That's a damning quote from an evalulation written two years ago about the Fort Hood shooter Nidal Hasan. It was written by his supervisor at Walter Reed hospital and sent with his file when Hasan moved to Fort Hood.
Forgive the rambling nature of my thoughts in this diary; I'm just so angry about this I wanted to get it out.
NPR had a story this morning on this memo that recently surfaced; you can listen or read it here:
Hasan's Supervisor Warned Army In '07
The story describes how in 2007, the director of psychiatric residents at Walter Reed wrote a page-long damning memo about grave concerns he had regarding Hasan, including incompetence, proselytizing to patients, mistreating a homicidal patient and letting her escape from the emergency room, reckless behavior, not answering his pager or calls when he was on call, and seeing only 30 patients over the course of 38 weeks.
Those last two items made me gasp. My husband is a physician (although not a psychiatrist). If he missed answering emergency calls when he's on call, he would be disciplined instantly, and fired if it happened more than once. His pager service got cut off one Thanksgiving when he was on call (my fault; I thought I had mailed the payment but hadn't and they were very strict about it) and it was sheer hysteria at the house trying to get the service re-activated on a holiday before emergency calls started coming in. At his busiest job, he once saw sixty patients...in a day. He routinely sees 20 a day. Now, we could have lots of discussions (and he and I have!) about insurance companies dictating how many patients he has to see in how much time and how ridiculous that is, but even leaving that aside...30 patients in 38 weeks. When his colleagues were seeing, according to the article, "10 times that number."
I suppose on the good side though, seeing only 30 patients limits the amount of damage Hasan could do, given that
soldiers seeking therapy may be falling apart, filled with rage and a distrust of authority. What those soldiers need, she says, is a psychiatrist they can trust completely — not a therapist who fails to show up and abandons his patients.
"This kind of behavior could, in fact, set off a stress reaction" in a patient, she says. "It could be a trigger to a post-traumatic stress reaction."
I think the part of the article that bothered me the most though was the faint praise that the supervisor put in:
"He is able to self-correct with supervision." And Moran writes, "I am not able to say he is not competent to graduate."
Officials at Walter Reed told NPR that those statements were very carefully worded. What they convey is that when Hasan's supervisors read him the riot act — when they gave him intensive supervision — he would improve just enough so that they had to tell their commanders: "Hasan is capable of doing better."
In other words, Hasan was manipulative enough to improve just enough to skate by.
In my last real corporate job, I supervised 25 people at one of the big investment banks. One aspect of the supervision I really disliked was the pressure from above always to find essentially equal amounts of good and bad in everyone. I had some awesome wonderful staff, but was required on the forms to find "areas for constructive criticism". And while of course people can always improve and grow, at times I found myself taking one minor item and blowing it up to be a "developmental need", just to satisfy what corporate HR thought a performance review should do.
Similarly, I had, fortunately only one, junior VP who was terrible. Nice guy, we got along over lunch, but he could not perform even the most basic tasks. His only job was to compile a monthly report for me, and I gave him a checklist to follow. The few items on the checklist he completed, he did poorly. It took hours and hours every month to get even mediocre results, and that was sitting with him for days on end showing him what to do. He was completely disinterested and the mistakes were so basic most high schoolers wouldn't make them. But in his performance review? I had to be even-handed. It took me a year of documentation and a tightly supervised performance plan before I could fire him....and I only started that process after working with him for several months of seeing no improvement or interest in improving.
Seeing this article reminded me of that corporate environment I finally escaped. Hasan's supervisor had to put in some faint praise, and whoever received the memo must have focused more on that ("I am not able to say he is not competent to graduate") than on the truly disturbing evidence throughout the rest of the memo. Why have supervisors if their opinions aren't taken seriously? Why did someone not see this memo and jump all over it? 13 lives would have been saved, and scores more families and soldiers would have been spared trauma and tragedy.
It's easy in retrospect for people to say, as they did in the article, ""I would never, ever hire a physician with this kind of a record," or "Oh, no, this is not somebody that we would take a chance on." or the administrator of a nearby psychiatric facility who said
"Even if we were desperate for a psychiatrist, we would not even get him to the point where we would invite him for an interview" ...if he had seen a memo like this about an applicant, Sharfstein would have avoided him like the plague."
If someone like Hasan wouldn't have been hired...why was he allowed to stay on when so many warning signs were flashing?
I could go on and on - the numerous ignored complaints to the SEC about Madoff. Numerous complaints about priests for molesting children where the response is simply to move the priest elsewhere. There are days when I just can't stand anything about corporate bureaucracy. Imagine what a different world this would be if people had more encouragement to take action when they saw something wrong.