By Gerry J. Gilmore
American Forces Press Service
WASHINGTON, Sept. 13, 2012 – A
three-star general who commanded the NATO and U.S. training missions in
Afghanistan told a House subcommittee yesterday that his command conducted a
transparent investigation into alleged patient neglect, mismanagement, theft
and corruption at the Afghan-run Dawood National Military Hospital in Kabul.
Appearing before the House Oversight and
Government Reform Committee’s national security, homeland defense and foreign
operations subcommittee, Army Lt. Gen. William B. Caldwell IV testified that he
became the first commander of the NATO Training Mission in Afghanistan and
commander of the U.S. Combined Security Transition Command Afghanistan on Nov.
21, 2009.
The NATO command was established to
coordinate and synchronize the multinational efforts to raise, equip, train and
sustain an Afghan national security force, the general said, and the U.S.
command was responsible for the oversight of U.S. funding, training and
ministerial development.
Caldwell told the panel that he
recognized early on that his command faced immediate challenges, including
issues within the Afghan medical system.
“This was a unique challenge, as we had
three simultaneous tasks,” Caldwell said. “First, we had to establish a new
multinational command; second, we had to train, generate and sustain an
enduring Afghan national security force that included the Afghan army, police
and air force and all of their associated support systems; and third, we had to
develop, advise and mentor at all levels of the Ministry of Defense and the
Ministry of Interior.”
The Dawood Hospital treats wounded
Afghan 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 regarding
widespread theft, mismanagement and patient neglect at the hospital” during the
summer of 2010 and as early as 2006, subcommittee chairman Rep. Jason Chaffetz
of Utah said at the hearing. Evidence, he said, indicates that wounded Afghan
soldiers endured starvation, bedsores and gangrene. Some patients, he added,
were “extorted for medical care, while others were abused, neglected and made
to suffer.”
Caldwell recalled the state of Afghan
medical care at the time of his assumption of command in November 2009.
“Afghanistan is a sovereign nation where
their medical care was ranked in the bottom 10 percent globally by the World
Health Organization,” Caldwell said. “This poor medical care presented issues
that were complex and required a high degree of coordination with our Afghan
partners, coordination that was necessary and critical in order to have any
chance 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 [Afghan
medical] system, and we were then trying to establish whether, is it just going
into warehouses? Is it corruption where people are making a profit off it? And
so we internally started looking very hard at the whole corruption issue.”
Caldwell testified that he’d also
recognized early on that there were problems at the hospital.
“Part of our challenge was we didn't
have the number of people in the hospital really providing the oversight inside
the hospital until about August of 2010, when we really put our first two
mentors in on the wards and started giving us some real day-to-day look at what
was going on in that, because we just didn't have the depth,” the general said.
Caldwell also told the subcommittee that
he’d “supported all investigations, audits and assessments into any aspect” of
his command in Afghanistan.
“At one time during my tenure, we had in
excess of 27 simultaneous audits or assessments by multiple government agencies
external to our command, ongoing,” Caldwell said. “We embraced these so we
could remain transparent as possible and to demonstrate sound stewardship of
the resources that had been entrusted to us by the American people and the U.S.
Congress.”
At all times, he added, he and his
command team addressed issues aggressively and immediately as they were
presented to them.
Caldwell now commands U.S. Army North
and 5th Army, and he’s senior commander of Fort Sam Houston and Camp Bullis in
San 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 deputy
commander for army training and as commander of the U.S. transition command,
and Ambassador Kenneth P. Moorefield, the Defense Department’s deputy inspector
general for special plans and operations. Patton is now the director of DOD's
Sexual Assault Prevention and Response Office.
Patton said the problems associated with
the Dawood Hospital “were highly complex ones, complicated by elements of
Afghan corruption, failed Afghan leadership and hospital staff apathy, worsened
by the inherent problems of national illiteracy and the historic inadequacy of
Afghan health care.”
The hospital’s operations also were
burdened by the consistent flow of wartime casualties, he added.
Patton said the NATO training command
stepped up to the challenge and devoted considerable time and energy to improving
the 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 as
advisors to drive positive change at the hospital through active, persistent
and firm engagement with our Afghan partners,” he added.
It was important to conduct a partnered
effort, Patton said, “because in our experiences working with other Afghan
systems, although a coalition solution to a problem would usually yield an
immediate fix, only a partnered or Afghan-led solution would produce an
enduring result.”
Moorefield told the subcommittee that in
late October 2010, the Combined Security Transition Command Afghanistan
inspector general requested DOD IG assistance in addressing possible
discrepancies concerning the distribution of and accounting for pharmaceuticals
distributed to the Afghan National Army.
On November 10, 2010, Moorefield said,
Caldwell sent him a message reconfirming his command's request for DOD IG
medical logistics mission assessment, adding that with the assistance of a
recent increase in personnel, he had become increasingly concerned about
“possible illicit activities and inadequate accountability measures concerning
pharmaceuticals supplied.".
His team deployed to Afghanistan on Nov.
28, Moorefield said. After visiting the Dawood National Military Hospital and
three of four regional hospitals and associated medical depots, he told the
panel, the IG team briefed the command on deficiencies related to dysfunctional
medical logistics that negatively affected hospital management and patient care
at Afghan National Army hospitals. The team also found and reported a lack of
strategic planning to better focus joint efforts by the NATO and U.S. commands
and the Afghan army to make effective use of scarce resources and noted that
hospital mentoring teams were staffed at only 50 percent of authorized
personnel, among other issues.
In February 2011, as a result of the
November assessment mission, Moorefield said, his team “held an inspection of
just the [Dawood facility] focused on unacceptable conditions reported by the
command 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 command
and the U.S. transition command of the national military hospital.
Although the state of general sanitation
and medical supplies had improved at Dawood, Moorefield said, “a number of the
other concerns were confirmed, and we made recommendations to the command for
corrective actions.”
This June, the DOD IG again inspected
the Dawood military hospital and the Afghan national security forces medical
care system and a number of key areas necessary to create an independent,
sustainable system, Moorefield said.
“We found that development had advanced
in the areas of planning and mentoring, leadership and management, and
logistics, and patient care,” he said. And there is “evident commitment” by the
new Afghan army surgeon general and the Dawood hospital commander to continue
work on improving whatever needs improvement, he added.
Significant challenges still remain with
respect to the development of the Afghan national security forces medical
system and Dawood’s capacity-building initiative, Moorefield said, noting that
as U.S. and coalition forces draw down, the decreasing numbers of medical
mentors will focus on priority medical areas requiring improvement.
At Dawood, he said, these areas include
emergency room, anesthesia, physical therapy, preventive medicine and
radiology. “And improving medical logistic support for the [Afghan forces] and
its medical care system is critical and is expected to require attention
through 2014 and perhaps beyond.
Reinforcing the Afghan security forces’
commitment to the enduring stewardship of the health care system “will need to
remain a priority of both the command and the Afghan government,” Moorefield
said.
Moorefield emphasized the DOD IG is
committed to continued oversight of the development of Afghan national security
forces health care, including at the national military hospital.
Chaffetz said he was “encouraged by more
recent reports of progress at Dawood hospital and the Afghan medical system.”
“Our men and women in uniform have an
exceptionally difficult task [in Afghanistan] and should be commended for their
efforts,” he added.
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