Toxic Care - Revised

This is a revision to the previous article, Toxic Care. Some minor details were in error in the first article but the main content of the stories remain the same. I've also added a story a wife emailed to me after the original article.

I spoke with a mom yesterday who told me her son, who served as a combat medic in Iraq, is having his PTSD diagnosis revoked until he can produce three witnesses to corroborate his traumatic events. The soldier was in Iraq three years ago. After his tour in Iraq he was assigned to work as a medic in Walter Reed's spinal cord injury and amputee unit.

Walter Reed became a nightmarish recreation of Iraq for the medic. Eventually he was involuntarily extended and sent back to a combat unit about to deploy to Afghanistan. He wasn't able to redeploy, however, because of a physical injury incurred while serving in Iraq that required surgical repair.

After coming back from Iraq and while working at Walter Reed, the medic began to drink and was having combat nightmares. He was constantly depressed and having suicidal thinking at times.

He resisted seeking mental health care because he felt it would adversely affect him if he did have to redeploy. He feared others in his unit wouldn't trust him if he was considered a "nut case".

Finally with continued urging from his family and friends outside the military, he did seek mental health care. The medic was diagnosed with PTSD, Generalized Anxiety Disorder and Circadian Rhythm Sleep Disorder. He also entered a treatment program to help prevent the use of alcohol as a way to self medicate.

The medic had turned against the war during his time in Iraq but continued to do his duty without a strong declaration of that opposition. He felt an obligation toward his fellow soldiers to support them which kept him from overt dissent.

Finally in 2005 he joined anti-war veterans to oppose the war when he wasn't on duty. Finally, the young medic decided the only way he could truly support his fellow troops was to oppose their deployment and redeployment. And to support them coming home.

The Army came to the conclusion the soldier couldn't be successfully rehabilitated for physical and emotional problems while in the service. He's being told he’ll receive a medical discharge in the near future.


It now appears the Army has decided to award the young medic's duty of treating wounds of other troops by revoking his PTSD diagnosis if he fails to produce three witnesses to specific events of trauma.

How ludicrous the Army appears to demand a combat medic prove he witnessed the trauma of war while assigned to a combat unit in Iraq. How foolish they appear telling this medic he needs witnesses three years after he served in Iraq.

Any soldier or Marine who served in combat knows there is a constant flux of men coming and going in their unit because of death, wounds requiring evacuation and just the normal rotation for discharge and end of tours.

Any soldier and Marine knows finding witnesses to what they are asked to do in combat is the farthest thing from their mind. And a military personnel record can verify if an individual has been in a combat situation.

Any professional with experience in combat induced PTSD can testify memory loss and repression of memories are cardinal symptoms of the disorder. They can also testify that suicidal thinking, depressive symptoms and hyper-vigilant and paranoid appearing behaviors are common symptoms of PTSD. Use of alcohol or other substances to try forgetting horrible events of combat (self medication) is very common, as well.

The medic exhibited all the classic symptoms of combat induced PTSD, was diagnosed with the disorder and was treated for the disorder. But, now, the Army has mysteriously decided to make his continued treatment much more difficult or impossible with the foolish imposition of witness corroboration.

Not too long ago, the VA attempted to do the same thing with Vietnam veterans diagnosed with PTSD. Only a loud outcry by veterans' advocacy groups stopped that attempt.

The callous attempt to manipulate combat veterans' treatment has an obvious reason. The reduction of healthcare costs for veterans will be at the expense of their healing. Once again it is the veteran who will bear the costs of war even in the promised care for their wounds.

The Army says the young medic can go to the VA to regain his diagnosis of PTSD once discharged. His mom rightfully worries it will be a long time before he can be seen at the VA to determine he has PTSD that has already once been diagnosed. She worries he'll be without treatment and his symptoms and problems will worsen.

All recent studies and investigations have shown the VA system fails the veterans returning from Iraq and Afghanistan because of poor funding and understaffed clinics. Waits for disposition of diagnoses such as PTSD have been as long as two or more years.

Any professional with experience in treating combat induced PTSD can testify the best prognosis for controlling PTSD symptoms and avoid intractable, lifetime symptoms is early intervention.

A key problem with the care of active duty and VA eligible veterans struggling with PTSD continues to be the lack of experienced therapists. Seventy per cent of the therapists treating the men and women presenting with symptoms of PTSD have no previous experience in treating the disorder.

I also recently spoke with a soldier who was about to be redeployed even though he'd been diagnosed with PTSD, Adjustment Disorder and Major Depression.

The young soldier had attempted to harm himself but a fellow soldier had intervened.

Another soldier had called me because he was worried the young soldier would harm himself before he deployed or once he was back in Iraq. He asked that I call his friend to consult with him about his mental health issues.

I called and began a lengthy evaluation of the soldier's situation over the phone. I have several years experience working with psychiatric emergency teams, emergency phone triage and in a psychiatric emergency room.

The soldier was very polite, using the word, "Sir", often in our discussion. He told me he was worried he couldn't perform the duties he would be asked to do if he was in Iraq because he was having daily panic attacks. The attacks were increasing in number and duration.

The soldier also had an eighteen year old wife who had taken a restraining order out against him. There hadn't been violence but the soldier had become involved in verbal altercations with his wife and she was frightened he might act out against her.

He also has a three month old daughter he hasn't been able to see since the restraining order had been taken out. He worries about the care of the daughter because he discovered his wife is going out with old high school friends every weekend while leaving the daughter with the wife's mother. The wife was spending late hours in bars with the friends.
He reported having suicidal thoughts almost daily. He says he's had thoughts of killing his squad leader who has been petty and harassing toward him since his return from Iraq.

The soldier was seen by an Army psychologist recently and diagnosed with PTSD, Adjustment Disorder and Major Depression. The psychologist arranged an appointment with an Army psychiatrist for the soldier to be evaluated for medication treatment.

The appointment date with the doctor just happened to be one day after the soldier was to return to Iraq. His command told him mental health treatment would be available for him once he got settled in his base at Iraq.

The soldier knew, however, the mental health unit (Combat Stress Team) wasn’t on the base he was to be assigned to. The soldier would have to be taken by convoy to the where the stress team was located. Fellow soldiers would have to accompany him to go to the appointments for his treatment.

The soldier adamantly told me he'd never put fellow soldiers at risk for possible IED and roadside bomb attacks to transport him to have treatment.

He was also clear he felt he'd be unable to be as reactive and alert as he would need to be in a combat situation because his panic attacks were unpredictable and made him "freeze up".

The soldier asked me if I felt he should be treated before returning to Iraq. I reviewed his risk factors with him.

He had panic attacks with increasing regularity and intensity. He had suicidal thinking. He was having domestic problems. He had homicidal thinking. He faced a return to combat and he was untreated for any of his emotional problems.

The soldier was sure he couldn't get the help he wanted through the military healthcare system because he'd already tried and they dismissed his symptoms as normal. He didn't feel they were "normal".

My assessment from our discussion was he had significant risks that would make him a danger to himself or others. I felt his risks would be especially debilitating should he be in a combat zone trying to perform the duties of a combat infantryman.

I told him that I wouldn't want him covering my back in the condition he described. I felt I had a certain expertise from my own combat experiences as a Marine infantryman in Vietnam during the 1968 Tet Offensive and the following eleven months.
I suggested the soldier could use a emergency room at a civilian hospital to get a full psychiatric evaluation if he felt sure the Army hospital on base wouldn't address his mental health issues. The soldier told me he'd consider taking such action.

I found out the soldier did go to a local hospital ED the following day with two active duty soldiers accompanying him. He was placed on a mental health hold and admitted to the hospital's psychiatric unit. They kept the soldier hospitalized over a week before discharging him back to the military.

In today's healthcare system being admitted to a psychiatric unit requires an individual be an extreme risk to themselves or others or be gravely disabled. The fact this soldier was hospitalized confirmed what I feared when I spoke with him.

I was later told the soldier was medically discharged from the Army under honorable conditions about a week after he left the civilian hospital. Now he faces getting his treatment expedited at the VA.

The good news in his story would be he didn't go to Iraq again and possibly endanger his own life or the lives of his fellow soldiers.

Had the soldier gone along with the military in seeking help for his PTSD condition he'd be in Iraq with his symptoms worsening every day he was in country. And, he'd be without treatment.

The sad news in the story is the news he was medically discharged proved to be untrue. Instead, the young soldier was placed on a temporary medical hold but will soon return to his unit and be redeployed to Iraq.


Another mom called a friend of mine seeking help for her son stationed in Iraq. My friend works with local military families who are opposed to the war. Her son is the combat medic I first wrote about.


The mom with her son in Iraq was frantic because her son had gotten in trouble with his command. He was facing a Summary Court Martial for threatening the life of his 1 st Sergeant, failing to carry out several normal duties expected of him and missing several formations.

The soldier had seen some of his fellow troops killed during his tour in Iraq and had been shot himself but his Kevlar vest had prevented him being wounded. He had also become suicidal as well as homicidal.

His command placed the soldier on suicide watch and placed him in a barracks closet for observation purposes. The closet was situated next door to the quarters of his 1st Sergeant. The closet had a fire ax and ropes that weren’t removed even though the soldier could harm himself or someone else with them if he wasn't closely watched.

This soldier had enlisted in Colorado despite his mom's objection. His mom was terribly worried about him enlisting because he'd been diagnosed with Attention Deficit Disorder when he was eight years old.

He'd been treated with medications with only partial effectiveness up until the time of his enlistment. His psychiatrist, who testified by phone at his Summary Court Martial, stated he would be unable to function in the Army if he stopped taking his medication and in all likelihood even if medicated he'd be unable to withstand military life.

The soldier's recruiter in Colorado was informed of the ADD by the mother. The recruiter told the mom he'd "note" it on the recruit's record. During an Inspector General's investigation requested by the soldier, there was no record of the recruiter "noting" the ADD diagnosis.

The soldier says the recruiter had advised him not to mention the diagnosis because “plenty” of soldiers had the ADD diagnosis. The recruiter denied doing this during the IG inspection. The IG found no basis for the recruiter falsely enlisting the soldier.

They did find basis for the soldier being prosecuted for fraudulent enlistment under federal law. If convicted of that charge the soldier could be sentenced up to ten years in federal prison.

The soldier's mom went to her congressman's office for help. She felt she was patronized by the military liaison. He told her the soldier should just go along with "the program" to avoid problems. He said the soldier reminded him of himself when he was a young rebellious soldier.

The frustrated mom then went to her Senator's office. They told her it would take up to three weeks to do a welfare check. They also told her the soldier faced "big trouble" for his fraudulent enlistment and should just accept the Summary Court Martial and move on with his military service.

Finally the mom became frantic and called my friend who works with military families. She had some previous contact with the Senator's military liaison. My friend was able to cajole the liaison to make an inquiry faster than the three weeks the mom had been told it would take.

The mom was also advised to seek legal assistance. She hired a local attorney who had military law experience. That attorney contacted a friend of his in the Green Zone to request that he make inquiries about the soldier's case.
The attorney in the Green Zone told the local attorney he felt the commanding officer of the soldier planned on making an "example" of him because he'd made a threat against the 1 st Sergeant.

He also said the Combat Stress Team had not become involved while the soldier was under indictment for a Summary Court Martial. Only the soldier's civilian psychiatrist would testify about his mental health problems.

The soldier was convicted and sentenced to 15 days in the stockade in Kuwait and another 15 days in a Baghdad stockade. After his Baghdad incarceration the soldier was to return to his unit under the same command of the 1 st Sergeant and commanding officer.

Currently there has been conflicting reports the Army plans on mustering the soldier out with a medical discharge based on his preexisting condition of ADD or that he will have to make up the time spent in the stockade and finish his tour in Iraq.

If the soldier is discharged for the preexisting condition he'll be ineligible for VA benefits and all other veteran benefits. He'll be without benefits despite being shot, though saved by his Kevlar vest, and spending time in combat.

The last time the mom heard from her son he told her he'd still not been given medications despite the psychiatrist's testimony. In fact, the soldier hasn't had medications since he joined the military.

There is some research that shows the regimentation of the military is beneficial to individuals diagnosed with ADD. The military does give waivers for individuals with ADD but their regulations state the person must have a stage of ADD that is controllable.

This soldier's psychiatrist stated the soldier has never been fully controlled even with a higher dose of medications. He functioned poorly in school and in his attempts to go to college. And still the military seems to hold on to the need to not only punish the soldier but to further exacerbate his condition by returning him to a combat condition.

Just this past week (Oct 7-Oct 14, 2007) the mother talked with her son. He reports he’s now back with his company and again under the command of the 1st Sergeant. The 1st Sergeant, 38 years old, is harassing the 20 year old soldier by calling him “ a piece of shit soldier” and suggesting this Halloween he should “dress up as a ‘real’ soldier”.

Other members of the company have joined in on the hazing and harassment. The soldier and his parents are sure the 1st Sergeant is overtly attempting to cause the soldier to “snap” in order to provoke reactions that will allow charges to be filed.

Maybe the 1st Sergeant fell in love with the movie, “From Here to Eternity” and wants to be the sadist sergeant, Fatso Judson, but his actions toward a 20 year old soldier do nothing to further the reputation of the military. In fact, it really seems the 1st Sergeant is the soldier that should face charges based on the Uniformed Military Justice Code.

And a mother continues to frantically try saving her son from the possible horrible consequences of a toxic military healthcare system that seems to lack all standards of care normally expected in the treatment of mental health problems.

Addendum:
Since the first writing of the Toxic Care story I've received another email from a wife of an Iraq vet who lives in Colorado Springs, CO. The wife was desperate to find help for her veteran husband who has severe PTSD symptoms.

Recently the husband held the wife literally hostage in a flashback incident. The wife reports he was speaking Arabic and forced her into a prisoner position often seen in photos from the Iraq war.

The wife was somehow able to reach a phone and call a Vietnam vet friend of her husband. The friend was able to talk the husband down from his dissociative state and he "released" his wife from her captivity.

The wife called the Colorado Springs VA outpatient clinic but because of the hour discovered there was no help available. The clinic was closed, even though a large military base was just outside Colorado Springs (Fort Carson) and the city has many returned combat veterans in residence.

Desperate, the wife called Penrose Hospital, a private facility in Colorado Springs. When she reached the psychiatric team at Penrose she was instructed to take her two children out of the house to avoid any further threat of violence.

The wife made sure to tell the Penrose psychiatric team her husband had been having a flashback and needed immediate psychiatric care. She also told them he was no longer a threat because he had finally fallen asleep.

The nurse at Penrose told the wife they would send an ambulance to the home of the veteran. Moments after the wife had talked to Penrose, the Colorado Springs police arrived and barged into the home of the sleeping veteran to arrest him.

He was charged with felony menacing and domestic violence and by state law a restraint order to prevent him contacting his wife and children was implemented. The veteran was taken to El Paso County's jail and held for over three days. He was never seen at a psychiatric facility or provided a psychiatric evaluation.
The wife immediately tried to provide the veteran's medication to the jail personnel but was refused. She wasn't given a reason why the jail wouldn't provide medications prescribed by the VA to her husband.

Before the veteran could return home the wife had to get the restraint order removed. It took her three days to accomplish that.

The wife reports her husband has received minimal care at the local outpatient VA clinic in Colorado Springs. The family moved from the state of New York, where the husband had been treated for PTSD at a VA clinic. He had been prescribed medications for his symptoms.

Once in Colorado Springs, the VA clinic there told the veteran he should call for a possible appointment every Wednesday morning but there was no guarantee of available appointments.

The Colorado Springs VA didn't bother to inform the Iraq vet about the Vet Center program that was available to him. Only later would he and his wife find out about the Vet Center and enter treatment.

The veteran was arraigned for felonies. The wife informed the local El Paso County DA she wouldn't testify against her husband and would invoke the 5th Amendment refusal to testify.

The DA informed the judge assigned the case the wife had told him she wouldn't honor a subpoena if given one. The judge chastised the wife that he would institute a bench warrant for her arrest if she failed to report. She informed him she'd never told the DA she wouldn't honor a subpoena.

Seeing that her husband faced imprisonment in a criminal case rather than getting the help he needed, the wife hired a criminal attorney. The attorney had little knowledge about PTSD and seemed unwilling to use the veteran's state of mind as a defense.

In fact, the attorney suggested the veteran accept a plea bargain for a deferred sentence on the felony menacing and domestic violence charge. Accepting the plea would mean the veteran would be obligated to be in mandatory treatment for a period of time. If he accepted the plea and met the terms of the sentence, the felony would be dropped from his record.

The veteran refused to accept the plea fearing the felony would still be on his record and feeling he'd made a good faith effort to get into treatment but had been turned away from the VA because of the lack of available appointments.

Days after the veteran was released from jail in Colorado Springs he and his wife went to Denver's VA Medical Center. He was admitted to the psychiatric unit for PTSD. His medications were changed from what he had been prescribed in New York. He was then referred back to the Colorado Springs VA clinic; the same clinic which couldn't guarantee an appointment on a timely basis.

The Iraq vet works as a steelworker but his medication has caused him to miss several days because of adverse side effects. He also missed work because he had been jailed.

The wife reports she's going to school to become a massage therapist with the express intent that using an alternative care might help her husband. She says she's read and studied everything she could get her hands on about PTSD. She was certain her husband would have traumatic memories and emotional problems because of his combat experiences.

The wife reports her attorney showed her emails from the DA to him stating he intended to prosecute the veteran as a criminal and would try to block any attempt to use his mental status as a defense.

The DA also told the wife at one point he didn't care what the veteran did to her but he did care about what he might do to someone else.

The current status of the case is the veteran faces prison for what his wife describes as a dissociative state or flashback to his combat experience. Instead of getting the immediate mental health treatment he deserved, he faces punishment for incurring trauma in a war.

The message the El Paso County DA gives to all veterans who are troubled with PTSD caused by their wartime experience is clear. He doesn't care. He will not accept young men or women can have flashbacks or angry outbursts when triggered. He has no regard for the emotional state of veterans despite the known symptoms of combat PTSD.

The El Paso County DA probably has no problem with young men and women going to war, killing and wounding other humans or being traumatized while he sits in the comfort of his home. He probably doesn't mind going to parades or other patriotic ceremonies honoring the returning troops. He just doesn't want to hear about their problems.

I doubt the El Paso County DA cares that more than one in three soldiers and Marines will need mental health care. His answer to PTSD seems to be punishment and the use of forensic mental healthcare. No one can say he's soft on crime.

In many ways the refusal to care about the problems of returned veterans is not just confined to the supporters of the war. I can't say how many times I've tried to get peace activists fired up about the trauma veterans have endured and the cost it will have on families and all of society if left untreated.
The activists are constantly asking me if I can find a veteran to take part in a rally or march to speak about their wartime experiences. And most times there are veterans who do want to speak out but we fail these veterans if we aren't willing to listen to the emotional toll it takes to talk about their trauma. We fail the veterans if we don't recognize the urgent need for them to get needed treatment and to begin healing.

And we have to wonder just how many more mothers and fathers face such horrors for their children. How many parents have gone along with the suggested chain of command "ways" and lost a child because of it?

We have to wonder how many spouses face the same situations of a returned husband or wife facing long waits for care and being unable to adjust after their time in combat. How many will face flashbacks leading to possible violence toward them or their kids? How many veterans will lose hope and decide suicide by cop or at their own hands is their only solution?

The latest news about the care of returning soldiers with both physical and mental health problems remains much the same as before the Washington Post’s Walter Reed story came to light.

Now it's coming to light that many of the troops who have lost limbs or are disabled because of mental health problems also face bankruptcy, loss of homes and poverty because of a system wide failure to provide the needed care and to compensate at a level above impoverishment when a disability is given a veteran.

The American support of troops obviously stops once the troops have done the bidding of their military masters. We fail to remember what was asked of the young men and women who sought to serve their country once they return from that service.

We've become a disposable society to such an extent we aren't troubled with the disposal of our young troops. Just as we marginalize the communities of color and poverty, we've come to do the same with the veteran.

Wm. Terry Leichner, RN
Psychiatric RN
USMC combat infantry veteran
RVN 1967-69