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
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Stoddert Assignment Berlin
Corruption at Madigan

By Thom Stoddert

 
   The murders at Fort Hood were investigated and it was found that the Army medical services were aware that something was wrong with Dr. Nidal Hasan. While he was in the Army long enough to be promoted one rank, the Medical Department had enough time to evaluate him; but chose to ignore his evaluations and transfer him to Fort Hood. Thirteen people paid with their lives for the same reason the earlier scandal at Walter Reed happened. The medical commanders decided to ignore the problem and hope it would go away. Now there are the issues of kickbacks, corruption, retaliation, and cover ups at Madigan Army Hospital, Joint Base Lewis McChord.

Madigan Army Medical Center (MAMC) is just one of many examples, from San Antonio to Washington, DC, Fort Carson to Fort Lewis, of corruption and inefficiency. It effects how veterans receive their care directly and indirectly. Many of these former high ranking officers/administrators retire and go to work for the VA’s medical system, degrading that system. Next, these people are causing a huge waste of tax payer money with their preference of certain drug companies and medical equipment manufacturers. This is not to overlook the fact that the toxic work environment results in an expensive turnover of staff. All at a time when the Army that defends us is facing major financial cutbacks.

  A reporter for the Seattle Times recorded on Oct. 7, 2011, a story of a whistle blower who was first ignored by the command of Madigan and then retaliated against for his attempts to correct illegal activity. He, in essence, had his reputation shredded. If you read the comments made to this article there were other staff in the Cardiology Department that suffered the same for their efforts

  Dr. Jason Davis, a cardiologist at Madigan, was fined almost $13K for kick backs, the pharmaceutical company was fined $600, 000, and others walked free. According to the Seattle Times - “Davis, in a lengthy statement to the court on Friday, accepted responsibility for taking illegal payments but noted that other Army medical personnel also had accepted expensive dinners…” It was further reported in the same article, Dr Davis’ statement, "There is more to this than some rogue physician who is corrupt — because I am not corrupt, sir." In other words Davis was inadvertently indicating that his activity was normal; if others are doing it, then how can I be a bad person? Of further note, Davis does not seem to remember his retaliatory efforts against fellow staff, nor does it seem he will be held responsible for it.

  Let’s put this into perspective. Two former staff members went to deputy commanders and were ignored. In one instance the General herself was made aware of the issues and did nothing. By the way, she is due to be the next Surgeon General of the Army. In both cases they were retaliated against.

Expanding this perspective is the civilian Chief of Quality Services and her subordinate, the civilian Risk Manager, both of whom have been around the hospital for years, both of whom have terrible reputations, either chose to ignore the problems or were ignorant of the issues and thus failed at their duties. These are the folks who should have been investigating in the first place. They will be the ones to determine if patients were hurt or improper procedures were performed by the cardiologist. Will they sweep things further under the rug? They have done so many times in the past from what I have seen and others have told me.

The cardiologist, Dr. Davis did not act alone. There is indication that another cardiologist, if not getting rewarded,  was also at least aware of the kick backs, the $300.00 dollar bottles of wine at dinners, and such. But even more important, these proponents of Boston Scientific products had to work with the cooperation of the Logistics Department at Madigan. They are the ones that can override federal law and allow the purchases of equipment that is more expensive without normal competition of the suppliers. 

While the doctors were being wined, dined, and paid; other companies with less expensive products were knocked out of the competition at the Army’s (and taxpayer’s)expense. Thus pretty much everyone at Madigan was either not doing their job or looking the other way; looking the other way and playing ignorant like they did with Maj. Hassan.
Is this really all so far off course from Fort Hood? No! It was once reported to me, while on active duty at Madigan, that a psychotic clerk was threatening to bring a gun to work. A Lieutenant Colonel, my boss, and I went to the Chiefs of the Department of Nursing and reported it, pointedly expressing our concerns for the safety of the staff. We left disappointed. The chiefs, in so many words, said they would do nothing, just ignore it and hope it would go away. It didn’t, the clerk attacked another civilian and the Chief of Nursing went to work in a veterans’ retirement home.

The Army’s Medical Department’s culture of covering things over can be overcome; it was once the best health care delivery system in the world.

First, put clinicians away from a desk and back to patient care. They can be put to better use supervising and training junior staff instead of justifying their jobs by pushing papers and brown-nosing. Next, get rid of the Army’s policy of “up or out” for the Medical Department. Base promotions on a history of successful problem solving, not on making one’s boss a “mushroom” -  kept in the dark and fed bulls**t. Lastly, have an office of oversight that has real teeth, not the cowards that are presently entrenched in the system and have that office report directly to the Department of Defense, not a Surgeon General, as they have already proven that they only continue the corruption. Punish severely abusive civilians, like Madigan’s Chief of Quality Services; the inefficient, like the Risk Manger, and the oxygen thieves who pose as chiefs and deputies. Maybe then we will have no more murdered soldiers like at Fort Hood.


Thom Stoddert, former VA Rating Specialist
Bio Here

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