The Army terminated its psychological testing contract at Fort Hood, Texas, only seven months before Spc. Ivan Lopez’s eight-minute shooting rampage that left Lopez and three other soldiers dead and 16 more wounded on April 2, WND has learned.
Instead, Fort Hood – one of the largest military installations in the world and the primary hub for deploying U.S. soldiers overseas – has been using free tests it finds on the Internet to evaluate soldiers’ psychological health and only employs a single neuropsychologist to treat up to 500 soldiers a month.
And while the post’s traumatic brain injury clinic has a brand-new hot tub in storage, it receives little money to test soldiers for psychological trauma.
The senior neuropsychologist in charge of Fort Hood’s outpatient psychiatry clinic – who resigned from his position only two months ago – tells WND the post has insufficient resources to treat soldiers seeking psychological help, including:
- Inferior testing and evaluation procedures,
- Lack of adequate funding for clinic services,
- Senior mental health professionals forced into retirement by the Army,
- Months-long wait times for soldiers seeking evaluation and treatment for psychological conditions,
- Only one trained clinical neuropsychologist for more than 50,000 soldiers
Lopez, who had been assigned to Fort Hood in February, was in treatment for anxiety and depression, among other health problems, and was being evaluated for post-traumatic stress disorder, Army officials said. Lopez claimed to have suffered a traumatic brain injury while he was deployed to Iraq from August to December 2011.
Army Secretary John McHugh, the U.S. Army’s top civilian official, said, “His records show no wounds, no involvement – direct involvement – in combat.” While it remains unclear whether Lopez actually suffered from the condition, a congressional report revealed confirmed traumatic brain injury cases skyrocketed among Army soldiers in 2011 – reaching nearly 21,000 cases in that year alone, almost five times pre-war levels.
Soldiers ‘lined up’ for psychological screening
Dr. C. Alan Hopewell, was a senior neuropsychologist in the Department of the Army and prescribing psychologist who served as officer in charge of Fort Hood’s Traumatic Brain Injury clinic and Resilience and Restoration Center. Hopewell, who was awarded a Bronze Star Medal for meritorious service in Operation Iraqi Freedom, was the first prescribing psychologist to ever serve in a combat theater. He retired from the Army as a major in 2010 and continued to treat soldiers from the post’s outpatient psychiatry clinic until the beginning of this year.
He worked on Fort Hood at the same time as Army psychiatrist Maj. Nidal Hasan, who brutally murdered 13 people and injured 32 people on the post on Nov. 5, 2009.
Hopewell, who said he hadn’t evaluated Lopez for treatment, told WND his personal horror stories of urging leadership to hire more mental health personnel as the Resilience and Restoration Center was being inundated with soldiers requesting evaluation.
“By spring of 2007, with the re-deployment of the 4th Infantry Division, we had soldiers literally lying on the grass and lined up outside the building as the waiting room was full and they could not be seen for service,” he explained.
The Resilience and Restoration Center was busier than the Army hospital emergency room in 2007, exceeding 300 patient encounters every day, he said. In many cases, he was forced to send patients more than two hours away from the military post, to Dallas and San Antonio, for treatment.
Soldiers and veterans who have, or who claim to have, a traumatic brain injury, or TBI, must often be evaluated by specially trained clinical neuropsychologists. Hopewell said now there is only one neuropsychologist doing testing on Fort Hood in the TBI clinic. There are only about 203 of them at any time on active service with the Army Medical Command, which covers five regions in the U.S. and Europe.
WND requested comment from Fort Hood, but officials provided no response to those requests.
The Department of Defense calls traumatic brain injury “one of the invisible wounds of war, and one of the signature injuries of troops wounded in Afghanistan and Iraq.” Since 2000, more than 287,000 U.S. service members have sustained a TBI.
Post-traumatic stress disorder, or PTSD, frequently occurs with TBI. Both conditions may include the following symptoms: insomnia, memory problems, poor concentration, emotional instability, depression, anxiety, irritability and fatigue. In June of 2013, Brig. Gen. (Dr.) John M. Cho, deputy chief of staff for operations with Army Medical Command, acknowledged, “We’re nowhere near where we want to be, however, when it comes to researching PTSD and TBI. A lot more needs to be done.”
According to a 2008 study, around 20 percent of soldiers returning from Afghanistan and Iraq reported symptoms of post-traumatic stress disorder or major depression. Only half of those soldiers sought treatment.
Treating soldiers from a trailer
After Hasan’s attack, the TBI clinic’s three new brick buildings were closed off for an entire year. Hopewell said three civilian neuropsychologists resigned between 2009 and 2011, due to similar problems of which he has complained, and half of the entire staff quit after the Hasan attack because of stress.
Without his clinic buildings, Hopewell had to treat soldiers out of troop trailers in a parking lot.
“My car still has a bullet hole in it,” he said. “For months, I used a piece of plywood on two chairs for my desk. After six months, all the electricity was turned off and we were given about 24 hours to move to another set of trailers … I did not have enough electrical outlets for a fax machine, and many other limitations. The clinic was basically run from my cell phone and perhaps a phone the clerk had at the desk.”
That arrangement lasted until Oct. 30, 2010, when Hopewell acquired more trailers for his work.
The clinics serve two complete combat divisions, non-divisional support units, dozens of U.S. Army Reserve units passing through Fort Hood (about 50,000 soldiers) and tens of thousands of retired veterans living in the surrounding area. He said hundreds of temporarily retired soldiers live between San Antonio and as far as Arkansas, and they also must be evaluated in a timely manner or they stand to lose their disability benefits.
Taking psychological tests from Internet
In September 2013, Fort Hood allowed its contract to expire after five years of using the psychological testing to evaluate troops returning from combat. Also, Hopewell said the sequestration shut down 20 percent of all mental health services for several weeks during the summer of 2013. Just last week, Sen. Tim Kaine, D-Va., expressed concern that across-the-board sequestration cuts may have compromised the military’s mental health services.
The contract was for a number of critical tests to use for patients, such as the Minnesota Multiphasic Personality Test, the most frequently given test in the world; pain tests; tests for driving, depression and anxiety; tests for personality disorder and PTSD; and tests for patient responses to medical illness and injury.
The soldiers’ responses were sent to the contracted company, which would score the tests and return a complete report within 24 hours.
Dr. Robert Christopher of Professional, Clinical, and Forensic Assessments, a company that holds testing contracts with both military and law enforcement agencies, told WND, “We didn’t receive any notification that the contract would not be renewed. There were only indications that the need for assessment was increasing tremendously.”
He added, “This year, all the troops are coming back from Afghanistan, so the huge volume anticipated was a good justification to renew the contract. Not only did they not renew the contract, they failed to pay us for the last month.”
Instead, Hopewell said the clinic is now using free tests it can find on the Internet, like the Epworth Sleepiness Scale, adding, “There is no comparison between these approved, standardized tests and something like the Epworth.”
Christopher said: “That really doesn’t make any sense because usually it takes a psychologist three, four or even five hours to do a complete profile on an individual. Our capacity is about five to 10 tests an hour. It was unusual and, to be honest with you, a little bit of a mystery why the military decided not to renew the contract.”
Both Hopewell and Christopher say the testing services were offered “at a fraction of the price” of other vendors.
Christopher added, “When you look at what’s going on with the military, based on the publications on the number of suicides and cases of PTSD, which is a very complex kind of issue, it’s a mystery to me why there’s not a military-wide assessment.”
Up to 6 months before soldiers get treatment
Hopewell said soldiers often wait up to two months for an initial appointment for psychological evaluations. Then they are seen by either a social worker or psychologist for an initial diagnostic interview. If medications are needed, they typically wait two more months to be seen by a psychiatrist or be referred out to the civilian community.
“Once seen by the psychiatrist, a second medical review would be done and perhaps lab work before anything would be prescribed,” he said. “So, perhaps two months after all that, the soldier might actually receive a prescription.”
Hopewell would have his patients come in once a week for three weeks to ensure they didn’t suffer from side effects and possibly increase the medications to the proper therapeutic dosage.
In Lopez’s case, the soldier had only been stationed at Fort Hood since February, two months before he shot himself and 19 other soldiers. Officials have stated that he was receiving antidepressants and the sleep aid, Ambien. If he had been following the Fort Hood treatment process Hopewell describes, he wouldn’t receive a full medical review and treatment plan for several more months.
However, Hopewell argues that things might have been different for Lopez if mental health professionals hadn’t been forced to deal with the complicated bureaucratic process.
“If we had been civilians and [the psychiatrist] turned around and said, ‘Look this guy has problems. I’m evaluating him for PTSD. I gave him some Ambien, but I need to know more about his overall psychological status,’ within two or three days I would normally have had a report back to the psychiatrist and we would be able to construct an overall treatment plan,” he said.
“But working in the Army system, this took weeks and weeks and months.”
When Hopewell needed outside help to speed up the testing process – even though a premiere TBI treatment facility was located only two hours away at Fort Sam Houston’s Brooke Army Medical Center – he said he was ordered not to send soldiers there.
“We were given direct orders never to send anybody to Brooke Army Medical Center or to the civilian community for neuropsychological testing,” he said. “I was given these as direct orders, even though the clinic as a whole was screening 500 patients per month some coming from as far as Arkansas for their medical boards.”
Hopewell added, “Now that there is only one psychologist at the TBI clinic doing all the testing, and he is not even board certified, there is no way to keep up with the workload that I can see.”
Fort Hood is also subject to the military’s Title 10 law, which forces out the very mental health professionals that Hopewell says are desperately needed – experienced, senior psychologists – through mandatory retirement. Title 10 allows waivers to mandatory retirement for all medical personnel except psychologists and social workers.
‘The clinic doesn’t do Jacuzzi work’
At the same time the post is plagued by inadequate funding for psychological testing and treatment, Hopewell said “tens of thousands of dollars’ worth of useless equipment” sits in a storage facility at the TBI clinic.
“We had a new Jacuzzi sitting in the Conex [storage container], at one time four extra refrigerators, beds and toilets that would only be used for extremely impaired patients who could not get into or out of bed by themselves, and stuff like that,” he said.
“I kept beating my head against the wall. I could never figure out who in their right mind would set up a clinic and provide nothing in the budget for the testing materials that were the main thing we needed.”
Hopewell said testing is the main priority of a TBI clinic with high-functioning patients who almost always present with co-morbid psychiatric disorders.
“This is an ambulatory concussion clinic with patients who also have PTSD, depression, stress, pain and other psychological issues,” he said. “The clinic doesn’t do Jacuzzi work and does very little physical therapy. It does primarily medical screening for headache management, psychological testing, psychological therapies and high-level speech and occupation therapy.”
Meanwhile, Hopewell said he built a biofeedback service, a computerized program that takes a soldier’s heart rate and respiratory measures and helps him learn to physiologically control anxiety, muscle tension and heart rate. However, there was no funding even for an adequate chair for his soldier-patients while they received the treatment.
“We had the equipment, but it is useless if the patient cannot learn properly due to discomfort,” he said. “Usually a soft type of recliner is used, which is adjusted so the patient can see the screen.”
Fortunately, Hopewell was able to buy a chair, but only with the help of the Red Cross.
‘Re-traumatized’ by April mass shooting
A recent poll conducted by the Washington Post and the Kaiser Family Foundation found, “More than half [56 percent] of the 2.6 million Americans dispatched to fight the wars in Iraq and Afghanistan struggle with physical or mental health problems stemming from their service, feel disconnected from civilian life and believe the government is failing to meet the needs of this generation’s veterans.”
Now, after a second mass shooting at Fort Hood, local civilian counselors say some of their patients – survivors of the 2009 attack – have been re-traumatized.
A counselor in the adjoining city of Killeen, Maryanne Bell, explained: “You’re seeing a lot of the victims, even the ones that I work with who’ve been through a lot of therapy, being re-triggered again. The sensory information gets stored in your brain – sights, smells, sounds, pictures. So in that part of your brain, anything that happens in the present that reminds you of something in the past, it’s automatically going to send it back into thinking that you’re still in that same situation.”
On April 9, President Obama traveled to Fort Hood and vowed to improve mental health services for troubled soldiers while also limiting their access to firearms.
“This tragedy tears at wounds still raw from five years ago,” he said. “… [A]s a nation, we can do more to help counsel those with mental health issues, to keep firearms out of the hands of those who are having such deep difficulties. As a military, we must continue to do everything in our power to secure our facilities and spare others this pain.”
He added, “We must honor these men by doing more to care for our fellow Americans living with mental illness, civilian and military. Today, four American soldiers are gone. Four Army families are devastated. As commander in chief, I’m determined that we will continue to step up our efforts – to reach our troops and veterans who are hurting, to deliver to them the care that they need, and to make sure we never stigmatize those who have the courage to seek help.”
But Hopewell said Obama’s speech presented the ideal moment for the president to help soldiers and families recovering from the 2009 attack get compensation, awards and special medical services – rather than continuing the classification of the Hasan mass shooting as “workplace violence.”
“[It] would have been the perfect time for Obama to use his famous pen and sign an executive order to classify correctly the Hasan jihadist attack at Fort Hood a terrorist attack, thereby providing the medical and financial help and the military service recognition to the survivors and families of that terrorist attack,” he said.
Hopewell said President Obama could have agreed to meet with Staff Sgt. Alonzo Lunsford, who was shot seven times by Hasan, for the 10 minutes Lunsford requested and then signed the executive order immediately. Instead, the president declined to meet with Lunsford.
Rep. John Carter, R-Texas, introduced H.R. 705, a bill to ensure the victims and victims’ families of the 2009 attack “receive the same treatment and benefits as those Americans who have been killed or wounded in a combat zone overseas and their families.” But the bill stalled in committee. (The Army doesn’t consider the recent mass shooting by Lopez to be combat or terror related.)
Hasan described himself as a soldier who “switched sides,” claiming he was acting to protect Islamic insurgents from American aggression. He had been on federal officials’ radar screen for at least six months prior to the shooting over postings he made on the Internet. He likened a suicide bomber who kills women and children to a soldier who throws himself on a grenade to give his life in a “noble cause.”
Hasan received the death penalty in August 2013 and awaits execution at Fort Leavenworth in Kansas.
As WND reported, nearly four years after Hasan’s brutal attack, he received free helicopter rides from the local jail nearly every day, lived in a private room built to accommodate his medical needs, wore a beard against Army regulations, traveled with his own security detail, had received numerous trial delays and collected a full salary of about $80,000 a year – all while many of his victims say they’ve been forgotten and at least 170,000 soldiers continue to suffer the invisible scars from 13 years of war.