi and LTC David Gillingham to COL (P) Kiley for reckless endangerment of emergency patients by violation of JCAHO standards of medical care.  TWO HOURS LATER, COL Kiley ordered my removal from his Command via psychiatric referral in violation of DOD Directives against such reprisal actions.

 

Dr O’Leary and Mr Mancuso,  your assistance in initiating the investigation in October of 1997 was essential so that other patients will not be harmed at Landstuhl and elsewhere. However, the investigation appears now to have faltered. I believe that COL David Lipsi retired from active duty in July 1999; LTC David Gillingham was promoted and will remain on active duty. COL (P) Kiley is now Brigadier General Kiley and reports to LTG Blanck.

 

Dr O’Leary and Mr Mancuso,  have you determined whether the JCAHO violations of due process which I am reporting to you in this appeal are related to the now-faltered investigation against BG Kiley's former subordinates at Landstuhl?

 

As part of the investigation which MEDCOM authorized, I received an alarming report originating from 2 medical personnel assigned to Landstuhl now. In November of 1998, they reported incomplete maintenance records for 10 years previously on instrumentation used by LARMC Ethics Committee for brain death determinations. The inability to predict the baseline readings implied that it is possible to declare a person brain-dead when that person is alive. I relayed the report via e-mail and verbally to the investigator in Heidelberg.

 

Dr O’Leary and Mr Mancuso,  Dr Nielsen's testimony was crucial to the other case involving the LARMC Ethics Committee in 1996.  Dr Nielsen declined to participate in the investigation partly because medical records and radiology data were not supplied to him in advance from the case of the infant who was allowed to die of an easily correctible condition. The investigator from Heidelberg told me that he had gone to Landstuhl in November 1998 to obtain that documentation; however, all documentation regarding that case and others in his purview, was unaccounted for. Dr O’Leary and Mr Mancuso,  what progress has been achieved by LTG Blanck’s office  in retrieving the missing medical records and radiologic data?

 

What has been the testimony of Ms Michelle Jung, now Secretary to BG Kussman, regarding her memory of events on 12 February 1996 when I presented my complaint to then COL (P) Kiley at 1300 hours in her presence (with a copy to her)?

 

Dr O’Leary and Mr Mancuso,  why are my credentials records being utilized at MAMC as a repository for documents which belong to a an investigation in Heidelberg which was ordered by Department of the Army, based on recommendations of MEDCOM’s Quality Management Office?

 

Am I correct that while I have been facing such time-intensive skirmishes with MAMC Command regarding my own credentials, that the investigation in Heidelberg has faltered?

 

Dr O’Leary and Mr Mancuso, are you going to assure that BG Kiley of the Armt surgeon General’s, within whose sphere of influence BG Mack Hill serves, be recused from any portion of the credentials actions regarding me? In order for you to accomplish this, am I required to request that he recuse himself, during official proceedings or  memorandum (as during my credentials hearing in the case of COL Jones.) Would JCAHO’s legal office  be willing to assist me in preparation of such a document?

 

#22

Mr Cleaver reported that my uniform was disheveled on 1 September 1998. This is disputed by the other witnesses. What has BG Hill mentioned to you regarding this episode? What description of the events immediately following my chat with Dr Bailey has emerged? BG Mack Hill appeared to challenge me by name in apparent anger for my discussion with Dr Bailey; however, BG Hill did not mention to me any problem with my uniform. How can this be resolved without a sworn statement from BG Hill? Can such a statement be arranged as soon as possible, so that I can receive my full credentials back?

 

#26

 

There is a need for a sworn statement from Ms Carole Meines to explain why I was denied access to my performance evaluations of August, September, and October until 3 March; this was many months too late for me to react to any constructive criticism in those evaluations. Even more importantly, why was Dr Russell Hicks, now MAMC Chief of Psychiatry, still considered my Army psychiatrist as shown by his continuing reports on me to the Impaired Provider Committee from August through November 1998. And if so, why did his written evaluations of me not contain the official report which I made to him of the episode of harassment involving BG Hill personally, an episode which was instrumental in aggravating my clinical depression which then caused my own self-reported lateness with records.

 

MAJ  Jordan appeared to indicate that the MAMC Command was preventing him from showing me the performance reviews which he had written for my use. What do JCAHO and AR 40-68 provide for guidance on denial of quality improvement information for an enrollee in the impaired provider program?

 

#31

 

When I transferred to Department of Medicine, I provided to MAJ Jordan and COL Reed complete documentation of my Landstuhl IG report of reckless endangerment by officers reporting to then COL (P) Kevin Kiley. The reason that I did so was that I expected the investigation to move forward in August 1998. In the past, the demands of having to remember the reckless incidents from Landstuhl, and the time demands of testifying by telephone and affidavit, have diminished my capacity to work as efficiently. I considered that both supervisors would need that information in order to help me prevent a recurrence of major depression.  As the Germany investigation was proceeding, the events of 1 September occurred. I reported these happenings as related to my role in the Germany investigation, and as reprisal in violation of Whistleblower protection. And I became increasingly depressed as I reported to both Dr Hicks and Dr Hickey, my private psychiatrist. Dr Hicks would then be expected to report these events to the Impaired Provider Committee under JCAHO provisions which attempt to prevent worsening of the clinical condition for which a provider is enrolled into the Program. In my case, depression was a very predictable outcome. Even 300 mg of Sertraline daily and frequent appointments with Dr. Hickey were not enough to prevent a relapse, since the time to complete late records was not given even after due notice.

 

#32

 

Indeed, Department of the Army in August mandated the investigation in Heidelberg into my allegations of reckless endangerment by COL Lipsi and COL Gillingham in response to what they said were direct orders by then COL (P) Kevin Kiley,  then-Landstuhl Commander.  At the time of Dr Bailey's visit on 1 September 1998, BG Mack Hill was in the process of transferring to become MAMC Commander in mid-September. He had just arrived from working in close association with BG Kevin Kiley, Assistant Surgeon General of the Army for Force Projection.

 

Dr O’Leary and Mr Mancuso,  what has BG Mack Hill discussed with you about his own feelings and actions at the time that MAMC Command Group pointed me out to him by name at the time that I was speaking to Dr Bailey about George Washington University Medical Center, where we both trained?

 

#33

 

COL Jones  demanded that I turn in 100% of charts to MAJ Jordan within 24 hours, according to what I remember of MAJ Jordan's comments to me. This demand was impossible to comply with, given the increasing depressive symptoms which I was experiencing, especially as I considered myself in danger of more episodes of false arrest or other harassment by MAMC Command; specifically by BG Hill who was a close associate of BG Kiley.

 

#34

 

My memoranda of 2 and 22 October  addressed to COL Jones, MAJ Jordan, and COL Reed corroborate that I was complying with the Departmental plan to bring my records up to date as expeditiously as possible. These memorandum constitute the “first supervisory plan” of this whole process, a plan which had the approval of COL Reed, my Chief, as well as the clinic staff with whom I worked daily.

 

#35

 

I kept LTC Jordan and the other Clinic staff informed of my need for increasing frequency of psychiatry appointments.  Clinic Secretary Lissette Ortiz and LTC Jordan arranged for my replacement in the Clinic if these appointments required me to leave during Clinic hours. I kept my clinic supervisors and the nursing staff with whom I worked closely informed about  the adverse emotional impact on my family and myself imposed by the Germany investigations, the worry concerning them, and the time demands in order to arrange witnesses and evidence, and to continue my patient-care responsibilities.

 

#37-39

 

LTC Jordan and I had both discussed our symptoms of depression with COL Russ Hicks, the Clinic's designated psychiatrist.

 

#42

 

There is no precedent within Department of Medicine at MAMC for permanent suspension of clinical privileges because of record-keeping delays secondary to an episode of situational depression. BG Hill's inaction in restoring my credentials for 8 ˝  months may in fact not have any precedent within the AMEDD.

 

#44

 

Dr Hickey interpreted LTC Johnstone's request to confirm  "paranoid delusions" as inappropriate and out of the ordinary. She knew that Dr. Russell Hicks was my assigned Army psychiatrist, and that I had reported all of the events to him personally twice in September 1998.

 

#45

 

Dr Hickey reported BG Hill's credentials actions taken against me as reprisal in violation of Whistleblower Protection. This report was furnished to COL Robert Johanson and LTC Ed Bodling of the DA IG's office. I requested their intervention because of my fears for a recurrence of the detention and physical assault, and my fears of MAMC's reprisal on my credentials files. I reported this in detail to MAJ Cusker, LTG General Crocker's JAG Officer, before she was abruptly requisitioned by BG Hill in January 1999.

 

#46

 

The effect of BG Hill's anger directed at me followed by Mr Cleaver's detention and physical assault, both aggravated my depressive symptoms from 1 September 1998 onward.

 

#48-49

 

I can provide evidence that the psychometric test was indeed placed into the written record and did not corroborate an impaired score. This discrepant test was utilized by Ms Nancy Greenfield, MAMC JCAHO expert, according to witnesses to place my credentials under supervision.

 

With Dr Hickey's assistance, this situation has been reported to American Psychological Association and JCAHO as an ethics violation which may have interfered with due process. Dr O’Leary and Mr Mancuso,  have these organizations provided you yet with their report of investigation? If so, may I request that you supply me and my counsel with a summary of their report under Freedom of Information Act, so that the information may be included in my credentials records?

 

#50

 

Dr Hickey did not respond to LTC Johnstone's request for a "paranoia" diagnosis, because she considered the request irregular and unjustifiable.

 

#53

 

Dr Hickey corroborates no paranoia. This is confirmed by the Independent Medical Evaluation ordered by BG Hill and accomplished on 10 May by Dr Dunner. Dr Dunner corroborates that the events reported in Army Times of 15 February 1999 regarding what occurred on 1 September 1998 would contribute to my depression. He recommends on the basis of what BG Hill provided to him for documentation, that my credentials be restored.

 

#54