Second set starts here

The bullet sliced through his jugular vein, traveled through his skull and exited near the top left side of his head. He crumpled down in the road. Even if the bullet had failed to rip through his brain, shooting through the jugular was solid insurance. He would have bled out in minutes anyway.

Bagosy, 25, who had served in Iraq and Afghanistan, had become another statistic in the war-fatigued military and its steadily escalating suicide rate. Last year, 52 Marines committed suicide. The suicide rate among Marines has doubled since 2005, and the Corps has the highest suicide rate in the military. The circumstances of Bagosy’s death, however, provide a particularly poignant case study in what many critics say is the military’s inadequate response to that suicide crisis.

Bagosy’s story shows how the military’s ineptitude in the face of crisis affected a single family — in this case, a Marine in the last hours of his life, and his two young children and his wife, who waited in vain that day for him to come back to his home just outside Camp Lejeune.

These circumstances are particularly troubling because Bagosy died a year after a former Camp Lejeune psychiatrist risked his reputation and career to warn Navy officials that unless Camp Lejeune dramatically improved mental health services — and in particular, develop precise, rigorous protocols for handling Marines who might kill themselves or others — there would be deadly consequences.

That psychiatrist, Dr. Kernan Manion, repeatedly warned Camp Lejeune and Navy officials in writing starting in the spring of 2009 about the risk of more Marine suicides, murder and “immediate concerns of physical safety” if Camp Lejeune did not improve. Frustrated by what he saw as a lack of action by officials at Camp Lejeune, Manion took his concerns to a series of military inspectors general in late August. He was fired four days later. The Defense Department inspector general is investigating that case.

The lessons from Bagosy’s suicide are especially provocative because minutes before his death, Bagosy was inside the Camp Lejeune Deployment Health Center, the place where doctors are supposed to help Marines like Bagosy. Healthcare workers there knew he had problems. They knew he had already been diagnosed with both a brain injury and post-traumatic stress disorder, the signature injuries of the current wars. He’d been seeing a doctor there and a therapist. He’d talked with his therapist about thoughts of suicide. Officials at the clinic the day he died also knew Bagosy was acutely suicidal that very morning and that he was armed, because his wife, Katie, had called to warn them about all of it. They had decided he needed to be hospitalized.

Yet he managed to get away from the clinic, and minutes later Bagosy would lay covered by a bloody sheet on one of Camp Lejeune’s main thoroughfares.

Bagosy first started seeing doctors at Camp Lejeune in the summer of 2007 after a tour in Iraq. He was soon diagnosed with a brain injury and PTSD. His wife described the change in her husband after that first tour in Iraq this way: “The man I married died in Iraq and I didn’t know the man who came back.” Then Bagosy went to Afghanistan, with Marine Corps Forces Special Operations Command. A close friend died in an explosion there. He returned in November 2009. Bagosy struggled with typical symptoms for his continuing problems: depression, anxiety, alcohol abuse and bouts of sudden, intense suicidal and homicidal thoughts. At work at Camp Lejeune in February of this year, Bagosy threatened to “shoot up the place” according to his medical records, a threat his superiors took so seriously they temporarily confiscated Bagosy’s weapons from his home. (He later signed them out again, claiming he wanted to practice at a nearby shooting range.)

He was seeing a counselor and a psychiatrist at Camp Lejeune, but Bagosy didn’t think it was helping much. Mostly he felt overmedicated. His condition worsened. In April, Katie wrote a letter to her husband’s psychiatrist, worried about poor treatment, and suggesting he switch doctors. “I can no longer stand by and watch my husband lose control and watch as his life slips away,” she warned.

In March, Tom and Katie argued in the kitchen. He pulled a handgun from the top of the refrigerator and put it to his head. “Do you want me to kill myself?” he screamed at Katie.

The day before Easter they fought again. Tom went for the gun. “He was sitting at the computer,” Katie recalled later, huddling on her sofa in her home just outside Camp Lejeune. “He stood up and started to walk toward the kitchen. I knew where he was headed and I tried to get there first.” They struggled over the weapon. “It was like a movie. We were hand-in-hand fighting over that gun. Obviously, he is stronger than I am,” she said. “He pushed me off and got in his car and drove off.”

Katie called the police, who could not find him. Tom later told his mental health counselor at Camp Lejeune about the incident. The counselor asked him if he’d been drinking at the time. Bagosy admitted that he had. The counselor informed his commanders, who referred him to a later appointment at the substance abuse program that was also located inside the Deployment Health Center.

Tom got worse. The day before he went to that substance abuse appointment, May 9, Mother’s Day, Tom was despondent. “I spent the whole day trying to convince him not to kill himself,” Katie recalled. He took a handful of anti-anxiety pills. It didn’t kill him.

That night, Katie recalled, “He had the gun and he was waving it around,” and said to her, “Don’t worry. I’m not going to kill you.”

“I’m not worried about that. I’m worried about you killing yourself,” Katie replied. “There is no way I can keep you from doing this, is there?”

“No,” Tom said. Katie quotes him as saying: “I went from being so angry that I want to take someone with me, to I just want it to end.”

She convinced him to go to his appointment at the Deployment Health Center the next morning. She thought she might be able to save him, if she could just get him in the door.

The next morning when Tom went out to his GMC Sierra, he had a handgun in the middle console of the truck between the two front seats.

The details of what happened on May 10 are not in dispute. Tom arrived as scheduled. He filled out some paperwork to begin treatment at the substance abuse center. Tom’s written responses about his depression alarmed one counselor there so much he immediately escorted Tom into a doctor’s office.

At the same time, Katie called her husband’s mental health counselor who was sitting upstairs inside the same building. She told the counselor that Tom was there and that he wanted to kill himself. Katie said he needed to be hospitalized, but would probably resist efforts to do so. “He has a tattoo that says, ‘Death Before Dishonor’” Katie explained later. “To him, this was dishonor.” That wasn’t all. “I told them he had a gun,” she remembered.

The counselor called downstairs and relayed all of this information to workers there. The counselor informed them that Tom should not even be allowed out of the building to smoke a cigarette. He needed to go to the hospital.

The counselor and the healthcare officials in the substance abuse center all agreed that Tom needed hospitalization immediately, but they were unsure on just how to transport him there. Ultimately, the staff called Tom’s commanders at the Marine Corps Forces Special Operations Command to arrange an escort. Tom seemed calm and cooperative throughout this process. He also agreed to wait for his escort.

Despite his cooperative demeanor, the officials at the clinic were still worried that Tom might flee before his escort arrived, though, again, they were evidently unclear on just what to do about that as well. A substance abuse counselor agreed to keep an eye on Tom, who sat on a sofa in the counselor’s office.

When the counselor turned to his computer to work, however, Tom stood up and struck up a conversation with a civilian in the hall. Then he simply walked quickly down the hall, out of the clinic, and broke into a run as he headed toward his truck. This was a prospect that the clinic staff had no protocol or tools at their disposal to prevent; there was not even a military police officer on hand to watch the door.

The substance abuse counselor panicked, chased Tom outside and asked some nearby Marines in the parking lot — patients themselves — to tackle Tom. There was a struggle at Tom’s truck. Tom produced the gun from the console. The counselor and the Marines backed off. Tom got in the truck and drove away.

Clinic workers had already called the M.P.s. Tom had barely made it a block when an officer passed him driving in the opposite direction. The officer noticed that Tom was talking on a cellphone while driving.

“He called me and was crying hysterically,” Katie remembered. “He said, ‘I love you and I don’t think I’m going to ever see you again.’”

Tom hung up. The police car had turned around and pulled Tom over on the shoulder of McHugh Boulevard.

The commander of the Naval Hospital at Camp Lejeune, Capt. Gerard Cox, says staff at the Deployment Health Center followed established protocol in their efforts to hospitalize Bagosy. “We practice by the exact same standards as the civilian world,” Cox explained. “There is a risk assessment that is conducted by that medical professional, and then it is a matter of judgment as to whether the person needs to be taken right now” to the hospital, he said. “One extreme would be taken under armed guard and another extreme would be they take themselves.” In this case, Cox said, calling Bagosy’s command to come to the clinic to escort him to the hospital seemed sufficient.

Those judgment calls are that much more difficult when a patient appears to cooperate, Cox argued. “He was not overtly agitated, violent, threatening, or stating any intent for violence against himself or for anybody else,” Cox explained.

Indeed, by civilian standards, officials at the clinic handled Tom appropriately. “They did not blow it,” said Lanny Berman, a psychologist and executive director of the American Association of Suicidology. “The physician needs to make arrangements to have the patient escorted,” Berman explained.

The very fact that Bagosy died following the ad hoc nature of the clinic’s effort to arrange for his hospitalization, however, suggests that civilian protocol might not suffice for a clinic treating combat-hardened troops with acute, explosive conditions. “This is exactly the sort of event I was trying to help them prevent when I repeatedly urged them to implement a comprehensive and truly fail-safe violence response protocol,” Manion said.

Indeed, the account of the treatment gaps that preceded Bagosy’s suicide track closely to what Manion complained about. The psychiatrist told his supervisors that the various doctors treating Marines should compare notes and coordinate care. He wanted specially trained M.P.s on hand at all times at the clinic and ready to intercede if any cases got out of hand, as Bagosy’s did.

Manion was adamant because he insisted these were no ordinary patients. They are traumatized, volatile, armed and trained to kill, requiring extra precautions, top-shelf care and the exercise of rigorous safety protocols. “This service population is one of high risk, high intensity and frequent crisis,” Manion desperately wrote his superiors in an April 24, 2009, memo seeking improvements in the way Camp Lejeune handled Marines in crisis.

“Tom’s suicide, as sad as it is, also makes me furious because it was entirely preventable,” Manion said recently. “His death highlights Lejeune’s grossly inadequate understanding of the specific needs of these psychiatrically high-risk troops.”

Cox said Camp Lejeune officials continue to investigate why things went so wrong. “It is an interesting question that you ask, that since the population is different, whether our services and capabilities should be different,” he said. “I think they are.”

Manion disagrees, and says the Navy should know better, particularly after nearly 10 years of war. “To me, their persistent lack of preparation — repeatedly refusing to heed the explicit warnings they’ve received from me and others — exemplifies not only willful ignorance, but a defiant arrogance,” he said.

Bagosy was buried at Arlington National Cemetery earlier this month. Casualties of the wars in Iraq and Afghanistan are buried in one revered section there, called Section 60. Bagosy is buried in Section 59, since he is not considered a casualty of those wars. Katie is furious, and sees his burial in Section 59 as a marginalization of her husband’s psychological wounds. It is well known that the military struggles with the stigma of mental trauma. “They are even stigmatized in death,” she said. 

The commission’s review comes after a series of Salon articles chronicled complaints by Dr. Kernan Manion, a civilian psychiatrist who formerly worked there. Last year, Manion complained in writing to superiors about life-threatening deficiencies in the management of mental health care for Marines with psychological injuries from combat. Seeing little response, a frustrated Manion finally appealed to a series of military inspectors general and was fired four days later last September.

Salon also documented an apparent effort by Navy officials to doctor Manion’s performance evaluation after his concerns were first aired in Salon in order to make him look like a bad doctor.

It is possible that this latest review by the commission has nothing to do with Manion’s concerns about the management of mental health care. A number of doctors at the Camp Lejeune hospital have contacted Salon to describe frightening resource shortages, corners being cut, and sloppiness in other medical departments. Perhaps the commission is looking into another department altogether.

If, however, this review is focused on the management of mental health care there, then commission officials have joined the flurry of investigations that have followed the Salon series about Manion and Camp Lejeune. Hospital sources confirm that Brig. Gen. Kenneth Lee, the inspector general of the Marine Corps, visited Camp Lejeune earlier this week, looking into allegations of mishandling Marines returning from war suffering from acute combat stress.

The Navy also says it conducted its own quality assurance review of mental health care at Camp Lejeune last fall. That review showed that all is well.

“I am very assured that the quality of mental health care that is available to the Marines and sailors at Naval Hospital Camp Lejeune is very high,” Rear Adm. Bob Kiser, commander of Navy Medicine East, which oversees healthcare at Camp Lejeune, told Salon in a recent interview. Kiser also dismissed the notion that the Navy doctored Manion’s record

Kiser’s statements have not reassured Rep. Walter Jones, R-N.C. Jones has been going back-and-forth with the Department of Defense inspector general on the scope of an entirely separate probe that would be kept out of the Navy’s hands. Jones wrote Defense Secretary Robert Gates in January to ask that the inspector general look into Manion’s firing, the alleged smearing of his record, and also the care of Marines at Camp Lejeune, which is what troubled Manion in the first place.

The Defense Department inspector general responded to Jones on Feb. 4 and confirmed an investigation “into Dr. Manion’s allegations concerning the termination of his employment.”

The scope of that probe, then, remains unclear, since Jones wants a broader investigation into the handling of Marines. Jones told Salon in an interview Thursday that he believes the inspector general must look into Manion — and also the treatment of Marines — at the same time. “I don’t see how they can do the investigation without knowing why Dr. Manion’s performance record was changed,” Jones told Salon.

“Why would he go from being an outstanding psychiatrist and doing a great job and then all of a sudden he is not doing a great job?” Jones asked. “That only came about when (Manion) started speaking out that these Marines were having problems. That is what I think and hope is going to come out.”

Sources inside the Defense Department inspector general’s office, however, say narrowing an investigation — say, to focus on Manion but not the treatment of Marines — is an infamous way of burying problems.

In his interview with Salon, Jones did not rule out pushing to ensure the probe is wide and the treatment of Marines at Camp Lejeune gets the attention the matter deserves.

Meanwhile, Marines familiar with mental health care at Camp Lejeune describe a mess. “I was in the inpatient ward for about a week. I was the only officer there,” a Marine who attended the Naval Academy told Salon. “Mostly they just hand out meds. They never really brought up how to take care of your thoughts or how to train yourself how do deal with emotions. It was just, ‘Here. Take this. Take this.’”

He said the Marine Corps treats soldiers with mental problems like garbage. “They kick you to the curb and treat you like an outcast. It’s horrible,” he said. “Would you rather find an officer swinging from his shower stall or abusing alcohol or other things Marines are doing because they won’t get help? Obviously, the Marine Corps is saying, ‘Yes.’” 

“I’ve gotten new information,” Jones said about the reports coming in to his office. He described an “explosion” of suicides and violence among returning Marines. He said years of straining to maintain a fighting force while troops go through multiple combat deployments has contributed to the emergence of a toxic military culture of hostility and retribution. “We are breaking the military,” Jones worried. He asked for an investigation into Manion’s termination — and the Pentagon has committed to doing it.

The Navy admiral who oversees medical care at Camp Lejeune disagrees with complaints about care, based in part on a two-day visit to the base last week on the heels of a series of Salon articles. “I am very assured that the quality of mental health care that is available to the Marines and sailors at Naval Hospital Camp Lejeune is very high,” Rear Adm. Bob Kiser, commander of Navy Medicine East, which oversees healthcare at Camp Lejeune, told Salon.

Kiser disputed accounts that the Navy smeared Manion for blowing the whistle, but admitted that during his trip he did not dig much into whether Navy officials altered Manion’s personnel records to make him look bad, as Salon reported.

Specifically, Kiser said he does not know if the Navy has backup documentation showing that Manion was, in fact, a bad doctor, as the Navy has alleged. “I don’t know because I don’t have a need to know,” Kiser told Salon in a telephone interview. Kiser explained that privacy rules prohibited him from looking into that documentation. “I am not privy to the exact nature of those sorts of documents,” he said.

Walter Jones says he will seek a second opinion on that as well.

The North Carolina Republican is hotly pursuing allegations of poor care and coverups at Camp Lejeune. Jones worries Manion might have been fired in retribution for blowing the whistle. Jones told Salon last week he is mostly motivated by Manion’s underlying concerns — that Camp Lejeune is poorly responding to Marines coming back from war with psychological injuries from combat.

“I care about what has happened to Dr. Manion, especially if there has been a contrived effort to undermine him,” Jones told Salon. More important, he said properly handling Marines returning from war with combat stress is “what I care about and Dr. Manion cares about.”

This story is unfolding rapidly. Salon previously reported that Jones had requested an independent probe by the Defense Department inspector general — kept out of the hands of the Navy entirely — that would look into the experience of Marines returning from war at Camp Lejeune as well as allegations the Navy fired and then smeared Manion’s performance record.

The Pentagon inspector general has now responded to Jones with a letter dated Feb. 4. It says that the Pentagon inspector general “has opened an investigation into Dr. Manion’s allegations concerning the termination of his employment.”

Jones told Salon that’s not good enough. He said he would insist that the inspector general’s investigation look into the smearing of Manion’s record, but more important, probe the experience of Marines returning from war with sometimes life-threatening mental injuries from combat. “I am not going to let this thing go,” Jones pledged to Salon. “I am going to insist that there be a fresh look at this problem.”

Jones agrees that the tale of Manion, complicated as it may be, is a vehicle to get to the heart of that bigger story about Marines. “We have got to get to the truth on this thing,” he vowed.

Marines from Camp Lejeune also dismissed Kiser’s rosy portrayal, describing a much harsher reality. “It is a song and dance,” a Marine Master Sgt. at Camp Lejeune said about Kiser’s comments. “I think this is lipstick on a pig. They have a nice building. They threw some money at this. Now they can say these guys are being taken care of.”

That Marine, who requested anonymity, described significant stigma attached to mental health treatment at Camp Lejeune, including harassment from fellow Marines and superiors. “It is a career ender,” he said about seeking help. “They will tell you it is not. But it is.” He had been a patient of Manion’s, but after Manion’s termination, he said, he was shuffled off to another healthcare provider without even an explanation of where his doctor went. “Dr. Manion is amazing. I will just say that,” he said. “To see his name dragged through the mud is, well, that is the kind of shit that the military is famous for and that is why I want to stay anonymous.”

The Marine was referring to Manion’s termination and what came next, which is the back story to this whole affair.

Manion, a psychiatrist with 25 years of experience who specializes in the treatment of combat stress and concussions, was fired last Sept. 3. Manion had repeatedly warned his superiors at Camp Lejeune, including Cmdr. Robert O’Byrne, head of mental health at the Camp Lejeune Naval Hospital, that poorly managed mental health care could contribute to an already worrisome rash of deadly violence among returning Marines. Frustrated by what he said was an inadequate response from his superiors, Manion warned a series of military inspectors general on Aug. 30 about the “immediate threat of loss of life and/or harm to service members’ selves or others.”

Manion was fired four days later. Salon wrote about the whole episode on Nov. 15, suggesting Manion’s termination may have been retribution for blowing the whistle. The contractor who employed Manion told Salon the psychiatrist was terminated at the Navy’s request.

Jones, who says he’s bent on getting to the bottom of all this, asked Defense Secretary Robert Gates about the situation the very next day, in a letter dated Nov. 16. On Dec. 17 Navy Secretary Ray Mabus responded to Jones. Far from silencing a whistle-blower, Mabus said, the Navy had terminated a bad doctor who deserved to go. Mabus alleged that Manion had been “counseled on multiple occasions” for being unprofessional, absent and disrespectful, among other things.

Mabus’ allegations track closely to what appears to be a doctored performance evaluation of Manion’s time contracting with the Navy. After his termination, one of Manion’s peers had filled out Manion’s exit evaluation, giving him high marks. Salon obtained internal e-mails and documents showing that on Nov. 24, just days after the original Salon article, Camp Lejeune mental health chief O’Byrne “pulled back” that performance, according to an e-mail from O’Byrne to that peer.

O’Byrne then returned the review with new derogatory information in it, panning Manion’s professional judgment, ethical conduct and ability to work with peers, similar to some of the negative information that Mabus would later reiterate in his letter to Jones. Salon published an article exposing that paper trail on Jan. 31

Kiser, however, said Salon’s article about Manion’s evaluation reflected only a snapshot of the collaborative process of drafting a performance review, which is based on input from multiple healthcare officials. “The whole allegation that there was some alteration done reflects a misunderstanding of the performance evaluation process,” he said. “What happened, I suspect, is that there are several copies with several inputs, but nothing has been altered,” he explained. “The final (review) is not anything that you have shown on your website.”

In fact, Kiser said, there is yet another version — the official final evaluation — of Manion’s performance review that was completed just within the last few days.

Manion received that review Monday, Feb. 15. It is dated Feb. 11, two days after Kiser’s visit to Camp Lejeune and over five months after Manion left the base.

This version of Manion’s review rates Manion’s “ability to work with peers and support staff” as unsatisfactory. A paragraph is attached that alleges Manion “openly argued with staff.” It also alleges that Manion was counseled multiple times for poor use of the chain of command, but did not improve. It notes, however, that this counseling was “informal.”

That could be a key word. In addition to the tangled story of Manion’s evaluation, a potentially larger bombshell still lingers: Navy Secretary Mabus’ Dec. 17 letter to Jones, saying that Manion was such a bad doctor, he had been “counseled on multiple occasions” but failed to improve.

Manion says he was never counseled or reprimanded by the Navy during his time as a contractor. And it’s well known that such counseling in the military generates a lengthy paper trail. Salon asked Kiser if he is confident this paper trail exists. That is when Kiser responded that he does not know because he does not need to know.

Where is that paper trail? A doctor who formerly served at Camp Lejeune said the “informal” counseling in this latest review is a dodge, because it means there is no paper trail. “As far as this informal counseling — my training has always been you document everything, you have them sign it and you put it in the record,” he said. “The Navy needs to come clean. They need to say, ‘Look, we screwed up.’”

Salon also asked Kiser about the timing of O’Byrne’s move to add derogatory information to Manion’s performance review, just days after Manion went public in a Salon article that named O’Byrne. Isn’t it possible, Salon asked Kiser, that O’Byrne used the performance review process to try to smear Manion?

Without going into specifics, Kiser responded that he was confident that the process was perfectly fair. “One can, I think, take some comfort in that the process is fair and objective,” Kiser insisted. He said everything in Manion’s final review would be “quantifiable, substantive and objective.”

Not surprisingly, now that Manion has the final review, he disagrees. “I’m truly hoping that Congressman Jones is able to get a new DOD inspector general investigation,” the psychiatrist says, “so that we can get to the heart of this and restore integrity to this process.” 

“I am compelled to request an additional investigation by the Department of Defense IG’s office,” Jones wrote Gates, insisting that the new probe be kept out of the Navy’s hands. “I believe this should be a priority, given the additional strain our country is placing on our service members during this time of war.”

Manion generated a long paper trail at Camp Lejeune last year warning base hospital officials, including Cmdr. Robert O’Byrne, head of mental health there, that poorly managed care for troubled Marines could result in more violence and deaths. Frustrated by what he saw as an inadequate response, Manion finally appealed to a series of military inspectors general on Aug. 30, warning of “immediate threat of loss of life and/or harm to service members’ selves or others” if management did not improve. (There has been a string of suicides and murders among Marines at Camp Lejeune.)

Manion, who worked for a contractor, got fired four days later, on Sept 3, with no explanation.

On Nov. 15, Salon first published an article exposing Manion’s complaints and concern for the Marines at Camp Lejeune. The contractor that fired Manion said it did so at the Navy’s request.

On Nov. 16, one day after that Salon article, Jones wrote Gates about Manion and the doctor’s subsequent termination. Gates referred the matter to Navy Secretary Ray Mabus.

Mabus responded to Jones on Dec. 17. That letter says Navy officials had completed their own investigation into Manion’s termination. Mabus wrote that the investigation showed that rather than firing Manion as an act of retribution, Manion got terminated because he was an unprofessional, disrespectful doctor who failed to improve his performance despite formal warnings.

On Jan. 31, Salon published an article and supporting documentation showing that within days of Salon’s first article on Nov. 15, O’Byrne edited a once-satisfactory performance evaluation for Manion, adding new, derogatory information. With his changes, O’Byrne characterized Manion as unethical and unprofessional, similar to some of the claims that ended up in Mabus’ Dec. 17 letter to Jones.

Presumably, Mabus got his information from Camp Lejeune officials, perhaps from the same people who doctored Manion’s file. Navy officials have not responded to Salon’s questions about where Mabus got his information and whether anyone in Mabus’ office checked the veracity of the negative information about Manion. A Camp Lejeune hospital spokesman has denied “allegations” about O’Byrne but will not say what allegations specifically.

Jones obviously has the same documents obtained by Salon showing an apparent smear of Manion. “My office is in receipt of emails showing that Dr. Manion’s final performance evaluation … was altered prior to the arrival of Naval investigators,” Jones charged in his Jan. 25 letter to Gates. Jones also notes e-mail traffic, also cited by Salon, showing an apparent order by O’Byrne to destroy Manion’s earlier, positive performance evaluation.

Jones now wants the Defense Department inspector general to take a fresh look at the whole mess. “The investigation should remain in the DOD IG and not be referred to the Navy IG,” Jones requested in his latest letter to Gates. “I continue to receive complaints regarding the operations surrounding mental health care at Naval Hospital Camp Lejeune.”

Jones has a long track record working to improve treatment of combat stress and brain injuries among returning troops, the signature injuries of the wars in Iraq and Afghanistan. There is no word yet on whether Gates will launch the new investigation requested by Jones.

In his Jan. 25 letter to Gates, Jones also pointed out another shortcoming in the Navy’s own investigation into Manion’s termination — nobody called Manion to get his side of the story. “I have difficulty understanding how thorough an investigation into Dr. Manion’s termination was conducted, when the complainant was never interviewed,” Jones noted.

Salon called Manion to determine if that’s right. Manion said his phone never rang. “That is correct,” Manion said. “No one has ever contacted me about that.”

Download the letter here.

But Salon has obtained internal Navy documents and correspondence that suggest officials at Camp Lejeune altered Manion’s favorable personnel records after he went public with his concerns, adding new, derogatory remarks similar to some of the information in Mabus’ letter to Jones.

As Salon reported in November, Manion warned superiors, on multiple occasions and in writing, that mental healthcare at Camp Lejeune was overwhelmed with Marines suffering psychological injuries from combat. It was a toxic environment, Manion argued, that would only contribute to a rapidly escalating suicide epidemic in the military.

Manion also warned the situation at Camp Lejeune threatened to provoke a Fort Hood-style explosion of violence, or one like the acts allegedly carried out by Sgt. John Russell, who the Army says last May executed five fellow soldiers at a military mental health facility in Baghdad. Manion also claimed that troubled Marines sometimes experienced harassment from superiors for seeking help.

In one instance last April, for example, Manion warned Cmdr. Robert O’Byrne, head of mental health at the Camp Lejeune Naval Hospital, of “immediate concerns of physical safety” due to mistreated Marines teetering on the edge of violence. “There was — and continues to be — no means of discussion of high-intensity/dangerous cases,” he wrote. Later that month, Manion quoted to O’Byrne some Marine superiors who were calling troubled Marines “worthless pieces of shit” if they sought help.

Frustrated by what he said was little reaction from O’Byrne and other superiors, on Aug. 30 Manion notified a series of military inspectors general about the risk of “immediate threat of loss of life and/or harm to service members’ selves or others.”

Manion worked as a contractor for Spectrum Healthcare Resources, a subcontractor for NiteLines Kuhana. The contractor told Salon that the Navy ordered Manion fired on Sept. 3, four days after Manion wrote the inspectors general. “The treatment facility at Camp Lejeune notified [NiteLines] that Dr. Manion did not meet the Government’s requirements in accordance with the contract, and they directed he be removed from the schedule,” it reads. His termination dated that day notice provides no explanation.

Manion saw a case of retaliation. He has hired a lawyer. Manion also appealed to his congressional representative, Jones. That is when Jones asked for an explanation from the Pentagon last year.

Jones’ inquiry prompted the Dec. 17 response from Navy Secretary Mabus. That letter includes some stinging allegations about Manion. “Dr. Manion alleged he was improperly terminated from his job due to the complaints he raised concerning patient care,” Mabus wrote Jones. Not true, Mabus said. “A review of the record revealed that Dr. Manion was removed from the contract due to a sustained pattern of non-compliance with numerous contract stipulations,” he wrote, including absenteeism, disrespect and unprofessional conduct. Mabus added that Manion had been “counseled on multiple occasions but with little effect.”

While Manion’s activism likely chafed some Navy officers, he was never counseled for poor performance, he insists. “Nobody counseled me, ever,” he said. Referring to Mabus’ letter, Manion added, “That was the first I had heard of it.”

Jones told Salon he worried that Manion might have been slandered. “We continue to monitor this issue because we are concerned that Dr. Manion has not been treated like a professional,” said Jones. “We intend to get to the bottom of this because integrity does matter.”

The paper trail suggests Jones is right.

Manion was fired on Sept. 3. A lieutenant commander filled out Manion’s final performance review, called an “exit PAR,” and signed it on Nov. 10, 2009. The document, obtained by Salon, evaluates Manion as “satisfactory” in every applicable performance category, including his judgment, ethical conduct and ability to work with peers.

On Nov. 14, Salon published the first article chronicling Manion’s concerns about the management of mental health care at Camp Lejeune. The article included his allegation that he was fired for blowing the whistle.

On Nov. 24, O’Byrne, the head of mental health, e-mailed that lieutenant commander about the exit evaluation. “I pulled it back,” O’Byrne wrote. “We need to redo.”

O’Byrne sent the evaluation back to the lieutenant commander on Nov. 30. “Please see section VIII and XII of the attached specifically for comments I think capture the essence of what we discussed last week,” O’Byrne wrote.

In section VIII of this new evaluation, Manion’s professional judgment, ethical conduct and ability to work with peers had been changed from “satisfactory” to “unsatisfactory.” A new paragraph, labeled XII, now included, “Dr. Manion demonstrated poor ethical conduct and professional judgment.” It added that Manion had “disruptive relationships with his superiors and peers that had a negative impact on patient care and clinic process.”

In a Dec. 3 email, O’Byrne orders the previous, flattering version of Manion’s review destroyed. “Due to the sensitive nature of issue [sic]” O’Byrne wrote, “please immediately delete all copies of this PAR.”

The lieutenant commander who filled out the original evaluation seems to have stuck to his guns, insisting that Manion performed his job well. He wrote a Camp Lejeune attorney on Dec. 16 that despite O’Byrne’s changes to Manion’s records, “Kernan Manion was considered clinically competent to practice general psychiatry,” he wrote. “I had no specific concerns about his judgment or ethical conduct.”

In that exchange, the lieutenant commander described O’Byrne’s changes to Manion’s evaluation as “drastic.” He added that he was “instructed to sign” the new evaluation.

O’Byrne declined an interview request from Salon. “The allegations in question are completely unfounded and untrue,” Camp Lejeune hospital spokesman Lt. j.g. Mark Jean-Pierre said in a statement to Salon. (Despite numerous requests, Jean-Pierre would not say which allegations are unfounded and untrue.) He went on to suggest that Manion, or perhaps Salon, was irresponsible. “The fact that such accusations are being made against a senior naval officer with an impeccable service record is not only wrong, but irresponsible,” the statement says. It adds, “Officers are held to the highest standards and any behaviors that contradict the naval core values are not tolerated.”

Salon asked the Navy two questions: 1) What is the basis for the derogatory information about Manion in Mabus’ letter? And, 2) What is Mabus’ basis for believing that information is accurate?

The Navy did not answer either question. Instead, a Navy spokesman sent Salon a statement saying the Navy had already investigated Manion’s original concerns about healthcare at Camp Lejeune. “The allegations made by Dr. Manion concerning mental health services being provided at Camp Lejeune were thoroughly reviewed in a recently completed quality assurance investigation,” Navy spokesman Lt. Justin Cole said in a statement to Salon. Cole also added that Navy would not share the results of that investigation. “The results of the quality assurance investigation, to include its findings and recommendations, are not releasable.” Cole insisted, however, that Navy officials were taking unspecified “action” in response to the results of that investigation.

The contractor that hired and fired Manion did not respond to a request for comment on the changes to Manion’s Navy personnel records.

Manion insists he never heard a word about his allegedly poor performance until he reviewed the documents obtained by Salon through multiple sources. Indeed, after his termination by the contractor back in September, Manion wrote the Navy Medical Logistics Command arguing that his otherwise-clean record provided further evidence that he was fired in retribution for blowing the whistle. “Given that I have received no allegations of wrongdoing by any party throughout the course of my employment and given that this termination occurred in the immediate context of my having filed an emergency complaint with the inspector general’s office,” Manion wrote Sept. 30, “I am concerned that your office may not have been aware of such an action having been taken.”

Now that this new paper trail has emerged, Manion has responded by firing off a series of letters to Camp Lejeune officials, including O’Byrne and Manion’s former contractor employer, requesting access to his own personnel files. “I think it is both fair and important that I have the immediate opportunity to review my full personnel assessment, particularly that which pertains to…blatantly false characterizations, so that I may respond in detail to it.” Manion says he recently received a response from the hospital commander at Camp Lejeune, Capt. Gerard Cox, saying Camp Lejeune would process his request through the Freedom of Information Act.

Eugene Fidell, a professor at Yale and president of the National Institute of Military Justice, said it is unclear whether tinkering with Manion’s performance record could result in judicial punishment. It is possible it might violate any number of complex military regulations governing performance evaluations.

Wasting time smearing Manion, however, also seems like a misplaced priority for Navy mental health officials battling an unprecedented military suicide epidemic during the wars in Iraq and Afghanistan. In 2008, for example, 42 Marines committed suicide and 146 tried to do so. During the recent Pentagon’s second annual Suicide Prevention Conference, the military announced that 52 Marines committed suicide in 2009, surpassing the national average.

Manion agreed. “That’s precisely what I was trying to address,” Manion said. “It is a crisis of suicides.”