The Fort Hood Aftermath-Army Accountability Review and Psychiatrists

While the Army considers what, if any, disciplinary actions to take against those who directed the medical training of MAJ Nidal Hasan-the accused Fort Hood shooter-one psychiatrist’s legal counsel faults the military for blaming a handful of officers for a broader institutional failing.

“The history of the Department of Defense, when dealing with broad-based problems within the department, is to isolate and vilify a few individuals,” said Gary Myers, a lawyer representing COL Charles Engel, a psychiatrist.

Last January, Defense Secretary Robert Gates ordered an independent review panel to investigate the “noncriminal” aspects of the shooting that left 13 dead and 32 wounded. The panel concluded “that some medical officers failed to apply appropriate judgment and standards of officership with respect to the alleged perpetrator” and failed to include the alleged perpetrator’s overall performance as an officer, rather than solely his academic performance in his formal performance evaluation.

Subsequently, an accountability review was conducted to determine whether leaders were negligent in their supervision of Hasan. That report is currently under legal review.

Recent press accounts specify that the military plans to formally discipline officers, mostly from Walter Reed Army Medical Center (WRAMC) and the Uniformed Services University and Health Sciences (USUHS). Senior Army officials reportedly told The Wall Street Journal “that as many as 8 officers could ultimately be censured over MAJ Hasan, mostly with letters of reprimand that effectively end their military careers.”

When asked about possible disciplinary actions, Gary Tallman, an Army Public Affairs spokesperson, said, “These are very sensitive issues and because of the legalities involved we cannot comment on actions that may or may not take place.”

The same system that delivered this alleged shooter has trained thousands of highly proficient practitioners.

Administrative letters of reprimand (LOR) as mentioned in the Journal article do not automatically end one’s career, said George Wright of Army Public Affairs. He added that promotion and selection boards consider the totality of an officer’s career and a soldier can refute an LOR. “There are officers who continue to serve and some who are even promoted with such letters,” he said.

Evidence trickling out in the media indicates that several psychiatrists who trained and supervised Hasan at times were concerned about his performance and tried to warn and guide him. An Associated Press story reported that while Hasan was a medical student at USUHS from 1997 to 2003, he received “a string of below average and failing grades, was put on academic probation and showed little motivation to learn.” Yet this information was not included in his military personnel file.

As a psychiatry intern and resident at WRAMC from 2003 to 2007, Hasan was counseled frequently for deficiencies in his performance, attendance, and attitude. After completing a fellowship in preventive and disaster psychiatry at USUHS in 2009, Hasan was transferred to Fort Hood.

Scapegoat charges

During the Fort Hood investigations, COL Engel, assistant chair of research at USUHS’ psychiatry department and director of Hasan’s psychiatry fellowship, received an e-mail saying he could be the target of an investigation, his attorney told Psychiatric Times. But to date, Engel has not been notified of any disciplinary or adverse action to be taken by the Army.

“This action, if taken, will be an assault on Army Medical Corps, and it will be very much misplaced,” said Gary Myers, Engel’s attorney. Myer noted that he wanted to make sure that Engel’s “contributory life is not impugned by an attempt to ascribe blame where blame does not belong.” He added, “In so far as ascribing responsibility to those individuals who knew or should have known Nidal Hasan had a potential for violent action, it would be the intelligence community, which chose to do nothing with the information.”

He was referring to reports that the FBI and other intelligence analysts had been tracking Hasan’s e-mails with at least 1 suspected Islamic extremist since December 2008. The FBI dismissed the e-mails as apparently part of Hasan’s work as a psychiatric counselor.

Internal e-mails exchanged by Hasan’s superiors at WRAMC (not released to the public) showed that some of Hasan’s superior officers were worried about him-particularly MAJ Scott Moran, program director for the National Capital Consortium psychiatry residency program.

A March 16 Washington Times article reviewed some e-mails from Moran to others (also not available to the public). Moran had told a superior that he was preparing to put Hasan on probation and extend his residency, but the superior rejected the idea, saying it would prompt a total reevaluation of Hasan. On May 11, 2007, Moran told a second superior that Hasan did not have sufficient months in a psychiatric clinic to complete his residency. A second superior also dismissed his concerns. Moran warned that Hasan’s research project required for completing his residency, a presentation on Koranic world view as it relates to muslims in the US military, was “not scholarly project level.” Hasan was asked to modify it.

National Public Radio obtained a May 17, 2007, memo from Moran to the WRAMC’s credentials committee. In it, Moran said, “the Faculty has serious concerns about CPT Hasan’s professionalism and work ethic. Clinically he is competent to deliver safe patient care. But he demonstrates a pattern of poor judgment and a lack of professionalism.”

The memo cites several problems, including inappropriately discussing religious topics with patients, seeing only 30 outpatients in 38 weeks of outpatient continuity clinic, failing height/weight screenings, and failing to appropriately document an emergency department (ED) encounter with a homicidal patient who subsequently eloped from the ED.

Despite the problems, Moran said Hasan is able to “self-correct with supervision” and he could not say that Hasan “is not competent to graduate.” Moran had written “to give the credentials committee the benefit of full disclosure and the opportunity to modify CPT Hasan’s plan of supervision following initial privileging.”

Charles Gittins, Moran’s attorney, told The Washington Times that his client was trying to hold Hasan to Army standards. “He did everything he could to hold the guy to standards, and he was only with the guy for 14 weeks before Hasan graduated from the residency program,” Gittins said.

[Moran’s memo to the credentials committee states he became program director for the residency program in March 2007 but was assistant program director from July 2006 and a faculty member of the residency since July 2004-Ed.]

In Hasan’s officer evaluation report from 2004 to 2007, the Associated Press reported that Moran rated Hasan, then a captain, as having “outstanding performance, must promote,” and COL John Bradley, chair of WRAMC’s department of psychiatry until recently, rated him as “best qualified.”

Morale issues

The controversy surrounding Hasan’s supervision has hurt the medical department’s image as it tries to hire 519 additional mental health specialists to deal with the growing demands of combat stress, said LTG Eric Schoomaker, the Army surgeon general. According to USA Today, Schoomaker said morale has slumped, particularly among Army behavioral health workers at WRAMC. He said, “The same system that delivered this alleged shooter has trained and career-developed professionally as officers, as well as clinicians, thousands of dedicated and really highly proficient practitioners.”

WRAMC and USUHS spokespersons chose not to respond to Psychiatric Times’ requests for information about Hasan’s supervisors and departmental morale, deferring to Army Public Affairs and Army Medical Command Public Affairs. Army Public Affairs said it couldn’t comment on the results of the accountability review and individual psychiatrists, and Army Medical Command Public Affairs has not responded to PT’s questions.

References:

Photo by Jay Janner/Austin American-Statesman