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How organizations fight change and punish whistleblowers: Military hospitals

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Sharon LaFraniere reports in the NY Times:

Beyond conducting their periodic evaluation of Womack Army Medical Center, one of the military’s busiest hospitals, the inspectors who came here to Fort Bragg last March had a special task. A medical technologist had complained of dangerous lapses in the prevention of infections. The inspectors planned to follow up.

But Teresa Gilbert, the technologist, said supervisors excluded her from meetings with the inspectors from the Joint Commission, an independent agency that accredits hospitals. “I was told my opinions were not necessary, nor were they warranted,” said Mrs. Gilbert, an infection-control specialist.

The review ended disastrously for Womack, one of 54 domestic and overseas military hospitals that serve more than three million active-duty service members, retirees and family members. The inspectors faulted infection prevention and many other aspects of care, putting the hospital’s accreditation under a cloud for months.

It was disastrous for Mrs. Gilbert, too. She said she was reprimanded for being an obstructionist, reduced to part-time hours, investigated for what she called trumped-up charges and transferred to a clerk’s job.

The message to Womack workers, she said, was clear: “You don’t go against us. If you do, we will get you.”

At any hospital, patient safety and quality of care depend on the willingness of medical workers to identify problems. The goal is for medical workers to be free to speak bluntly to — and about — higher-ups without being ignored or, worse, punished.

In interviews and email exchanges, many doctors, nurses and other medical workers said military hospitals fall short of that objective.

During an examination of military hospitals this year, The New York Times asked readers to recount their experiences via a private electronic portal. Among more than 1,200 comments were dozens from medical workers about how the system thwarted efforts to deliver superior care.

Physicians and nurses described in follow-up interviews how they were brushed off, transferred, investigated, passed over for promotion or fired after they pointed out problems with care.

Senior military health officials said they were working aggressively to instill a culture where complaints are welcomed and addressed.

“We want people to come forward,” Lt. Gen. Patricia Horoho, the Army surgeon general, wrote in a statement. “We are committed to patient safety, we are committed to transparency, and there will be NO COMPROMISE.”

But hospital workers, both military and civilian, described compromise as routine. The nature of military medicine, they say, muddles the emphasis on patient safety and quality of care.

Military hospitals must train a combat-ready medical corps while treating fevers and delivering babies. The staffs are top-heavy with novices, and active-duty medical workers are constantly rotated. Experts say some hospitals are dangerously small.

The command structure is so rigid that a nurse can oversee a doctor because the nurse holds a higher military rank. Promotions often reward administrative deeds over medical performance. Legal accountability is diminished: Active-duty service members cannot sue for malpractice, and other patients can sue only the government, not individual doctors or nurses.

Military supervisors wield more power than civilian ones; they are authorized to enforce rules that govern even the size of earrings a doctor can wear. Stepping out of line can be perilous for subordinates: One former Army radiologist said her supervisor threatened to transfer her to an outpost so remote that the only housing was in trailers.

“In the military you are not taught to question; you are taught to obey. And that’s great on the battlefield,” said Bill Benham, until recently first sergeant of the hospital at Fort Knox in Kentucky. “But health care is another beast.”

Risk in Raising Concerns

An analysis of military hospital data by The Times this year foundpreventable errors are chronic and rates of complications, when measured, are high in two cornerstones of treatment, maternity care and surgery. The Times also found that hospitals routinely failed to investigate after patients died unexpectedly or suffered permanent harm.

Continue reading.

One sidebar to the story:

Accreditation Trouble

In March, the Joint Commission found Womack Army Medical Center failed to comply with a long list of hospital standards. Inspectors cited continuing problems in two follow-up visits. A final inspection last month found no violations.

In the initial report, Womack was found to be out of compliance with 19 standards including the following:

  • Staff are competent to perform their responsibilities
  • The hospital effectively manages its programs, services, sites, or departments.
  • The hospital has an infection prevention and control plan.
  • The hospital plans the patient’s care
  • The hospital reduces the risk of infections associated with medical equipment, devices, and supplies.
  • The hospital uses data and information to guide decisions and to understand variation in the performance of processes supporting safety and quality.

Written by LeisureGuy

21 December 2014 at 6:16 am

We tortured many more than the Senate report discusses

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Peter Maass writes at The Intercept:

Have you heard the screams of a prisoner who is being tortured in America’s war on terror? I can’t forget them.

They pierced the walls of a detention center I visited in Samarra during an offensive by American and Iraqi forces in 2005. In a small room, I was interviewing a frightened detainee whose head was bandaged from an injury he unconvincingly attributed to a car accident during his capture. Bloodstains dripped down the side of a desk, and there was an American military adviser with us, as well as a portly officer of Iraq’s special police commandos.

Suddenly there was a chilling scream.

“Allah,” someone wailed. “Allah! Allah!”

As I wrote at the time, this wasn’t a cry of religious ecstasy. It was the sound of deep pain, coming from elsewhere in the town library, which had been turned into a detention center by Iraqi security forces who were advised by American soldiers and contractors. I was embedded with the Americans for a week, and I had already heard two of them, from the Wisconsin National Guard, talk about seeing their Iraqi partners trussing up prisoners like animals at a slaughter. During raids, I had seen these Iraqis beat their detainees — muggings as a form of questioning — while their American advisers watched.

The CIA’s violations of its detainees is the tip of the torture iceberg. We run the risk, in the necessary debate sparked by the Senate’s release of 500 pages on CIA interrogation abuses, of focusing too narrowly on what happened to 119 detainees held at the agency’s black sites from 2002-2006. The problem of American torture — how much occurred, what impact it had, who bears responsibility — is much larger. Across Iraq and Afghanistan, American soldiers and the indigenous forces they fought alongside committed a large number of abuses against a considerable number of people. It didn’t begin at Abu Ghraib and it didn’t end there. The evidence, which has emerged in a drip-drip way over the years, is abundant though less dramatic than the aforementioned 500-page executive summary of the Senate’s still-classified report on the CIA.

Matt Aikins, whose reporting on human-rights abuses in Afghanistan has been path-breaking, made this point the other day in a series of concise tweets: . . .

Continue reading. Keep reading—it makes a good point with an interesting anecdote.

The piece ends with a reading list:

Here’s a partial reading list of essential reporting on torture in Iraq and Afghanistan:

Senate Report on Abuses of Military Detainees (2008):

Haditha Killings by Tim McGirk:,8599,1174649,00.html

Taguba Report on Abuses at Abu Ghraib:

Abu Ghraib Abuses by Seymour Hersh:

Special Forces in Afghanistan by Matt Aikens:

Constitution Project’s Task Force on Detainee Treament (See especially chapter 3):

“The Dark Side” by Jane Mayer:

“None of Us Were Like This Before” by Joshua Phillips:

The Killing of Dilawar by Carlotta Gall:

“Pay Any Price” by James Risen (See especially Chapter 7):

“Dirty Wars” by Jeremy Scahill (a founder of The Intercept):

“How to Break a Terrorist” by Matthew Alexander:

“The Black Banners” by Ali Soufan:

“Kandahar’s Mystery Executions” by Anand Gopal:

“No Good Men Among the Living” by Anand Gopal:

Written by LeisureGuy

16 December 2014 at 4:47 pm

Nukes are Back, and Obama’s Pentagon is the Cause

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Yet another disappointing fizzle from Obama. James Carroll writes at Informed Comment:

Mark these days. A long-dreaded transformation from hope to doom is taking place as the United States of America ushers the world onto the no-turning-back road of nuclear perdition. Once, we could believe there was another way to go. Indeed, we were invited to take that path by the man who is, even today, overseeing the blocking of it, probably forever.

It was one of the most stirring speeches an American president had ever given. The place was Prague; the year was 2009; the president was the recently sworn in Barack Obama. The promise made that day is worth recalling at length, especially since, by now, it is largely forgotten:

“As the only nuclear power to have used a nuclear weapon, the United States has a moral responsibility to act… So today, I state clearly and with conviction America’s commitment to seek the peace and security of a world without nuclear weapons. I’m not naive. This goal will not be reached quickly — perhaps not in my lifetime. It will take patience and persistence. But now, we, too, must ignore the voices who tell us that the world cannot change. We have to insist, ‘Yes, we can…’”

President Obama had been in office only three months when, boldly claiming his place on the world stage, he unequivocally committed himself and his country to a nuclear abolition movement that, until then, had at best existed somewhere on the distant fringes of power politics. “I know,” he added,

“that there are some who will question whether we can act on such a broad agenda. There are those who doubt whether true international cooperation is possible… and there are those who hear talk of a world without nuclear weapons and doubt whether it’s worth setting a goal that seems impossible to achieve. But make no mistake. We know where that road leads.”

The simple existence of nuclear weapons, an American president declared, paved the road to perdition for humanity.

Obama as The Captain Ahab of Nuclear Weapons

At that moment, the foundations for an imagined abolitionist world were modest indeed, but not nonexistent.  The 1968 Nuclear Non-Proliferation Treaty (NPT) had, for instance, struck a bargain between nuclear haves and have-nots, under which a path to abolition was treated as real.  The dealseemed clear enough: the have-nots would promise to forego obtaining nukes and, in return, the world’s reigning nuclear powers would pledge to take, in the words of the treaty, “effective measures in the direction of nuclear disarmament.”

For decades before the Obama moment, however, the superpower arsenals of nuclear warheads continued to grow like so many mushrooms, while new nuclear states — Israel, Pakistan, India, North Korea — built their own impressive arsenals.  In those years, with the singular exception of South Africa, nuclear-weapons states simply ignored their half of the NPT bargain and the crucial clause mandating progress toward eventual disarmament was all but forgotten.

When the Cold War ended in 1991 with the disappearance of the Soviet Union, and the next year Americans elected as president Bill Clinton, who was famously against the Vietnam War, it was at least possible to imagine that nukes might go the way of internationally banned chemical weapons. But Washington chose otherwise.  Despite a paucity of enemies anywhere on Earth, the Pentagon’s 1994 Nuclear Posture Review insisted on maintaining the American nuclear arsenal at Cold War levels as a “hedge,” an insurance policy, against an imagined return of Communism, fascism, or something terrible in Russia anyway — and Clinton accepted the Pentagon’s position.

Soon enough, however, even prominent hawks of the Cold War era began to worry that such a nuclear insurance policy could itself ignite a global fire. In 1999, a chief architect of the nuclear mindset, Paul Nitze, stepped away from a lifetime obsession with building up nuclear power to denounce nukes as “a threat mostly to ourselves” and to explicitly call for unilateral disarmament. . .

Continue reading.

Written by LeisureGuy

14 December 2014 at 11:56 am

The Usual Suspects and ISIS

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You’ll recall how bringing together the worst of the worst from all over the place and keeping them together led to acquaintance, friendship, alliance, planning, pooling ideas, trading tactics—a graduate school of crime (in The Usual Suspects) and of terrorism in our prison camps and black sites. The US, at enormous expense, got as many terrorists as possible and put them together. And we also added a fair number of innocents, doubtless some of those became terrorists, through anger, hopelessness, and recruitment by the harder core.

You know how hazing builds bonds? Certainly fraternities, sports teams, and other groups believe that hazing really strengthens group bonds. And so we did the hazing for them: our EITs made those who survived have something profound in common. And in that (wonderful) documentary on Whitey Bulger the point is made that Whitey had served time in Alcatraz, a notoriously tough prison, and that got him a lot of respect in his circles—as they said, it was the same sort of respect that other parts of Boston give to Harvard graduates. I imagine that those who went through the Salt Pit and our other dungeons and torture chambers are accorded respect for that. Plus, as the article describes, we helped them work together as a group, we fused them into a united mass—it’s practically Marxian: the capitalist pressures on the proletariat fuse them into a solid mass and push them to revolution.

I’m sure that this has happened before—in American prisons, for example, but elsewhere as well. Instances? The IRA?

Written by LeisureGuy

12 December 2014 at 3:30 pm

American ideals of heroism

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It has occurred to me that a superhero whose only superpower is the ability to kill people would face a big problem: if your only tool is a hammer, how do you address problems for which the solution is not pounding something? Killing, per se, is a pretty blunt tool.

But it occurs to me that, starting with Vietnam, US foreign policy has been dominated by the idea that problems are solved by killing people. When we are not killing people directly, we are giving military aid so that others can kill people. Killing people seems to be the universal answer.

I was pondering that, and it occurred to me that many of our lone-wolf, individualistic heroes in novels and movies use the same approach: killing people. Our culture seems to dote on killers: Shane, James Bond, tough private eyes, gunfighters in the old West, special forces troops, cops, espionage agents—they all kill a lot and seem to derive their power from that (rather than from, say, negotiating skills or finding effective compromises that benefit all parties). Of course, I doubt that I’d watch a movie of a committee meeting, regardless of the quality of the program it adopted: one wants dramatic action in a drama, and fighting for one’s life tends to be dramatic.

Still, there does seem to be a cultural component that looks quickly to killing as a solution for a messy problem. And yet quite often it seems that killing creates problem—as well as modeling the responses one gets.

UPDATE: Youngest Nobel prize winner asks why it’s easier to given guns than books.

Written by LeisureGuy

11 December 2014 at 10:56 am

Killer cops, drone wars and the crisis of democracy

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Andrew O’Hehir has a good column in Salon. Just one paragraph from the column:

It was also a week when another news nugget flashed by in my Twitter feed, noticed by hardly anyone and unlikely to be much remembered. But there were disturbing lessons to be found there also. A British legal nonprofit called Reprieve reported this week that, on average, every United States drone strike in the Middle East kills 28 unidentified people for every intended target. In America’s fruitless quest to kill al-Qaida head Ayman al-Zawahiri, the Reprieve report alleges, your tax dollars and mine have paid for the deaths of 105 individuals, 76 of them children. In its attempts to kill 41 specific people deemed “high-value targets” in the war on terror, the U.S. has apparently killed more than 1,000 people as unintended collateral damage. Incidentally, al-Zawahiri and at least five other of those celebrity villains remain alive. No one has taken to the streets to mourn those deaths and cry out for justice, largely because they took place far away in a murky war we are told nothing about. (Finding any media coverage of the Reprieve report proved to be a challenge.)

We don’t much notice, here in the US, the massacre of innocent people by our military, but people in those other lands do indeed notice, and their families particularly notice. The casual brutality of our military and the lack of concern for collateral damage (and trying to disguise by saying that any adult male who is killed was a militant, Obama’s childish ploy) is a very bad sign about our democracy.

Written by LeisureGuy

6 December 2014 at 1:42 pm

Ashton Carter worries me

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He seems eager to start wars, including a war with North Korea. We fought a war with North Korea. Let’s not fight another just because Ashton Carter wants to assert his manhood.

Written by LeisureGuy

5 December 2014 at 4:15 pm


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