Overdose Raises Questions at Walter Reed

Navy Times

March 24, 2008 – The night before he was to enter a drug and alcohol rehabilitation program, Army Pfc. Chris Eckert swallowed a pill prescribed to help him sleep without the nightmares that have tormented him since he left Iraq.

Then, sitting in his barracks at Walter Reed Army Medical Center on Jan. 17, he counted out seven methadone tablets and popped them into his mouth.

The next morning, his squad leader found him on the floor in a puddle of his own vomit, but still alive.

“They told me, ‘Your son is not going to make it,’ ” said Eckert’s mother, Rose Szymborski. “He was on life support for five days.”

Since June 2007, 11 troops have died in the Army’s Wounded Warrior units, according to Lt. Gen. Eric Schoomaker, the Army’s Surgeon General.

Eckert’s mother blames the Army for not looking out for him, while Army officials say Eckert needed to do more to help himself. But both sides agree his case is an example of the difficulties of treating troops working through substance-abuse issues linked to post-traumatic stress disorder or traumatic brain injuries.

“I felt like my hands were kind of tied,” said Capt. Scott Beam, Eckert’s case manager. “In my heart … I knew I had done all I could have.”

Szymborski said she tried to alert Eckert’s chain of command at the hospital that her son was dealing with symptoms of PTSD. He suffered nightmares, couldn’t handle loud noises and was angry. He told friends he was suicidal. He was abusing pain medications and alcohol.

Eckert was serving in Iraq in early 2007 when an IED blast killed his platoon sergeant and left him with a mild traumatic brain injury.

“He was getting worse by the week,” his mother said.

Yet when he went to talk with a mental health worker, he came across as fine. Beam said Eckert was in denial about his problems and refused treatment.

“I felt kind of helpless,” Beam said.

Col. Terrance McKenrick, Wounded Warrior Brigade commander, said untruthfulness about high-risk behavior is common in such situations. He said the challenge for health care providers in treating soldiers with mental health disorders is figuring out their real symptoms and whether they are, in fact, abusing substances.

“It’s something we struggle with every day,” he said.

Eckert’s primary care doctor, Capt. Ingrid Pakowski, said she sends all her soldiers to mental health and tells them to consider it part of their routine medical care. She said Eckert often missed appointments, and fooled even his psychiatrist.

“He was hiding his symptoms … he didn’t have a PTSD diagnosis for a while,” she said, adding that PTSD and TBI “will make a substance abuse disorder that much more difficult.”

Things became further tangled when Eckert’s doctors asked Szymborski to support them in an intervention — to confront the soldier with the fact that she had seen him abuse medications over Christmas break. She refused, fearing her son would no longer speak to her. That, in fact, is what happened when Eckert’s doctors told him his mother was worried about him.

Without her help, and unable to prove Eckert was a threat to himself or others, doctors could not hold him against his will or force treatment.

“I spoke with Rose about all of these concerns,” Beam said. “We can’t admit him against his will.”

Because of his failed alcohol breathalyzer tests and counseling sessions about substance abuse, they did persuade Eckert to go to 28 days of rehabilitation, as well as PTSD counseling. His mother worried that he would go on a final binge before rehab, and she called his chain of command.

“I begged them to help him, to search his room, to sit with him,” she said.

But, McKenrick said, “he was not at the point where we felt he needed to be an inpatient.”

But Szymborski said the staff “did not act aggressively enough with the information I had given them. They chose to take his word.”

If they had searched her son’s room, she said, “they would have found the methadone, and he would have been in trouble instead of almost dead.”

McKenrick said Eckert was, in fact, heavily monitored, having been designated “high risk.” His squad leader called twice daily to check on him, and he had been assigned a roommate. His squad leader said they even took the precaution of not notifying Eckert that he would be leaving for rehabilitation the next day.

But somehow, he found out. He bought the seven methadone pills from another soldier — who is being prosecuted for possessing hundreds of the pills — and swallowed them.

Army officials acknowledge that such overdoses are a problem. Schoomaker has talked of having a team of experts look into the issue, assigning one provider per person to prescribe drugs, tightening supervision of those deemed at risk, and establishing alcohol-free zones.

All those proposals have been implemented at Walter Reed, McKenrick said. Soldiers used to be allowed a six-pack of beer or a bottle of wine in the barracks, but no longer.

“It was just too much of a temptation for those who can’t drink with their medications,” McKenrick said. Alcohol also has been banned from Mologne House, where family members stay while visiting sick or injured troops at Walter Reed.

And when a manpower team came through Walter Reed in mid-March, McKenrick talked with them about boosting the ratio of staff to injured troops at facilities with the most seriously wounded people, such as Walter Reed and Brooke Army Medical Center in Texas.

Though Eckert lived through his overdose, all of his problems have not been resolved. He completed 28 days of rehab and did “really well,” Szymborski said.

She took him home to Albany, N.Y., in early March, after being told a Department of Veterans Affairs psychiatrist would see him. But his psych appointment is not until April 21, and he has had no follow-up since leaving rehab, Szymborski said.

She said her son’s case manager, Capt. Brian McMillion, kept reminding her that her son had access to emergency VA psychiatric care if needed.

“But it isn’t the same,” she said. “You’re not magically cured after 28 days of rehab, and you should not be going it alone for weeks with no professional support.”

She worries about the soldiers who remain at Walter Reed.

“Many soldiers I have met … are addicted,” she said. “I don’t want anyone else to go through this. The things that happened with us could have easily been prevented.”

The staff at Walter Reed seems to agree, but also said much progress has been made in the year since the Wounded Warrior Brigade was stood up.

Still, McKenrick acknowledged, the job is far from finished.

“We are halfway there,” he said. “It continues to be a challenge.”

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