Coming home: The Army's fatal neglect

Over the past week, Salon has published a dozen stories and sidebars about the healthcare problems at just one Army post among the many Army installations worldwide, Fort Carson, Colo. Salon dug up 25 cases of suicide, prescription drug overdoses or murder involving Fort Carson-based soldiers since 2004. In-depth study of 10 of those cases exposed a string of preventable deaths. In most cases, deaths seemed avoidable if the Army better identified and then appropriately treated soldiers’ combat stress or brain injuries from explosions. In others, the Army, under pressure to deploy more troops in Iraq, brought into the ranks mentally damaged soldiers and then sent them to war. After combat had exacerbated their preexisting problems, the Army set them loose on the streets with deadly consequences.

Untreated, combat stress can cause bad behavior — insubordination, substance abuse, violent outbursts. The Army was quick to crack down on soldiers for misbehavior but showed little interest in figuring out the underlying cause. Our reporting suggests that saying there is a “stigma” in the Army associated with seeking mental healthcare is an understatement. Harassment or punishment of those soldiers who show signs of mental strain or “weakness” seems like a more accurate description. One mock official Army document at Fort Carson asked soldiers seeking mental health help to pick one of the following explanations for their “Hurt Feelings”: “I am a pussy,” “I am a queer,” “I want my mommy.” In that environment, some troops opted to self-medicate with alcohol or drugs, making their problems worse.

We chose, whenever possible, to have our stories focus on the lives of individual soldiers, to illustrate the real-world, flesh-and-blood impact of inadequate care. Some examples: After the Army failed to diagnose or treat his post-traumatic stress disorder for two years after his return from Iraq, Pvt. Adam Lieberman swallowed an overdose of prescription drugs last October. He lived to tell about it — though his mother had to clean up the suicide note he’d painted across his barracks wall so the Army wouldn’t charge him with defacing public property. Pfc. Ryan Alderman suffered symptoms nearly identical to Lieberman’s, but floundered in a similar predicament at Fort Carson for a year. He was found dead in the barracks of an overdose around the same time Lieberman made his suicide attempt. The Army allowed Staff Sgt. Chad Barrett to go back to Iraq on Christmas day in 2007, despite his PTSD and a previous suicide attempt. Barrett killed himself by downing some of his eight prescription drugs five weeks after arriving in Iraq.

Blond California surfer John Needham seemed mentally fit when he went to Iraq in late 2006. A year later he held a gun to his head as his PTSD took over. (A buddy grabbed the gun. The bullet hit a wall.) He and his family fought the Army for healthcare through the summer of 2008, when the Army broke its own rules and put him out without required benefits. A few weeks after his discharge, he allegedly beat to death his girlfriend, 19-year-old aspiring model Jacqwelyn Villagomez. The Army brought into the ranks two mentally damaged soldiers, Kenneth Eastridge and Robert Marko. Though the Army knew of their problems, both went to Iraq anyway, further damaging their minds or fulfilling their violent delusions. Eastridge was later an accessory to murder. Marko faces murder charges.

Since the Army surgeon general runs medical care at all Army posts, it is likely that the care at Fort Carson is representative of the care experienced by Army personnel everywhere. So are the problems. Nearly 300,000, or 20 percent, of military service members who returned from Iraq or Afghanistan report symptoms of PTSD, major depression or possible traumatic brain injury, according to a RAND Corp. study last year.

Throughout all of our reporting, we are unaware of any instance of the Army holding anyone accountable in any way — from a soldier’s first sergeant up to the Army surgeon general — for any of the missteps documented in our articles.

Former Health and Human Services Secretary Donna Shalala served on a presidential commission, along with former Republican Sen. Bob Dole of Kansas, to formulate solutions to the problems made famous at Walter Reed. Their July 2007 report heavily emphasized better diagnosis and treatment of invisible wounds like PTSD and brain injuries.

Dole and Shalala can correctly identify the problems, but a commission can’t make the Army do much. “If one person is dying from something that is preventable, then we haven’t gotten it right,” Shalala told Salon in a telephone interview.

When asked what she would tell President Obama if given the chance, she responded, “I’d tell him to get ready. We’ve got a nightmarish situation.”

“The problem with the pullout [of troops from Iraq] is not what it will do to Iraq, but what it will do to the United States of America if we are not ready with teams to absorb not simply these young men and women into our society and into our economy, but absorb them into our healthcare system with appropriate and sensitive treatment,” she said. “One of the things we had better think about is if we are going to bring a bunch of troops back pretty quickly, we had better be ready for it.” She also heavily emphasized preventing troubled soldiers from going to war in the first place.

The Army suffers no shortage of initiatives that, at least on paper, have improved care for soldiers suffering combat stress. “We’ve really tried to enhance our access to care,” Col. Elspeth Ritchie, the Army’s lead psychiatrist, said in a telephone interview.

The Pentagon set up a 24-7 hot line for struggling soldiers to arrange counseling and established a new program, called RESPECT-Mil, to better incorporate mental health treatment into primary care. Since the spring of 2007, Ritchie says, the Army has hired 250 new mental health providers through civilian contracts and more than 40 marriage and family therapists. Another new policy, started in the spring of 2008, means mental health counseling is no longer supposed to muss up a soldier’s security clearance. Two memos from the Army surgeon general in 2007 and 2008 also aim to encourage more accurate post-traumatic stress disorder diagnoses.

Certainly the programs saved somebody. We’ve met soldiers who called that 24-hour hotline and received vital help. Army officials, however, struggle to explain the obvious gap between the well-meaning new programs and the pattern of soldiers at Fort Carson battling for medical treatment and suffering something akin to harassment from some superiors for seeking help in the first place.

Army officials complained they can’t discuss individual cases without running afoul of privacy rules. In our search for answers, we were often left with platitudes. “We continue to reach out, to search for methods, practices and procedures to help our soldiers,” the commander of the Army hospital at Fort Carson, Col. Kelly Wolgast, said in an interview at her office. “Clearly we are not there yet with making it perfect because we’ve had some losses and we’ve had some soldiers who have done some behaviors that are not accepted in our society.”

Top Army officials are in lockstep in saying that they are largely vexed about why things keep getting worse. Late last month the Army unveiled the most frightening Army suicide statistics in three decades. The Army says 128 soldiers committed suicide in 2008 with another 15 still under investigation. “Why do the numbers keep going up?” Army Secretary Pete Geren asked at a Jan. 29 Pentagon press conference. “We can’t tell you.” The Army said a new $50 million study might crack the mystery.

A week after Geren’s press conference, the Army announced new figures showing 24 suspected suicides in January alone. That number exceeds combat deaths in Iraq and Afghanistan in January.

Ritchie, the top Army psychiatrist, suggested factors other than undiagnosed, untreated combat stress lurked behind the new numbers, though her statistics could arguably show exactly the opposite — undiagnosed soldiers wreaking havoc. “When you look at the 2008 cases, only about 9 percent have a diagnosis of PTSD,” she said. “About 70 percent of our completed suicides, there are failed relationships, either intimate relationships or with family.”

Ritchie has worked in the top echelons of Army medicine for years. When asked if she has ever had the opportunity to query enlisted soldiers, personally, in an off-the-record environment by strolling the barracks or hanging out in a hospital smoking area, she said no. “I don’t, per se, do that in an informal way,” she admitted. “But the Army has a number of mechanisms to gather information from all levels, through anonymous surveys, through focus groups.”

Inside the Pentagon, at least, the rising trend of apparently preventable suicides, murders and other avoidable deaths remains a complicated mystery. Soldiers and their families, meanwhile, are attending too many funerals.

Now Needham is gone too. He died on Feb. 19, about 10 days after back surgery at a Veteran’s Affairs hospital in Tucson, Ariz. The circumstances surrounding Needham’s death are unclear. According to his father, Mike Needham, an older brother discovered John Needham slumped over his bed at his mother’s house in Arizona, his face blue. Efforts by his brother, and then rescuers, to revive him were unsuccessful.

Needham, a tall, blond, sturdy California surfer and house painter, was deployed to Iraq in 2006. Not long after arriving, his life turned into a blur of roadside bombs, bloodshed and confusion. He was knocked unconscious by a grenade, suffering a brain injury. Shrapnel ripped into his legs. His back eventually gave him problems. He got a Purple Heart.

The damage to Needham wasn’t just physical. He also suffered from mental wounds. In Iraq in September 2007, when the carnage he had witnessed and participated in became too much, Needham pointed a pistol at his head and pulled the trigger. It would have ended there if a friend had not leaped forward to push the gun aside. The bullet hit a wall. Needham, who had a clean bill of health when he entered the Army, was shipped home.

When de Yoanna met him briefly in the airport in Colorado, Needham seemed nervous. He’d spent several weeks receiving care at Walter Reed Army Medical Center. Back at Fort Carson in Colorado Springs, Needham complained about punishment instead of treatment for his mental issues. His commanders threatened him with charges for discharging his weapon in his suicide attempt. Superiors also harassed him for falling asleep while heavily medicated. He was called a pussy. Though he had been diagnosed with post-traumatic stress disorder, Needham was punished for showing symptoms: failing to appear in formation, insubordination to superiors, and other problems.

With the advocacy of his father and others fighting behind the scenes, the charges against Needham disappeared and in July of 2008, the Army had washed its hands of him. He received an honorable discharge and a partial disability — but his benefits didn’t provide full access to mental health treatment, a critical gap in his care.

Had he received such care, things might have been different just weeks later. In September 2008, Needham made headlines across the country after allegedly beating his girlfriend, 19-year-old aspiring model Jacqwelyn Villagomez, to death in his San Clemente, Calif., condo.

After 10 months in a maximum-security jail cell awaiting trial, Mike Needham raised the $1 million needed to bail his son out to prepare for the murder trial.

Based in Colorado, de Yoanna traveled to California last summer and spent several days with Needham — part of Salon’s ongoing effort to understand veterans struggling with the hidden wounds of war.

Needham told de Yoanna during that visit that he couldn’t provide specifics about his case, fearing any statements he made to the press might become ammunition for prosecutors. He emphasized, however, that he was “not the murderer” authorities and the press had made him out to be. Looking over the crashing waves he loved to surf, the war veteran also said he had become an outcast and wanted to leave his home and live somewhere on the California coast where nobody would know him.

So he lived in the present, often on the beach. He surfed some, hoping the ocean would restore his body, but the pain in his lower back persisted.

After a first V.A. surgery on his back in Los Angeles that did not go as planned in late November, Needham struggled with severe pain. He developed an addiction to painkillers and was hospitalized in Long Beach in the following weeks to deal with it. Then his family brought him to Tucson, hoping the V.A. hospital near his mother’s home would do better. There was another surgery a few weeks later and one more — Needham’s third – earlier this month. Each was an effort to repair Needham’s deteriorating lower back.

Though Needham had a serious infection after his last surgery and a “tumor the size of a grapefruit” on his back, according to his father, he was only cared for by a visiting nurse while staying at his mother’s home at the time he died.

Autopsy and toxicology reports are being completed; medical investigators did not return a call to Salon by deadline.

Needham’s father feels the Army and perhaps the V.A. let his son down. “He never got correct care in the Army and, in my opinion, never got correct care from the V.A. either,” Mike Needham said. “What if they helped him when he first struggled after the explosions in Iraq? Instead, they sent him into battle day after day and harassed him when he struggled. As for the V.A., I think they’re the medical authority and responsible. I question why he was on outpatient status with a tumor the size of a grapefruit on his back.”

Mike Needham plans to join with family and friends in a small private ceremony to scatter the ashes of his son at the beach where he loved to surf. “That’s our spiritual altar — the ocean.”

View a slide show

According to the report, “Survey data from this investigation suggest a possible association between increasing levels of combat exposure and risk for negative behavioral outcomes.” The study also says that “combat intensity/exposure . . . may have increased the risk for violent behaviors” and that its “findings are consistent with recent research on combat exposure and subsequent behavior outcomes among Soldiers.”

Salon’s Coming Home series showed that soldiers who returned from combat duty with symptoms of stress were often ridiculed or otherwise discouraged from seeking help, were overmedicated or misdiagnosed, or chose to self-medicate with drugs and alcohol. Many had been deployed even though they were already displaying signs of combat stress. Additionally, some of the soldiers involved in violence against themselves or others had preexisting conditions that should have disqualified them from service, but were allowed into a military hard-pressed for new recruits via waivers.

The 126-page report issued by the Army Wednesday — an epidemiological study, or EPICON in military lingo — focused largely on 14 of the Army post’s soldiers allegedly involved in murders since 2005. Ordered by Fort Carson commander Maj. Gen. Mark Graham in the wake of the slayings, it is studded with statistical evidence that buttresses Salon’s investigation. The numbers point to a link between violent behavior and substance abuse, repeated deployments, exposure to combat and enlistment waivers. In addition, many of the 14 soldiers allegedly involved in murders witnessed incidents described in the report as War Crimes. Five either heard of or witnessed the “murdering/killing” of non-combatants; three, “detainee abuse;” and, two, “fabricating evidence to justify attacks or criminal acts.”

Yet the Army officials presenting the report denied that it established any cause-and-effect relationships. Eric Schoomaker, the Army’s surgeon general, waved his hands across his chest under clear blue skies during the outdoor press conference, dismissing the notion that the report proved a tie between soldier-involved killings and the horrors those soldiers experienced in the war.

“While this is probably the most intensive and in-depth investigation on the clustering of violent-on-violent crimes in the Army that we’ve ever seen or are aware of,” said Schoomaker, “it is still in many respects preliminary.”

Without causation, there is no way to establish how the murders could’ve been prevented. “We would all like to look back at the cluster of misconduct and criminal activities,” said Schoomaker, “that resulted in devastating human tragedies here in Colorado and be able to say, ‘This is the reason they happened and we know exactly what could have been done to prevent them,’ but that’s rarely the way things work when dealing with human behavior.”

Without causation, there is also limited accountability. While commanders were blamed for standing in the way of soldiers receiving mental health and substance-abuse care, Lt. Gen. Michael Rochelle, the Army’s director of personnel, said the report “was not a tool that was intended to be used to either fix accountability or to be used for any sort of disciplinary action that may follow.”

Schoomaker, Rochelle and Maj. Gen. Graham, who was also on the podium Wednesday, were able to deny cause-and-effect because of caveats in the study. The authors of the report, a 24-member team assembled the Army’s Center for Health Promotion and Preventive Medicine, issued recommendations to stop the belittling of soldiers who seek mental health care and to identify units with high exposure to combat. They stopped short, however, of positing causation, saying that “”the cross-sectional nature of the study does not allow for making causal inferences.”

Thus Schoomaker could say, truthfully, “It’s pointing the finger to levels of causation, but we don’t know direct causation yet. … I’m very reluctant to put cause and effect there. In fact, the authors [of the report] are very careful to say these are correlations … not necessarily one causing the other.”

Yet Schoomaker also seemed to place some blame on the soldiers themselves for failing to seek help. He suggested that units where the soldiers were more willing to get help were less likely to be plagued with violence. The study, he noted, analyzed two brigades at Fort Carson, the 4th and the 3rd. “What did seem to differ between the two was the willingness and ability of those soldiers within the unit where crimes were committed to seek and get effective care for emerging behavioral health problems — alcohol and drug problems — and prompt attention to misconduct.”

But Schoomaker also claimed that the experiences of the 4th and 3rd Brigades in combat were “similar.” That’s not what’s indicated in the report — the 4th Brigade, where the murder suspects were clustered, had eight times more combat deaths than the 3rd. Moreover, the report indicated that the Army itself played a role in denying care to the soldiers — half, some with suicide issues, were sent back to Iraq “early,” according to the report.

U.S. Senator Mark Udall, a Colorado Democrat, who met on Tuesday with Schoomaker, issued a statement following the release of the report, noting it raises “serious questions about whether the military is doing enough to help service members transition from battle back into civilian life.”

“This is a matter of life and death, for our service members – and civilians,” Udall stated. “We must do everything in our power to ensure that the military is providing all necessary treatment and support to protect our service members, their families, and our communities.”

That could be a long road. The report indicated that “overall staffing” for behavioral health at Fort Carson’s Evans Army Community Hospital between 2006 and 2008 was just 65 percent of authorized positions.