Misdiagnosed Green Beret Demoted, Nearly Court-Martialed Before Rare Illness Revealed

TBO.com ^

[RANGERAIRBORNE]

"I think they're protected from any medical-based lawsuit."

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?

[Squantos]

This soldiers story and the treatment he did and didn't receive is just wrong all the way round....."shaking hands disrepectfully"....???? I'd like to hear that story if ya care to share Ern .....:o) Gotta be a good one !

Stay Safe

[Polybius]

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.

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.

[xzins]

I'm pretty sure that I remember what you're speaking about. I believe that a family can sue if it was a DEPENDENT who was injured by military medical.

If it's a soldier that's injured, the worst that can happen is an inquiry into the competence of the doctors involved. I don't think damages can be awarded.

But disability can be awarded to the soldier. (ari is a lawyer....maybe he'll give us a read on this.)

[Polybius]

The docs at Mayo clinic probably would've missed it first time around.....LibWhacker

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:

The only way to confirm a diagnosis of CJD is by brain biopsy or autopsy. In a brain biopsy, a neurosurgeon removes a small piece of tissue from the patient’s brain so that it can be examined by a neuropathologist. This procedure may be dangerous for the patient, and the operation does not always obtain tissue from the affected part of the brain. Because a correct diagnosis of CJD does not help the patient, a brain biopsy is discouraged unless it is needed to rule out a treatable disorder. In an autopsy, the whole brain is examined after death. Both brain biopsy and autopsy pose a small, but definite, risk that the surgeon or others who handle the brain tissue may become accidentally infected by self-inoculation.

[LibWhacker]

Found these two little interesting items on a New Zealand website. The information appears to be up-to-date.

How is vCJD diagnosed?
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 notice that even with an MRI they don't get anything more than a probable diagnosis. Confirmation generally only comes post-mortem.

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.

[Alter Kaker]

Horrible for him and his family. But folks should take it easy on the Army docs. With a probability like that, it's not going to show up in any initial differential diagnosis, I don't care how good the doc is. The docs at Mayo clinic probably would've missed it first time around.

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.

[pabianice]

Let's try an Army success story for a change.

http://www.navlog.org/williams_1.html

[LibWhacker]

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.

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!

[Sunshine Sister]

My heart is breaking for this family. I will remember them in my prayers.

[RANGERAIRBORNE]

" But first question, whether he is sick or isn't, should be job of doctor to know."

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!

[Polybius]

But first question, whether he is sick or isn't, should be job of doctor to know.

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.

[RANGERAIRBORNE]

Did you ever read "The Good Soldier Schveik", by Hasek? I don't have it here to quote from, but I recall a scene in which a soldier is described as "pretending tha he has tuberculosis- then pretending to cough upo blood. After a while, he pretended to be dead".

Not exact quote, but the idea is the same.

[neverdem]

Although I'm not a neurologist, the only "sign" with which he presented was a loss of memory and impaired judgement.

As CJD progresses, patients may only develop muscular atrophy, tremors, ataxia and involuntary movement as "signs", according to a medical text I bought this year.

Very few neurologists treating the active duty population would think of CJD, IMHO.

[neverdem]

"In a 25 year-old, Creutzfeldt-Jakob Disease is not simply a zebra. It is a purple zebra with pink stripes."

LOL

BINGO, give that doc a cigar.

[LibWhacker]

I think it's better to think of it as a hypothesis testing situation. The null hypothesis is always that nothing is wrong, nothing is different, the guy isn't sick, etc. Then, you collect your data. Is it enough to reject the null hypothesis? If not, you cannot say he is sick, much less diagnose a particular disease or injury. This is the correct scientific approach and doctors have to take it. It's a conservative approach, but you could argue to do otherwise puts patients at even greater risk.

[RANGERAIRBORNE]

Hmmm- you or I COULD have the early stage of some hard-to-diagnose disease. Let's say that I had a new onset of svere headache, with visual problems associated with it.

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).

[Plutarch]

He had Creutzfeldt-Jakob disease, an extremely rare and fatal degenerative brain disorder...

...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.

[neverdem]

Your link made my eyes water. Thanks

[RANGERAIRBORNE]

Rather than retyping the whole thing, I would ask you to read my post #40. I am being accused of making an accusation that I am not, in fact, making. I KNOW that CJD is not the first (or the hundredth) thing that a physician- even a Neurologist or an Infectious Disease specialist- might consider when presented with these symptoms in a young person. If I were on a jury, and a physician was being sued for malpractice for missing this specific diagnosis, I would NEVER vote to award damages.

BUT, if the physician had brushed the symptoms off, and done no reasonable work-up, I'd award the family millions.