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Proudly Serving All Branches & All Eras Since 1999
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Thomas W. Stoddert, US Army Retired, is right on every point and I applaud his courage to write a very exacting letter.  My tenure at Madigan Army Medical Center as the NCOIC of the Department of Medicine made me aware of mismanaged policies and management issues.  I worked with a wonderful staff of professionals and paraprofessionals who conducted themselves very appropriately and courteously, with politeness, knowledge, experience and timeliness.  However, all of our efforts were frequently clouded by the frustrations of personnel shortages, ancillary demands of personnel, frustrations secondary to multi-echelon mismanagement issues, and numerous other problems.

The Department of Medicine includes 13 separate sections, clinics, and sub-departments, each with specific medical missions comprised of doctors, PA's, nurses, medical technicians, and support personnel, including military and civilian staff.  Some clinics have direct access through central appointments while many others required a referral from the primary care provider.  All too often miscommunication between various services and ancillary personnel would complicate scheduling problems.  An appropriate example: Patient "A" might be scheduled to see doctor "Z" in a specific clinic, but Dr. Z had to cancel all appointments because he/she had to support another military mission somewhere else on post or deploy to another country.

Frequently, the appointment schedule confusion was not because of medical staffing, but due to Central Appointments or Tri-Care issues for providing less than appropriate information to the patient and the provider.  Regardless who was at fault, the senior enlisted member of each clinic, section or department always tried to resolve relevant matters at the lowest level before involving the members of the Patient Representative Office and Patient Affairs Office. 

As the NCOIC or the department, I coordinated with the Patient Representative Office and Patient Affairs Office and designed placard's which identified the OIC and NCOIC of each clinic, section and department with a current photograph and a customer service statement bent on resolving problems or complaints at the lowest level.  The commanding general at the time accepted the design and ordered that it be implemented throughout the hospital.  The implementation was done in 2000 and I hope it is still in place. I am confident that the NCO's and OIC's at each level are fully capable of resolving conflicts and complaints, providing they get support from the senior management of medical care at Madigan Army Medical Center.

On the other hand, I and many others have all too often witnessed many frustrated and dissatisfied patients and family members who lack the patience to allow the system to work as it is designed.  These patients complain every chance they get and they become very loud and ugly about it, making treats, breaching the chain of command, and writing letters and memos to anyone who will listen.  The members of the Patient Representative Office and Patient Affairs Office do everything possible to bring providers and patients to a equitable arrangement, resolve appointment conflicts and ultimately bend-over-backwards.  Still, the patient complains and will ultimately use the same tactic every time they feel the need, regardless of how well or how often they have been treated with the same professional level of care that all patients and family members are given.

I am not blind and I do not wear rose colored glasses.  I know there are problems with the management of care at Madigan Army Medical Center and other military medical facilities.  However, there is no single mission in the military service that is as resource intensive as the medical mission on a daily basis.  Then the medical facilities must comply with and satisfy military and civilian laws, protocols, standards, inspections, and funding agencies.  All of this while still supporting the military missions of deployments, training, education, reassignments, and command emphasis issues. 

So, yes, a problem exists, but it will take the collective initiative of the soldier's at each facility to make the improvements, with the support of the Army Medical Corp senior management and mass influence of money and personnel.

Sincerely,
Alan B. Candia
U.S. Army (Ret.)   

Reader's Response Below
Question:
I am rated 100% unemployability. My ratings are as follows.
30% for chlorache from Agent Orange exposure
30% for PTSD
40% for diabetes
It also says on my award letter, "No Future Exams."
My question is do you think they can re-examine me in the future and take away my benefits?
Thank You,
Bob Clark

Answer:
Bob, Thanks for writing in to the "Veteran's Voice."

The VA can require a future exam at any time  if they feel there may be an issue of fraud or if a   gross mistake was made. But generally in cases like yours where they say no future exams,
they mean just that.

The VA can, if they have sufficient reason, propose to lower a rating percentage only if they        believe you may have gotten better or something has happened and they have to review
certain awards. This can happen as an example as the result of a mandate from Congress. The   issue of PTSD, was getting a lot of nasty attention by the national press and the VA went back   and started looking at this issue when it was awarded to  non-combat veterans.

However, the general rules are basically after five years, service connection can not rescinded,   but the rating percentage can be lowered; after ten years there can be no reduction in the rating percentage or severance of a service connected condition unless there was fraud.

All this to say, if you got a fair rating and they have said no future exams, just run with it. The  VA does not like to hassle vets when they do not need to.

Now, the down side, FYI. The VA does  routinely check up to see if you are working and so does    the Social Security Administration. They both allow you some grace in making some extra income because they know staying home vegetating is harmful. However, 100% unemployability is just that and both agencies frown on a veteran receiving benefits because they can not work and then go out and work full time. So check carefully and see what they allow you. I was told recently that these rules may have changed not too long ago.

Assuming you are not working you may want to consider doing volunteer work in the community and/or working with veterans. Here is where the fun starts. The VA, through the education department,  will sometimes purchase items to make a veteran's life more meaningful. In my case they helped me purchase computer equipment so that I can write like I am now and aid other veterans. Now that there is a war on, there are many opportunities to use your talents and experiences for others, particularly other vets.

So good luck and welcome home.
Thom
Thank you for your courage to tell it like it is!   The General is a good person but what can one person do?   Do you know who the members of her so-called command group are?   The Deputy Commander for Administration is ineffective, disinterested, weak and lame.   The Deputy Commander for Clinical Services is pretty smart but he is a poor leader, has no clue what his subordinates are supposed to do and he is leaving in a few weeks.   The Deputy Commander for Nursing is also lame and she is about to retire.   The Hospital Sergeant Major is also about to retire!    In addition to the problems you described, there are many others.   For example, I wish someone would approach Mr. and Ms. Horrell  and ask them what they know about nepotism and the merit system!   Madigan is a wonderful institution and has many great people but the fat, ineffective and overstaffed upper management needs to replaced and realigned now!  

Husband of a very concerned member of the Madigan Team  
Thomas W. Stoddert, US Army Retired, is right on every point and I applaud his courage to write a very exacting letter.  My tenure at Madigan Army Medical Center as the NCOIC of the Department of Medicine made me aware of mismanaged policies and management issues.  I worked with a wonderful staff of professionals and paraprofessionals who conducted themselves very appropriately and courteously, with politeness, knowledge, experience and timeliness.  However, all of our efforts were frequently clouded by the frustrations of personnel shortages, ancillary demands of personnel, frustrations secondary to multi-echelon mismanagement issues, and numerous other problems.

The Department of Medicine includes 13 separate sections, clinics, and sub-departments, each with specific medical missions comprised of doctors, PA's, nurses, medical technicians, and support personnel, including military and civilian staff.  Some clinics have direct access through central appointments while many others required a referral from the primary care provider.  All too often miscommunication between various services and ancillary personnel would complicate scheduling problems.  An appropriate example: Patient "A" might be scheduled to see doctor "Z" in a specific clinic, but Dr. Z had to cancel all appointments because he/she had to support another military mission somewhere else on post or deploy to another country.

Frequently, the appointment schedule confusion was not because of medical staffing, but due to Central Appointments or Tri-Care issues for providing less than appropriate information to the patient and the provider.  Regardless who was at fault, the senior enlisted member of each clinic, section or department always tried to resolve relevant matters at the lowest level before involving the members of the Patient Representative Office and Patient Affairs Office. 

As the NCOIC or the department, I coordinated with the Patient Representative Office and Patient Affairs Office and designed placard's which identified the OIC and NCOIC of each clinic, section and department with a current photograph and a customer service statement bent on resolving problems or complaints at the lowest level.  The commanding general at the time accepted the design and ordered that it be implemented throughout the hospital.  The implementation was done in 2000 and I hope it is still in place. I am confident that the NCO's and OIC's at each level are fully capable of resolving conflicts and complaints, providing they get support from the senior management of medical care at Madigan Army Medical Center.

On the other hand, I and many others have all too often witnessed many frustrated and dissatisfied patients and family members who lack the patience to allow the system to work as it is designed.  These patients complain every chance they get and they become very loud and ugly about it, making treats, breaching the chain of command, and writing letters and memos to anyone who will listen.  The members of the Patient Representative Office and Patient Affairs Office do everything possible to bring providers and patients to a equitable arrangement, resolve appointment conflicts and ultimately bend-over-backwards.  Still, the patient complains and will ultimately use the same tactic every time they feel the need, regardless of how well or how often they have been treated with the same professional level of care that all patients and family members are given.

I am not blind and I do not wear rose colored glasses.  I know there are problems with the management of care at Madigan Army Medical Center and other military medical facilities.  However, there is no single mission in the military service that is as resource intensive as the medical mission on a daily basis.  Then the medical facilities must comply with and satisfy military and civilian laws, protocols, standards, inspections, and funding agencies.  All of this while still supporting the military missions of deployments, training, education, reassignments, and command emphasis issues. 

So, yes, a problem exists, but it will take the collective initiative of the soldier's at each facility to make the improvements, with the support of the Army Medical Corp senior management and mass influence of money and personnel.

Sincerely,
Alan B. Candia
U.S. Army (Ret.)   

Reader's Response Below
Thank you for your courage to tell it like it is!   The General is a good person but what can one person do?   Do you know who the members of her so-called command group are?   The Deputy Commander for Administration is ineffective, disinterested, weak and lame.   The Deputy Commander for Clinical Services is pretty smart but he is a poor leader, has no clue what his subordinates are supposed to do and he is leaving in a few weeks.   The Deputy Commander for Nursing is also lame and she is about to retire.   The Hospital Sergeant Major is also about to retire!    In addition to the problems you described, there are many others.   For example, I wish someone would approach Mr. and Ms. Horrell  and ask them what they know about nepotism and the merit system!   Madigan is a wonderful institution and has many great people but the fat, ineffective and overstaffed upper management needs to replaced and realigned now!  

Husband of a very concerned member of the Madigan Team  
Question:
I am rated 100% unemployability. My ratings are as follows.
30% for chlorache from Agent Orange exposure
30% for PTSD
40% for diabetes
It also says on my award letter, "No Future Exams."
My question is do you think they can re-examine me in the future and take away my benefits?
Thank You,
Bob Clark

Answer:
Bob, Thanks for writing in to the "Veteran's Voice."

The VA can require a future exam at any time  if they feel there may be an issue of fraud or if a   gross mistake was made. But generally in cases like yours where they say no future exams,
they mean just that.

The VA can, if they have sufficient reason, propose to lower a rating percentage only if they        believe you may have gotten better or something has happened and they have to review
certain awards. This can happen as an example as the result of a mandate from Congress. The   issue of PTSD, was getting a lot of nasty attention by the national press and the VA went back   and started looking at this issue when it was awarded to  non-combat veterans.

However, the general rules are basically after five years, service connection can not rescinded,   but the rating percentage can be lowered; after ten years there can be no reduction in the rating percentage or severance of a service connected condition unless there was fraud.

All this to say, if you got a fair rating and they have said no future exams, just run with it. The  VA does not like to hassle vets when they do not need to.

Now, the down side, FYI. The VA does  routinely check up to see if you are working and so does    the Social Security Administration. They both allow you some grace in making some extra income because they know staying home vegetating is harmful. However, 100% unemployability is just that and both agencies frown on a veteran receiving benefits because they can not work and then go out and work full time. So check carefully and see what they allow you. I was told recently that these rules may have changed not too long ago.

Assuming you are not working you may want to consider doing volunteer work in the community and/or working with veterans. Here is where the fun starts. The VA, through the education department,  will sometimes purchase items to make a veteran's life more meaningful. In my case they helped me purchase computer equipment so that I can write like I am now and aid other veterans. Now that there is a war on, there are many opportunities to use your talents and experiences for others, particularly other vets.

So good luck and welcome home.
Thom
Thom Stoddert
KAZMIERCZAK
VA 101: The Basics
Know & Understand VA Benefits
A.O. My Perspective
VA Rating Schedule
Understanding Basic VA Benefits
Evidence Is Everything With the VA
Don't Be Stupid,                 Get the Truth
Veterans For Peace....???
Stoddert Assignment Berlin
The ABC’s of Individual Unemployability
Like the VA, Army Hospitals are Under Investigation

  By Thom Stoddert


     The VA hospital administration has been under investigation for corruption and contributing to the death of veterans, and the scandal is getting bigger each day, we are all aware of that. However, the Army’s Madigan Army Medical Center, at Joint Base Lewis-McChord in Tacoma, Washington has also been under scrutiny and may be much more corrupt. Though it has been quiet and not in the news, the accusations and findings have led to additional investigations of high ranking military and civilian personnel, several leaving employment at the same time last year.

  In February of 2013, a loosely linked group called the “Book Club” (B-C, because it met in a local library), was formed by former and current doctors, nurses, pharmacy personnel, administrative staff, and retired military from Madigan. Their single common purpose was to expose the corruption and effect changes for the better. All of the members had been victimized or witnessed abuse of other employees. They described in detail the chronic disregard of federal hiring practices, significant waste of resources, and frequent substandard care with injuries to patients - some of which had been reported in the Seattle-Times by several writers.

  Starting in early spring, 2013, the B-C organized their material, sharing copies of emails, official documents, personal stories, and even PowerPoint presentations smuggled out of Madigan. Many of the members stayed in the back ground for fear of retaliation, however they still contributed evidence and information. Retaliation was a significant fear for most everyone, especially for the physicians who had their medical credentials threatened. Therefore, their names will not be provided by this story.

  Once the issues were identified and documented, the B-C assembled the most revealing and condemning info into large packets for distribution. By April of last year several members of the B-C began visiting the offices of  various elected officials. Just this phase of the project was an education about government for the B-C, and this in itself became concerning.

  Congressmen Denny Heck D-WA, Derik Kilmer D-WA, Adam Smith D-WA, David Reichert R-WA and Senators Patty Murray D-WA, Maria Cantwell D-WA were all contacted and given a copy of the complaint packet with the supporting evidence. All of the politicians, despite everyone saying “this is serious,” deferred leadership to Patty Murray. Congressman Dave Reichert was the exception. After he had reviewed the evidence packet with his staff he asked one question, “Can I take this to Washington, DC?” ( Reichert was the detective who solved the Green River serial murders and later became the King County (Seattle) Sheriff.)  

  The B-C spent the  rest of the spring and summer trying to get a one-on-one meeting with Sen Murray, the most senior elected official in Washington State.
  Senator Murray was an essential key to the B-C’s request that a third party, such as the General Accounting Office,  conduct an investigation into the fraud and waste that the present Surgeon General of the Army appears to have enabled.  In emails and phone calls back and forth it was made clear to Murray’s office that the Book Club wanted to meet with her and get exposure on Madigan, tax payer money and patient safety was contingent on it.

  The B-C assumed Murray must be aware of some of the problems taking place. Over the years Murray has responded to many complaints about Madigan and the Wounded Warrior Transition Battalion. In April 2012, Senator Murray, in Lakewood, WA, held a formal senatorial investigation of Army senior officers without any of the Medical Department’s staff being present, but she did include senior staff from the VA flown in from Washington DC for the day. Murray’s investigation was about Madigan’s Behavioral Health scandal concerning changed diagnosis of PTSD so to deny VA benefits to vets. This scandal had already made the national news.

  When the B-C requested support from Murray, her office (staffer Kristine Reeves) provided this guidance after having received  50 pages of evidence, “….  At this point, we need documentation that you have exhausted all of the process resources available to you to address this issue before our office can “demand” any kind of action.” In other words, they wanted the Book Club to use the chain of command, which already had been used resulting in  whistleblowers being retaliated against.  The instructions continued, “As part of the documentation you compile or may have already compiled, you would need to include responses in writing from these divisions in order to show the steps and responses that have been taken.  We need your help building the strongest case possible …”.  This was received as a deliberate road-block!

  Two weeks later a member of the B-C received a phone call from a soldier identifying himself as a member of the US Army’s Western Regional Medical Command Inspector General’s (the IG) office who had been tasked by the Department of Defense to look into allegations of corruption at the Army’s Madigan Army Medical Center.

  Several members of the B-C met with the IG in office. The IG began the meeting by saying that his investigation was the result of a congressional complaint made to the Department of Defense (DoD), and as such, would have to report directly back to DoD only. The meeting lasted for several hours. The IG was also given the same copies of the accumulated evidence that was originally given to Rep. Reichert and Sen. Murray.

  Members of the B-C were contacted by the IG a week later by email, a portion of it reads, “…I am meeting with my Chief tomorrow to go over the documents you provided me and the information I wrote down during our meeting. Based on the preponderance of evidence against a Senior Official (COL or above) and Senior Executive Service (GS-15 and above) our office by regulation will have to send the case to the Department of the Army Inspector General (DAIG). However, in this case, we will have to provide DoDIG a written report of our findings”.

  In November of last year Congressman Reichert’s office confirmed that the evidence packet he had received was given to the Chairman of the House Armed Services Committee and Con. Buck McKoen R-CA did contact the Department of Defense with the complaints.

  By the end of the year, Ann Horrell (LTC, US Army retired) Chief of the South Sound Medical Home (that was delayed two years in opening), Lisa Danforth-Lewis, Chief of the Quality Services Division/Risk Management, and Margie Belton filling the position of a GS-12 but working as a GS-6; all left employment at Madigan.  

  The B-C held significant documentation of their behavior and shared it the news media and with politicians. The IG investigation was to be completed by mid-December, yet continued on into the new year.  

  The new Madigan commander, Ramona Fiore, is reportedly making headway in cleaning up the falsified records and other issues. However others, such as often named, Stephen Yoest remains. He has been described as a bully/thug by several physician members of the B-C.

  Last month the Public Affairs Office (PAO) of Madigan confirmed that Dr. Alvin Tui was no longer at Madigan. Tui prescribed blood pressure medication to a 30 year old handicapped man without a five day check or examining the patient personally. The patient died in less than ten days, the medication implicated by the Thurston County, WA coroner. This event was shared by his mother, Cheryl Balcon, an employee of Madigan, along with her supporting documentation. The mother further described how when she went for assistance to report this sentinel issue, she was given the run-around by Col. Irene Rosen, who may be scheduled to take over the trouble hospital at Fort Carson, CO.

It was also confirmed by the PAO that Dr. Jason Davis, cardiologist, who made the Seattle news for taking kickbacks from a medical supplier, is also gone. Davis was fined in federal court, but was never held accountable under military law and later was made chief over the more senior doctor who had exposed him.  Tui and Davis would normally have been expected to be rehired by Madigan as civilians in slots converted for their convenience so to fill the vacancies.

  I would like to thank the members of the “Book Club,” especially Cheryl Balcon of Lacey, WA, Robert Salinger of Yelm, WA, SGM Paul Hardy of San Antonio, TX,  former pharmacy staff and the many other doctors, nurses, and staff who shared the documentation and their stories so this could be written.

  At the time of submission of this article for printing, the commander of Womack Army Hospital, Fort Bragg, has been relieved of command and the Secretary of the Army has ordered a similar investigation of the Army’s hospitals to that which the VA is receiving. What more is going to be revealed?

Thom Stoddert, former VA Rating Specialist
Bio Here
How the VA Does Not Work
Saudi Syndrome from a VA
Finding Supporting Evidence
Healing, Reunions and Branson, MO
The Rating Schedule and Special Monthly Compensation
Ordinary Info that Every One Screws Up!
Scams & VA Benefits       Part 1
Scams & VA Benefits       Part 2
Scams & VA Benefits       Part 3
VA Ratings Basics
VA Ratings for Hearing
VA Benefits Basics 10
Veteran’s Overcoming Common VA Errors
VA Math
s, DIC and Pension
gger than Most Realize
PTSD Coach
Hearing Loss compensation
Aid and Attendance, Pension, Without Strings Attached
I Hope This Upsets You!
Special Cases of Unemployability
Corruption At Madigan
An Informative War Memorial Torpedoed By Pettiness & Politics
Nigerian Banker's Corruption Surpassed by Army Hospitals
It’s All About the Evidence
Scams, Shams, and Deceit
Scams, Shams, and Deceit
Care With Compassion?
A “Combat” Clerk Typist More
Roger Flygare Should Apologize More
Care With Compassion?
Madigan Corrunption
VA Unemployability
Little Known Tidbitsfrom VA
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