Posted on 11/22/2003 9:37:51 AM PST by Sub-Driver
Misdiagnosed Green Beret Demoted, Nearly Court-Martialed Before Rare Illness Revealed By Lisa Falkenberg Associated Press Writer
KARNACK, Texas (AP) - By the time he shipped out for the war in Iraq in January, Special Forces Sgt. James Alford was a wreck of a soldier. For five months, he had been doing odd things. He disappeared from Fort Campbell, Ky., for several days last year. He lost equipment and lied to superiors. In December, he was demoted from staff sergeant to sergeant.
In the Kuwaiti desert, he came apart. The hotshot Green Beret who a year earlier ran circles around his team members and was recommended for a Bronze Star in Afghanistan was ordered to carry a notepad to remember orders. By March, he was being cited for dereliction of duty, larceny and lying to superiors. He couldn't even keep track of his gas mask.
Finally, in April, his commanders had had enough. They ordered him to return to Fort Campbell to be court-martialed and kicked out of the Special Forces.
"Your conduct is inconsistent with the integrity and professionalism required by a Special Forces soldier," Lt. Col. Christopher E. Conner of the 2nd Battalion, 5th Special Forces Group Headquarters in Kuwait, wrote April 10.
Confused and disgraced, the soldier moved back into his off-base home where he ate canned meat and anchovies, unaware of the day, the month or the year.
Sensing something was wrong, a neighbor called Alford's parents. They drove 600 miles from East Texas to find a son who'd lost 30 pounds and could no longer drink from a glass, use a telephone, button his shirt or say Amber, the name of his soldier wife who was still stationed in the Middle East.
They rushed him to an emergency room. A month and several hospitals later, Alford's family learned he was dying of a disease eating away his brain. He had Creutzfeldt-Jakob disease, an extremely rare and fatal degenerative brain disorder akin to mad cow disease that causes rapid, progressive dementia.
Now, as the 25-year-old soldier wastes away in his boyhood home, his parents and his wife are struggling to understand how the military could have misdiagnosed Alford's erratic, forgetful behavior as nothing more than the symptoms of a sloppy, incompetent soldier.
"He had to hold his hands to keep them from shaking, but they saw nothing wrong with my child," his mother Gail Alford, a nine-year Army veteran, said recently from her home in a rural community near Marshall, Texas.
Alford's parents say Special Forces staff told them that a doctor in Kuwait found nothing wrong with him and that a psychiatrist there had said Alford was "faking it."
Army officials have acknowledged that the 5th Special Forces Group erred and, more than eight months after Alford's demotion, they reinstated his staff sergeant rank.
But the dying soldier's family wants more. They want a public apology for the ridicule and disgrace that they say filled Alford's final days of service.
"They called him stupid, told him he was lazy, he was a liar, that he wasn't any good, that he was a faker," his mother said, recalling what little her son could tell her about his time in Kuwait. "I want them shamed the way they shamed my son."
And they want his pay restored and his medical benefits maintained. The Army declared Alford medically incompetent, placed him on retirement status and froze his pay earlier this month until his parents can prove in court they are his legal guardians. His mother said she was given power of attorney long ago.
Army officials say they're just following procedures intended to protect soldiers.
Alford's father, retired Army Command Sgt. Maj. John Alford, who served 34 years, said Army doctors have been caring and professional, and commanders stationed his son's wife, Army Spc. Amber Alford, in Texas near her husband.
He mainly faults the Special Forces.
"I think they did everything they could to break him, mentally and physically," he said.
Maj. Robert Gowan, a spokesman for Army Special Forces Command, said 5th Group is saddened by the soldier's disease and regretful that it wasn't diagnosed sooner, but that a public apology may not be appropriate.
"This disease was not caused by 5th Group and the regret they express is in regards to the tragedy," Gowan said Wednesday, adding that the unit "acted on the information they had available at the time. If everyone would have known that Sgt. Alford was sick, things might have been handled differently."
Alford himself may have tried to conceal his symptoms, said Dr. Steve J. Williams, a clinical fellow in the Division of Infectious Diseases at Vanderbilt University Medical Center in Nashville, Tenn.
"He was capable of masking the symptoms because he was resourceful and he was a smart guy," said Williams, who diagnosed Alford with CJD. "I'd ask him what floor he was on and I could catch him looking outside and counting the number of windows."
Doctors believe he has the classic form of the disease, which develops spontaneously. It affects just one in 100 million people under 30, according to the Centers for Disease Control and Prevention.
Col. David Dooley, an infectious disease doctor at Brooke Army Medical Center in San Antonio, said Special Forces staff shouldn't take the blame for missing Alford's illness. A delayed diagnosis is "typical and classic;" the average lag time for Creutzfeldt-Jakob disease is five to seven months, he said.
"If I'm going to hold anything against them, they might have come around a little faster when a medical problem was recognized," Dooley said. "The Special Forces group was fairly inert to the face of data that we medics were showing them."
Alford's parents believe he has the "variant" form of CJD, caused by eating brains or nervous system tissue from an infected cow. They worry he may have got it from eating sheep brains locals served to soldiers as an honor in Oman two years ago.
But there is no evidence people can get the disease from sheep.
Doctors also note Alford didn't have the outbursts of anger and depression usually associated with the variant form of the disease, and his illness has progressed at the faster rate resembling the classic form.
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Alford was the youngest man in 5th Group and his wife says some of his team members resented his promotion. At least one team member said Alford seemed a bit immature and made a few bad decisions when he first joined, but he earned decorations, military records show.
His parents said he was awarded the Bronze Star in May 2002 for "gallant conduct" in leading reconnaissance patrols in Kandahar and helping capture suspected Iranian terrorists.
But in yet another painful point of contention, Gowan said the Bronze Star recommendation was downgraded to an Army Commendation Medal. Gowan was unable to explain the Bronze Star on Alford's uniform.
Staff Sgt. Miguel Fabbiani, a friend of Alford's and a member of the same team based at Fort Campbell, said Alford's symptoms escalated during wartime when he was working with a new group that didn't know him as well. And people remembered past youthful errors.
Alford's parents said they didn't see him enough to detect a problem. His wife was stationed near him for a while in Kuwait, but she chalked up his odd behavior to stress.
Alford's father said the actions of his son's superiors broke the spirit of a young man who had wanted to become a soldier since he was 4.
He now lies in pastel sheets next to a wall painting of John Wayne. Wearing a Houston Texans T-shirt that hangs like a hospital gown, he stares absently into a TV that glows 24 hours, his hands gripping stuffed animals to keep them from clenching shut.
"He knows his name, sometimes," says his wife, a tiny woman in sneakers who helps tend to her husband as she ponders a life alone. "Sometimes I'll go up to him, wink at him and make kissy faces and he laughs."
Her eyes well up as she remembers the handsome, arrogant boy she met as a teenager at a barrel racing contest in Texas.
As his brain deteriorates, his organs will fail.
"He will go blind, he will go deaf, he will lose everything," his father says.
He stopped walking more than a month ago, mumbles when he tries to speak, is fed intravenously and takes medicine for insomnia, pain and tremors. Doctors have told the family he probably won't live to see Christmas.
The Army told the family the issues over Alford's pay could be resolved within weeks, but the family is skeptical. They aren't sure how they will pay his bills and maintain his 24-hour care without his salary.
"It's very sad when the people who are putting their life on the line for this country should be treated like this," Alford's father said. "This has been a bureaucratic nightmare. We've got enough to deal with on a daily basis, caring after our son and dealing with our pain and weariness and our suffering to have to fight the U.S. Army."
The Army may be coming around, though. The Alfords got their first call from 5th Group Command this week. The soldier's father said the deputy commander apologized for what the family had been through, assigned a lawyer to work with them on pay and benefits issues and said he would personally handle any future problems.
"It would seem to me that they are now finally accepting responsibility and that's what I wanted in the first place," the father said.
The family had fought for four months before the soldier's rank was reinstated in September.
John Alford knew his son might not live long enough to get the good news, so he had already told him a "white lie" that he had been vindicated.
"It was very important to him because he kept saying, 'I didn't do anything wrong, Daddy.'"
Not being an attorney, I don't want to sound like I know more than I really do about the Feres Doctrine and thre Federal Tort Claims Act. BUT, it seems to me that I do recall cases in which the FAMILY was able to sue, even though the injured or dead soldier was barred from doing so,
I know that there are real lawyers out there- what about it?
Stay Safe
Now, as the 25-year-old soldier wastes away in his boyhood home, his parents and his wife are struggling to understand how the military could have misdiagnosed Alford's erratic, forgetful behavior as nothing more than the symptoms of a sloppy, incompetent soldier.
Although it is certainly tragic that this soldier was stricken with this disease, this part of the article has degenerated into sanctimonious bashing of the U.S. military by the press and the family.
"His parents and his wife are struggling to understand how the military could have misdiagnosed Alford's erratic, forgetful behavior?"
Could the reason possibly, just possibly, be that, as the previous sentence in the article stated, that he was suffering fron "an extremely rare" condition?
Creutzfeldt-Jakob Disease affects less than one person in a million per year. The median age of onset of symptoms is the seventh decade of life.
CT and MRI results are usually negative. If there is a high index of suspicion that includes "rapidly progressive dementia" and not merely "sloppiness and forgetfullness", the diagnosis can only be diagnosed with certainty with a brain biopsy in order to look from brain tissue cavities that are only 50 microns in diameter.
There is a saying in medicine regarding diagnosis, "When you are in Texas and you hear hoofbeats behind you, think of horses and not zebras".
In a 25 year-old, Creutzfeldt-Jakob Disease is not simply a zebra. It is a purple zebra with pink stripes.
As a Navy medical officer, every one of my Sick Calls had it's fair share of sailors and Marines with "erratic, forgetful, sloppy and incompetent" behavior. The majority of the time, such behavior had a direct correlation to their blood-alcohol level the previous night(s).
I admit that, not once, did I ever consider ordering a brain biopsy on a 25 year-old to rule out Creutzfeldt-Jakob Disease.
I do admit that, with a certain sailor who came to every Monday morning Sick Call to get patched up after his Saturday night bar brawl, I was certainly tempted to do so.
Is it something that a brain scan would see?......HiTech RedNeck
Nope. Diagnosis requires a brain biopsy.........or an autopsy.
See my Post 43.
Here is more information:
How is vCJD diagnosed?I notice that even with an MRI they don't get anything more than a probable diagnosis. Confirmation generally only comes post-mortem.
Once a suspected case of vCJD is reported New Zealand's CJD Registry, the Registry coordinates testing and works with case physicians and international experts to confirm the diagnosis. The diagnosis of vCJD is very difficult, but brain scans, using magnetic resonance imaging (MRI), and tonsil biopsy are two types of tests used to establish a probable diagnosis. However, the final confirmation of vCJD can only be done by examining brain tissue, generally after the patient has died.
Is there a test for vCJD?
Not yet. The types of tests that are used to screen blood donations for viruses cannot be applied to vCJD because it is a different type of disease. Several international groups of research workers are working to try and develop a blood test, but it is unclear whether this will be possible and, if so, what the time frame is likely to be.
I don't want to make too many excuses for the Army. Their handling of this was definitely ham-handed. But we have to be fair to them, too. I don't think a five-month-long search for a diagnosis could have been greatly improved upon, considering the rarity of the disease, the difficulty of diagnosis, the fact that he was in Iraq, etc. Perhaps all that is moot anyway; it is a fatal disease with no chance of being successfully treated. All the Army can do now is try to make it right for the family and it does appear they're trying.
There is difference between knowing what is wrong with person and saying there is nothing wrong. Is clear this man was sick. What was he sick with? Well, is possible for them not to know that. But first question, whether he is sick or isn't, should be job of doctor to know.
LOL, God bless you, doc! I knew guys like that in the Army. I don't imagine they're still around, poor guys; your liver just can't take that much abuse.
Good information in both posts, thanks!
EXACTLY the point I have been trying to make on this thread(without much success, I'm afraid). Posters keep coming back to the incredible rarity of this disease, especially in a young man, and conclude that the medics are therefore off the hook. But it is not necessary to know the specific diagnosis to avoid jumping to erroneous conclusions and destroying a career and a life.
Let's hope that everyone involved in this tragedy learned something from it- perhaps someone will be saved from this reflexive pigeon-holing in the future because of this case.
I think that your formulation should be added to the Hippocratic Oath!
Only God has such absolute knowledge.
The doctor's job is to try to find out with whatever imperfect medical tools human science has made available to him in the medical era he happens to live in.
You or I could have an early cancer or other disease right now, including early Creutzfeldt-Jakob Disease, and I can assure you that every medical test known to man could miss it until it declares itself more evidently in the future.
I realize that some people joke that "M.D." stands for "Minor Diety" but that is merely a joke.
Doctors have no gift from God that allows them to "know" every everything that could possibly be going wrong within a human body.
Not exact quote, but the idea is the same.
I would expect a competent provider to do a good history of the illness, review of systems, and a fairly detailed physical exam (because some of the diagnostic possibilities are grave, even if unlikely at my age).
What I would NOT accept would be to be branded as a hypochondriac, or a drugseeker, or told (without a work-up) that I had migraines and should take IMITREX and come back in a year.
I suspect that you would not accept this either.
Why should this soldier and his family accept such shabby treatment? I am not so concerned that they missed this diagnosis- am pretty sure that they never really looked beyond the facile label of "malingerer".
By the way, my visits to the medical facilities in the Army were few and far between- ewer than ten visits for illness or injury in twenty years- and I was injured a lot more often than that. So I am NOT defending real malingerers, because they have always existed in armies).
...his parents and his wife are struggling to understand how the military could have misdiagnosed...
Uh, maybe because he had an extremely rare disorder that would likely baffle many neurologists.
BUT, if the physician had brushed the symptoms off, and done no reasonable work-up, I'd award the family millions.
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