1 in 5 Army hospital leaders suspended in 2 years: What's behind the discipline?

Brig. Gen. (Dr.) John M. Cho talks about post-traumatic stress disorder and traumatic brain injury on Capitol Hill in this file photo from June 22, 2013.


By ADAM ASHTON | The (Tacoma, Wash.) News Tribune | Published: September 22, 2014

The Joint Base Lewis-McChord general who lost his command earlier this month is one of eight senior Army medical officers around the world who have been suspended or relieved of command during the past two years.

That means almost one in five major Army medical facilities has had a commander suspended during that time.

It's an eye-grabbing amount of public discipline for an Army often criticized for being too slow to remove commanders in high-profile positions rather than dismissing them when controversy arises.

It's unclear whether a theme unites the eight suspensions; each was carried out for a distinct reason.

But some officials with recent experience in Army medicine are concerned that the suspensions point to broader problems as the system recovers from 13 years of ground war in Iraq and Afghanistan. The discipline could stem from an increasing demand for health care services, they say, or from oversights in preparing top doctors for leadership positions.

"The ones that I know are very good people who have done very well in their careers, otherwise they wouldn't be hospital commanders," said Dr. Elspeth Ritchie, a former colonel and Army psychiatrist who is now chief clinical officer for the District of Columbia Department of Mental Health. "The way I put this together is that there's an enormous amount of need that has overwhelmed the system."

Brig. Gen. John Cho, the latest senior Army doctor to face a public suspension, leads the Western Regional Medical Command. It's a JBLM headquarters that manages 11 hospitals in Western states. Cho has been assigned to other medical duties while the Army investigates his leadership and determines whether to reinstate him.

The Army won't say why Cho was suspended, except that the Defense Department's Inspector General is investigating his command climate, an Army term that refers to how he works with his subordinates and the messages he sends as a leader.

The move caught many officials in and outside the Army by surprise, so they're paying close attention.

"When the leadership of someone entrusted with overseeing the medical care of our nation's heroes is called into question, it must be taken very seriously," said Sen. Patty Murray, D-Wash. "I am closely following the Inspector General's investigation into this matter."

The other seven who've faced public scrutiny were colonels who led Army hospitals around the world. The Army has 36 hospitals led by full colonels.

"I don't recall eight simultaneous, or near simultaneous, (Army Medical Department) senior level command suspensions going on at any point in my career. There might have been, but they might have been done more quietly," said retired Maj. Gen. Philip Volpe, who led Western Regional Medical Command from February 2010 to March 2012.

Suspensions are a serious matter in the military and are often viewed as a career-ending move even if the officer stays in the Army. Of the suspended colonels, just two returned to command positions.

Three were removed from command, and two more did not return to their offices because their command terms expired during the investigations at the root of their suspensions, according to the Army Medical Command.

The suspensions are being carried out by Army Surgeon General Lt. Gen. Patricia Horoho. She's the first nurse and the first woman to hold her office. She's also a recent past commander of the Western Regional Medical Command and Madigan Army Medical Center at JBLM.

Horoho declined an interview request from The News Tribune but released a statement in which she said she takes seriously decisions about whether to suspend hospital commanders.

"When an allegation is made against a commander or leader, I have to decide whether it is in the command's best interest to temporarily suspend that leader during the investigation," she said. "That is a difficult decision, and one that I recognize impacts the organization and individual leader. My guiding principle is to ensure a thorough inquiry while enabling the command to continue its mission."

The Army medical system, which includes 54 hospitals and clinics around the world, has been under sustained scrutiny since 2007 when The Washington Post reported on substandard care at Walter Reed Army Medical Center in Washington, D.C.

Army hospitals are separate from the Department of Veterans, though former military service members can receive care at Defense Department facilities.

In recent months, The New York Times has published a series of stories drawing attention to relatively high error rates in the Army health system. Defense Secretary Chuck Hagel in June also ordered a systemwide review of military medicine after complaints about delays in care at VA hospitals.

"In health care, you're dealing with life and death every day, and you're not just dealing with the active-duty. You have children and spouses. I think there is a lot more pressure on the medical command to take swift action" when a crisis develops," said Lourdes Alvarado-Ramos, the director of the Washington state Department of Veterans Affairs. She is a retired soldier who capped her career as the command sergeant major at Madigan Army Medical Center.

Intense probes at Madigan

Without knowing what caused each suspension, Volpe said the public discipline of eight senior officers raised questions for him about how the Army is preparing its best doctors for command positions.

"Are these officers getting the right leader developmental assignments, education, and training to develop the skills necessary to succeed and excel in these demanding positions, or are we bypassing some essential developmental steps?" he asked. "Are the organizations structured properly to provide the right amount of oversight, guidance, coaching and mentoring? Are more senior commanders investing the time necessary to assist their subordinate commanders through some of the challenges they face, or are they left on their own to navigate the complex landscape?"

Volpe's tenure at JBLM spanned two intense investigations into care at Madigan that illuminated pressures on Army doctors to act immediately when complaints arise. He did not want to comment on them, but The News Tribune has obtained investigative reports through the Freedom of Information Act on how they unfolded.

The first, in the spring of 2010, centered on services Madigan provided to Oregon National Guard soldiers returning from Iraq. The complaint about lapses in care spurred widespread congressional interest.

Volpe concluded the problem was a systemic issue for the Army that required broader changes, according to documents obtained by The News Tribune. Neither Volpe nor then-Madigan Commander Col. Jerome Penner was suspended during the medical investigations.

Two years later, complaints surfaced about Madigan doctors changing psychiatric diagnoses late in the medical retirement process in ways that patients did not understand. Sen. Murray spoke up for the patients and compelled the Defense Department to conduct broad reviews and standardize its diagnoses.

That investigation also led to system-wide changes in Army medicine, but then-Madigan Commander Col. Dallas Homas was out of command for six months when part of the inquiry turned on him.

Officials in Army medicine determined that Homas should have his command suspended when a complaint arose about his command climate. The Army eventually concluded the complaint was without merit. In the meantime, Homas' supporters thought he was made a scapegoat.

"That was clearly to my mind a situation where you had a higher commander that was looking to pin something on somebody," said retired Maj. Gen. Eric Olson of Lakewood, a former commander of the 25th Infantry Division and a friend to Homas. "It was a huge black eye for MedCom in general and for Madigan specifically."

Outside pressures strong

Olson was one of many officers who wrote letters to senior Army leaders on Homas' behalf. At the time, Olson was leading an Army medical program for children and families at JBLM.

He remains concerned that hospital commanders are taking the fall for larger problems in Army medicine.

"I hear the argument that suspensions aren't that serious, that they give a commander an opportunity to do an investigation," Olson said. "That argument doesn't hold for me. It is a serious move to suspend a commander and make him disappear like that."

Volpe said senior generals face difficult decisions in choosing whether to suspend subordinates, especially in situations in which leaders feel pressure to act from outside forces.

"At the end of the day, a leader must understand that when a subordinate fails, they bear some of that failure," he said, "and also at the end of the day, a leader must be able to 'sleep comfortably' by the ethical decisions they make."

Volpe said pressures from higher-ups are "the greatest challenges for contemporary commanders to deal with."

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