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
(Excerpt 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 itıs 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.
"Iım angry, but what can I do?" Wood said. "They know they have
done something wrong, but wonıt do anything about it." Wood has filed a
claim against the U.S. Army for malpractice, but he and his family arenıt
optimistic. The Armyıs Office of the Judge Advocate General in March turned
down Woodıs initial claim for $7.5 million. Woodıs 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 Armyıs review of the case was thorough and
above-board. John De Crosta, Thurmondıs
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. Landstuhlıs
emergency-room doctor sent Wood home after treating him for scrapes and
bruises, according to Woodıs claim. The doctor didnıt 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 Woodıs 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. Woodıs 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. "Itıs a good faith system," Brem said.
"Potentially, the Army could come back and say, Yes, we were negligent,
but we still arenıt going to award you damages." Another lawyer working on
Woodıs 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 Armyıs denial.
"Self-regulation doesnıt 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 donıt worry because
they know people canıt 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 Woodıs treatment as one example of a number of problems. Despite what Brem calls "extremely
substantial" evidence supporting Woodıs 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 Woodıs head because it didnıt start until the next
day. But Smith said that wasnıt necessarily true, and the doctor should have
held the boy overnight anyway for observation because Wood had lost
consciousness during the fall.
EXCERPT
Editor
Tacoma,
Washington
11 May 1998
Dear Editor:
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
..
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