| ACTION - Mabon 2006 - Article 4 |
Action is the official newsletter of the Alternative Religions Educational Network
INTERVIEW WITH ROBERT CARLTON JONES, M.D. |
Editor: You had a pretty good idea what you wanted in a career and worked quite hard to get it. The Air Force requires a great deal from its doctors, doesn’t it? Jones: I had wanted to become a physician since age 5. I was a very sickly kid...almost died from pneumonia when I was three...and I remembered vividly how many doctors worked to save my life. I started my pre-med course work in ninth grade at Eleanor Roosevelt Science and Technology Center in Greenbelt, Maryland; from that time until my graduation from residency in 1994, I was pretty monomaniacally focused on being the best physician and anesthesiologist I could be. The Air Force I knew from the 1980s expected you to act as both an officer and a physician. For many years, I found no conflict between these roles. In the late 1990s, however, the combination of ill-advised policies and stunning cutbacks in personnel, funding, and facilities made Air Force medicine increasingly intolerable to me. Although the USAF paid lip service to the concept of "Integrity First", what they really wanted...demanded...was silent obedience first, last, and always. As a lowly 2nd Lieutenant medical student and as a Captain intern, it was pretty easy to defer to one's "betters"; I guess I had faith that *someone* could see that slashing physician residency training slots would have a devastating effect on the quality of medical care in the years to come. As a senior Major and, finally, Lt. Col, it became crystal clear to me that the Generals in charge were actively working to destroy the institution of professional, uniformed military medicine in which I had grown up, for two reasons: 1) in order to save money by preventing access to medical care, thus guaranteeing themselves promotions; and 2) to enrich the civilian contract "Health Care" corporations tasked to prevent care via the monstrous bureaucracy of "TRICARE" (nicknamed: TRY to get CARE); the primary motivation appeared to be the Generals' own lust to land cushy post-retirement consulting jobs at these same corporations, in order to supplement their pathetic military stipends. Editor: This was also the time you were developing your Pagan beliefs was it not? Jones: I was first introduced to Magick and the Goddess when I was given a book on Ritual Magick by a relative in 1985. I had previously abandoned my Southern Baptist upbringing in favor of Zen Buddhism, which I studied at Harvard under Nagatomi Sensei. In Magick, I saw the yang completion of a philosophy of the universe that reflected the yin nature of Zen. Through the combination of rituals and meditation, I felt that one could hope to gain true insights into the nature of oneself, which is, of course, indivisible from the nature of the All (as Above, so Below...). By 1986, I was immersed in the tarot and the Crowleyan, thelemic worldview. From time to time, when I got bored at medical school during 14 hour study marathons, I would draw multicolored unicursal hexagons and 777 heptagrams on the blackboards in the USUHS library; at the time, I never thought twice about the possibility that my spirituality/religion might have negative repercussions on my military career. Editor: Did you have any difficulties being Pagan in the Air Force at first? Jones: Not at all. I felt that the USAF, and the military in general, went out of its way in the 1980s to foster inclusively and tolerance, regardless of "race", creed, or color. I put "race" in quotes because, as a student of evolutionary biology (A.B., Harvard, 1985, Organismic and Evolutionary Bio), the entire concept of "race" is a social/political construct, rather than a scientific one. In any case, the Air Force made it clear that its dual missions: Support and Defense of the Constitution, and Fighting the Evil Empire of the Soviet Union, dwarfed and rendered insignificant any religious/cultural differences among the millions of Americans in uniform. Editor: When did that seem to change? Jones: For me, it began to change under Bill Clinton circa 1998. Many social conservatives in the military had despised him from the beginning. When the whole Lewinski affair came to light, it seemed as though many of my co-workers felt free to express their Senior ranking officers began writing letters to the editor decrying Clinton's adulterous ways...thus setting a terrible example for their subordinates. In essence, to me as a Pagan, it seemed that Christian religious and cultural taboos trumped the UCMJ in the minds of many active duty military. After the election of George W. Bush, the Christianization of the military increased asymptotically. First, the President himself went on about how God had personally selected him for the job. Second, military retirement ceremonies increasingly used the blatantly Christian flag-folding ceremony, which was NOT official, but which was claimed by many to BE official. Third, the Commanding General of my hospital, Malcolm Grow at Andrews AFB, set about forcing his "Vision" of the importance of spirituality to health...by which he meant the rabidly evangelical version of Christianity to which he had devoted his life (see:http://www.medicalcorpse.com/oneUSAFunderJesus.html). Fourth, the General saw fit to have a Christian prayer inserted at the top of the official hospital e-mail newsletter every single day...without any attempt at religious/spiritual inclusion (i.e., even on Rosh Hashanah, no Jewish prayer was allowed...and forget about Samhain or Beltane...). Fifth, the General set up a "Spiritual Life Committee" at our hospital; his admitted goal was to change the cultural environment to make supervisors comfortable quizzing their subordinates about their "spiritual biceps" during official military feedback sessions. Sixth, the U.S. Air Force academy was embroiled in religious scandal which reminded me of the Thirty Year War and the British Civil War, where those who did not believe exactly as you did were labeled heretics, and slain in the name of Jesus. The Air Force Academy even instituted the practice of marching off those who did not wish to sit through an after-dinner Christian chapel session in a "Heathen Flight" formation. Finally, Air Force Materiel Command, under the leadership of its Command Surgeon (my evangelical former Hospital Commander), declared July, 2006 to be "Spiritual Wellness Month" throughout the entire command: http://tinyurl.co.uk/d3sb. Certainly, no Wiccan or Atheist/Freethinker or agnostic is allowed to take part in this Christian Faith-Fest, which is being paid for by *your* tax dollars, in violation, among other things, of the First Amendment to the U.S. Constitution. I highly recommend your readers to support the Military Religious Freedom Foundation http://militaryreligiousfreedom.org/), which is also fighting the Department of Defense to protect our service members from the unwarranted, unprecedented, and unconstitutional intrusion of religion and proselytization into what *used* to be the secular institution of the U.S. Armed Forces. Editor: You advanced in your medical career fairly fast. How did you feel about your career in the beginning? Jones: In the military, advancement through the rank of Major is based on longevity alone. After Major, in the USAF, you were supposed to take Air Command and Staff College (ACSC)...10,000 pages of extremely poorly written, acronym-strewn garbage designed to teach me, a physician healer, how to target nuclear (er, excuse me, to quote our President, "nuculer") weapons and/or order conventional air strikes for maximum damage. Like a good Airman, I took the course via CD-ROM correspondence, and passed it in 1997. Ironically, I was called into the Travis hospital Vice Commander's office in 1999 and chewed out, because (so this anesthesiologist bureaucrat thought) not one physician eligible for promotion to Lt. Col had taken time out of their crushing clinical workloads to complete this torturous course. When I pointed out that, among all my colleagues, I alone *had* completed the course as soon as I was able to take it, he harrumphed a few times, neglected to apologize for his stupidity, and dismissed me back to the operating room. The reason why no one was taking ACSC was because the Air Force, in its infinite stupidity, was forgiving people passed over for Lt. Col all the time they owed the military (and the taxpayers), discharging them honorably from the service, giving them $60,000 in severance pay, and helping them find new civilian jobs that paid twice as much as they got in the service. I considered this to be an "intelligence test"...one that I, in my gung-ho desire to fulfill my Active Duty Service Commitment to my country, failed miserably. Thus, in 2002, I was promoted to Lt. Col on the 12th anniversary of my graduation from medical school; by that time, I had been so terminally demoralized by mismanaging cretins, including especially the "Col. Rusty" described in my book, that I knew I was going to leave the military without retiring. In the beginning of my aborted career, I felt very proud to be among the "elite" physicians around me, who had dedicated their lives to defending our country. As things got progressively worse in the late 1990s, and the best and brightest fled the military, while the worst and dumbest remained to do e-mail and make rank, I became, as you can see, somewhat disillusioned. Time after time, I spoke out verbally and in writing to try to correct terrible, systemic problems in military medicine that threatened patients' lives:
Editor: What were a few of the high points of your career? Jones: I was proud to be selected as the first student voting member of the Uniformed Services University of the Health Sciences (USUHS) Promotions Committee. I was proud to be selected as "Medical Director of Anesthesia" at Travis...until I came to realize that the position consisted of responsibility without authority. I was proud to be part of the first JCAHO Sentinel Event Committee in the Air Force in December, 1998...although the results of our month-long analysis of problems in the Operating Room were completely ignored by the Command, to the permanent detriment of a young active duty troop in 2003 (http://www.medicalcorpse.com/weak.html). I was proud to deploy in support of Operation Enduring Freedom as the only USAF anesthesiologist in Turkey (July-Aug 2002), even though my absentee landlady boss had shirked her deployment on me, so that she could stay home to celebrate her twins' birthday party (so she told me). Finally, I was proud to leave the Air Force after 19 years on active duty without retiring. Although I lost all retirement pay and benefits, I left with my honor intact. Editor: You seemed especially interested in medical ethics and proper medical procedure. When did that begin to become a source of problems between you and others in the Air force? Jones: Looking back over my medical school grades the other day, I saw that I had gotten an "A" in the course "Ethical, Legal, and Social Aspects of Medicine". Even from the beginning of my medical studies, I felt that being a Military Medical Officer meant doing the right thing for my patients, as best I could, regardless of costs to myself and my career. I guess that my strict, Southern Baptist upbringing had inculcated in me a strong sense of right and wrong. Moreover, since 1978, I have been programming computers; I even got paid to be a software engineer while at Harvard. Thus, I usually think in terms of algorithms: (If [this condition], and [no contraindication], then [this treatment]). My studies in Zen and Magick have convinced me that courage in the face of the universe will give me better karma, in the long run, than cowering in fear in silent abdication of my mind to those who know (and/or care) less than me. The Wiccan Rede states: "An None Be Harmed, Do What Thou Wilt"...but what if a patient were harmed by my inaction, what then? Would the bad karma of my cowardice come back to me thrice? I thought...and still think...so. Ayn Rand became my personal heroine in 2004; I have read "Atlas Shrugged" several times since I fortuitously picked it up that summer. Speaking of the degraded type of person the military wants nowadays, Ms. Rand wrote: "At the crossroads of the choice between "I Know" and "They Say", he chose the authority of others, he chose to submit rather than to understand, to *believe* rather than to think." Yet, once such a person makes rank in the military, "He wants to deal with men by means of faith and force-- he finds no satisfaction in their consent if he must earn it by means of facts and reason." Those of my colleagues who understood where I was coming from, who also stood up to support patient safety over political correctness, were brutalized and demoralized by the system as I was. The Japanese saying states: "Deru kui wa utareru"-- the stake that stands up will be hammered down. Ninety percent of them have left the service in disgust; 9% are still paying back their service commitments; 1% have learned to identify with their aggressors; to shut up, sit down, and make rank in order to grasp the magical brass retirement ring. Sadly, they will find that, in the future, the ring will turn green from Congressional neglect of our retirees, and continued chipping away at the non-monetary perks of military retirement (medical care, BX/Commissary privileges, Officers' Clubs, and other downsized DoDos of DoD history). Editor: When did you feel that medical care had gotten so bad that you were feeling frustrated and not getting proper reaction to pointing out flaws in it? Jones: Starting in October 1997, with the imposition of the Objective Medical Group (OMG) paradigm at Travis AFB, I found myself faced with a layer of bureaucracy that embodied the brain-dead attitudes described above. The OMG made nurses equal to physicians in terms of promotion and authority. This inevitably led to implementation of Scott Adams's "Dilbert Principle", which dictates that people are promoted within dysfunctional institutions *way above* their level of competence, thus terminally demoralizing their non-clueless underlings. We had an absentee Colonel Flight Commander who, when I told him that lack of planning at higher headquarters would result in critical shortfalls in anesthesiologists in the coming years, told me the following: "Go clone yourself". We had a literally berserk Lt. Col Chief Nurse Anesthetist who screamed at physicians, made unilateral medical care policies, and even slammed a door on my foot in anger. She once stood up at a meeting announce her unilateral decision to overturn the anesthesia care team policy codified in our hospital's Operating Instructions and Air Force Instructions; she got away with it due to her political connections. In order to assert her petty turf rights, the nurse O.R. commander kicked me out of the office I had shared with other physicians for five years, so that she could give it to a lone Sergeant, who only showed up to work around three days per week. When I got to Andrews, I was faced with incomprehensible denial regarding the degree to which the former "Medical Center" had devolved since I had done my internship there ten years prior. My first Squadron Commander surgeon insisted on placing a pacemaker in a patient on a Saturday, just because he said so, even though the temperature and humidity in the O.R.s were so out of control that condensation was dripping like rain from the ceilings onto the patients. The OB deck was so chronically overcrowded, that the Command tried to bully me and other anesthesia "providers" into doing two things at once: For example, abandoning one epidural patient to start another epidural before it was safe to do so; or "staffing" a room with a nurse anesthetist, while personally performing anesthesia alone for a C-section (in violation of civilian federal law and written codes of anesthesiology ethics, I might add). Time and time again, I was faced with a terrible quandary: Did I do the right thing, as I saw it, and anger boneheaded superiors; or did I do the wrong thing, and lose my self-respect, and possibly my patient's life. Editor: What happened when you complained about improper medical procedure? Jones: In 1999, When I stood up with two fellow anesthesiologists to complain to the Chief Anesthesiologist in the Air Force that patient care conditions were unsafe at Travis due to poor leadership and policies, I was fired as "Medical Director of Anesthesia"; one of my colleagues, who had been my junior resident two years behind me, was given the job, instead, because everyone knew he would shut up and not rock the (sinking) boat. When my absentee landlord Flight Commander was fired for, among other things, failure to enforce "Good Order and Discipline", his good buddy from the Air Force Academy and USUHS tried to have me sent to Alaska alone, without my three handicapped children and active duty physician wife, on what was usually an "accompanied" tour, just out of spite and raw reprisal (so I was later told by my absentee landlady Flight Commander at Andrews). In November, 2001, after being on call every other night for three months, When I stood up to refuse to commit elective anesthesia on a nine-year old child whose neck hadn't been cleared after a major traumatic injury, and then consign him to recovery on an adult ward without pediatric nurses, equipment, or inpatient pediatricians, I was given my first, career-ending Letter of Reprimand by "Col. Rusty", the vindictive former navigator, surgeon Squadron Commander, who was also, evidently, good buddies with my two former commanders. When I pointed out to a surgeon, verbally, that I was "afraid" that something bad would happen to my very sick vascular surgical patient if everything weren't done "by the book", I got my second LOR from the Squadron Commander. When I went to the Wing Inspectors General, they basically shrugged and stated that, although they personally felt I was the victim of illegal reprisal for my repeated protected communications to the Command in writing regarding severe patient care problems, they couldn't prove it without a smoking gun. When I asked them whether they intended to "Inspect" for this in the e-mail traffic of my Commander, they just looked at me with pity for my naivete. There was no way they were going to go up against a powerful full bird Colonel in order to save a Major from having his career destroyed...it just wouldn't look good on their Officer Performance Reports. As a result of my complaints, the Adult Medicine Ward at Andrews (2A) was hastily renamed the "Multi-Service Ward"; non-pediatric nurses were magically given authorization to care for kids, regardless of their own nursing skills or training (or pediatric patient care supplies). Furthermore, after several episodes of needless death and brain damage among vascular surgery patients at Andrews, the entire program was yanked out of Andrews and sent to Walter Reed. The vascular surgeon who had "frightened" me was "promoted" to be a professor at USUHS, the military medical school; in actuality, his commanders wanted to make sure that he gained some additional skills under "adult supervision" by more experienced surgeons at Walter Reed. Ironically, at his farewell ceremony, the idiotic "Col. Rusty" took credit for "improving liaison between the Andrews and Walter Reed Vascular Surgery programs"-- an improvement which cost me my career-- which I count as nothing compared to the lives saved by this long-delayed decision to match patient care with hospital capabilities. Editor: What was the straw that broke the camel's back? When did you make the decision to leave before retirement benefits kicked in? Jones: On 4 Dec. 2001, after I had sacrificed literally hundreds of hours slaving long into the night as one of only two clinical anesthesiologists at Andrews, "Col. Rusty" handed me a formal Letter of Reprimand which stated: "...you made treatment recommendations to a patient's parent that were in direct conflict with the treatment plan of the attending surgeon." Funny, I always thought that was my job: to act as if I were an independently board-certified, physician consultant in the medical specialty of anesthesiology (at least, is what the piece of paper on my wall says). "...The attending provider is responsible for overall care of the patient. When the plan of care involves surgery, you, as the anesthesia provider, have a responsibility to fully evaluate the patient and make recommendations for the care and treatment of the patient in the delivery of anesthesia...However, any identified problems or concerns must be discussed with the attending provider for resolution. Unilateral decision-making and recommendations to the patient, prior to discussion with the attending provider, are unacceptable." Ah, now I get it..."Col. Rusty" was setting up a two track system: Surgeons were "Attending Providers" (note caps), while anesthesiologists were merely "anesthesia providers"...even though I was just as much a staff attending physician as the orthopedic surgeon, and even had military date of rank on him (for what it was worth, which turned out to be nothing). What was bitterly ironic to me was that I did not act unilaterally. I had spent three hours discussing the case with the surgeon, my boss, the chief physician of the hospital, the chief (nurse) of the ICU, and everyone involved except this "Col. Rusty" (whom I had tried to contact, only to be told he was on leave that day). When I realized that he was serious in relegating me to the status of "provider" rather than attending physician; that he was willing to destroy my career in order to stage a low-tech lynching of an uppity anesthesiologist who insisted on being treated as a co-equal, rather than as a mere technician; then I knew that, for the sake of my honor, I could not remain in an Air Force system that would allow such injustice to stand. Sadly, I could not appeal to his boss, the Chief Nurse of the Air Force and our hospital Commanding General, because I had been told by the Chief Physician (SGH) that she was "furious" at me for correctly pointing out that her nurses were not capable of caring for pediatric patients...as they had proved multiple times before this episode. To put this into perspective for the non-military folks reading this: the Commanding General at Abu Ghraib received a lesser punishment (Letter of Admonishment) for turning a blind eye to torture than I did for correctly advising that a child be transferred half an hour away to Walter Reed Army Medical Center, which had a pediatric ward, pediatric ICU, pediatric anesthesiologist, pediatric orthopedic surgeon, and the rod for the patient's leg (which our O.R. was frantically trying to borrow from a nearby civilian hospital). Of course, it didn't make me feel better when I found out that my patient's father, who had been subjected to surgery by the same orthopedic surgeon at our hospital the night before the incident in question, died a few days later of (preventable) post-op complications, while my patient survived to go back to his mother's arms. Editor: When did you decide you needed to write about the problem? Jones: I knew that I needed to write about these problems in order to do three things: 1) to set the record straight 2) to explain to my children why I didn't stay in the Air Force for a career, and thus guarantee our family money and benefits for life and 3) to cathart my grief and anger at the mistreatment of myself and our military beneficiary patients at the hands of the corrupt system which had killed the Medical Corps I had known and loved. Thus, the title of my book and website: “Military Medical Corpse: The Premeditated Murder of U.S. Military Medicine.” Editor: You have some definite ideas on how to bring back good medical care, don”t you? Jones: At this point, I am concerned that I have taken up too much of your publication with my verbose responses to your excellent (and short) questions. I wrote an editorial entitled: "Support Our Troops: 16 Simple Steps to Revive Military Medicine from the Brink of Death"; your readers can find it here: http://www.medicalcorpse.com/editorials.html. Although no mainstream media outlet has seen fit to print it yet, I think it summarizes my ideas on how to fix military medicine in as cogent a fashion as I can manage 8-). The basic ideas involve returning medical care to physicians, not nurses or non-physician bureaucrats; making anesthesiologists co-equal to surgeons on the org chart; enforcing the anesthesia care team model, where CRNAs work with, rather than against, physician anesthesiologists; removing disincentives to transferring patients from incapable, "force shaped" (= downsized) Military Treatment Facilities to capable civilian hospitals; reinforcing the role of military docs as healers, rather than as torturers; and removing all traces of the unconstitutional Christianization of the military, which continues to subject our troops to unwarranted proselytization and prayers in the name of Jesus, when what the vast majority in uniform wants is to support and defend the Constitution...not religion of any flavor. Editor: Any idea when your books will be ready for publishing? Jones: I am finishing up the book of quotes right now. I still haven't completed the first book...I guess the website, my family, and my job have kept me busy. And, no, I haven't even started looking for a publisher...any advice or help would be appreciated: webmaster_AT_medicalcorpse_D0T_com. To paraphrase "Bones" McCoy of Star Trek, "Dammit, Jim, I'm a doctor, not an author!" Editor: Will you let us know when it comes out? Jones: Certainly! Editor: Thank you for your time. Jones: Thanks for giving me this opportunity to speak with you and your readers, and, as always, Blessed Be! |