General: Decision to Delay Afghan Hospital Investigation Not Political

by U.S. Medicine

October 11, 2012

By Sandra Basu

WASHINGTON — Politics played no role in the timing of a request to investigate corruption and patient neglect at a U.S. funded hospital in Afghanistan, a U.S. general told Congress.

Lt. Gen. William Caldwell IV made an appearance before Congress last month to defend himself against accusations by other high-ranking military officials that he sought to delay an Inspector General investigation at Dawood National Military Hospital until after the 2010 congressional election.

He explained that he sought a short delay in the investigation because he wanted to inform his boss, Gen. David Petraeus, of the need for it, and he wanted to coordinate with Afghanistan officials.


Rep. Jason Chaffetz

“It had everything to do with the necessary and critical coordination and nothing to do with the national elections,” he told a subcommittee of the House Committee on Oversight and Government Reform.

Caldwell served as the former commander of the NATO Training Mission-Afghanistan and now is senior commander of Fort Sam Houston in Texas. His testimony comes as lawmakers are trying to sort out whether the allegations of mismanagement and patient abuse were appropriately handled by senior military officials at the U.S.-funded hospital in Kabul, Afghanistan.

“Witnesses testified that there may have been a deliberate effort to delay an investigation for political reasons,” said Rep. Jason Chaffetz (R-UT), who chaired the hearing. “This was followed by an apparent attempt to prevent information from reaching Congress and the American people.”

This summer, at hearings where Caldwell was not present, other officials told the committee that U.S. and coalition military medical personnel serving as “medical mentors” to the Afghan healthcare providers reported substandard care, mismanagement and patient neglect to their superiors in 2010.

In July, retired Army Col. Gerald Carozza, who served as chief of legal development for the Afghan National Army and Ministry of Defense, told the committee that the conditions at the hospital were, in fact “Auschwitz-like.” An adviser to the Ministry of Defense IG who began inspection of the hospital also saw the abuse, he said.

“What he saw was horrifying. Patients were lying in filth, in some cases starving and with grotesque bed sores. One patient who was on the brink of starving to death, became known to the advisory team as ‘Patient Zero.’ Sadly, despite intense efforts led by the U.S. Medical Advisory Group to save him, ‘Patient Zero’ died,” Carozza said at the July hearing.

Army Col. Mark Fassl, who was Inspector General for the NATO Training Mission Combined Security Transition Command Afghanistan at the time, told the committee that when he emailed the DoD IG for an investigation, Caldwell initially wanted it withdrawn, citing the 2010 midterm elections. Fassl said Caldwell remarked to him “He calls me ‘Bill,’” referring to President Obama calling Caldwell by his nickname.

When the IG request did go forth in November of 2010, it was limited in scope to not include some of the more serious patient-care issues, according to July testimony from then- Col. Schuyler Geller MD, who served as command surgeon in Afghanistan for NATO’s Training Mission.

At the more recent hearing, Caldwell refuted that he mentioned the president calling him “Bill,” in any conversation regarding an investigation at the hospital. He had only brought up the president calling him “Bill” to staff several months earlier, after he gave a briefing to the president and was “impressed” that he knew his nickname, he said.

General: Decision to Delay Afghan Hospital Investigation Not Political

Denied Knowing About Neglect

Caldwell also said the patient neglect shown in pictures during the hearing was not something he knew about until Nov. 10, 2010. Rather, it was the hospital corruption that was brought to his attention and the subject of discussions.

Lt. Gen. William B. Caldwell IV, then-commander NATO Training Mission in Afghanistan and Afghan Maj. Gen. Ahmad Zia Yaftali, Afghan national army surgeon general, talk with the medical staff at the National Military Hospital in 2010. Photo byStaff Sgt.Sarah Brown.

“The pictures that you showed, chairman, that is patient neglect. That is unacceptable. There is nobody in a uniform who is going to see those kinds of deplorable conditions and is going to accept that,” he told Chaffetz.

Once he did know, he said his team took “decisive and immediate action.”

Lawmakers, however, seemed flabbergasted that he would not have been aware of the patient-care problems earlier.

“That is precisely what these colonels said and saw and shared with you,” Chaffetz said, referring to testimony from military personnel this summer. “That is why we had three colonels come before this committee and say that you were the one that was preventing bringing additional resources [to this problem], and that is why we are here.”

Rep. John Tierney (D-MA) said he was pleased to hear that conditions have improved at the hospital, despite the “alleged attempts at interference” in the IG investigation.

“It is my understanding that due to the utmost professionalism of the DoD Inspector General, the alleged attempts at interference did not impair the Inspector General’s ability to timely perform its critical work in Afghanistan,” he said in his opening statement.

He also called for an expansion of the subcommittee’s investigation.

“I believe we must change our ‘spend-first, ask-questions-later’ approach to reconstruction in Afghanistan, where the U.S. has already committed nearly $100 billion to reconstruction efforts,” he said.

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