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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 ½ 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 ½ 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 it¹s 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. "I¹m angry, but what can I do?" Wood said. "They know they have done something wrong, but won¹t do anything about it." Wood has filed a claim against the U.S. Army for malpractice, but he and his family aren¹t optimistic. The Army¹s Office of the Judge Advocate General in March turned down Wood¹s initial claim for $7.5 million. Wood¹s 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 Army¹s review of the case was thorough and above-board.  John De Crosta, Thurmond¹s 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. Landstuhl¹s emergency-room doctor sent Wood home after treating him for scrapes and bruises, according to Wood¹s claim. The doctor didn¹t 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 Wood¹s 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. Wood¹s 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.  "It¹s a good faith system," Brem said. "Potentially, the Army could come back and say, Yes, we were negligent, but we still aren¹t going to award you damages." Another lawyer working on Wood¹s 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 Army¹s denial. "Self-regulation doesn¹t 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 don¹t worry because they know people can¹t 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 Wood¹s treatment as one example of a number of problems.  Despite what Brem calls "extremely substantial" evidence supporting Wood¹s 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 Wood¹s head because it didn¹t start until the next day. But Smith said that wasn¹t 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 ½  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

 

There is an element of post traumatic stress in my response to events at Landstuhl and the resulting investigation.

 

#58

 

There is a lack of trust in Ms Nancy Greenfield and the Credentials Office because of the use of the psychometric test result, now missing, in order to take adverse action on my credentials.  BG Mack Hill is on record, within the Freedom of Information Act denial by MEDCOM FOIA office, stating that there was NO WRITTEN REPORT BY LTC POWELL of the psychometric test. I know that LTC Powell did in fact generate a written report of the test, because he did so in my presence, during my followup talk with him on 4 April 1997! I can provide for you my verbatim record of LTC Powell's analysis of the psychometric test; my meticulously detailed notes of his comments to me, which he repeated for me to render them word-for-word, is discrepant with the results as summarized in the credentials documents under Ms Greenfield's purview. In particular, LTC Powell’s report is full of references to the escalating investigation into Brigadier General Kiley’s management at Landstuhl in the years 1994-1996; it contains a brief timeline of events and the psychological effects of such events.

 

Dr O’Leary and Mr Mancuso,  the records of both the MAMC Psychiatry Clinic and Psychology Clinic which would corroborate this, both were unaccounted for when BG Hill referred me to Dr Dunner on 10 May 1999. COL Victor Bell is the former Chief of Psychiatry at MAMC. The Credentials Hearing Chairman, COL Kelley, with concurrence of LTG Crocker's JAG officer LTC Pearson, had delegated to COL Bell on 3 March that he investigate the issue for the Committee. What explanation can be given for the fact that those specific records are missing, and that BG Hill has reassigned COL Bell to Alaska?

 

I believe that two persons still at MAMC have knowledge of the contents of the missing records: Deputy Commander COL Gilman, whose arrival coincided with the disappearance of the records,  and Chief of Psychiatry Dr. Russell Hicks, who discovered the records missing and reported that fact to LTC David Smith, Chief of PAD.

 

#63

 

Dr Hickey verifies that my ability to handle stress is improved despite, or maybe because of, the experiences of the last few months. Dr Dunner documents that the major depression which generated the credentials action in November, has now resolved. Both Dr Hickey and Dr Dunner recommend restoration of my credentials and my early retirement from the Army.

 

LTG Blanck’s approval of my early retirement, as relayed to me by your Quality Management Office on 14 May, is much appreciated. Why has BG Hill not allowed my full credentials to be restored so that I can leave MAMC and seek civilian employment?

 

Dr O’Leary and Mr Mancuso,  specifically why has BG Mack Hill not verified for Washington State Medical Licensing Office that my credentials were restored on 3 March 1999 by vote of the MAMC Credentials Committee?

 

#65

 

Dr Hickey remembers Mr Cleaver from MAMC. She depended upon his security help if there was a psychiatric emergency.  In Dr Hickey's opinion, Mr. Cleaver would not have detained a  MAMC physician and shoved him down the escalator without a direct order from a high-ranking MAMC officer. A review of Mr Cleaver's job description provided by the Fort Lewis Freedom of Information Act Office confirms that Mr Cleaver would follow "higher authorities" for such actions relating to policy. He has no independent powers of arrest contained within his job description.

 

#72

 

Dr Hickey is not required to talk to job supervisors of her patients without their permission. She was depending upon Dr. Hicks, my officially assigned Army psychiatrist, to interact with my supervisors. Why did Dr. Hicks exclude himself from this role? I believe that the reason is the following: Dr. Hicks is already a principal witness in any investigation into then COL (Promotable) Kiley’s infringement of my due process rights to review of both the psychiatric hospitalization and the suspension of credentials. Dr.Hicks may not have carried out his role as my Army psychiatrist out of fear that his involvement might threaten his career advancement. BG Kevin Kiley now controls career advancement for Army Medical Corps officers, and BG Kiley oversees their credentialing.

 

#73

 

MAJ Rumph and Ernestine Russell and Donna Hewitt of Internal Medicine confirm that I DID report myself as late with records and in need of administrative time to bring them up-to-date.

 

#85

 

I requested software from MAJ Rumph to help bring my charts up-to-date.

 

#88

 

MAJ Rumph in his past assignment worked directly for BG Mack Hill, and has just been selected for an administrative assignment within MAMC Command Group at BG Hill's direction.

 

#96

 

COL Cushner gives testimony that is discrepant with other witnesses whom I would call, who are members of the credentials committee. Cushner said that he did not act with COL Jones in removing my credentials; however, this is directly contradicted by LTC Johnstone's memoranda.

 

#114

 

Why did the Impaired Provider Committee not meet as per standard procedure?

 

#132

 

LTC Hobbs demonstrates no familiarity at all with identifying symptoms of depression through difficulties with medical record keeping. He said that he was not informed that I was experiencing a severe situational depression during the periods of his evaluations of my work.

 

#134

 

Maria Turner, RN, is mentioned in my memorandum of 22 October 1998 as assisting with my rehabilitation from the acute depression.

 

#148-151

 

The discrepant role of Dr Hicks is discussed. He was still my doctor according to Impaired Provider Committee records, however, would not comment fully on the events during the time period in question.

 

Ms Nancy Greenfield refused to be my witness. I therefore do not have an official ruling from MAMC's JCAHO expert Ms Greenfield on the manner in which the reported errors in my credentials records will be corrected in accordance with JCAHO guidelines.

 

I submitted a computer disk to the hearing committee with my request for correction of inaccuracies in my credentials records.

 

The objection was registered that there are gross inaccuracies in my credentials records. What action has LTC Pearson, Fort Lewis  JAG, taken on my request? Have you received such a request yet from Fort Lewis JAG?

 

#152

 

Was this accepted as an official  challenge to accuracy?

 

Why were the memos documenting charting plan not accepted into the hearing record?

 

What are the rules of relevancy?

 

How is LTC Pearson interpreting AR 40-68 with respect to rules of relevancy?

I believe that all Article 138 documents (including my correspondence with the offices of the Honorable Louis Caldera and Dr Sue Bailey should be accepted because the issues and the witnesses are the same. Dr O’Leary and Mr Mancuso,  What is your judgment regarding this issue?

 

#157

 

The rating scheme NEVER included COL Cushner; therefore, why did he with COL Jones remove my credentials. What is your opinion of their actions?

 

Two witnesses on the Credentials Committee, if given adequate anonymity and protection, will testify on my behalf that COL Cushner was responding to orders by COL Jones, and excluded the Department Chief and those on the official rating chain. JCAHO guidelines require that the Department Chief's recommendation be considered in order for JCAHO guidelines of due process to be fulfilled. Why did BG Hill appear to decide to the contrary? What is your opinion on this matter?

 

The computer records from my previous duties in Department of Emergency Medicine were submitted to the Committee to show my own ideal model of record keeping which I achieved during my work in the Emergency Department, but were not accepted by the Committee. Why  not? Dr O’Leary and Mr Mancuso,  in your hearing of this matter, would you be willing to accept evidence of my job performance from before the time frame of July 1998 which BG Hill imposed on LTC Pearson and the hearing.

 

#159

 

No evaluation was received by me. Why not? Does this fact invalidate the credentials actions taken by BG Hill?

 

#172

 

Why did BG Hill delay his independent medical examination of me until 10 May? Would you please request that he supply any information on whether the missing Psychiatry and Psychology Clinic Records have been found, or can be reconstructed? What if BG Hill cannot supply the missing records? Dr O’Leary and Mr Mancuso,  would you be able to facilitate my calling of witnesses who are able to reconstruct the information? Both are now civilians, and would need travel orders to be able to testify.

 

#173

 

Only COL Kelley and Ms Meines signed the hearing minutes. Why did LTC Pearson LTG Crocker's JAG officer not sign? Was the document reviewed by JAG?

 

Enclosures

 

#LTC Foster's statement is included; however, it is not properly sworn. Why not?

 

#Dr Bailey's letter for the Credentials Committee of 3 March.

 

Was Dr. Bailey's letter not accepted as evidence? If not,  was LTC Pearson's legal opinion stated?

 

#CID STATEMENT/JCAHO

 

How did the signed statement from Fort Lewis CID reach my credentials file. Why was my sworn statement read during the Credentials Hearing, while no other witnesses submitted a sworn statement regarding the events of 1 September? Why were my JCAHO reports against then-COL (P) Kevin Kiley allowed into the documentary portion of my Credentials Records? Dr O’Leary and Mr Mancuso,  if Fort Lewis CID Agent Navora submitted his report to MEDCOM of the 1 September incident, how did his report find its way into MAMC's Credentials Records under my name? Is the CID record not a protected document under current Whistleblower protections?

 

#American Psychological Association ethics violation report, draft by Dr Hickey

 

The official report is on file with APA and with JCAHO.

 

#Army Times, 15 February 1999, page 15, Karen Jowers

 

#Bubble sheet order of 9 November 1998

 

Documentation of written unlawful order which COL Cushner was directed to carry out.  I reported this during the hearing to LTC Pearson of LTG Crocker's JAG.

 

My evaluations from August, September, and October from LTC Jordan to Impaired Provider Committee were entered into evidence; however, I did not see them before 3 March, contrary to regulations. I reported this during the hearing to LTC Pearson of LTG Crocker's JAG.

 

I have other legal challenges to forward to you regarding the documents in my credentials records: however, I will reserve these until we can review the original documents together with attorneys present.

 

22 March 1999 Credential Hearing

 

#6

 

The final finding was as follows:

1. Possible actions unbecoming an officer

2. Bizarre behavior

3. Several discrepancies in testimony

4. Possible 15-6 investigation by BG Hill

 

Why was this language inserted into the hearing record before BG Hill signed the record? Much of this language was not present in previous records. Was LTC Pearson of LTG Crocker's JAG present when the language recommending 15-6 investigation was added? Did LTG Crocker's JAG office approve these apparent inconsistencies in the minutes? If not, why not? If not, would you please send the record for legal review by Mr Bressler, General Counsel for JCAHO, as well as DOD attorneys?

 

#7

 

Signatures

Col Kelley

Ms Meines

BG Hill

 

Why did no JAG officer sign? Did either MAJ Cusker of LTG Crocker's JAG, or LTC Olmsted of MAMC, participate in the additional language which was apparently added after the hearing ended?

 

Credentials file received 13 January 1999

 

#20 Page

 

Discussion of ad hoc minutes

 

My clinician Dr Williams considered the test result normal according to his memorandum just obtained under FOIA. These inaccuracies were reported to LTC Pearson of LTG Crocker's JAG office. What action has been taken to correct the record?

 

When BG Brown withheld his signature, is that when the psychometric test was entered into my record? If it was a normal result, how could it have been used to call the emergency meeting to place my credentials under supervision?

 

There is a confusion whether or not JCAHO or Army Regulations were being used to consider the psychometric test abnormal, when the numerical reading was normal. Dr O’Leary and Mr Mancuso,  what is your interpretation of whether the normal test result, called abnormal, was utilized properly under JCAHO or Army Regulations?

 

The memorandum by MEDCOM which identifies me as whistleblower accusing COL (P) Kevin Kiley of issuing orders to abandon care of emergency patients was sent to BG Brown by Cynthia Vaughn of MEDCOM on 3 April. What was the reason that BG Brown took the credentials action which he did utilizing a normal psychometric test? Has this had a legal review by JAG or JCAHO.

 

#14

 

There is a discrepancy about whether JCAHO or Army Regulations were applied here. Dr O’Leary and Mr Mancuso,  what is the reason that MAMC Center JAG ruled that his would not hold up to legal scrutiny? If, as the credentials minutes reflect, that MAMC's own JAG was concerned about this point, what is your decision?

 

#58

 

Hearing notice

 

LDr O’Leary and Mr Mancuso,  did BG Hill's order to schedule the hearing date before assigning me Trial Defense Attorneys have LTG Blanck’s approval? Had it been staffed through LTG Crocker's JAG?

 

#72

 

Supervisory Plan

 

COL Cushner was never my supervisor-never in rating chain. Who gave him authority to relieve me for cause? Did BG Hill ask for LTG Blanck’s authority to act outside of the usual rating chain, and if so, why? Was the Troop Commander at MAMC informed of this irregularity, and is there a notation to that effect in my Army Personnel Record?

 

LEGAL CHALLENGE NOTATIONS

 

The following are notations of documents and portions of documents which I intend to point out to you when you hear my case:

 

#1 sept 98: where is the report of arrest?

 

#memos 2+22 oct to these supervisors

 

#secret chart review by non-superv cushner, while I was out of

town ordered me out of my office

 

# 086

21 may 98

088 Health Provider Action Report

DD Form 2499 forwarded to OTSG per Regulation

12 Sep 96 "followed continuously by MPHP "

 

Dr O’Leary and Mr Mancuso,  my credentials document that MAMC kept LTG Blanck informed fully of my enrollment in the Impaired Provider Program because of the situational major depression which I sustained at LARMC. Was LTG Blanck informed when my Fort Lewis CID report reached MEDCOM? Was he briefed that a physician at MAMC, enrolled in the Impaired Provider Program reported to his office, had reported meeting Dr Bailey, Assistant Secretary of Defense for Health Affairs on 1 September 1998.

 

Was LTG Blanck informed that the CID report documented an angry approach toward me by BG Mack Hill followed by detention and physical assault by Mr Cleaver of MAMC Security? If BG Hill did not report this to you, CID says that they did report it. What action was taken? I remember that LTG Blanck was  scheduled to be present that day, but was called back for an urgent meeting with General Dennis Reimer, former Army Chief of Staff. Was General Reimer briefed that day by LTG Crocker's office about the event.

 

Dr Bailey states in her letter that she does not recall such a report at the official briefings that day. What is your opinion? I have a more detailed report filed with MAJ Cusker of LTG Crocker's JAG office which I will provide you with at the appropriate time.

 

I request that MAJ Cusker of LTG Crocker's JAG be granted travel orders to be present for any briefing.

 

#97-99

 

Dr O’Leary and Mr Mancuso,  the following notations are regarding documents on file in BG Hill's credentials record under my name. They provide some of the information which was in the Clinic Records under COL Bell's purview, before the records were “unaccounted for.”

 

#23 February 1996

LARMC Ad Hoc Credentials Meeting

Timeline notes for future reference:

LTC Gillingham had threatened to  deploy 3 out of 6 ER physicians, quoting orders from then COL(P) Kiley.

Change in meds to resolve depression.

Situational depression is the more correct description.

No notification of rights of due process was ever rendered.

 

#99 16 Feb 96

Impaired Provider Minutes

What is evidence for delusional thinking during a situational depression?

 

#Impaired Provider Referral

Ordered by then COL (P) Kevin Kiley 2 hours after the presentation of the IG complaint against COL David Lipsi and LTC David Gillingham.

 

#142

Memo irreg 5 feb 96

Did LTC Gillingham not approve my clinical privileges previously? Did COL Gore then have to write a memorandum to explain this irregularity? Was OTSG briefed on this at the time?

 

#190

Why did BG Hill have the MAMC Credentials Office call the legal offices of ALL states in which I have EVER had a medical license, in order to check for infractions? Were you informed of this action? Why did the Credentials Office label my California State License "delinquent" when that certainly is not substantiated by California State records? Were you informed of this discrepancy? What does BG Hill mean by the term "delinquent?" Is the use of the term "delinquent" the reason that Washington State has not yet granted me a licence, or is the delay explained otherwise?

 

Abeyance 25 nov98

#216-219

Abeyance 3 Nov 98 states "lack of medical documentation despite counseling." There WAS no counseling. What is your opinion of the lack of signature of counseling on LTC Jordan's counseling statement of 1 December, my lack of knowledge about the performance evaluations that LTC Jordan had written about me to Impaired Provider Committee, and my written statements for the record on 2 and 22 October documenting my best effort to catch up on medical records?

How do you intend to reconcile such deficiencies?

 

COL Cushner went to Col Jones without any authority from the Department Chief COL Reed.

 

"Last monthly report from supervisor showed significant decreased function." However, as I have stated, Impaired Provider Committee evaluation reports were never shown to me so that I could either catch up on record keeping, or take a leave of absence for depression.

 

What does JCAHO rule on required feedback to be given by Impaired Provider Programs to their enrollees? What do Army Regulations state about required feedback to be given by supervisors to their rated officers before they have adverse personnel actions initiated against them? Has this had your own review?

 

#220-231

 

"delusional":

Where is the documentation of this diagnosis?

"1 sep inappropriate":

Without a sworn statement from BG Hill and with no mention of BG Hill or the detention with physical assault arrest.

"disheveled uniform": Where is the evidence?

"counsel sessions documentation completed but not signed by either LTC Jordan or LTC Smith": How could this have been a valid counseling session?

 "manic depressive/catatonic": At the hearing, I entered the objection that these were false statements made into my credentials records, and requested their correction. What actions has LTC Pearson LTG Crocker's JAG taken to correct my record? Why did Nancy Greenfield, RN, categorically refuse to correct these fasle statements.

 

"COL Jones' overview: October performance review poor:" However, there was no valid counseling session documented.

 

An erroneous clinic visit history is traced: that is, there is omitted any mention of the cardiac catheterization by a MAMC cardiologist Dr Miller and consequent referral to pulmonologist Dr Pluss. An accurate timeline from the MAMC computer database was evidently not utilized.

 

#231

 

Psychiatry Evaluation is requested by Impaired Provider Chief LTC Johnstone in November 1998.

 

Why did BG Hill not order the Command Directed Independent Medical Examination until 10 May 1999?

 

Dr O’Leary and Mr Mancuso,  the following documents are also relevant and can be made available to you and your staff:

 

#322 Article 138 denied by BG Hill.

 

Not only did BG Hill refuse to allow his own actions of 1 September to be investigated impartially; he also arranged transfer of my JAG counsel MAJ Cusker to his own service! In such a serious allegation that I made against him in the letters to Dr Bailey et al (that BG Mack Hill participated in a series of reprisals against me for talking with Dr Bailey, including my subsequent detention and physical abuse) it certainly conveys the appearance of impropriety that he requisitioned the one JAG officer who was assisting me with the official complaint.

 

Dr O’Leary and Mr Mancuso,  I had appealed to LTG Crocker, Commander of I Corps and Fort Lewis, for JAG assistance: LTG Crocker responded to my request IMMEDIATELY and in good faith, by assigning me MAJ Cusker.

 

BG Hill's actions seemed to  derail LTG Crocker's good intentions by arranging transfer of the JAG? Dr O’Leary and Mr Mancuso,  this action requires your review.

 

What was BG Hill's fear of facing an investigation in the nature of a 138, which is still pending at the DA level?

 

#329

 

Letter by e-mail from BG Kussman's investigating officer

 

I requested help from BG Kussman's JAG officer against reprisal from BG Hill. I documented my evidence that BG Hill's actions are intended and timed to derail the MAMC portion of witness interviews and evidence-gathering. I provided information that Dr Nielson's memorandum of 4 December 1998 to BG Hill's JAG predated the investigating colonel's visit by 2 days.

 

Dr O’Leary and Mr Mancuso,  NO witnesses were available besides myself who could verify the reckless endangerment case from Landstuhl. Yet before Dr Nielson's notification to MAMC Command of the impending visit of the investigator, I had arranged for 3 major witnesses to give testimony regarding one infant death and one untreated neuro-trauma case, as well as orders to abandon care and to deliver below standard of care, all regarding Landstuhl Army Medical Center under Command of then COL (P) Kevin Kiley.

 

#455

 

Apr 94 reprisal memo: This memorandum was delivered in person to COL (P) Layland 2 months before COL (P) Kiley's arrival at Landstuhl. It concerned JCAHO violations which endangered patient care, including ambulances without adequate airway equipment and brakes. COL Layland recommended an initial approach to the problems.

 

On COL (P) Kiley's arrival as Commander, fully expecting that he would take decisive action as COL Layland and I had agreed, I transferred all of the information to COL (P) Kiley.  LTC David Gillingham was just arriving from Madigan Army Medical Center. COL Lipsi ordered me to alter a document for LTC Gillingham's credentials file.  Since the request seemed irregular, I refused the order as unlawful. COL (P) Kiley  then made LTC Gillingham my new Chief and LTC Gillingham issued orders which he said originated with COL (P) Kiley for me to suppress all adverse quality assurance reports from my Department (Emergency Medicine.) I refused to do so on the basis of danger to patients; LTC Gillingham and COL Lipsi then initiated reprisals against me and my ER personnel.

 

We received orders to abandon care of certain unstable ER patient who could not immediately produce valid ID cards. Memoranda for record were generated, and we refused to carry out the reckless orders. LTC Gillingham and COL Lipsi then increased the level of reprisal, claiming direct orders from COL (P) Kiley.

 

Adverse patient outcomes were reported, and when this information was to be presented to JCAHO, I was medically evacuated 7,000 miles away to MAMC, where I have continued the complaint despite what I am reporting to higher headquarters as reprisals by MAMC Command. The investigation was finally coming to fruition in August 1998, with the help of LTG Blanck's report to DA and the 12 point 15-6 investigation under BG Kussman's jurisdiction.

 

Apparent violations of due process regarding credentialling were initiated against me in apparent reprisal, under the command of BG Mack Hill. My credentials are still not officially restored by BG Hill. Meanwhile the Heidelberg investigation recommended by LTG Blanck has faltered. COL Lipsi will retire 1 July 1999. This would not be allowed under current DOD guidelines if COL Lipsi were truly a respondent in an on-going investigation.

 

 

PLEASE SEE ATTACHMENTS AND THE FILES TO BE REVIEWED IN THE PROCEEDINGS

 

#462

 

Letters to Secretary Caldera and Dr Bailey

 

#467

 

McClatchy newspaper memo

 

#475

 

LARMC witness memos

 

#495

 

Kelly Theriot article

 

#496

 

Island Packet article on neuro-trauma case

 

#517

 

Ft Myer CID report

 

#521

 

MG David Hale Article regarding Court-martial at Fort Lewis

 

#522

 

Meines Medcom Memo

 

#525

 

Da IG Blackened out

 

#526

 

Col Jones

 

#528

 

BG Kussman

 

#530

 

Neilson Memorandum

 

 

Bubble Sheet Memo

 

 

#534

 

COL ALLEN RHODES MEMORANDUM (former MEDCOM Inspector General)

From - Sat Oct 18 14:33:07 1997
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        <cpt_jeanette_stone_at_medcom11__fshtx@medcom2.smtplink.amedd.army.mil>,

        <ltc_stephen_smith_at_medcen4-mamc@medcom2.smtplink.amedd.army.mil>

Subject: Re[2]: OFFICIAL REPORT TO MEDCOM JAG  &  TO MEDCOM CID

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Phil-

 

As I am taking a day or two off, am working this one from home.  I am

disturbed, to say the least, by LTC Smith's accusation that the

MEDCOM IG office never instigated an investigation--they guy is

clearly a few bricks short of a load.  I will provide him a reply

next week when I am in the office and have access to my regulations

and policy documents. 

 

His expectations and reality are not necessarily the same.

 

Birds were thicker yesterday than I have ever seen before, anytime,

anywhere.  See you Monday.

 

allen

 

 

 

 

 

_______________________ Reply Separator _______________________

 

Subject: Re: OFFICIAL REPORT TO MEDCOM JAG  &  TO MEDCOM CID

Author:  COL Phil Savoie at MEDCOM11_FSHTX

Date:    10/1/97 4:47 PM

 

    

     Dr. Smith

    

     As I am certain CPT Stone advised you, the MEDCOM Judge Advocate

     office stands ready to assist in any investigation that is initiated

     regarding your allegations.  The JAG office does not, however, have

     independent investigative authority, as does the CID, IG, commanders

     IAW AR 15-6 and AR 40-68 (QA focused) and members of congress.  The

     JAG office simply cannot initiate an investigation.

    

     We do, however, work closely with those investigative activities and

     provide legal support and advice when needed.  Undoubtedly, if one of

     the agencies finds evidence of wrongdoing, they will consult with my

     office for advice on how to proceed further.  We stand by to assist in

     any way possible.  You may feel free to advise anyone who is

     investigating this matter that they may consult with this office.

    

     Philip A. Savoie

     COL,JA

     Staff Judge Advocate

 

 

______________________________ Reply Separator _________________________________

Subject: OFFICIAL REPORT TO MEDCOM JAG  &  TO MEDCOM CID

Author:  LTC Stephen Smith at MEDCEN4-MAMC

Date:    10/1/97 08:35

 

 

     1 October 1997

    

     COL Savoie

     CPT Stone

     

     I appreciate your participation in assisting with my report to COL

     Atkinson for LTG Blanck about allegations of unlawful command activity

     at my previous assignment. Your help is appreciated since, as my

     witnesses reported to me on 6 September 1997, the witnesses reported

     evidence of falsification of Medical Records in the neuro-surgical

     case of 3 June 1995, as well as diversion of ambulance equipment from

     patient care, where it was badly needed to maintain standard of care,

     to apparent black market activities which CID is already

     investigating.

    

     I have reported to my Members of Congress that I requested THREE

     investigations at MEDCOM last week: (1) MEDCOM QA, (2) MEDCOM JAG,   

     and MEDCOM CID (Agent Patrick Tangarine). Is there a case # or file # to identify the JAG investigation? If so,

     I have also reported to the Members of Congress that the MEDCOM

     Inspector General investigation was NEVER initiated in regard to

     interviews of any of the 65 witnesses. In fact, MEDCOM IG NEVER

     interviewed me either by telephone or in person. This failure to

     investigate extremely serious allegations involving a Medical Corps

     LTC and a COL reporting to and following orders of the overall

     Commander, a promotable COL, seems to me also a JAG and CID matter.

    

     LRMC JAG CPT Heller also received a request to investigate on 9

     February 1995; however, like LRMC IG LTC Stearns, there was a failure

     to investigate.

    

     What other information do you require in order to pursue the MEDCOM

     JAG investigation of these matters?

    

    

     Respectfully,

    

    

     Stephen Whitlock Smith, MD

     Fellow, American College of Physicians

     Fellow, American College of Emergency Physicians

     LTC, MC

 

 

 

 

#536

 

13 points redacted---

1. Whether COL Lipsi, former Deputy Commander, Clinical

       Services, LRMC,

       and LTC Gillingham, former Chief, Ambulatory Patient Care

       Services, LRMC,

       created a hostile work environment for the Emergency Room (ER)

       staff, and

       LTC Stephen W. Smith, former Chief, ER, LRMC.

 

       2. Whether COL Lipsi and LTC Gillingham ordered LTC Smith and

       other ER

       physicians to violate their medical profiles.

 

       3. Whether COL Lipsi and LTC Gillingham placed unsubstantiated

       derogatory

       information in the credentials of physicians at LRMC.

 

       4. Whether COL Lipsi and LTC Gillingham improperly influenced

       the

       investigation of the treatment provided to ..............

 

       5. Whether COL Lipsi and LTC Gillingham altered medical records

       pertaining

       to his treatment of ............. and altered ER, LRMC,

       workload.

 

       6. Whether COL Lipsi and LTC Gillingham improperly ordered

       LTC Smith and

       the ER staff to refuse to provide medical treatment to critically ill and

       injured German national patients technically ineligible for ER care.

 

       7. Whether COL Lipsi and LTC Gillingham improperly conspired to

       create

       circumstance that would cause a bad patient outcome by exhausting

       and

       ruining the health of LTC Smith.

 

       8. Whether COL Lipsi and LTC Gillingham reprised against LTC

       Smith by

       deliberately under- staffing the ER.

 

       9. Whether COL Lipsi improperly threatened to refer LTC Smith to

       a mental

       evaluation (MHE).

 

       10. Whether COL Lipsi improperly ordered the opening of a fifth

       operation

       room while the surgical unit was critically understaffed.

 

       11. Whether COL Lipsi improperly required ............., former

       Neuro-Surgeon, LRMC, to be "on-call" 24 hours a day for 1 year.

 

       12. Whether LTC Gillingham intentionally violated the medical

       confidentially of LTC Smith's treatment for depression.

 

       13. Whether LTC Gillingham improperly transferred 15,000

       workload medical

       expense performance reporting system counts from LRMC

       emergency medicine

       service to the LRMC primary care clinic.

 

 

LEGAL CHALLENGES BASED ON FOIA DOCUMENTS

NOTATIONS REGARDING FOIA DOCUMENTS JUST RECEIVED

Hearing record+FOIA Documents+ 2 missing clinic records on me

11 May 1999

#1->22

#1 cred file ->13 Jan 1999

#2 cred apart from file?none

#3 given 13 Jan 1999

**NOT**Not evals until 3 march

#2,7,13,15,19 none @ Mamc

#4 Pa names withheld

#5,8,11,12,14 enclosed

#5 psycho ltc bruce crowe

written report not generated

**I saw him generate written report**->Ap f/u visit

#6 cred mi

**Impaired Provider**

#8 be more specific

#9  ->larmc

#10 ->larmc

#16 ->jcaho denied 10 usc 1102

#17,18 jag

#20,21 not finalized by mamc cmdr

#22 tape request ->not req verbatim transcript

#2,7j13,15,19 'no records finding'

#6,16 OTSG DENIAL

 

 

LEGAL CHALLENGES BASED ON JCAHO STANDARDS

Joint Commission

1998

Update #4

Automated CAMH

Comprehensive Accreditation Manual for Hospitals

The Official Handbook

Accreditation Policies

Standards

Scoring

Aggregation Rules

Decision Rules

1998 Copyright JCAHO.     Bound VIEWS Infobase, '98 upd #4

#39

Sentinel Event

Accreditation Watch

#40    

Flow Chart

#121  

Pt Rights

ethical questions

conflict resolution

reasonable access

#129

Code of Ethical Behavior

#133  

implementing ethical process

#140  

ethical behavior

ethical business practices

#145

Federal Crackdown on Fraud

#146

Maintaining ethical conduct throughout an Organization

#148

internal investigation

#149

handbook for hospital ethics committees

philosopher kings

#150

gag clause

#188

h+p w/i 24h

HCFA conditions of participation

#204

'a prison plugs in'

#203

'reducing risks of phone triage'

#207

telemedicine

#208

 telephone triage

#333  

'a fuzzy picture'

'pathways'

#334

telemed legal slow

#337

pts respn to md mistakes

#349

SCORING AND AGGREGATION FOR

#358

SUGGESTED READINGS AND OTHER RESOURCES

#383

Hcfa conditions of participation

discharge planning

BALANCED BUDGET ACT OF 1997 (EFF 3 NOV 97)

HOME HEALTH AGENCIES (HHA)

#388

SECTION II

ORG BASED

#392

'the following is a list of all standards for this function.'

#424

GOVERNMENT HOSPITAL

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

#427

Allison mj

including dissatisfied customers on a quality improvement team

enriches the possibilities

#436

'sentinel events'

#440

leadership

#472

radionuclides

#503

HEALTH CARE FINANCING ADMINISTRATION

#512

Env of Care

#521

Hazardous Waste

#569

Medical Equipment

#573

OSHA

#584

Human Resources

#587

HR.1 DEFINE EXPECTATIONS

#591

PEER REVIEW PROCESS

#592

*RECEIVE FEEDBACK

#588

*UNUSUAL EVENTS

#600'S

Information

#725

Governance

**#727

GO.2.2 THROUGH GO.2

*medical staff membership may be terminated

*fair-hearing

*GO.2.3

qualified and competent CEO

*GO.2.4

compliance with applicable law + regulation

*GO.2.5 + MS.3->MS.3.1

review bylaws + rules + reg c/w org policy and applicable law and

other requirements

GO.2.6

*conflict resolution

GO.2.1

*conflict of interest

#730

GO.2.4

*ALL APPLICABLE LAWS+REGS

#734

*nuclear regulatory commission

#736 Management

MA.1.1 edu/exp for respons

MA.2 ceo complies w/ appl law + reg

MA.2.1 ceo prompt reg

#742 COMPLIANCE OFFICER

20.22 Medical Staff

#745

*MS.2.3.2

*fair hearing and appellate

#747

*med staff exec committee

*fair hearing

#749

*credentialing

**DOD DIRECTIVES

WHISTLEBLOWER

#749

*cred process

'range of info must be explicit'

MS.5.2

*fair hearing

(CONFLICT

(COMPLIANCE

inad ceo (Accusation 8)

*MS.5.4

*uniformly applied

*MS.5.4.4.1

*fair hearing and appeal process

*MS.5.4.5

*decisions directly related to quality of care

#751

*MS.5.13

*DEPT CHIEF REC CONSIDERED

#757

*Intent of MS.1->MS.1.13

#775

*STANDARDS, INTENTS, AND EXAMPLES FOR CREDENTIALING

#797

**MS.5

**'All cred files rev'd ind that thes mech hv bn cons/unif applied

#846

Suggested readings

#965

***HCFA

REVISION TO CONDITIONS OF PARTICIPATION

 

 

LEGAL CHALLENGES EXTRACTED FROM AR 15-6

1.4.D Concurrent investigations

'procedures under this regulation do nut hinder or interfere w/ a concurrent inv dir'd by higher HQ.'

1.7       Respondents

(designated only in formal investigations)

1.8       notify respondent in writing

2.0       Resp of App Authority

2.1.C Who appointed?

Senior to respondents x military exigencies.

2.2 Admin Support

*necess facilities, etc

?contract reporter

2.3.B Legal review

servicing JA

2.3.C Effect of errors

(1)       Harmless errors

(3)       Substantial errors->nullity

material effect on an individual's substantial rights,

(d)       In case of an error that cannot be corrected otherwise, the app auth may set aside all findings

· >rec new inv off

(4)       Failure to object

3.SECTION-I

Conduct of the Investigation

Subtopics

Challenges/rules of evidence/Witnesses/Commo w/ the App Auth

3.1.A Requirement

'swearing of witnesses'

3.2 Challenges

lack of partiality

3.6.A General

a-General

rules of evidence

mind of reasonable persons

3.6.C Limitations

Privileged commos

(5)       Ordering witnesses to testify (self-incrim UCMJ, Art 31) 5th Amendment

(d)       read rights under Art 31

3.7.A General

(1)       no authority to subpoena

b. Expert witnesses

3.7.C testimony & statements

3.7.D discussion of evidence

3.8

*Commo w/ App Auth

enlarging

3.SECTION-II Findings/rec

3.9       Findings

f.Expl by invest off of any irreg

3.15 Exh

b. Real evidence

**disposal per AR 190-22

3.15.E Objections.

Noted in proceedings

5.1.D legal advisor

respondent & counsel must be present when legal advice provided to

board

5.3.A Before a session

(6)all approp records

5.3.C after proceedings

prompt prepn of proceedings

5.7. Challenges for cause

5.8.A Rights of respondent

a. Right to be present

 

 

LEGAL CHALLENGES EXTRACTED FROM AR 40-68

** upon report of recovery

impaired provider ad hoc committee req & review statements from a physician.

1.7 confidentiality statute

(4) provides immunity

good faith

rev med QA records

1.7. E Exceptions to nondisclosure

**(1) agency

accreditation

**(2) adm/jud by dod practiioner

**(3) Gov boards, agencies, orgs to lic/cred/mon prof stds

**(6)(criminal investigators)

**(7) protect publ health/safety

1.7.F Sec Disc

**1.7.J

FOIA

INITIAL DENIAL AUTHORITY

OTSG

2.1.B Cred committee

b.        

**recs sent to Medcom for approval

2.3 Impaired provider ad hoc committee

**g.

members receive appropriate training to assume the responsibilities of the committee.

4.1       General

a...,**The privileging process

is directed solely & specifically to the provision of quality pt care

is not a disciplinary or pers mng mech.

4.2.B

priv acts

b.

4.4.A Military

**a.(1) elim under AR 635-100 or Ar 135-175

4.9       Suspension

(3)

QA Inv

**(a) In cases of summary action there will be an immediate investigation.  The chairperson of the cred comm will appoint an officer, pursuant to the authority of this reg, to conduct an informal invest and report to cred comm.

(3)       Collateral actions

**suspected drug

memb imp prov com apptd to hearing com

(2) A susp period will not ordin exceed 60 days & can only be ext by

cmdr for good cause

f. Hearing committee procedures

(3)       practitioner free to consult w/ legal counse4..

May attend....not allowed to participate.

(5)       If crim misc susp

chair adv of rights using DA Form 3881

**Any objections made by pract ruled on by chairperson

4.9.G Action on hearing recomendations

**(2) Prior to action by cmdr recorp, incl findings and rec, will be reviewed by a JAG or DA civ att for legal suff/not CJA.

**3)Cmdr review

Cmdr decision

Written notice of deciio and date deliv will be delivered to practitioner.

If restn->appeal rights

*4.9.Kk. Reporting reqs

susp->cmdr DD Form 2499

Health Care Provider Advers9 Clin Priv Ac7io rep

RCS DD-HACAR)1611

*one copy w/i 3 d

thru nxt higher hq

to HQDA

(b) If allegn not subst

cmd will send a report w/i

7 workdays of compltn inv

to HQDA

1. Summ of info giving rise to inv

2. Rationale for cmdr's decision.

3.         Notation signifying level of confidence in practnr'5 performance

(c) Status reports (status changes) using DD FORM 2499 until final action completed.

Form 2499

have date mailed from MTF in the top rt corner.

(3) Hearing decision

Copies of written notice of cmdr's decision (g above) will be sent to

the next hhq

(4)**Restn

DD Form 2499

submitted per (1) above

(5) Rep actns unprof conduct.

DD Form 2499per (1)

(a)fraud/(b)fraudcontract/(c)cheating/(d)serious misdemeanor/(e)nolo

contendere/(f) abr prof res

**(6)Charged practitioner sepn

until crim invs & res priv action final

**UNLESS SEC ARMY authorizes earlier sepn.

**(7)Reporting authority=TSG

***FOIA INIT DENIAL AUTHORITY

FED ST MD BDS

NAT PRAC DB

OTHER APPR CENTR CLEARING HOUSES

(8)

Late charges

**12 months after sepn

**DD Form 2499

***4.10

Appeal process

OTSG

(HQDA (SGPS-PSQ), 5109 Leesburg Pike, Falls Church, VA 22041-3258

CERT MAIL RET/REC/REQ

4.11    Practitioner's credentials file

a.PCF

**DOCUMENTS

SIX PART FILE

(1) I

a. Id photo

b. Da f 4691-R

c. Da f 5440-R series (current and past)

d. Da f 5441-R series (current and past)

e. Da f 4692-R clin priv ann eval (past)

f. Da f 5753-R USAR for RC

II

a. Da f 5374-R (current and past)

b. Prov act prof data per

4-8e(3)

c. Cred/priv granted from civ mtf's

(3)

III

Documents of adv actn

a) Letrs of notif

b) Letrs of ack

c) Hearing summary or minute

*d) Investigations

e) Adv stm to include NPDB reports

f) Letters of decision

g) Mal claims

NPDB

h) Copies of any other adverse infm

IV

a. Cme

b. Lectures

(5)

Sec V

Da forms frum preu mtf's

(6)

Sec VI

a. Dipl/lic

b. Verif para 4-6 c

B. Pcf release only

c. Pcf kept for career

d. PCF forwarded

e. Disp pcf

(1) pcf/paf w/ p

Ar 40-68 cont

(1) Hqda at sepn

(2) pcf stays 12 months at mtf

(3) pcf if sep/ret->  Ar 25-400-2, fn 40-66d

4.12    PAF

a. Peer rev working file

(1) Practice profice AQCESS practice profile reports:

dc's, proc./deliv/icu/deaths

(2) ave daily pt load/#times emerg suc/deployed/supvr

AR 40-48

(3) Outcome

numb cases subst

(4) MALPR

**(5) Adm

**(6) Committee Actions

(7) Other

4.13    NPDB REPORTS

**Pl 99-660

NPDB

HCP DATA BANK INQ

(HEALTH CARE QUAL IMP ACT of 1986 PL 99-660, title IV

'HCP (para 9-1) reported

10 USC 1102 protection

unless info false

4.13.C Prof rev actions

**c. Prof rev actns  (TSG notif auth)

(1) adv priv

(2) unprof conduct

(3)

4.13.D

PCF

d.         For NPDB placed in Part III

4.13.E

NPDB Reports to nxt higher HQ TO

***TSG

***copy given to HCP**

**Inq made

**by Medcen at beginning of inv of HCP for

subst perf or unprof behav

**7.2

Obj of Imp Prov Prog

a.         Prev imp and promote well-being ...minim factors that contribute to impairment

b.         Id imp asap in order to promote recov & ensure pt safety

d.         Prov mech for returw to clin prac for HCP's who have been successf rehab

e.         Prov a mech for ongoing monitoring

7.3 Mnmnt imp by med/psych

a. Any hcp KNOWN OF having Psych

rep to imp prov ad hoc comm

(para 2-3)

c. Imp Prov ad hoc comm

will review

e-Upon report of recovery

rec to cred comm re removal of limitations

7.4.B

Imp prov rep

b.         Imp prov susp of drug abuse

rep to Imp Prov Ad Hoc Comm

**7.4.C Program Compon

c.         AR 600-85

(1)       Prevention

7.5**Notif to prof reg auth

a.         Per para 4-9k for privileged

b.         Notif for any HCP who

(1)       susp/lim/restr/revoked

(2)       illegal drugs

(3)       separates in less than full practice

(4)       leaves w/i 2 yr monitoring

9.0 Prof Lic

**Ar 600-8-2

Susp fav pers actions

 

 

OTHER REFERENCES TO WHICH WE SHALL REFER AT THE HEARING

References

 

1. 1993 Accreditation Manual for Hospitals, volume I.  Standards.  1992 by the Joint Commission on Accreditation of Healthcare Organizations.  One Renaissance Blvd, Oakbrook Terrace, IL 60181.

2. 1993 Accreditation Manual for Hospitals, volume II.  Scoring Guidelines.  1992 by the Joint Commission on Accreditation of Healthcare Organizations.  One Renaissance Blvd, Oakbrook Terrace, IL 60181.

3. USAREUR Regulation 632-10, paragraph 26a:

"Personnel will not interfere with, or prevent any person from presenting, a complaint or grievance, real or imagined, to the person's superior, commanding officer, Member of Congress, or other appropriate agency."

4. US P.L. 102-484, Sec 546: Mental Health Evaluations of Members of the Armed Forces.

 

 

 

LEGAL PRECEDENTS

 

VOGE

KIRKLAND

TUFARIELLO

PEARL

WALLENBERG

WEISS

REID

REIMAN

NORRIS

SCHALLER

 

 

Dr O’Leary and Mr Mancuso,  my counsel and I have other legal challenges to forward to you regarding the original documents in my credentials records: however, I will reserve these until we can review the original documents together with JAG and other counsel and a recorder present.

 

 

 

 

PLEASE SEE ATTACHMENTS AND THE FILES TO BE REVIEWED IN THE PROCEEDINGS

 

Honorable Louis Caldera

Secretary of the Army

101 Army Pentagon

Washington, DC 20310-0101

 

 

SUBJECT:      REQUEST FOR AN INVESTIGATION IN THE NATURE OF AN    

                    ARTICLE 138 INVESTIGATION          

 

Dear Sir:

 

I am an active duty Army Lieutenant Colonel and a doubly board-certified physician currently assigned to Madigan Army Medical Center in Tacoma, Washington. I urgently request that you initiate an investigation, in the nature of an investigation under Article 138 of the Uniform Code of Military Justice, and that the subjects of the investigation include, but not be limited to, Brigadier General George Brown, Commander of Madigan Army Medical Center, and of Brigadier General Kevin Kiley, former Commander of Landstuhl Army Medical Center and currently assigned to the Office of the Surgeon General of the Army.

 

In February 1996, when I was assigned to Landstuhl Army Medical Center in Germany, I requested an Inspector General and Congressional investigation of allegations of wrongdoing by certain high ranking Army doctors at Landstuhl. General (then Colonel) Kiley was specifically aware that I had initiated the complaint, which concerned allegations of intentional reckless endangerment of emergency patients at Landstuhl by two physicians who said they were following General Kiley's orders.

 

In my view, General Kiley's Inspector General at Landstuhl, LTC Stearns, failed to undertake an adequate investigation of the allegations. When I continued to pursue the complaints and press for an investigation in February 1996, the response included  (1) medically unjustified incarceration in a locked psychiatric ward at Madigan Army Medical Center, then and now under the command of BG Brown; (2) orders, against Army Regulations, to move my family from Landstuhl to Madigan immediately (even with two school-aged children) (3) explicit threats to remove my medical credentials after the Army Times began making inquiries about General Kiley, (4) explicit threats by the Command in early 1998 to reduce my credentialing status to that of a General Medical Officer (one who has not completed residency training), and (5) most recently, unjustifiable detention by General Brown's civilian chief of security who told me he was acting under instructions from the Command.

 

Selected documentation concerning this matter is attached, consists of  (1) a lengthy, detailed letter to the editor dated May 11, 1998, concerning the events at Landstuhl and my efforts to get them investigated and  (2) a July 28, 1998, article from the Hilton Head (South Carolina) Island Packet about one of the tragic events at Landstuhl referred to in my May 11, 1998 letter to the editor. There is already some press awareness of and interest in the allegations concerning Landstuhl Army Medical Center.

 

Sir, should you so direct, I am prepared to brief you or your representative regarding this serious complaint. My duty telephone number at Madigan Army Medical Center is: (253) 968-3866. Before other patients are harmed, I request an immediate investigation regarding the now long-reported actions and related orders of BG Kiley, COL Lipsi, and LTC Gillingham at LARMC, as well as the resulting coverup. 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.

 

In order to brief yourself or other officials high in the chain of command in Washington, DC, I would require military travel orders to be released from my patient care responsibilities long enough to give a thorough testimony regarding these extremely serious allegations.

 

 

Thank you for your attention,

                                     

STEPHEN WHITLOCK SMITH, MD, LTC, MC

(GEORGE WASHINGTON UNIVERSITY, 1980)

Fellow, American College Emergency Physicians (1990)

Fellow, American College Of Physicians (1983)

Cc: Rep. Dicks, McDermott, Pelosi, Spence, Sen. Boxer, Feinstein, and Thurmond, For Record

 

 

 

September 19, 1998

Honorable Sue Bailey, MD

Assistant Secretary of Defense (Health Affairs)

1000 Defense Pentagon

Washington, DC 20301-1000

 

 

 

RE: Our Discussion at Madigan Army Medical Center on the Occasion of  

the Ribbon Cutting Ceremony for TriCare Senior Prime, 1 September 1998

 

Dear Dr Bailey:

It was a great pleasure to make your acquaintance as another graduate of George Washington University School of Medicine. I have very fond and valuable memories of our school, and about what I learned there about the patient's welfare coming first before all other priorities.

 

As you may recall, when you were recently at Madigan Army Medical Center, we talked briefly in front of the Internal Medicine Clinic where I am the Acute Care Physician for Medicare Internal Medicine patients. As we discussed, I had hoped to participate in guiding your tour through our clinic, particularly since Internal Medicine has signed up the majority of the new Medicare enrollees.

 

After my conversation with you, however, Brigadier General (BG) Brown's civilian personal security chief detained me and escorted me away from your tour. He physically obstructed my access to the first floor of the medical center; coerced me with a hand at my back and waist; and escorted me to his office on the second floor. I was astonished when he said that the Command (or Commander, (I did not hear distinctly which of the two titles he used) had accused me of being a security threat to you; that I was accused of carrying a concealed weapon; and that he might have to "pad me down" for weapons. I had nothing of the kind in my possession, do not own a weapon, and, even if I did, would never bring a weapon to work. I offered to allow him to search me; however, he did not do so. He finished the interrogation by telling me that the Command ordered me to return to my duty station, and that my Department Chief was directed to lead your tour through Internal Medicine's new TriCare Senior Prime Clinic instead of myself. He escorted me, again physically restraining me with a hand behind my waist, down two escalator flights, well away from BG Brown's conference room where your afternoon tour was to begin. Rather than make an inappropriate scene, I remained quietly in the Internal Medicine TriCare Senior Prime Clinic where I am assigned as the Acute Care Physician. Your tour never entered our section.

 

I'm not absolutely certain why the General's security chief took this extraordinary action, but, given that I am the source of an official complaint, currently being investigated, about alleged wrongdoing by several high-ranking Army physicians, I have to wonder if the purpose was to limit my contact with you lest I take the opportunity to discuss the complaint and related investigation to you.

 

I respectfully request and would appreciate an opportunity to discuss this situation with you, at your earliest convenience.

 

I am requesting today that the Secretary of the Army initiate an investigation, in the nature of an investigation under Article 138 of the Uniform Code of Military Justice, to determine what actions BG Brown instructed his civilian security chief to take against me, the reasons for such actions, and whether such actions improperly restricted me from having access to you to discuss my pending complaint of wrongdoing by high ranking Army doctors which I observed at Landstuhl Army Medical Center when I was assigned there before coming to Madigan Army Medical Center. As BG Brown knows well, I have not been silent about what happened at Landstuhl and I frankly believe that certain actions taken against me at Madigan were reprisals for my refusal to keep quiet about the events at Landstuhl which are the subject of my complaint.

 

Selected documentation concerning this matter is attached, consists of  (1) a lengthy, detailed letter to the editor dated May 11, 1998, concerning the events at Landstuhl and my efforts to get them investigated and  (2) a July 28, 1998, article from the Hilton Head (South Carolina) Island Packet about one of the tragic events at Landstuhl referred to in my May 11, 1998 letter to the editor. There is already some press awareness of and interest in the allegations concerning Landstuhl Army Medical Center.

 

Dr Bailey, should you so direct, I am prepared to brief you regarding this serious complaint. My duty telephone number at Madigan Army Medical Center is: (253) 968-3866. Before other patients are harmed, I request an immediate investigation regarding the now long-reported actions and related orders of BG Kiley, COL Lipsi, and LTC Gillingham at LARMC, as well as the resulting coverup. 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.

 

 

In order to brief yourself or other officials high in the chain of command in Washington, DC, I would require military travel orders to be released from my patient care responsibilities long enough to give a thorough testimony regarding these extremely serious allegations.

 

 

Thank you for your attention,

                                     

STEPHEN WHITLOCK SMITH, MD, LTC, MC

(GEORGE WASHINGTON UNIVERSITY, 1980)

Fellow, American College Emergency Physicians (1990)

Fellow, American College Of Physicians (1983)

Cc: Rep. Dicks, McDermott, Pelosi, Spence, Sen. Boxer, Feinstein, and Thurmond, For Record

 

 

 

(From HILTON HEAD ISLAND PACKET, McClatchy Company)

Header: Category: Local News, Creator: Mike Ramsey, PaperDate: 7/28/98, PaperPage/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 it¹s 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. "I¹m angry, but what can I do?" Wood said. "They know they have done something wrong, but won¹t do anything about it."

Wood has filed a claim against the U.S. Army for malpractice, but he and his family aren¹t optimistic. The Army¹s Office of the Judge Advocate General in March turned down Wood¹s initial claim for $7.5 million. Wood¹s 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 Army¹s review of the case was thorough and above-board.

John DeCrosta, Thurmond¹s 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. Wood¹s 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. Landstuhl¹s emergency-room doctor sent Wood home after treating him for scrapes and bruises, according to Wood¹s claim. The doctor didn¹t 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 Wood¹s 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. Wood¹s 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.

"It¹s a good faith system," Brem said. "Potentially, the Army could come back and say, Yes, we were negligent, but we still aren¹t going to award you damages." Another lawyer working on Wood¹s 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 Army¹s denial.

"Self-regulation doesn¹t 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 don¹t worry because they know people can¹t 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 Wood¹s treatment as one example of a number of problems.

Despite what Brem calls "extremely substantial" evidence supporting Wood¹s 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 Wood¹s head because it didn¹t start until the next day. But Smith said that wasn¹t necessarily true, and the doctor should have held the boy overnight anyway for observation because Wood had lost consciousness during the fall.

 

 

Author:  LTC Stephen Smith at MEDCEN4-MAMC

Date:    9/18/97  11:24 AM

Priority: Normal

Receipt Requested

TO: LTC Darrell Stafford

TO: COL Sid Atkinson at MEDCOM3_FSHTX

TO: COL James Kirkpatrick at MEDCOM5_FSHTX

TO: LTC Ann Brazil at MEDCOM3_FSHTX

TO: Charles Deal at MEDCOM3_FSHTX

TO: Karyn Del Rio at MEDCOM3_FSHTX

TO: Andrea Shea at MEDCEN3_MAMC

TO: COL Matthew Rice at MEDCEN1_MAMC

TO: Michael Meines at MEDCEN1_MAMC

TO: COL Casey Jones at MEDCEN1_MAMC

TO: BG George Brown at MEDCEN1_MAMC

TO: LTG Ronald Blanck at OTSG5_FLSCHRCH

TO: BG John S Parker at OTSG1_FLSCHRCH

Subject: Re[3]: REPORT TO MEDCOM QA STARTING 22 SEPTEMBER (NEXT MONDA

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

Thursday, 1100 hours

    

    

I am very grateful for all of the assistance which

you are providing to enable my report to the

Quality Assurance experts at MEDCOM.

    

I have just talked with LTC Ann Brazil of your office

who is initiating travel orders.

    

Special thanks are due to LTG Blanck and Brigadier General Brown

and their staffs.

    

     

Respectfully,

    

    

Stephen Whitlock Smith, MD

LTC, MC

FACEP, FACP

    

    

per Senators Feinstein/Glenn/Thurmond PL100-456

    

______________________________ Reply Separator _________________________________

Subject: Re[2]: REPORT TO MEDCOM QA STARTING 22 SEPTEMBER (NEXT MONDA

Author:  LTC Darrell Stafford at MEDCEN4-MAMC

Date:    9/18/97 9:46 AM

    

    

     Dr. Smith:  Please contact LTC Brazil at DSN 471-6195 on your travel

     plans.  I just spoke with her and they cannot see you on 23 Sep, but

     can see you on 24 Sep.  Please call her or Charles Deal and they will

     make the arrangements.  DES

    

    

______________________________ Reply Separator _________________________________

Subject: Re: REPORT TO MEDCOM QA STARTING 22 SEPTEMBER (NEXT MONDAY)

Author:  LTC Stephen Smith at MEDCEN4-MAMC

Date:    9/17/97 6:14 PM

    

    

     17 SEPTEMBER 1997 1430 HOURS

    

    

     LTC STAFFORD:

    

     I AM NOTIFYING YOU THAT I GRATEFULLY ACCEPT LTG BLANCK'S OFFER FOR TDY

     TO DISCUSS QA CONCERNS WITH MEDCOM.

    

     THE ONLY TIME FREE FOR ME TO LEAVE THE DEPARTMENT IS NEXT WEEK, AND I

     AM SORRY FOR THE LATE NOTIFICATION. I REQUEST THE FOLLOWING IF AT ALL

     POSSIBLE:

    

    

                   1. TRAVEL STARTING MONDAY 22 SEPTEMBER IN THE AFTERNOON

     (SO THAT I CAN WORK HERE DURING THE DAY)

    

                   2. A MEETING WITH MEDCOM QA IN THE LATE AFTERNOON

     TUESDAY 23 SEPTEMBER.

    

    

     MY DEPARTMENT CHIEF AND ADMINISTRATOR HAVE BEEN INFORMED AND ARE IN

     AGREEMENT.

    

    

     RESPECTFULLY,

    

    

     STEPPHEN WHITLOCK SMITH, LTC, MC

    

    

    

Author:  LTC Stephen Smith at MEDCEN4-MAMC

Date:    9/18/97  12:45 PM

Priority: Normal

Receipt Requested

TO: stevewsmith@pol.net at Internet-Mail

TO: llamer@pop.flash.net at Internet-Mail

TO: lyancey@pol.net at Internet-Mail

TO: cbottoni@aol.com at Internet-Mail

TO: hasket@gwsmtp.mgmc.af.mil at Internet-Mail

TO: RTabach123@aol.com at Internet-Mail

TO: wwmed@pop.mindspring.com at Internet-Mail

Subject: POC's and Summary

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

    

     Because time is short before the appointment that I have with MEDCOM,

     I am sending information and POC's as available.

    

    

    

     Author:  LTC Stephen Smith at MEDCEN4-MAMC

     Date:    9/18/97  11:24 AM

     Priority: Normal

     Receipt Requested

     TO: LTC Darrell Stafford

     TO: COL Sid Atkinson at MEDCOM3_FSHTX

     TO: COL James Kirkpatrick at MEDCOM5_FSHTX

     TO: LTC Ann Brazil at MEDCOM3_FSHTX

     TO: Charles Deal at MEDCOM3_FSHTX

     TO: Karyn Del Rio at MEDCOM3_FSHTX

     TO: Andrea Shea at MEDCEN3_MAMC

     TO: COL Matthew Rice at MEDCEN1_MAMC

     TO: Michael Meines at MEDCEN1_MAMC

     TO: COL Casey Jones at MEDCEN1_MAMC

     TO: BG George Brown at MEDCEN1_MAMC

     TO: LTG Ronald Blanck at OTSG5_FLSCHRCH

     TO: BG John S Parker at OTSG1_FLSCHRCH

     Subject: Re[3]: REPORT TO MEDCOM QA STARTING 22 SEPTEMBER (NEXT MONDA

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

     -------------------------------

     Thursday, 1100 hours

         

         

     I am very grateful for all of the assistance which

     you are providing to enable my report to the

     Quality Assurance experts at MEDCOM.

         

     I have just talked with LTC Ann Brazil of your office

     who is initiating travel orders.

         

     Special thanks are due to LTG Blanck and Brigadier General Brown

     and their staffs.

         

         

     Respectfully,

         

         

     Stephen Whitlock Smith, MD

     LTC, MC

     FACEP, FACP

         

         

     per Senators Feinstein/Glenn/Thurmond PL100-456

         

     ______________________________ Reply Separator __

    

    

    

    

    

     A SUMMARY

    

    

     The precipitous drawdown of the Army's training and quality of life

     is, according to recent reports, also impacting adversely on

     healthcare delivery. A number of unresolved Inspector General and

     congressional cases, initiated both by patients and by Army physicians

     and nursing staff are setting off alarm bells in the halls of

     Congress. Multiple extremely serious allegations regarding risks to

     patients and staff at the Army Medical Center level have reportedly

     been bogged down at various IG levels for well over a year. Members of

     Congress have still not succeeded in convincing the DA IG to conduct

     interviews under oath of many key witnesses.

     Recent critical attention has focussed on the US military's ONLY

     Medical Center in

     Europe, Landstuhl Regional Medical Center. Since Landstuhl began

     transforming into the one Medical Center in 1994 and received

     casualties from both Somalia and Bosnia, expectations of its level of

     care have increased. Landstuhl has gained an in-patient psychiatric

     unit, as well as a high risk Labor and Delivery Unit and Neonatal

     Intensive Care Unit. The Intensive Care Unit has upgraded its

     technology.

     In 1995, a former OB-GYN service chief at Landstuhl had reported

     via the Command a former Landstuhl Deputy Commander for Clinical

     Services for reckless endangerment of patients and staff, and for

     unlawful orders. The key precipitant of this struggle was the alleged

     refusal of the former DCCS to ask for additional OB-GYN physicians to

     reinforce the newly designated high risk Labor and Delivery Unit at

     the beginning of Summer 1994. The written complaint alleges that only

     three OB-GYN physicians remained at Landstuhl in the late spring of

     1994, and that this was not enough staff for the safety of high-risk

     patients. The recommendations of the Army Surgeon General's Obstetrics

     Consultant were not observed, continues the allegation.

     The same Obstetrics Chief also reports that when he himself succumbed

     to the staff burnout which had been predicted, that the same DCCS

     harassed him repeatedly over the next year, first threatening and then

     actually issuing abysmally poor evaluations when the obstetrician

     refused to work beyond the medical profile designed to protect him

     from another major depression.

          The fundamental question is not whether, but rather HOW MUCH the

     quality of patient care deteriorates when physicians and nurses are

     deliberately worked beyond their physical and mental capacities. An

     even more dangerous situation involving deteriorating standards of

     emergency care is portrayed in the stalled IG complaint of a former

     Landstuhl Emergency Medical Service chief.

          Informed sources report that LTC Stephen W. Smith former LRMC ER

     chief presented an IG complaint to LRMC ASST IG MAJ O'Leary & to GEN

     Kiley in early February 1996. This IG complaint accused COL Lipsi,

     former DCCS, & LTC Gillingham, Chief of Ambulatory Patient Care, who

     worked for him, of recklessly endangering LRMC ER patients, nursing

     staff & physicians by unlawful orders, harassment, & disregard of

     regulations.

          The complaint alleges that COL Lipsi and LTC Gillingham strictly

     enforced a policy of withholding medical care from medically unstable

     patients who could not prove their eligibility for LRMC services.

     Whenever challenged on the basis of safety, both COL Lipsi and LTC

     Gillingham reportedly affirmed that it was GEN Kiley 's order to place

     unstable patients back in their cars and to advise them to go to the

     nearest German hospital.

          Allegedly, COL Lipsi repeatedly quoted General Kiley as ordering

     that the ER RECEPTIONISTS (who are not credentialed in medical triage)

     stop potentially noneligible patients at the front desk. (Emergency

     medicine sources report that the standard of care is that unstable

     patients are NEVER asked for their ID if there is an immediate threat

     to life and limb.)  LTC Smith and the ER Nursing Staff reportedly asked

     COL Lipsi for a written order that would explain hospital policy in

     this regard; COL Lipsi allegedly never confirmed these orders in

     writing; however, MAJOR Charles Oliver of Patient Administration

     Division is credited with supplying copies of two existing regulations

     which allowed lifesaving treatment until a safe transfer could be made:

        "Update AR 40-3:  4-59 (1993 Edition). Civilians in emergency:

                a. Any person is authorized care in an emergency to prevent

     undue suffering or loss of life. Civilian emergency patients not

     authorized Army MTF services will be treated only during the period of

     the emergency. Action will be taken to dispose of such patients as soon

     as the emergency period ends."

        "LARMC PAM 40-24: ADMINISTRATIVE HANDBOOK FOR PHYSICIANS:

     ELIGIBILITY FOR MEDICAL CARE (1993 Edition)

                page 16 b. In the case of US civilians visiting soldiers In

     Europe, the LARMC Commander's policy is that emergencies will be seen

     immediately, and non-emergencies will be seen on a pre-paid, space

     available basis when the provider determines that care is necessary to

     prevent undue suffering, to include the mental suffering of attempting

     to secure health care in a foreign environment. However, care will be

     limited to the acute minifestation only and will not include elective

     procedures or inpatient care which can be safely deferred until the

     patient returns to the US."

          The complaint continues that LTC Smith, MAJ Laurie Sandstrom,

     former LRMC ER Head Nurse, and COL Carolyn Bulliner, Deputy Commander

     for Nursing,  protected the ER receptionists from COL Lipsi's unlawful

     order to practice economic triage.  Reference to a copy of the IG

     report provided to Members of Congress shows the following case

     summaries:

     Specific Cases:

     CASE #1: April 1994, 35 year old Polish female immigrant with unstable

     ectopic pregancy - COL Lipsi allegedly ordered both Er physicians CPT

     Anderson and LTC Smith and the obstetrician on call  to ABANDON care

     of this patient, since she was technically ineligible for care at

     LRMC.  The ER physicians disregarded COL Lipsi's order as unsafe, and

     referred the patient to Obstetrics which diagnosed and treated the

     ectopic pregnancy. LTC Smith further reports receiving an angry,

     threatening telephone call from COL Lipsi later that evening

     containing the direct order for LTC Smith to turn that patient away if

     she should return.

     CASE #2: September 1994 - 60 year old female with disorientation, 

     generalized contusions, suicidal depression,  and without anywhere to

     go. The LRMC ER reportedly held the patient as too unstable to

     discharge; after x-rays ruled out the presence of fractures,  The

     patient was referred by LTC Smith to the general surgeon on call, and

     was seen by Social Work Chief LTC Robichaux and admitted by LRMC

     Psychiatrist Dr. Alfano. COL Lipsi and LTC Gillingham reportedly

     reprimanded LTC Smith for treating this patient. COL Lipsi is quoted

     as telling LTC Smith during the reprimand session that GEN Kiley had

     ordered a punitive deduction from LTC Smith's paycheck to pay for the

     patient's care.

     CASE #3: February 1995 - an elderly female with dehydration,

     orthostatic hypotension, loss of consciousness and altered mental

     status. LTC Smith reportedly received an angry direct order from COL

     Lipsi to discharge this patient, while COL Lipsi remarked, within

     hearing of all of LRMC ER nursing staff,  especially CAPT Cape, CAPT

     Lamer, MAJ Sandstrom, SSG Marmann, SSG Gaines, SSG Barrett, and TSGT

     Bulger, that LTC Smith was to pretend that Landstuhl was "a rural

     hospital in Kansas," and to put the patient back into her car and tell

     her to go to a German hospital. The report verifies that the ER

     personnel did not obey COL Lipsi's order but instead continued IV

     fluids and monitoring as well as cervical spine precautions, and

     stalled until the Liaison Representative was able to arrange an ALS

     ambulance transfer to a local intensive care unit.

     CASE #4: June 1995 - MAJ Brian Lein, General Surgeon, is reported by

     LRMC ER personnel to have received an unlawful direct order from COL

     Lipsi to send home a 15 year old boy with post operative sepsis.

          Accusations against col lipsi & ltc gillingham include forcing 2

     physicians, well known by the command to be under psychiatric care for

     rapidly worsening major depression, to work in the lrmc er, refusing

     them leave time & ignoring their official profiles. Further

     allegations are that LTC Smith and LRMC ER Nursing Staff were

     reprimanded by COL Lipsi at 0900 on Monday 12 June 1994 for the

     lifesaving transfer of a neurosurgical patient, who was in extremis

     secondary to brain herniation, to a local Neurosurgical Intensive Care

     unit. Other reprisals against ER personnel for requesting adequate

     resources to maintain a safe standard of emergency care include a

     reprimand session against LTC Smith chaired by GEN Kiley and LTC

     Gillingham at 1830 hours on Tuesday 20 June 1994 in GEN Kiley's

     office. The reprimands to LTC Smith were reportedly delivered in the

     wake of the neurosurgical tranfer in order to intimidate him.

          Also reported was the reprisal withholding of awards by ltc

     gillingham and col lipsi to two air force physicians because they had

     written a memo through their air force chain of command, 86th Medical

     Group at Ramstein AFB recommending enhancements to lrmc's emergency

     medical service as it became the only emergency trauma center of us

     military facilities in europe. Also reported was ltc gillingham's

     reprisal withholding of an award from an Army physician who had served

     in saudi arabia, because the physician elected to work in the lrmc

     emergency room instead of family practice which ltc gillingham headed.

          The report alleges that LTC Smith reported in writing the alleged

     harassment, unlawful orders, and resulting reckless endangerment by

     COL Lipsi and LTC Gillingham to GEN Kiley multiple times in 1995. The

     report documents multiple conversations reporting the unlawful

     behavior between LTC Smith and other ER personnel and COL Bulliner,

     Deputy Commander for Nursing, LtCOL Bodin, Chief of Medicine, and COL

     Freyfogle, Trauma Chief.

          LTC Gillingham reportedly delivered multiple angry orders to LTC

     Smith to force a general medical officer to work as an emergency

     physician who had been diagnosed with acute major depression and was

     medically forbidden to work in the Emergency Room. One of these

     episodes occurred in COL Bulliner's outer office within the hearing of

     both MAJ Sandstrom and COL Bulliner. COL Jewett, MC, USA, Chief of

     Psychiatry was reportedly notified 7 July 1995 by LTC Smith in

     presence of Dr. Darby; COL  Jewett said that he would notify the

     Commander and recommended that LTC Smith write a risk management

     memorandum for record, requesting GEN Kiley's written guidance, 

     through COL Lipsi to GEN Kiley, summarizing that LTC Gillingham was

     ordering the ER to place on the work schedule a seriously depressed

     general medical officer whom MAJ Linda Griffith, USAF psychiatrist,

     had recommended not to work in emergency medicine, and that the LRMC

     ER was critically short of ER physicians.  It is alleged that COL

     Lipsi then refused to allow the written memorandum to reach GEN Kiley.

          It is alleged that even after these official notifications to the

     Command of unlawful orders and reckless endangerment by LTC Gillingham

     and COL Lipsi, the unlawful behavior continued.

          Dozens of instances of clear violations of the Uniform Code of

     Military Justice are alleged against COL Lipsi and LTC Gillingham. 

     Most involve unlawful orders, deliberate understaffing, and

     intimidation, and failure to obey regulations.  One report accuses LTC

     Gillingham of misappropriating LRMC ER patient workload statistics by

     transferring these counts to other clinics. The resulting yearly

     patient count applied to the ER was reportedly so falsely low as to

     ensure a dangerously low number of ER physicians to take care of the

     REAL patient load. It is alleged that patient care was adversely

     affected by this misappropriation starting in the Summer of 1995.

           LTC Smith reports that both COL Lipsi and LTC Gillingham knew

     that he LTC Smith was becoming increasingly depressed. Documentation

     is available to show that LTC Gillingham had ordered LTC Smith to see

     the psychiatrist MAJ Perotta on call on 17 June 1994 for increasing

     depressive symptoms. LTC Smith's report quotes COL Lipsi as

     threatening him during the 12 June 1995 reprimand in COL Lipsi's

     office, with the following words: "No, LTC Smith, I do not think that

     LTC Gillingham and myself are trying to cause you to have a nervous

     breakdown. We do not SHOOT Army doctors 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 former OB-GYN

     chief who had earlier sustained a major depression under COL Lipsi's

     supervision.)

          The IG report alleges that LTC Smith was finally given leave time

     off starting 6 September 1995 after five months during which COL Lipsi

     and LTC Gillingham had allegedly refused him leave. It is reported

     that the Nursing Chain of Command had been aware of the high risk of

     situational depression among ER nurses and physicians. Starting in

     June 1995, it is reported that COL Bulliner ordered MAJ Mike Kusek,

     psychiatric RN, to make rounds on the LRMC ER staff twice daily until

     September to guard against suicides among ER nurses and physicians.

     Allegedly, MAJ Sandstrom, LTC Williamson, and COL Bulliner are

     credited with rescuing LTC Smith from increasing depressive symptoms

     by notifying COL Ney Gore, cousin of Vice President Gore and new DCCS

     (to replace COL Lipsi ) that LTC Smith needed time off for his own

     health. COL Gore is credited with partially protecting LTC Smith and

     the ER staff from further reprisals by LTC Gillingham, and with

     immediately increasing the resources to the ER toward achieving

     standard of care. COL Gore is aid to have initiated many much needed

     enhancements to the entire Medical Center.

          However, LTC Gillingham's intimidation of LTC Smith and other ER

     staff allegedly continued. During the last week of January 1996, LTC

     Smith reported to COL Bulliner and COL Gore that LTC Gillingham was

     trying to force deployment away from LRMC of three ER physicians

     simultaneously. This would reduce the number of ER physicians abruptly

     by 50%. On 12 February 1996 at 1300 hours by appointment, LTC Smith

     presented a formal IG complaint to GEN Kiley alleging harassment,

     unlawful orders, and reckless endangerment by LTC Gillingham and COL

     Lipsi.

          The IG complaint then alleges that GEN Kiley ordered LTC Smith's

     DECREDENTIALING that same afternoon, as well as airevacuation of LTC

     Smith one way to CONUS on 24 February 1995. LTC Smith's report alleges

     that the medivac was a reprisal for having lodged the IG complaint. The

     airevacuation orders were reportedly for major depression, but LTC

     Smith reported no specific restrictions in his activities during the

     Airevac. In fact, the record shows that letters to members of Congress

     were generated on the Airevac computer and printer of Andrews AFB

     Medical Center, where LTC Smith stayed; in addition, these letters were

     reportedly mailed at the post office at Andrews AFB. The report

     continues that as soon as LTC Smith arrived at Madigan Army Medical

     Center on 27 February 1996, he was admitted to the in-patient

     psychiatric unit.  It is alleged that two days later, the in-patient

     psychiatrist MAJ McDonald relayed an order from GEN Kiley to LTC Smith

     to move his wife and two school age children immediately on a PCS move

     from LRMC to Madigan. Reportedly, the intercession of MAJ Perotta and

     COL Gore prevented this abrupt move, and the dependents were allowed to

     stay at Landstuhl until school was finished in June. Meanwhile, it is

     reported that LTC Smith was kept on in-patient status for three weeks,

     at the HIGHEST SECURITY LEVEL 1, because of what MAJ McDonald

     repeatedly said was "a delay in clarification of orders from

     Landstuhl." A review of the hospital record reports no evidence of

     acute depression, only mental and physical exhaustion. LTC Smith says

     that his treatment by MAMC hospital staff was exemplary and

     compassionate. However, he alleges that the three week duration on

     in-patient status at the highest security level was due to reprisal by

     the Landstuhl Command, since he was still technically assigned to LRMC

     during that time.

          These & other serious allegations impacting adversely on the

     mission of quality healthcare

      delivery, were not investigated by the lrmc ig or the lrmc command.

     Consequently, since late february 1996 this complaint has been

     investigated by california senators feinstein & boxer & congresswoman

     pelosi.

Author:  COL Allen Rhodes at MEDCOM4_FSHTX

Date:    10/3/97  8:37 AM

Priority: Normal

TO: COL Phil Savoie at MEDCOM11_FSHTX

TO: CPT Jeanette Stone at MEDCOM11_FSHTX

TO: LTC Stephen Smith at MEDCEN4-MAMC

TO: stevewsmith@pol.net at Internet-Mail

Subject: Re[2]: OFFICIAL REPORT TO MEDCOM JAG  &  TO MEDCOM CID

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

Phil-

    

As I am taking a day or two off, am working this one from home.  I am

disturbed, to say the least, by LTC Smith's accusation that the

MEDCOM IG office never instigated an investigation--they guy is

clearly a few bricks short of a load.  I will provide him a reply

next week when I am in the office and have access to my regulations

and policy documents. 

    

His expectations and reality are not necessarily the same.

    

Birds were thicker yesterday than I have ever seen before, anytime,

anywhere.  See you Monday.

    

allen

    

     

    

    

    

_______________________ Reply Separator _______________________

    

Subject: Re: OFFICIAL REPORT TO MEDCOM JAG  &  TO MEDCOM CID

Author:  COL Phil Savoie at MEDCOM11_FSHTX

Date:    10/1/97 4:47 PM

    

    

     Dr. Smith

    

     As I am certain CPT Stone advised you, the MEDCOM Judge Advocate

     office stands ready to assist in any investigation that is initiated

     regarding your allegations.  The JAG office does not, however, have

     independent investigative authority, as does the CID, IG, commanders

     IAW AR 15-6 and AR 40-68 (QA focused) and members of congress.  The

     JAG office simply cannot initiate an investigation.

    

     We do, however, work closely with those investigative activities and

     provide legal support and advice when needed.  Undoubtedly, if one of

     the agencies finds evidence of wrongdoing, they will consult with my

     office for advice on how to proceed further.  We stand by to assist in

     any way possible.  You may feel free to advise anyone who is

     investigating this matter that they may consult with this office.

    

     Philip A. Savoie

     COL,JA

     Staff Judge Advocate

    

    

______________________________ Reply Separator _________________________________

Subject: OFFICIAL REPORT TO MEDCOM JAG  &  TO MEDCOM CID

Author:  LTC Stephen Smith at MEDCEN4-MAMC

Date:    10/1/97 08:35

    

    

     1 October 1997

    

     COL Savoie

     CPT Stone

    

     I appreciate your participation in assisting with my report to COL

     Atkinson for LTG Blanck about allegations of unlawful command activity

     at my previous assignment. Your help is appreciated since, as my

     witnesses reported to me on 6 September 1997, the witnesses reported

     evidence of falsification of Medical Records in the neuro-surgical

     case of 3 June 1995, as well as diversion of ambulance equipment from

     patient care, where it was badly needed to maintain standard of care,

     to apparent black market activities which CID is already

     investigating.

    

     I have reported to my Members of Congress that I requested THREE

     investigations at MEDCOM last week: (1) MEDCOM QA, (2) MEDCOM JAG, and

     MEDCOM CID (Agent Patrick Tangarine).

    

     Is there a case # or file # to identify the JAG investigation? If so,

     please send it to me for my records, in case the Members of Congress

     need more specifics.

    

     I have also reported to the Members of Congress that the MEDCOM

     Inspector General investigation was NEVER initiated in regard to

     interviews of any of the 65 witnesses. In fact, MEDCOM IG NEVER

     interviewed me either by telephone or in person. This failure to

     investigate extremely serious allegations involving a Medical Corps

     LTC and a COL reporting to and following orders of the overall

     Commander, a promotable COL, seems to me also a JAG and CID matter.

    

     LRMC JAG CPT Heller also received a request to investigate on 9

     February 1995; however, like LRMC IG LTC Stearns, there was a failure

     to investigate.

    

     What other information do you require in order to pursue the MEDCOM

     JAG investigation of these matters?

    

    

     Respectfully,

    

    

     Stephen Whitlock Smith, MD

     Fellow, American College of Physicians

     Fellow, American College of Emergency Physicians

     LTC, MC

 

 

 

LTG George A. Crocker, USA

Commander

I Corps & Fort Lewis

Fort Lewis, WA  98433-9500

14 December 1998

 

Subject: Article 138, UCMJ

 

Dear General Crocker,

 

I am an active duty officer in a tenant unit at Fort Lewis and I have prepared an Article 138 for filing.  I request your personal assistance in this matter, since I view it as extremely time sensitive.

 

I am a principal witness in two investigations directed by the Department of the Army Inspector General.  Both investigations center on the reckless endangerment of patients caused by two Army physicians at Landstuhl Army Regional Medical Center (Germany) between 1993 and 1996.  These physicians were following the explicit orders of then Colonel Kevin Kiley, MC who now serves as a Brigadier General in the Office of the Surgeon General of the Army.

 

As a result of the testimony I have given in these two investigations, I have been compelled by circumstances to report reprisals taken against me by my commander, BG Mack Hill, and other members of his command at Madigan Army Medical Center (Military Whistleblower Protection Act).

 

I have prepared an Article 138 that I intend to submit without delay.  In his letter dated 23November 1998 (enc. 1), COL Gerald J. Leeling, DAJA, advised me to file locally.   Following this advice I visited the installation JAG office on 11 Dec 98, and presented the salient points of the Article 138 to MAJ Custer, JAGC and CPT Vasquez, JAGC.  While attentive, they were clearly uncomfortable with their own knowledge and somewhat uncertain of how to proceed with an Article 138.

 

 

General Crocker, would you please arrange an appointment for me with a senior installation JAG officer who has experience in Article 138 matters?  An Article 138 filing is a serious and complicated undertaking which requires a great deal of legal and administrative experience.

 

Further, I ask that you guarantee my right to the lawyer-client confidentiality privilege and take into account my expectation of and need for continuous access and advice to this senior JAG officer for the duration of the proceedings that flow from the filing. 

 

During duty hours I can be reached at 968-3866 (DSN 782-3866).

 

 

Respectfully,          

 

 

 

Stephen Whitlock Smith, MD

LTC, MC

Department of Medicine

MAMC

ENCLOSURE 1 (2 Pages)

 

 

 

 

 

NOTHING FOLLOWS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

TO PERSONAL ATTENTION OF:

 

LTG Ron Blanck

Surgeon General of the Army (HQDA (SGPS-PSQ), Skyline 6, #672,

5109 Leesburg Pike, Falls Church, VA 22041-3258

(703) 681-3000

 

10 June 1999

 

LTG Blanck:

 

I am enclosing a copy of my long pending Washington State Verification and Evaluation of Privileges which Madigan Commander BG Mack Hill has still not signed. Without this verification, I am unable to obtain the Washington State Medical License and seek civilian employment.

 

LTG Blanck, I am therefore appealing to you directly  to verify my privileges and send the signed form directly to WASHINGTON STATE MEDICAL QUALITY ASSURANCE COMMISSION.

 

I am also enclosing your copy of my original FAX request to you for early retirement, so that you will have a better copy for your records.

 

Respectfully,

 

                

Stephen Whitlock Smith, MD, LTC

Telephone Voicemail (253) 968-3866

E-mail stevewsmith@pol.net

 

 

Cc:

Sen. Thurmond, Rep Spence, Rep Stark

Washington State Medical Quality Assurance Commission

Drs. O'Leary, Buck, Lee; Mr. Gaffney, Mr. Johnson

 

25 May, 1999

 

LTG Ron Blanck:

The Surgeon General of the Army

Commander

MEDCOM

Fort Sam Houston, TX

210-221-7118

 

 

1.         I request retirement from active duty effective 30 June 1999, and placement on the retired list effective 1 July 1999.  I request an early retirement based on my length of service, and constructive credit based on my quality management reports to higher authorities in lieu of Command and General Staff studies.  I anticipate no medical condition that would result in other than a routine length of service retirement.

2.         I request that I be placed immediately into an ordinary leave status until the balance of my account is exhausted and then to continue in an advanced leave status until my retirement becomes effective.

3.         I request that my local MTF and other credentials files and privileging records and any reports to licensing authorities reflect an unrestricted unsupervised Category III in Internal Medicine.

4. I further request that when my local MTF and other credentials files and privileging records reflect an unrestricted, unsupervised Category III in Internal Medicine, any and all local or other administrative processes involving the restoration of my clinical credentials be terminated.

 

                 

Stephen Whitlock Smith, MD, LTC

Telephone Voicemail (253) 968-3866

E-mail <stevewsmith@pol.net>

NOTHING FOLLOWS

 

 

 

 

 

 

 

 

 

 

 

 

8 June 1999

 

LTG Blanck:

 

I am thankful for your decision of 14 May to accept my credentials appeal, which I am enclosing. Our past association is two-fold:

* I am the Army-trained doubly-board certified Army physician who leads your Telemedicine Special Response Team for Madigan Army Medical Center; and,

* I am the former Emergency Medicine Chief at Landstuhl Regional Medical Center who as LRMC's Joint Commission (JCAHO) Liaison for Medical Staff filed a report critical of then COL (P) Kevin Kiley's Command for alleged reckless endangerment of patients and staff.

 

Your personal intervention has served well in the past. Your QM Team recommended an investigation in October 1997. However, as the European phase of the investigation began in summer of 1998, I found myself to be targeted with apparent reprisal actions by BG Mack Hill, MAMC's new Commander.

 

The reprisals have included BG Mack Hill's reported confrontation with anger apparently directed at me followed by my alleged forced detention by a Hospital Security Chief after I spoke briefly with Dr Sue Bailey, Assistant Secretary of Defense for Health Affairs, in the receiving line. More recently, BG Hill has summarily suspended my credentials to practice medicine in a series of credentials actions apparently at variance with due process protections under JCAHO and Army Regulations.

 

My credentials were restored on 3 March 1999 by a vote of my fellow physicians on the Credentials Committee, then again by means of memorandum by then Acting Deputy Commander COL Kelly and by my physicians However, BG Hill has delegated further action to his JAG attorney, including the threat of legal action via Army Regulation 15-6, a precursor to court-martial.

 

While I have been forced to skirmish over credentials with BG Hill, the investigation in Germany seems to have faltered. COL David Lipsi and LTC David Gillingham were named in my allegation that they ordered my ER staff to abandon care of unstable civilian patients on strict eligibility criteria and that we suppress adverse QA data (against JCAHO and AR guidelines). We refused those orders, and reprisal followed. Both officers alleged that they were following specific direction from then COL (P) Kevin Kiley. LTG Blanck, would COL Lipsi be retiring under current DOD guidelines if the investigation were progressing?

 

I have tried to remain on active duty long enough to see the investigation through which I help to trigger, along with my witnesses, because we do not wish to see vulnerable and sick patients endangered by what we considered to be reckless leadership at LRMC.  I find it very difficult to serve efficiently within your organization until these hazards have been recognized via formal investigation, and remedied.

 

When I gratefully accepted the Army's offer for medical scholarship at George Washington University School of Medicine in 1977, I considered whether I would ever be subject to unlawful orders that could endanger patients. After many years as an Army doctor, I found myself for the first time refusing to carry out orders by COL (P) Kiley's subordinates that I knew would harm unstable patients under my emergency care. I then found myself under apparent reprisal credentials actions similar to what Joint Commissioner examiner Dr Bert Hurowitz had reported previously. COL David Lipsi allegedly issued reprisal against 3 LRMC physicians who had filed reports with Dr Hurowitz. Known alleged deficiencies in emergency and other equipment and procedures were reported to COL (P) Kiley who arrived at LRMC several months later. Yet, COL Kiley instead chose in my opinion to hide evidence of JCAHO noncompliance and to issue reprisals against those who recommended adherence to standard of care.

 

One of the patients that I reported as harmed lives within the region represented by Senator Strom Thurmond and by Representative F Spence. An appeal is made to them to allow investigation of COL Lipsi before his retirement at Fort Jackson South Carolina, so that BG Kiley's alleged involvement in the apparent cover-up of case is made clear.

 

Only your personal intervention, LTG Blanck, will now resolve this situation. You will also require the assistance of outside organizations.

 

I therefore request of you the following actions in order to prevent harm to more patients, and reprisal against those who report such harm:

* Exclude BG Kevin Kiley,  who now works for you in the Surgeon General's Office of any influence in over the military and medical careers of myself and the other witnesses in the multiple Federal investigations stemming from my original Inspector General Complaint;

* Similarly exclude BG Mack Hill, since he serves well within the sphere of influence of BG Kevin Kiley, from recent past association as well as present day-to-day business;

* Afford me due process in completing full restoration of my medical credentials in conformity with JCAHO and AR standards.

* Please consider my application for early retirement, now pending since I became eligible last November.

 

Thank you for your attention,

 

 

 

Stephen Whitlock Smith, MD

FACEP, FACP

Lieutenant Colonel, US Army Medical Corps

Madigan Army Medical Center, B310-904 MAMC, Pendleton Avenue, Tacoma, WA 98431

(253) 968-3866 stevewsmith@pol.net

 

Cc:

Members of Congress, including Sen. Thurmond, Rep Spence, Rep Stark

Mr. Cohen, Mr. Caldera, Dr Bailey

Generals Reimer, Crocker

Drs. O'Leary, Buck, Lee

Mr. Gaffney, Mr. Johnson

Ms Jowers, Mr. Ramsey, Mr. Timms, Mr. Siceloff, Mr. Parker, other correspondents

Agencies

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stark Analysis Shows Weakness in JCAHO Audits,

Calls for Overhaul of Hospital Review Process

"Unsafe conditions and unacceptably high death rates are too often present in hospitals ranked as excellent by the Joint Commission for Accreditation of Healthcare Organizations (JCAHO)," Rep. Stark announced today. California's Health and Welfare Agency shows high mortality rates among JCAHO-accredited hospitals, and a report just issued by the New York City Public Advocate documents unsanitary conditions in hospitals with high scores.

Rep. Stark compared the California public health agency's list of survey results with JCAHO's list of accredited hospitals. He found 29 JCAHO-approved hospitals had higher-than-expected death rates for heart attack patients, some as high as 30-40%. "This means that patients may have a one in three chance of dying from a heart attack, even though they make it to the hospital, yet two of these hospitals received JCAHO's highest rating," Rep. Stark said.

California's report is the third published since 1993 that compares mortality rates from heart attacks across hospitals and controls for a variety of factors, including patient age, sex, type of heart attack, and chronic diseases.

In a separate analysis of New York hospitals, the non-profit Public Advocate presents strong evidence that hospitals circumvent JCAHO's annual announced survey visits -- simply by hiring extra staff to make operations look smoother than they really are.

In too many cases, the report finds that JCAHO's high test scores mask a darker reality -- that some accredited hospitals don't meet basic standards of care. For example, 15 accredited hospitals showed problems ranging from substantial delays in treatment of emergency room patients to outdated and broken equipment to overcrowded, understaffed clinics and unsanitary conditions.

"Clearly, when such conditions are present, JCAHO should respond with sanctions, not high praise," Rep. Stark said. "Yet only last year, JCAHO flunked fewer than 1% of hospitals. The organization says that it fails so few because it prefers to work with hospitals to 'correct' any violations that are detected. But if its accreditation standards are low to begin with, then can consumers and plans really rely on JCAHO reports?" This is a critical question for Medicare beneficiaries, since JCAHO-accredited hospitals are "deemed" to have met Medicare's "Conditions of Participation," a key proxy for quality of care.

The weaknesses of JCAHO's current system are made plain in the New York report. Simply put, there are no surprise inspections, and little apparent follow-up of pro-forma walk-throughs.

To make matters worse, under the Joint Commission's arbitrary scoring system, hospitals with serious quality of care problems are often given excellent ratings. In effect, JCAHO surveyors are encouraged to rank hospitals highly on each standard, even if the hospital is unable to meet that standard! This practice makes a mockery of the review process.

"I am astounded that of the 18,000 institutions surveyed each year, none are judged to fail outright," Rep. Stark said. In fact, ALMOST ALL (98 percent) of the institutions surveyed in the New York City study received scores of 80 or better on a 100 point scale, and NONE had a score below 70!

"The misguided scoring and lax oversight documented in the New York and California reports suggests that another system of oversight is needed. I am cosponsoring two bills that would overhaul the current voluntary review process," Rep. Stark said. The Accreditation Accountability Act of 1997 (H.R. 800) would require all Medicare-accrediting organizations to hold public meetings. One-third of governing board members would be members of the public.

Second, the Medicare and Medicaid Provider Review Act of 1997 (H.R. 2543) would levy user fees on hospitals and other health care providers to underwrite the costs of independent federal compliance and audits. President Clinton included the heart of this bill in the budget package he recently sent to Congress.

"For too long," Rep. Stark said, "we've given JCAHO and the health care industry the benefit of the doubt. Self-policing simply isn't working. The New York City report is all the evidence we need to show that patients suffer -- sometimes fatally -- from substandard care provided by JCAHO-accredited hospitals. Let's put patients' needs first, back where they belong."

Contact: Anne Montgomery

 

 

 

 

 

25 May, 1999

 

LTG Ron Blanck:

The Surgeon General of the Army

Commander

MEDCOM

Fort Sam Houston, TX

210-221-7118

 

 

1.         I request retirement from active duty effective 30 June 1999, and placement on the retired list effective 1 July 1999.  I request an early retirement based on my length of service, and constructive credit based on my quality management reports to higher authorities in lieu of Command and General Staff studies.  I anticipate no medical condition that would result in other than a routine length of service retirement.

2.         I request that I be placed immediately into an ordinary leave status until the balance of my account is exhausted and then to continue in an advanced leave status until my retirement becomes effective.

3.         I request that my local MTF and other credentials files and privileging records and any reports to licensing authorities reflect an unrestricted unsupervised Category III in Internal Medicine.

5. I further request that when my local MTF and other credentials files and privileging records reflect an unrestricted, unsupervised Category III in Internal Medicine, any and all local or other administrative processes involving the restoration of my clinical credentials be terminated.

 

                 

Stephen Whitlock Smith, MD, LTC

Telephone Voicemail (253) 968-3866

E-mail <stevewsmith@pol.net>

NOTHING FOLLOWS

 

 

 

OTHER CASES

 

 

 

Supervisory Plan #1

 

INTERNAL MED CHARTS FOR REVIEW (22 Oct 1998)

From: 

Stephen W Smith

<stephen_w.smith@mamc.chcs.amedd.army.mil>

Subject: 

INTERNAL MED CHARTS FOR REVIEW (22 Oct 1998)

MEMORANDUM FOR: CREDENTIALS AND DEPARTMENT OF MEDICINE

AS REQUESTED FOR REVIEW

COL Les Reed and MAJ Rich Jordan

              

FROM:           STEPHEN WHITLOCK SMITH, MD   

Date:           22 October 1998 

As requested, charts are attached for review, retrieved from computer

records. The others will follow shortly. (Please see previous memo of 2

October, attached.)

Thank you for streamlining the Acute Care system. The following improvements

are helping markedly: a) Allowing us to schedule patients directly with the

primary provider, so that the acute visit can become more focussed and

shorter, b) allowing nursing personnel to do a nursing assessment in the

S-O-A-P format, c) allowing charting time between patients as well as

designating one person to return charts, bubble sheets, and charts chosen for

audit directly to Dr Jordan, or Records, or bubble sheet area, whichever is

approriate. All of these changes seem to cost little in personnel time; these

changes help me personally to keep up with the work flow, and may be good

innovations to continue once the 2 Physician Assistants are in place.

The dramatic events unfolding from the 1 September 1998 visit of Dr Sue

Bailey, Assistant Secretary of Defense for Health Affairs, which I reported

promptly through official channels at the time and to Drs Reed, Jordan and

MAJ Rumph as appropriate, have impacted severely on the time and effort and

effort required to manage both the important assignment that you have given

me PLUS the required reporting of harassment clearly intended to silence a

high level complaint. The details are included in conversations which we have

had recently, as well as correspondence received in September by Secretaries

Cohen, Bailey and Caldera. Other government agencies are also investigating,

including a major investigation just now beginning in the MEDCOM centered on

USAREUR.

              

I made two requests to Ernestine Russell for administrative time in early

September in order to keep up with the increased demands on my time and

energy.

              

I know that this request WAS passed on up the chain of command, since it

was mentioned by MAJ Rumph at the counseling session which took place with

MAJ Jordan. I know now that the full circumstances underlying my request were

not known to you, since the Command had not informed you of the 1 September

incident.

              

I am proud to work for your Department, and I will try also to be responsible

as well as persistent, in presenting evidence from my past Command, since

adverse outcomes to patients did occur there. I reported what I reported in

order that these things would not occur in other Commands during the drawdown

in resources. 

              

Thank you, 

               

Stephen Whitlock Smith, MD

LTC, MC  

               

MailMan message for SMITH,STEPHEN W

Printed at MAMC.CHCS.AMEDD.ARMY.MIL  Thu, 22 Oct 1998 07:22:05  (#186)

Subj: INTERNAL MEDICINE CHARTS: CHCS (02 Oct 1998)  

Fri, 02 Oct 1998 16:46:43  229 Lines

From: SMITH,STEPHEN W (Internal Medicine) in 'DESK' basket.

              

MEMORANDUM FOR: CREDENTIALS AND DEPARTMENT OF MEDICINE

AS REQUESTED FOR REVIEW

              

FROM:           STEPHEN WHITLOCK SMITH, MD   

              

              

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

              

COMPLETE CLINICAL CHARTS FOR ALL OF THE PATIENTS SEEN BY ME ARE ACCESSIBLE 

UTILIZING THE FOLLOWING MENUS IN CHCS FOR ALL PATIENTS ON THIS LIST:

               

1. HEALTH SUMMARY ("MD" TRIPLER SUBMENU 

2. PROBLEM LIST (WITH ISD9 CODING) 

3. ORDER ENTRY  (FOR CLINICAL INTERVENTIONS AS A RESULT OF THE CLINICAL EXAM)

4. AFTERCARE INSTRUCTIONS (SPECIFIC FOR DEPARTMENT OF MEDICINE)

5. REFERENCE->PMI (FOR MEDICATION AFTERCARE INSTRUCTIONS) 

              

PLEASE NOTE: 

THIS PROJECT OF ENTERING ALL CLINICAL ENCOUNTER DATA AT THE TIME OF THE VISIT

IS MORE TIME-CONSUMING WITH JUST A CHCS VT420 TERMINAL, AS COMPARED WITH A

NETWORKED PC RUNNING QVT-WINDOWS OR KEA! (THE ALTERNATIVE PROGRAM).

HOWEVER, THIS ORDER-ENTRY (ESPECIALLY USING THE UPDATED CHCS DESKTOP) CREATES

A PERMANENT RECORD ACCESSIBLE BY ALL MAMC PHYSICIANS AND PA'S AND NURSE

PRACTITIONERS FROM THE DESKTOP. THIS PROJECT WAS UNDERTAKEN WITH THE HELP OF

THE NURSING STAFF OF APCC, AND IS EVOLVING. THE RATIONALE OF ITS USE,

PARTICULARLY FOR THE ACUTE-CARE PORTION OF THE ADULT PRIMARY CARE CLINIC, IS

THAT IT WILL BE VIRTUALLY IMPOSSIBLE FOR THE SAME PROVIDER TO SEE ONLY THOSE

PATIENTS ASSIGNED TO HIM OR HER; AT LEAST WITH A NETWORKED ELECTRONIC RECORD

LIKE THIS ONE, OR LIKE THE ONE IN PROGRESS BY LT KAITANI AND ALSO BY EPIC

SYSTEMS (WITH OR WITHOUT VOICE MACRO COMMAND INPUT), ANY APCC PROVIDER COULD

ACCESS ALL CLINICALLY RELEVANT DATA WITHOUT WAITING FOR THE PAPER RECORD,

EVEN IF IT IS AVAILABLE.

              

SINCE MY SCHEDULE IS KEPT FREE FOR ACUTE VISITS AND TELEPHONE CONSULTS, THERE

IS NO TEMPLATE WHICH WOULD ALLOW REVIEW OF MY RECORDS ARRANGED BY DAY OF

VISIT, CHRONOLOGICALLY.

               

THIS LACK OF TEMPLATE, A NECESSARY SITUATION AT PRESENT, HAS MADE IT

DIFFICULT TO ACCESS ALL OF MY CHARTING FOR ACUTE CARE WITHOUT USING A

SEPARATE LIST OF ALL PATIENTS WHICH I HAVE SEEN DURING ANY FIXED TIME PERIOD.

IF MY CHARTS ARE REQUIRED FOR REVIEW AT ANY TIME, PLEASE ASK ME OR THE ACUTE

CARE TEAM FOR A COMPLETE LIST OF MY PATIENTS.  

              

STEPHEN WHITLOCK SMITH, MD

LTC, MC 024-38-5114  

Followup Scheduling: (253)968-2410/2415 

Questions:           (253)968-3866 

Beeper;              # PENDING

E-Mail:              <stevewsmith@pol.net> 

Mailing address:     Adult Primary Care Clinic

MAMC, PENDLETON AVENUE, TACOMA, WA 98431

              

              

[PAGE]

              

Subj: INTERNAL MEDICINE CHARTS: CHCS (02 Oct 1998)                           

                                                       

Patient names are edited out 

 

           

Local Message ID: 5281549@MAMC.CHCS.AMEDD.ARMY.MIL

              

MITH,STEPHEN W (Internal Medicine) Last read: Thu, 22 Oct 1998 07:21:50

STEVEWSMITH@POL.NET   Sent: Fri, 02 Oct 1998 16:50:41 Time: 6 seconds.

Forwarded by: SMITH,STEPHEN W Fri, 02 Oct 1998 16:48:36 through

response

0.

REED,HARRELL L (Chief, Department of Medicine) Last read: Fri, 09 Oct 1998

15:48:55 Forwarded by: SMITH,STEPHEN W Fri, 02 Oct 1998 16:51:03

JONES,D E CASEY      Not read. Forwarded by: SMITH,STEPHEN W Fri, 02 Oct 1998

16:51:03

JORDAN,RICHARD A (Chief, Internal Medicine Services.) Last read: Mon, 05 Oct

1998 16:26:01 Forwarded by: SMITH,STEPHEN W Fri, 02 Oct 1998 16:51:03

              

[PAGE]

 

 

Supervisory Plan #2

 

18 Mar 99