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By Gerry J. GilmoreAmerican Forces Press Service
WASHINGTON, Sept. 13, 2012 – Athree-star general who commanded the NATO and U.S. training missions inAfghanistan told a House subcommittee yesterday that his command conducted atransparent investigation into alleged patient neglect, mismanagement, theftand corruption at the Afghan-run Dawood National Military Hospital in Kabul.
Appearing before the House Oversight andGovernment Reform Committee’s national security, homeland defense and foreignoperations subcommittee, Army Lt. Gen. William B. Caldwell IV testified that hebecame the first commander of the NATO Training Mission in Afghanistan andcommander of the U.S. Combined Security Transition Command Afghanistan on Nov.21, 2009.
The NATO command was established tocoordinate and synchronize the multinational efforts to raise, equip, train andsustain an Afghan national security force, the general said, and the U.S.command was responsible for the oversight of U.S. funding, training andministerial development.
Caldwell told the panel that herecognized early on that his command faced immediate challenges, includingissues within the Afghan medical system.
“This was a unique challenge, as we hadthree simultaneous tasks,” Caldwell said. “First, we had to establish a newmultinational command; second, we had to train, generate and sustain anenduring Afghan national security force that included the Afghan army, policeand air force and all of their associated support systems; and third, we had todevelop, advise and mentor at all levels of the Ministry of Defense and theMinistry of Interior.”
The Dawood Hospital treats woundedAfghan soldiers. It is largely U.S.funded but staffed by Afghan medical personnel who are mentored by U.S.military doctors.
“Allegations began to surface regardingwidespread theft, mismanagement and patient neglect at the hospital” during thesummer of 2010 and as early as 2006, subcommittee chairman Rep. Jason Chaffetzof Utah said at the hearing. Evidence, he said, indicates that wounded Afghansoldiers endured starvation, bedsores and gangrene. Some patients, he added,were “extorted for medical care, while others were abused, neglected and madeto suffer.”
Caldwell recalled the state of Afghanmedical care at the time of his assumption of command in November 2009.
“Afghanistan is a sovereign nation wheretheir medical care was ranked in the bottom 10 percent globally by the WorldHealth Organization,” Caldwell said. “This poor medical care presented issuesthat were complex and required a high degree of coordination with our Afghanpartners, coordination that was necessary and critical in order to have anychance of this care being established and enduring beyond our presence there.”
By the summer of 2010, Caldwell said,“it was becoming apparent to us that there was corruption in the [Afghanmedical] system, and we were then trying to establish whether, is it just goinginto warehouses? Is it corruption where people are making a profit off it? Andso we internally started looking very hard at the whole corruption issue.”
Caldwell testified that he’d alsorecognized early on that there were problems at the hospital.
“Part of our challenge was we didn'thave the number of people in the hospital really providing the oversight insidethe hospital until about August of 2010, when we really put our first twomentors in on the wards and started giving us some real day-to-day look at whatwas going on in that, because we just didn't have the depth,” the general said.
Caldwell also told the subcommittee thathe’d “supported all investigations, audits and assessments into any aspect” ofhis command in Afghanistan.
“At one time during my tenure, we had inexcess of 27 simultaneous audits or assessments by multiple government agenciesexternal to our command, ongoing,” Caldwell said. “We embraced these so wecould remain transparent as possible and to demonstrate sound stewardship ofthe resources that had been entrusted to us by the American people and the U.S.Congress.”
At all times, he added, he and hiscommand team addressed issues aggressively and immediately as they werepresented to them.
Caldwell now commands U.S. Army Northand 5th Army, and he’s senior commander of Fort Sam Houston and Camp Bullis inSan Antonio. He was accompanied at the hearing by Army Maj. Gen. Gary S.Patton, who served with Caldwell in Afghanistan as the NATO mission’s deputycommander for army training and as commander of the U.S. transition command,and Ambassador Kenneth P. Moorefield, the Defense Department’s deputy inspectorgeneral for special plans and operations. Patton is now the director of DOD'sSexual Assault Prevention and Response Office.
Patton said the problems associated withthe Dawood Hospital “were highly complex ones, complicated by elements ofAfghan corruption, failed Afghan leadership and hospital staff apathy, worsenedby the inherent problems of national illiteracy and the historic inadequacy ofAfghan health care.”
The hospital’s operations also wereburdened by the consistent flow of wartime casualties, he added.
Patton said the NATO training commandstepped up to the challenge and devoted considerable time and energy to improvingthe medical care and management of the hospital while simultaneously manning,building, training, developing and equipping the Afghan army while at war.
“We took very seriously our role asadvisors to drive positive change at the hospital through active, persistentand firm engagement with our Afghan partners,” he added.
It was important to conduct a partneredeffort, Patton said, “because in our experiences working with other Afghansystems, although a coalition solution to a problem would usually yield animmediate fix, only a partnered or Afghan-led solution would produce anenduring result.”
Moorefield told the subcommittee that inlate October 2010, the Combined Security Transition Command Afghanistaninspector general requested DOD IG assistance in addressing possiblediscrepancies concerning the distribution of and accounting for pharmaceuticalsdistributed to the Afghan National Army.
On November 10, 2010, Moorefield said,Caldwell sent him a message reconfirming his command's request for DOD IGmedical logistics mission assessment, adding that with the assistance of arecent increase in personnel, he had become increasingly concerned about“possible illicit activities and inadequate accountability measures concerningpharmaceuticals supplied.".
His team deployed to Afghanistan on Nov.28, Moorefield said. After visiting the Dawood National Military Hospital andthree of four regional hospitals and associated medical depots, he told thepanel, the IG team briefed the command on deficiencies related to dysfunctionalmedical logistics that negatively affected hospital management and patient careat Afghan National Army hospitals. The team also found and reported a lack ofstrategic planning to better focus joint efforts by the NATO and U.S. commandsand the Afghan army to make effective use of scarce resources and noted thathospital mentoring teams were staffed at only 50 percent of authorizedpersonnel, among other issues.
In February 2011, as a result of theNovember assessment mission, Moorefield said, his team “held an inspection ofjust the [Dawood facility] focused on unacceptable conditions reported by thecommand concerning hospital management, medical personnel conduct, sanitation,and patient care, and supply and inventory issues.” This inspection, he added,also resulted from a joint series of inspections by the NATO training commandand the U.S. transition command of the national military hospital.
Although the state of general sanitationand medical supplies had improved at Dawood, Moorefield said, “a number of theother concerns were confirmed, and we made recommendations to the command forcorrective actions.”
This June, the DOD IG again inspectedthe Dawood military hospital and the Afghan national security forces medicalcare system and a number of key areas necessary to create an independent,sustainable system, Moorefield said.
“We found that development had advancedin the areas of planning and mentoring, leadership and management, andlogistics, and patient care,” he said. And there is “evident commitment” by thenew Afghan army surgeon general and the Dawood hospital commander to continuework on improving whatever needs improvement, he added.
Significant challenges still remain withrespect to the development of the Afghan national security forces medicalsystem and Dawood’s capacity-building initiative, Moorefield said, noting thatas U.S. and coalition forces draw down, the decreasing numbers of medicalmentors will focus on priority medical areas requiring improvement.
At Dawood, he said, these areas includeemergency room, anesthesia, physical therapy, preventive medicine andradiology. “And improving medical logistic support for the [Afghan forces] andits medical care system is critical and is expected to require attentionthrough 2014 and perhaps beyond.
Reinforcing the Afghan security forces’commitment to the enduring stewardship of the health care system “will need toremain a priority of both the command and the Afghan government,” Moorefieldsaid.
Moorefield emphasized the DOD IG iscommitted to continued oversight of the development of Afghan national securityforces health care, including at the national military hospital.
Chaffetz said he was “encouraged by morerecent reports of progress at Dawood hospital and the Afghan medical system.”
“Our men and women in uniform have anexceptionally difficult task [in Afghanistan] and should be commended for theirefforts,” he added.
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