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HEIDELBERG, Germany — “A rear detachment commander stated there is a waiting list for mental-health appointments.”

“An FRG leader stated that same-day appointments at family practice are unavailable if you call after 0730.”

“A rear detachment NCO stated that well-baby appointments are backlogged and many babies do not receive medical check-ups at the correct interval.”

Brig. Gen. David Rubenstein, commander of the Europe Regional Medical Command, has heard these complaints and more from commanders, Family Readiness Groups, noncommissioned officers and others at community visits. They are unhappy with what they see as declining access to medical care from U.S. military doctors.

“Anytime a patient or a leader has a concern, it’s justified. But most of the time there’s a rest-of-the-story,” Rubenstein said in a recent interview.

Usually, he said, that involves the fact that the ERMC system, undergoing transformation and fielding military doctors to combat zones, is more reliant on patients seeing German medical providers.

A little more than a month ago, for instance, Gen. George Casey, Army chief of staff, was visiting, and a spouse, the mother of small children, told Casey the community had no pediatricians, Rubenstein said.

“The response is, there are four pediatricians,” Rubenstein said. “They all happen to be German pediatricians. They’ve been caring for American children for years.”

The idea of seeing German doctors is a difficult one to grasp for Americans more comfortable with — and accustomed to seeing — U.S. military doctors. More than a decade ago, U.S. soldiers and families stationed in Europe received nearly all their medical care at 11 U.S. military hospitals and 54 clinics.

“Sometimes the patient refuses to go downtown [to see a German physician]. Then they’ll voice that as a complaint,” Rubenstein said.

Now just two hospitals remain, and the biggest, Landstuhl Regional Medical Center, has as its first mission to treat soldiers wounded in Iraq and Afghanistan. From June 2005 through June 2007, there were only two days when no planes carrying wounded soldiers landed at nearby Ramstein Air Base, Rubenstein said.

“Most days, one lands,” he said.

On the day of his interview, there were three.

ERMC had kept open its dental clinic in Garmisch for 105 military personnel, Rubenstein said, even though there are supposed to be 800 patients for one dentist.

“So when the dentist goes to war, we’re not going to replace him,” Rubenstein said. “We don’t have an excess.”

The clinic is soon to be closed.

“We either don’t need the doctor because the population’s not there, or the doctor is not available,” he said. “Some communities, I will tell you, a physician is needed. But they’re just not available.”

One instance of unavailability is in mental-health care providers. ERMC determined that those patients, who can’t be easily referred to local Germans because of the nature of the treatment, are underserved.

Rubenstein has asked the Army for scores more mental-health professionals for next year. But he noted that it took nearly a year to hire a psychiatrist for one community.

Rubenstein also said ERMC is working to make improvements in how appointments are scheduled to get more people in to see military doctors.

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