U.S. Medical Personnel in Impossible Situation Mentoring at Substandard Kabul Hospital

By Sandra Basu

WASHINGTON — U.S. personnel have been placed in an “impossible situation,” serving as medical mentors at a corrupt Afghan hospital where patient neglect and abuse took place, a House member concluded at a recent hearing.

“How do you advise on administering care in that situation?” asked Rep. Jim Cooper, (D-TN). “This is the worst nightmare that a healthcare provider could ever possibly imagine, to even be associated with that without any control. How do you fix that?”

Congress members are seeking explanations after allegations of mismanagement and patient abuse at a U.S.-funded hospital in Kabul, Afghanistan.

In a December 2010 photo, Army Lt. Gen. William B. Caldwell IV, commander NATO Training Mission – Afghanistan, and Afghan Maj. Gen. Ahmad Zia Yaftali, Afghan national army surgeon general, talk with a patient who had been in a coma for more than a month at the National Military Hospital in Kabul.

The hospital, Dawood National Military Hospital, is managed by the Afghans, while U.S. and coalition military medical personnel serve as “medical mentors” to the Afghan healthcare providers. In that capacity, they do not treat patients, only advise and train.

In 2010, the medical personnel reported substandard care, mismanagement and patient neglect to their superiors. Questions have since arisen over whether the allegations were appropriately handled by senior U.S. military officials to whom they were reported.       

“As I understand it, no one to date has been held criminally responsible for what happened. Moreover, there has been no accounting of the millions of dollars of funds and medical supplies that disappeared since these issues came to light,” House Armed Services Oversight and Investigations Subcommittee Chairman Rep. Robert Wittman (R-VA), said at a recent hearing.

House Investigation

In June, Rep. Jason Chaffetz (R-UT), who chairs a subcommittee of the House Committee on Oversight and Government Reform, also expressed his concern to DoD.

“On a macro level, the mismanagement of NMH raises serious questions as to whether the Afghan government is capable of being proper stewards of U.S. taxpayer dollars… Equally as troubling is an apparent attempt by senior U.S. military officials to delay the exposure of — or cover up — these atrocities for political reasons,” Chaffetz wrote in a letter to Secretary of Defense Leon Panetta.

Chaffetz also wrote that he expected Panetta would agree with his view that “medical professionals should never be put in an environment where the conditions of employment conflict with the Hippocratic Oath to never do harm to anyone.”

The issue of what happened in the hospital and how it was handled by U.S. officials has been mired in controversy. In 2010, allegations began to surface of widespread theft and mismanagement of supplies at the hospital, as well as patient abuse. Photographs, taken by U.S. personnel, have surfaced that show wounded Afghan soldiers enduring starvation, bedsores, botched operations and undressed wounds.

Then-NATO Medical Training Advisory Group Command Surgeon and Commander Col. Schuyler Geller, MD, and other officials concluded that the DoD inspector general (IG) needed to be called in to investigate, but Geller and others also have alleged that Lt. Gen. William Caldwell IV, then the commander of the NATO Training Mission-Afghanistan, sought to delay any scrutiny until after the 2010 congressional elections. In addition, they say he sought to limit the scope of the investigation to exclude patient abuse. Caldwell has not publicly addressed the allegations, which DoD is investigating.

At a hearing held by the House Committee on Oversight Government Reform, retired Army Col. Gerald Carozza, who served as the chief of legal development for the Afghan National Army and Ministry of Defense, said conditions at the hospital were “Auschwitz-like.”.

“Patients were lying in filth, in some cases starving and with grotesque bedsores. 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, describing what one inspector saw.

Army Col. Mark Fassl, who was inspector general for the training command,  told the committee that he emailed the DoD IG to request an investigation, but Caldwell initially ordered it withdrawn.

When Caldwell eventually agreed to an investigation, “no request for any potentially embarrassing patient-care issues to be looked at were made, and the staff assistance visit was to be restricted to pharmaceuticals, medical logistics and mentoring, as opposed to the more comprehensive investigation requested,” Geller told the committee in written testimony.

Geller also charged that the abuse was hidden from U.S. medical officers, who were provided “a dog and pony show,” and that mentors sent to the hospital had no prior experience with medicine in less developed countries and  were told  “this is the way Third World healthcare is.”

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