Thomas Stoddert is a generous soul who is determined to make a difference in the life of veterans. He is a combat veteran and former VA Rating Specialist with 4 years experience making decisions on veteran's claims. He left the job when he could no longer control the symptoms of PTSD.
He is presently writing grants for non-profit orgs. and helping veterans file claims under the auspices of several groups, to include a VA Vets Center and he is now available to help here as well!
E-mail your questions for Thom to
Walter Reed and Madigan: Same Story - Different Place
Thom Stoddert
Dear Madam or Sir:
This letter is in response to the Army Patient Satisfaction survey that was sent to me twice. I have worked at many hospitals, both civilian and military. The management of care at Madigan Army Medical Center has deteriorated greatly in the last ten years. The problem is not the politeness, the knowledge, or the timeliness of the care providers as your survey seeks to measure. It is with the gross historic mismanagement of the medical center as a whole. Now a new commander, a very smart and considerate woman, is left trying to fix the lack of good outpatient care during a period of war.
The problems at Madigan can be best summarized by the following:
•
There is a historic lack of acknowledgement that problems exist within the Army Medical Corp senior management. When there is recognition, the usual answer is to implement another layer of management, another department, another division, or another office of ????. In any case, an enlisted person will always catch the flack.
There is a historic lack of acknowledgement that problems exist within the Army Medical Corp senior management. When there is recognition, the usual answer is to implement another layer of management, another department, another division, or another office of ????. In any case, an enlisted person will always catch the flack. •Management, at all levels, are evaluated not by their success in problem solving, but by how well “the boat was not rocked.” Subordinates are often punished in a variety of ways when problems surface in front of their senior. This goes well beyond the present local command structure. It is Medical Corp wide. “Brown nosers” promote “brown nosers," not the efficient.
Management, at all levels, are evaluated not by their success in problem solving, but by how well “the boat was not rocked.” Subordinates are often punished in a variety of ways when problems surface in front of their senior. This goes well beyond the present local command structure. It is Medical Corp wide. “Brown nosers” promote “brown nosers," not the efficient. •There are multiple levels of civilian and military staff, some of whom I have met, many do not demonstrate real concern for patients needs. The overall business efficiency of the work areas in which they work is usually poor. Efficient staff make the “brown noser” insecure because the efficient makes them look bad. The efficient are then forced to look for better job areas. This explains why the good junior nurses leave the Army after three to five years.
There are multiple levels of civilian and military staff, some of whom I have met, many do not demonstrate real concern for patients needs. The overall business efficiency of the work areas in which they work is usually poor. Efficient staff make the “brown noser” insecure because the efficient makes them look bad. The efficient are then forced to look for better job areas. This explains why the good junior nurses leave the Army after three to five years. •There seems to be a higher ratio of employees who do not have direct patient care to those who do, as compared to other civilian hospitals. This also takes into fact the current war mission of the Medical Corp.
There seems to be a higher ratio of employees who do not have direct patient care to those who do, as compared to other civilian hospitals. This also takes into fact the current war mission of the Medical Corp.This is all underlined by the fact that managers/supervisors only have to have a quiet assignment in a current duty position for a few years or months before he or she moves on to the next bigger and better job with a corresponding promotion. If the boat gets rocked and the next level of management has to get involved, job performance evaluations will suffer.
At the patient’s advocacy office, where there is real world exposure to the patients’ experiences at Madigan, it is subordinate to at least three layers of management before reaching the command level. This office appears to be severely understaffed and requires the use of Red Cross volunteers for its clerical/receptionist position. The hard working people in the Patient Representative Office are doing a tremendous job under the most difficult circumstances. It seems as if one of their primary functions has become finding appointments for patients when the Tri-Care appointment office and the clinics have failed to do so. This issue alone has become the biggest single complaint received at Madigan. Many of the clinics do not have a designated staff person to handle patient-relationship problems. Thus the patient is left trying to resolve their problem on their own or with a distracted clerk, leaving them angry and frustrated.
Once a patient is admitted, they receive excellent professional care even though the nursing floors have a nursing shortage.
I have continually observed hospitals that had excellent reputations for the care provided. They also had pleasant work environments for the staff. It stands to reason that quality management produced healthy work areas that also produced quality health care delivery systems that were delivered by staff that felt safe and fulfilled in their careers.
This survey on how well a physician listened to my problem is silly when management has told him to move as many patients along as possible. A doctor will be discouraged when they are looked at for their politeness and not the quality of their follow-up care. Several physicians have shared with me their frustrations. A patient can not really expect much courtesy from a hospital worker who is frustrated with the system and their own failed expectations of their chosen career.
How was my experience at Madigan on 01/29/2006? It was typical of the care I have been receiving overall by Madigan. An eight to ten hour wait in the Emergency Dept. is normal for a minor problem. Contract staff are paid by the hour not the number of patients treated and this is the wave of the future. I did not see Dr. Mullen as your survey states. The treating physician was open and honest in explaining that he had less experience in suturing than I did as a nurse, so I helped him along. I have seen my primary physician only twice in five years. I have as most patients have; a great difficulty in getting appointments in a reasonable amount of time. Follow-up care is very difficult to get. The problem is the system, not the politeness or attentiveness of a physician or clerk.
Sincerely
Thomas W. Stoddert
US Army Ret.
I request that this letter be forwarded to the appropriate office at U.S. Army’s Office of the Surgeon General, Department of the Army, Alexandria, VA.
Author's note:
Like many career medical NCOs I first felt bad for the fired generals because they took the brunt of the publicity and they were better men than the most of the congressional blowhards (Lieberman, I, CT, excepted) that questioned them on C-Span. But, then again they grew up in the system and they made no changes. They had been warned in many ways, but those really guilty have long since retired.
I know for fact that this letter did make it to the Office of the Surgeon General (OSG).
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
Alan,
Thank you for your kind thoughts and consideration. Your letter filled in much of what my letter did not not say. Neither of our letters said any thing about the gross acts of perversion and corruption that are covered up each day. I saw much heroism, working on the hopeless casualty, just in case. I also saw enough disgusting things that senior NCOs or any one else would not punish which resulted in the worst disrespect towards officers, Hollywood has yet to come up with.
I certainly agree with your answer or maybe to sum it up, Make, and I mean make, the Amedd professional in every way to include being a soldier. Starting at Ft. Sam. when an instructor is caught fraternizing both he and the subordinate are eliminated from the military. Stop releasing the names of the enlisted to the San Antonio Light, or add the officers names also. Clean up the barracks, they are not bordellos. Teach at Officer Basic that having rank means providing leadership by example not exemption from responsibility. NCO courses should be taught by infantry types and the kiss asses gotten rid of. I took PLDC at Ft. Hood, there was a screw up. When it was resolved I was called to an E-8s office so he could give me his apology to my face. At Ft Sam there was a major screw up, that eventually the State of Texas got involved. The Dept. of Nursing told me to get back to work and forget about of it. In the mean time a Captain got away with abusing her toddler.
The hard work you and others like you have consistently put in each day, 10 hours or more hours are negated by the morons like BG Leslie Burger, the first commander of the new Madigan. And , the crap went right up to the Clinton White House at that time. I suggest you find out how the former PAO. Mike M. got his job. The amount of wasted money spent developing the 91C course.
I can mention names, places and dates because there are people still around who can verify what I have said.
In the mean time I wish you the very best in what you are doing.
Thom S
Dear Sergeant (Ret) Stoddert,
I am writing to you from San Antonio, Texas. Thank you for your service to our country and for still trying to improve the conditions for our Soldiers and their families. You sound a little too bitter but I understand your frustrations. Madigan has a pretty good reputation in the AMEDD but that doesn't mean it could not do better. I don't know the players mentioned but I know CSM Yabut and CSM King are good men. I wonder if they have been informed about the serious issues mentioned here.
CSM (Ret) DeRobles
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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
