1 in 5 Army hospital leaders suspended in 2 years: What's behind the discipline?

The Joint Base Lewis-McChord general who lost his command earlier this month is one of eight senior Army medical officers around the world who've been suspended or relieved of command over the past two years.

That means nearly one in five major Army medical facilities has had a commander suspended during that time.

It's an eye-grabbing amount of public discipline for an Army often criticized for being too slow to remove commanders in high-profile positions rather than dismissing them when controversy arises.

It's unclear if a theme unites the eight suspensions; each was carried out for a distinct reason.

But some officials with recent experience in Army medicine are concerned that the suspensions point to broader problems as the system recovers from 13 years of ground war in Iraq and Afghanistan. The discipline could stem from an increasing demand for health care services, they say, or from oversights in preparing top doctors for leadership positions.

"The ones that I know are very good people who have done very well in their careers, otherwise they wouldn't be hospital commanders," said Dr. Elspeth Ritchie, a former colonel and Army psychiatrist who is now chief clinical officer for the District of Columbia Department of Mental Health. "The way I put this together is that there's an enormous amount of need that has overwhelmed the system."

Brig. Gen. John Cho, the latest senior Army doctor to face a public suspension, leads the Western Regional Medical Command. It's a JBLM headquarters that manages 11 hospitals in Western states. Cho has been assigned to other medical duties while the Army investigates his leadership and determines whether to reinstate him.

The Army won't say why Cho was suspended, except that the Defense Department's Inspector General is investigating his command climate, an Army term that refers to how he works with his subordinates and the messages he sends as a leader.

The move caught many officials in and outside the Army by surprise, so they're paying close attention.

"When the leadership of someone entrusted with overseeing the medical care of our nation's heroes is called into question, it must be taken very seriously," said Sen. Patty Murray, D-Wash. "I am closely following the Inspector General's investigation into this matter."

The other seven who've faced public scrutiny were colonels who led Army hospitals around the world. The Army has 36 hospitals led by full colonels.

"I don't recall eight simultaneous, or near simultaneous, (Army Medical Department) senior level command suspensions going on at any point in my career. There might have been, but they might have been done more quietly," said retired Maj. Gen. Philip Volpe, who led Western Regional Medical Command from February 2010 to March 2012.

Suspensions are a serious matter in the military and are often viewed as a career-ending move even if the officer stays in the Army. Of the suspended colonels, just two returned to command positions.

Three were removed from command, and two more did not return to their offices because their command terms expired during the investigations at the root of their suspensions, according to the Army Medical Command.

The suspensions are being carried out by Army Surgeon General Lt. Gen. Patricia Horoho. She's the first nurse and the first woman to hold her office. She's also a recent past commander of the Western Regional Medical Command and Madigan Army Medical Center at JBLM.

Horoho declined an interview request from The News Tribune, but released a statement in which she said she takes seriously decisions about whether to suspend hospital commanders.

"When an allegation is made against a commander or leader, I have to decide whether it is in the command's best interest to temporarily suspend that leader during the investigation," she said. "That is a difficult decision, and one that I recognize impacts the organization and individual leader. My guiding principle is to ensure a thorough inquiry while enabling the command to continue its mission."

The Army medical system, which includes 54 hospitals and clinics around the world, has been under sustained scrutiny since 2007 when The Washington Post reported on substandard care at Walter Reed Army Medical Center in Washington, D.C.

Army hospitals are separate from the Department of Veterans, though former military service members can receive care at Defense Department facilities.

In recent months, The New York Times has published a series of stories drawing attention to relatively high error rates in the Army health system. Defense Secretary Chuck Hagel in June also ordered a systemwide review of military medicine after complaints about delays in care at VA hospitals.

"In health care, you're dealing with life and death every day, and you're not just dealing with the active-duty. You have children and spouses. I think there is a lot more pressure on the medical command to take swift action" when a crisis develops," said Lourdes Alvarado-Ramos, the director of the Washington state Department of Veterans Affairs. She is a retired soldier who capped her career as the command sergeant major at Madigan Army Medical Center.

Intense probes at Madigan

Without knowing what caused each suspension, Volpe said the public discipline of eight senior officers raised questions for him about how the Army is preparing its best doctors for command positions.

"Are these officers getting the right leader developmental assignments, education, and training to develop the skills necessary to succeed and excel in these demanding positions, or are we bypassing some essential developmental steps?" he asked. "Are the organizations structured properly to provide the right amount of oversight, guidance, coaching and mentoring? Are more senior commanders investing the time necessary to assist their subordinate commanders through some of the challenges they face, or are they left on their own to navigate the complex landscape?"

Volpe's tenure at JBLM spanned two intense investigations into care at Madigan that illuminated pressures on Army doctors to act immediately when complaints arise. He did not want to comment on them, but The News Tribune has obtained investigative reports through the Freedom of Information Act on how they unfolded.

The first, in the spring of 2010, centered on services Madigan provided to Oregon National Guard soldiers returning from Iraq. The complaint about lapses in care spurred widespread congressional interest.

Volpe concluded the problem was a systemic issue for the Army that required broader changes, according to documents obtained by The News Tribune. Neither Volpe nor then-Madigan Commander Col. Jerome Penner was suspended during the medical investigations.

Two years later, complaints surfaced about Madigan doctors changing psychiatric diagnoses late in the medical retirement process in ways that patients did not understand. Sen. Murray spoke up for the patients and compelled the Defense Department to conduct broad reviews and standardize its diagnoses.

That investigation also led to system-wide changes in Army medicine, but then-Madigan Commander Col. Dallas Homas was out of command for six months when part of the inquiry turned on him.

Officials in Army medicine determined that Homas should have his command suspended when a complaint arose about his command climate. The Army eventually concluded the complaint was without merit. In the meantime, Homas' supporters thought he was made a scapegoat.

"That was clearly to my mind a situation where you had a higher commander that was looking to pin something on somebody," said retired Maj. Gen. Eric Olson of Lakewood, a former commander of the 25th Infantry Division and a friend to Homas. "It was a huge black eye for MedCom in general and for Madigan specifically."

Outside pressures strong

Olson was one of many officers who wrote letters to senior Army leaders on Homas' behalf. At the time, Olson was leading an Army medical program for children and families at JBLM.

He remains concerned that hospital commanders are taking the fall for larger problems in Army medicine.

"I hear the argument that suspensions aren't that serious, that they give a commander an opportunity to do an investigation," Olson said. "That argument doesn't hold for me. It is a serious move to suspend a commander and make him disappear like that."

Volpe said senior generals face difficult decisions in choosing whether to suspend subordinates, especially in situations in which leaders feel pressure to act from outside forces.

"At the end of the day, a leader must understand that when a subordinate fails, they bear some of that failure," he said, "and also at the end of the day, a leader must be able to 'sleep comfortably' by the ethical decisions they make."

Volpe said pressures from higher-ups are "the greatest challenges for contemporary commanders to deal with."

For single moms in uniform, 'Fort Bliss' movie shows costs and rewards

Army Master Sgt. Kerensa Crum wasn’t expecting much when she walked into an early screening of “Fort Bliss,” a new movie about the struggles of a single mom in the military.

She knows that struggle better than most.

The tattoo on her back marks Crum among those who have served in the “Rakkasans,” the 101st Airborne Division’s 187th Infantry Regiment, with which she deployed to Afghanistan. It’s a reminder of just one of her many tours downrange.

She needs no reminders, however, of her 11-year-old daughter Mia.

“Everything I’ve done in the Army has been for her,” Crum says.

But she also knows her success in the military has come at a cost.

Capturing the cost

Filmmaker Claudia Myers hopes “Fort Bliss” captures some of that cost while exploring the hard realities — and choices — of mixing single parenting with professional life.

“I want to spark a conversation: Can a woman have it all?” Myers tells OFFduty. It’s one thing to ask that among civilians, but it becomes particularly challenging when a mom — or a dad — must leave for a year or more at time, not to mention all the real dangers and anxieties that come with combat deployments.

“I’m not sure the film provides an answer, but there is admission that there is no way to do both without paying some kind of cost,” Myers says.

Her film, which opened in theaters and on-demand Friday, follows Staff Sgt. Maggie Swann, an Army medic and single mom just back from Afghanistan, as she tries to reconnect with her young son and readjust to life after a tour downrange.

According to the Pentagon, one out of every 20 service members on active duty is a single parent. That’s more than 72,000 single moms and dads. And the rates are even higher in the reserve components. It’s a reality most civilians can’t imagine.

Myers, who wrote and directed the film, says the movie was inspired by a single dad she met five years ago while working on a documentary about military life. “I was talking with a group of infantry soldiers, and one of them was a sergeant who had deployed twice to Iraq and was a single father. That struck me.”

The mom wasn’t in the picture, he told her. “I asked what he did with his son when he was deployed, and he said, ‘I leave him with my neighbors.’”

Myers, a mom of two, says that comment hit her hard. “This is a side of the war I’d never thought about, was never aware of. What must it be like for a parent to leave their child for 15 months, let alone a single parent? And on the flip side, what’s that like for the child?”

Ultimate working mother

Filmed in a 21-day blitz at the real Fort Bliss, Texas — with the full support of the Army — the movie goes to some very hard places, ranging from combat and post-traumatic stress to sexual assault among troops and the challenges of intimacy and sex after deployment.

At its core, though, the movie is about a soldier who must “relearn how to be a mother — that war could test something so primal as the bond between a mother and her child,” she says. “It is, in many ways, the ultimate working mother story.”

The film, which stars Michelle Monaghan, who played opposite Tom Cruise in “Mission Impossible III” and more recently was among the lead roles in the HBO series “True Detective,” walks a tightrope between emotional extremes without losing its balance or sense of authenticity.

During one pivotal exchange, Maggie tells her ex-husband that she has re-enlisted and might have to redeploy much sooner than expected.

Upset, the ex (Ron Livingston, of “Band of Brothers” and “Office Space” fame) threatens to sue for full custody. He has had to shoulder their boy’s pain and anxiety during her last tour, and can’t believe she would re-enlist.

Life happens

That’s just one of the scenes that got to Crum.

“I’ve had people say the same thing to me: How could you re-enlist? That I should choose between being a mom or soldier,” Crum says. “We shouldn’t have to choose. Why can’t I be a good soldier and a good mom? What if the military is my best option — my best way — to be the best mom I can be? It’s an honorable way. I can’t imagine doing anything else.”

Crum says she has long since gotten used to getting similar judgment from other service members as well who think single troops with kids look for special treatment.

“You shouldn’t get special treatment — I agree, I think that’s fair. But not everyone chooses to be a single parent. Sometimes marriages don’t work out. Life happens.”

Staff Sgt. Mylee Cardenas says the movie could “just as easily have been my life story. Dealing with threats of losing custody, sexual assault, what it’s like to come into a new unit as a female NCO, the emotion of learning how to be a mom again — I went through all of it,” she says.

Medically retired in March after 12 years in the Army, including a yearlong tour with a special operations unit in Afghanistan, Cardenas says, “There was always that question of whether I was doing the right thing for my daughter.”

And then there’s the guilt of actually wanting to deploy.

“There’s a simplicity that you miss. You only have to worry about yourself, the mission and the guys to your right and left.”

Repercussions and rewards

It’s a paradox, Cardenas notes. “You can have it all, but something will always suffer. There will be repercussions. You will miss things. When you get back, things will be different. It becomes this balancing act between your heart and your head.”

Is it worth it? “Fort Bliss” doesn’t try to answer the question.

But Crum pauses when asked.

“I don’t know ... it’s not a simple yes or no,” she says. She does know her daughter has had a better life already than Crum had growing up. And she’s knows it’s been hard, too.

Mia, just starting sixth grade, held tight to her mom’s hand as they walked to her new school in Southern California, where Crum is starting her latest Army assignment.

Crum was surprised. “Not many of these kids want to hold their mom’s hand,” she told her daughter.

“She said, ‘I don’t care. How many of these kids have had their mom go away three times for a year? I’m just glad you’re home.’”

“So, I don’t know,” Crum says again. “Maybe in five years she’ll resent me. But today, I feel like, yes, it was worth it.”

ACT experiments with electronic exams

Nearly 4,000 students took the ACT test on a computer this past spring, marking the first time that a national college entrance exam was administered without a pencil and paper.

The number of students taking the electronic version of the ACT is expected to grow dramatically this academic year, as ACT officially rolls out its new online exam in more school districts nationally.

“ACT is really committed to an approach of continuous improvement,” said Paul Weeks, the nonprofit company’s vice president of client relations. “We’re always trying to think of what are the user needs out there, what is the market demand, and what are ways we can better measure student skills to give them information that helps them. What we’ve learned is, number one, there’s great promise in computer-based testing.”

ACT field-tested the new exam April 12, a national testing date, to an invited group of juniors from 80 high schools across 23 states. The content of the exam was the same as the bubble-sheet version, and the results — using the ACT’s traditional 1 to 36 scoring — were considered official and could be reported to colleges.

Next spring, Weeks estimates that between 50,000 and 100,000 more students will take the computerized test, which ACT will make available to schools that administer the exam to all students on a school day as part of their districtwide or statewide assessment program. For the time being, the national testing days that ACT hosts on six Saturdays will continue to use the pen-and-paper test.

Students will take the electronic version of the ACT on desktop computers, laptops and tablets, though the paper test will continue to be offered in schools that do not have the capability to administer the digital version.

“We field test very carefully to make sure any new test other than paper and a pencil will be fair and would be workable in a digital format,” ACT CEO Jon Whitmore told the Press-Citizen in August. “So the technology advances our team is moving forward with is something we have to be proud of.”

ACT, which surpassed rival SAT in market share for the first time in 2012, is the first of the two companies to begin administering digital college entrance exams. In total, 1.84 million members of the graduating class of 2014 took the ACT, including 22,931 in Iowa.

ACT’s measured roll-out of the digital effort is to ensure that the tests are fair, the results are comparable no matter which version a student takes, that the timing is comparable and that the administration model works, Weeks said.

“We’re taking a very thoughtful approach to it because an awful lot of people count on the results of the ACT for its validity, its reporting and they count on that one to 36 score scale,” Weeks said. “So as we make changes to the ACT, we always do so very thoughtfully and gradually because folks count on that for their research and decision-making purposes. But we do realize there are emerging market demands, and we want to make sure we meet them.”

Challenges in moving to computer-based testing include ensuring facilities have an adequate number of devices to administer the tests, ensuring that web browsers are locked down to ensure that students can’t find answers elsewhere on the Internet and retraining test administrators.

“We want to meet young people in the world where they already live,” said Jon Erickson, president of education and career solutions at ACT, in a news release this spring. “We are working to continuously improve the ACT, and we’ll have more innovations to announce in the months ahead. The exam, of course, will remain a curriculum-based achievement exam that measures what students learn in school, as it has always been.”

Although the electronic test has the same content as the paper test, Weeks said technology could offer a more engaging experience in the future. Rather than the traditional format of providing information to students, then asking questions, test takers could be asked, for instance, to conduct virtual science experiments, pouring liquid from one beaker to another on their screens to solve problems.

“That’s the promise of technology, and that’s the promise of online testing,” Weeks said.

Tuition discount offered to lure adults back to college

When you’re 30, the first day of school can feel a lot like every other day.

You still have to worry about work, because you still have to pay bills. Those adult responsibilities age you beyond the teenagers and 20-somethings that fill the seats in your class.

Sometimes, those adult responsibilities will give you an advantage, a little extra focus. But they’ll also work against you.

On this day, they fuel your first-day-of-school jitters more than anything else: How will you juggle it all?

“I’m just going to do it,” says Ryan Morrolf, a 30-year-old military veteran and human services worker.

For years, she has thought about returning to school to get her bachelor’s degree. This year, a timely offer from Indiana University-Purdue University Fort Wayne cinched her decision:

If you come back, we’ll give you half off your college education.

Could slashing costs be just the right lure to hook the 737,000 Indiana adults who once aspired to college credentials but never reached the degree?

State officials think so. Even if just a fraction of those adults with some college and no degree went back to school, it could help push Indiana’s low college attainment rates up, narrow the widening workforce skills gap and prepare people for better-paying careers.

But for people who decided to start families early, who needed to jump right into work, who just might not have been sure how college fit into their life plans, that decision is not always so simple.

What makes IPFW’s incentive so attractive, and what could inspire another discount program across the state: Affording tuition can be tricky for people who have already dabbled in college.

“What we’re trying to do,” said IPFW vice chancellor for student affairs George McClellan, “is create a real incentive for people to come back. So here’s your chance. If you can come back, we’ll give you this amazing price.”

Many adults have to pay for college out-of-pocket. They likely have already tapped into — and perhaps tapped out — their eligibility for financial aid.

Look at Morrolf: After serving in the military, she said she exhausted her GI Bill benefits in more than a year at Brown Mackie College.

None of her credits transferred. She decided to start over at IPFW. After one semester, she moved to Ivy Tech Community College in Bloomington for about a year, and then bounced to Ivy Tech in Fort Wayne.

Job searches and a family member’s illness stalled her quest.

Despite receiving federal and state aid, she has already collected about $20,000 in student loan debt. She needed that, she said, so she could afford to attend full time without working.

When she goes back to IPFW this semester, she has at least one year of a federal Pell grant to cover tuition, with some cash left over — but she doesn’t know if that aid will run out before she earns her bachelor’s degree.

The IPFW incentive, she said, was “perfect timing.”

“It means a lot,” she said. “I haven’t had to take out any more student loans. That’s another reason I put off school. Until this past April, I wasn’t finding any employment. I didn’t see any point in continuing my degree path, because social work doesn’t pay much, and I already had all these student loans.”

Morrolf is distinct from the 737,000 “some college, no degree” population because she obtained her associate degree, but as an adult learner she faces many of the same challenges on her way to a bachelor’s.

For this semester only, IPFW extended the half-off offer to about 3,000 of its former students who were at least halfway to bachelor’s degrees but had taken at least a year off. They also had to be Indiana residents who had maintained good grades.

The offer touted a potential savings of $7,800. About 100 students enrolled with the comeback program, IPFW reported.

“It’s not as easy as it sounds,” McClellan said. “The longer you’re out of school, the more comfortable you become. You learn to build a life without a degree.”

The state’s Commission for Higher Education is working to create a database of former college students who never graduated. That’s one in five out of all Hoosier adults.

The database will identify how many credits they have collected, and how much financial aid eligibility they have left, said Sarah Ancel, associate commissioner for policy and legislation.

In partnership with public and private colleges, the state hopes to reach out to those adults by January 2016. The goal: to graduate 200,000 of those returning students.

“That’s very ambitious,” Ancel said, “but that’s driven by what the state needs.”

It’s such a critical population that state higher education chief Teresa Lubbers is hoping to pitch lawmakers to reward returning adults with a bonus if they go back and finish college.

She said she envisions a completion grant, perhaps by forgiving some of those returning students’ tuition costs once they earn degrees.

“It’s not something that’s a quick fix,” said Christine Marson, strategy officer at the Lumina Foundation, an education nonprofit. “But it’s certainly doable. It’s something Indiana can do if they have the resources and the will to do it.”

But Marson points out that success among returning adult learners is not as easy as just sending a letter and getting them back for one class.

It’s hard to say how many college dropouts ever return to school, how many earn degrees and how long it might take them on average.

In a 2012 push to encourage students to re-enroll, Ivy Tech sent out more than 50,000 postcards, emails and letters and left more than 6,000 voice mails for former students. About 8,000 came back.

Similar efforts in other states such as Georgia and Minnesota have reached out to masses of students and enticed small but significant percentages to re-enroll, Marson said. In Georgia, the data showed the recruiting efforts resulted in exponentially larger re-enrollment rates.

Graduation rates of those, however, remained very small in two years of data in Minnesota.

“A college degree. What’s it worth to you?” the marketing materials say. “Your degree may be closer than it appears. The more you learn, the more you earn. You’ve started, it’s time to finish.”

A key piece of Indiana’s push toward bringing former students back to school: Catering to the various and diverse needs of adult learners.

Schools can’t stop family and work conflicts from arising, but experts say they can smooth the path to a degree.

That means offering more online classes, giving credits for what students already know and creating accelerated degrees for adults to finish as quickly as possible.

“They want to see the application of, how is this going to help my career?” said David Rose, vice president of nonresidential enrollment management and marketing at Indiana Wesleyan University, which caters to nontraditional students. “It’s not just education for the sake of education.”

It will also require tweaks to make student services, like advisers and the bookstore, open at night or on weekends.

“The school has to be flexible in order to make these students feel comfortable,” said Kathy Lee, chancellor of Ivy Tech’s Central Indiana region. “When they do come back, they need to feel at home on campus. It’s OK to come back, no matter what age you are. We’ll accommodate that you’re not 18.”

At Ivy Tech, re-entry students have to take a one-credit orientation-type “101” class, on topics such as personal finance, problem-solving, calculating your GPA, tracking your financial aid and interacting with professors.

Returning students might also need help catching up academically if they’ve been out of school for long periods.

But just coming back, many say, shows proof of persistence. And that drive to return to college often motivates adult students to work through life challenges to finally reach their degrees.

Morrolf, the social worker going back to IPFW for her bachelor’s degree, is counting on that to carry her through the rest of her college career while she continues to hold down her job.

She can schedule her clients around her classes and on weekends, writing up case notes at night. If she can get to her degree in two or three years, she said it will bump up her current salary and open up more employment opportunities.

“I’m kind of, you know, apprehensive,” she said. “Just because it’s going to be a lot of work, with working full-time. But I’m excited. I need to do this for myself, even if I don’t want to.”

One in five Army hospital leaders suspended in two years: What's behind the discipline?

The Joint Base Lewis-McChord general who lost his command earlier this month is one of eight senior Army medical officers around the world who've been suspended or relieved of command over the past two years.

That means nearly one in five major Army medical facilities has had a commander suspended during that time.

It's an eye-grabbing amount of public discipline for an Army often criticized for being too slow to remove commanders in high-profile positions rather than dismissing them when controversy arises.

It's unclear if a theme unites the eight suspensions; each was carried out for a distinct reason.

But some officials with recent experience in Army medicine are concerned that the suspensions point to broader problems as the system recovers from 13 years of ground war in Iraq and Afghanistan. The discipline could stem from an increasing demand for health care services, they say, or from oversights in preparing top doctors for leadership positions.

"The ones that I know are very good people who have done very well in their careers, otherwise they wouldn't be hospital commanders," said Dr. Elspeth Ritchie, a former colonel and Army psychiatrist who is now chief clinical officer for the District of Columbia Department of Mental Health. "The way I put this together is that there's an enormous amount of need that has overwhelmed the system."

Brig. Gen. John Cho, the latest senior Army doctor to face a public suspension, leads the Western Regional Medical Command. It's a JBLM headquarters that manages 11 hospitals in Western states. Cho has been assigned to other medical duties while the Army investigates his leadership and determines whether to reinstate him.

The Army won't say why Cho was suspended, except that the Defense Department's Inspector General is investigating his command climate, an Army term that refers to how he works with his subordinates and the messages he sends as a leader.

The move caught many officials in and outside the Army by surprise, so they're paying close attention.

"When the leadership of someone entrusted with overseeing the medical care of our nation's heroes is called into question, it must be taken very seriously," said Sen. Patty Murray, D-Wash. "I am closely following the Inspector General's investigation into this matter."

The other seven who've faced public scrutiny were colonels who led Army hospitals around the world. The Army has 36 hospitals led by full colonels.

"I don't recall eight simultaneous, or near simultaneous, (Army Medical Department) senior level command suspensions going on at any point in my career. There might have been, but they might have been done more quietly," said retired Maj. Gen. Philip Volpe, who led Western Regional Medical Command from February 2010 to March 2012.

Suspensions are a serious matter in the military and are often viewed as a career-ending move even if the officer stays in the Army. Of the suspended colonels, just two returned to command positions.

Three were removed from command, and two more did not return to their offices because their command terms expired during the investigations at the root of their suspensions, according to the Army Medical Command.

The suspensions are being carried out by Army Surgeon General Lt. Gen. Patricia Horoho. She's the first nurse and the first woman to hold her office. She's also a recent past commander of the Western Regional Medical Command and Madigan Army Medical Center at JBLM.

Horoho declined an interview request from The News Tribune, but released a statement in which she said she takes seriously decisions about whether to suspend hospital commanders.

"When an allegation is made against a commander or leader, I have to decide whether it is in the command's best interest to temporarily suspend that leader during the investigation," she said. "That is a difficult decision, and one that I recognize impacts the organization and individual leader. My guiding principle is to ensure a thorough inquiry while enabling the command to continue its mission."

The Army medical system, which includes 54 hospitals and clinics around the world, has been under sustained scrutiny since 2007 when The Washington Post reported on substandard care at Walter Reed Army Medical Center in Washington, D.C.

Army hospitals are separate from the Department of Veterans, though former military service members can receive care at Defense Department facilities.

In recent months, The New York Times has published a series of stories drawing attention to relatively high error rates in the Army health system. Defense Secretary Chuck Hagel in June also ordered a systemwide review of military medicine after complaints about delays in care at VA hospitals.

"In health care, you're dealing with life and death every day, and you're not just dealing with the active-duty. You have children and spouses. I think there is a lot more pressure on the medical command to take swift action" when a crisis develops," said Lourdes Alvarado-Ramos, the director of the Washington state Department of Veterans Affairs. She is a retired soldier who capped her career as the command sergeant major at Madigan Army Medical Center.

Intense probes at Madigan

Without knowing what caused each suspension, Volpe said the public discipline of eight senior officers raised questions for him about how the Army is preparing its best doctors for command positions.

"Are these officers getting the right leader developmental assignments, education, and training to develop the skills necessary to succeed and excel in these demanding positions, or are we bypassing some essential developmental steps?" he asked. "Are the organizations structured properly to provide the right amount of oversight, guidance, coaching and mentoring? Are more senior commanders investing the time necessary to assist their subordinate commanders through some of the challenges they face, or are they left on their own to navigate the complex landscape?"

Volpe's tenure at JBLM spanned two intense investigations into care at Madigan that illuminated pressures on Army doctors to act immediately when complaints arise. He did not want to comment on them, but The News Tribune has obtained investigative reports through the Freedom of Information Act on how they unfolded.

The first, in the spring of 2010, centered on services Madigan provided to Oregon National Guard soldiers returning from Iraq. The complaint about lapses in care spurred widespread congressional interest.

Volpe concluded the problem was a systemic issue for the Army that required broader changes, according to documents obtained by The News Tribune. Neither Volpe nor then-Madigan Commander Col. Jerome Penner was suspended during the medical investigations.

Two years later, complaints surfaced about Madigan doctors changing psychiatric diagnoses late in the medical retirement process in ways that patients did not understand. Sen. Murray spoke up for the patients and compelled the Defense Department to conduct broad reviews and standardize its diagnoses.

That investigation also led to system-wide changes in Army medicine, but then-Madigan Commander Col. Dallas Homas was out of command for six months when part of the inquiry turned on him.

Officials in Army medicine determined that Homas should have his command suspended when a complaint arose about his command climate. The Army eventually concluded the complaint was without merit. In the meantime, Homas' supporters thought he was made a scapegoat.

"That was clearly to my mind a situation where you had a higher commander that was looking to pin something on somebody," said retired Maj. Gen. Eric Olson of Lakewood, a former commander of the 25th Infantry Division and a friend to Homas. "It was a huge black eye for MedCom in general and for Madigan specifically."

Outside pressures strong

Olson was one of many officers who wrote letters to senior Army leaders on Homas' behalf. At the time, Olson was leading an Army medical program for children and families at JBLM.

He remains concerned that hospital commanders are taking the fall for larger problems in Army medicine.

"I hear the argument that suspensions aren't that serious, that they give a commander an opportunity to do an investigation," Olson said. "That argument doesn't hold for me. It is a serious move to suspend a commander and make him disappear like that."

Volpe said senior generals face difficult decisions in choosing whether to suspend subordinates, especially in situations in which leaders feel pressure to act from outside forces.

"At the end of the day, a leader must understand that when a subordinate fails, they bear some of that failure," he said, "and also at the end of the day, a leader must be able to 'sleep comfortably' by the ethical decisions they make."

Volpe said pressures from higher-ups are "the greatest challenges for contemporary commanders to deal with."

Afghan inauguration next week; no word on security pact with US

KABUL, Afghanistan — After a bruising six-month election battle, Afghanistan’s President-elect, Ashraf Ghani, will finally be inaugurated next week, officials said Monday.

But there was no immediate word on the timetable for signing a key security agreement with the United States that would allow nearly 10,000 U.S. troops, primarily advisers and counterterrorist units, to remain in Afghanistan after the end of this year, when all combat forces withdraw.

On Sunday, Afghanistan’s electoral commission confirmed Ghani as the winner of the June 14 runoff against Abdullah Abdullah after the conclusion of a United Nations-sponsored recount of all 8 million ballots cast. The audit was initiated because of allegations of massive fraud. Abdullah led in the first round of voting in April.

Ghani’s win was announced just hours after he and Abdullah had concluded a far-reaching agreement on a national unity government.

The accord ends a three-month dispute over the results of the June elections, in which Ghani and Abdullah accused each other of fraud.

It envisions the creation of a new post of chief executive of the cabinet and sweeping constitutional reforms. Abdullah or one of his nominees is expected to fill the powerful new position, which both candidates had agreed to in principle after meetings last month with Secretary of State John Kerry.

Haleem Fidyee, a senior member of Ghani’s election team, said the inauguration ceremony would be held Monday. This was confirmed by international officials in Kabul.

Fidayee said it was unclear when the election commission would release the final vote tally.

He also said the two candidates and their aides had been “totally consumed” in recent weeks by negotiations on the power-sharing deal and had not had time to consider when the Bilateral Security Agreement with the U.S. would be concluded.

Outgoing President Hamid Karzai had refused to sign the agreement, putting at risk continued international support for the Afghan security forces after the withdrawal of coalition combat forces at the end of this year. Both Ghani and Abdullah have said in the past that they would sign the agreement, which would lay out the terms for the continued presence of U.S. and allied forces. NATO has a similar agreement with Afghanistan awaiting signature.

A U.S. diplomat, speaking on condition of anonymity because of the sensitivity of the matter, said Ghani had confirmed his intent to sign the Bilateral Security Agreement promptly after inauguration.

“The signing of the BSA remains a top U.S. and Afghan priority,” the official said.

The NATO-led international coalition, which numbered about 150,000 three years ago, still has 41,000 in Afghanistan — two-thirds of them Americans. Afghanistan’s security forces number about 350,000 members.

This year has been the bloodiest on record for the Afghan army and police, now fully responsible for the country’s security, as the Taliban has taken advantage of the long electoral impasse to launch a series of attacks across the nation.

Zubair Babakarkhail contributed to this report.

lekic.slobodan@stripes.com

Chinese ship spies on Valiant Shield, and that’s OK with US

YOKOSUKA NAVAL BASE, Japan — A Chinese surveillance ship has been detected observing the Valiant Shield military exercise from within the United States’ exclusive economic zone — a move the U.S. actually doesn’t mind.

One Chinese auxiliary general intelligence vessel has been watching most of Valiant Shield since it began Sept. 15 in and around Guam, military officials said Monday.

The exercise, which ends Tuesday, involves 18,000 servicemembers from the Navy, Air Force, Marines and Army simulating combat against each other.

Valiant Shield comes in the midst of tensions in the Asia-Pacific region, much of which involve China’s rapidly modernizing military and its territorial ambitions.

China stakes an ambiguous claim to about 90 percent of the South China Sea, including areas that the most nations consider international waters.

In recent years, Chinese ships have harassed U.S. ships operating in the international waters that compose China’s exclusive economic zone, or EEZ — mostly notably in 2009, when the USNS Impeccable was surrounded by five vessels.

Chinese ships have repeatedly been observed within United States EEZ borders in the past year. U.S. officials have stated they hope the moves will persuade China to shift its position against foreign military movements in its EEZ.

“We’d like to reinforce that military operations in international commons and outside of territorial waters and airspace is a fundamental right that all nations have,” Valiant Shield spokeswoman Lt. Cmdr. Kim Dixon said Monday. “The Chinese were following international norms, which is completely acceptable.”

An EEZ extends as far as 200 nautical miles from a nation’s borders. EEZs confer fishing, mining and other economic rights, but they are not territorial waters belonging to any one country.

EEZs make up about one-third of the world’s oceans. The United States and most other nations interpret international law to allow militaries to conduct surveillance in EEZs, but China and about 20 other nations generally see things differently.

On Aug. 19, a Chinese fighter jet intercepted a U.S. Navy P-8 flying 135 miles from Hainan Island, within China’s EEZ.

The armed jet performed a barrel roll and flew within 20 feet of the P-8’s wingtip, Pentagon spokesman Rear Adm. John Kirby said Aug. 22.

Kirby condemned the “unsafe and unprofessional intercept, which posed a risk to the safety and the well-being of the aircrew, and was inconsistent with customary international law.”

The Pentagon later released photos of the Chinese fighter displaying its armed underside to the P-8, a surveillance plane with a body resembling a commercial airliner.

Chinese officials said their pilot acted professionally and called on the U.S. to end “close-in” surveillance.

China also sent a surveillance ship to the EEZ surrounding Hawaii during the multinational Rim of the Pacific exercise this past summer. That decision, while in accordance with U.S. views on EEZs, surprised some military officials because China was also an exercise participant.

China’s surveillance of Valiant Shield was far less surprising. Much of the exercise has focused on countering “anti-access, area denial” — a strategy that stops militaries from entering international waters and airspace, and prevents any forces already within those spaces from maneuvering.

The Pentagon’s annual report to Congress on China’s military stated that Beijing is producing advanced long-range missiles and other weaponry to prevent access to large parts of the South and East China seas. The other country most often associated with an anti-access, area denial strategy is Iran.

Meanwhile, Iran’s Press TV reported Saturday that Chinese naval ships have docked in Iran for the first time ever.

Iranian media reported that the ships arrived in Bandar Abbas for joint exercises. China’s Xinhua news agency reported that the 17th Chinese escort naval fleet would be in Iran for five days.

slavin.erik@stripes.com

Twitter: @eslavin stripes