http://www.npr.org/templates/story/story.php?storyId=120540125
Hasan's Supervisor Warned Army In 2007
by DANIEL ZWERDLING

Two years ago, a top psychiatrist at Walter Reed Army Medical Center was so concerned about what he saw as Nidal Hasan's incompetence and reckless behavior that he put those concerns in writing. NPR has obtained a copy of the memo, the first evaluation that has surfaced from Hasan's file.

Officials at Walter Reed sent that memo to Fort Hood this year when Hasan was transferred there.

Nevertheless, commanders still assigned Hasan — accused of killing 13 people in a mass shooting at Fort Hood on Nov. 5 — to work with some of the Army's most troubled and vulnerable soldiers.

The Damning Memo

On May 17, 2007, Hasan's supervisor at Walter Reed sent the memo to the Walter Reed credentials committee. It reads, "Memorandum for: Credentials Committee. Subject: CPT Nidal Hasan." More than a page long, the document warns that: "The Faculty has serious concerns about CPT Hasan's professionalism and work ethic. ... He demonstrates a pattern of poor judgment and a lack of professionalism." It is signed by the chief of psychiatric residents at Walter Reed, Maj. Scott Moran.

When shown the memo, two leading psychiatrists said it was so damning, it might have sunk Hasan's career if he had applied for a job outside the Army.

"Even if we were desperate for a psychiatrist, we would not even get him to the point where we would invite him for an interview," says Dr. Steven Sharfstein, who runs Sheppard Pratt's psychiatric medical center, based just outside Baltimore.

Sharfstein says it's a little hard to read the evaluation now and pretend that he doesn't know that Hasan is accused of shooting dozens of people. But he says if he had seen a memo like this about an applicant, Sharfstein would have avoided him like the plague.

The memo ticks off numerous problems over the course of Hasan's training, including proselytizing to his patients. It says he mistreated a homicidal patient and allowed her to escape from the emergency room, and that he blew off an important exam.

According to the memo, Hasan hardly did any work: He saw only 30 patients in 38 weeks. Sources at Walter Reed say most psychiatrists see at least 10 times that many patients. When Hasan was supposed to be on call for emergencies, he didn't even answer the phone.

EnlargeU.S. Government Uniformed Services University of the Health Sciences/Getty Images
An undated handout photo of Maj. Nidal Hasan, who is accused of killing 13 people at Fort Hood, Texas, earlier this month.
Warning Signs

Sharfstein says the memo doesn't suggest that Hasan would end up shooting people, but it warns that Hasan was "somebody who could potentially put patients in danger."

"There are all kinds of warning signs, flashing red lights, that, in terms of just this paragraph, you'd say, 'Oh, no, this is not somebody that we would take a chance on.' "

Sharfstein says that in the 25 years he has been supervising and hiring psychiatrists, he has seen only a half-dozen evaluations this bad.

The memo does have a couple of qualifications that say something positive about Hasan. It says, "He is able to self-correct with supervision." And Moran writes, "I am not able to say he is not competent to graduate."

Officials at Walter Reed told NPR that those statements were very carefully worded. What they convey is that when Hasan's supervisors read him the riot act — when they gave him intensive supervision — he would improve just enough so that they had to tell their commanders: "Hasan is capable of doing better."

But officials say nobody has the time to supervise a doctor that closely.

Alerting Fort Hood

"I would never, ever hire a physician with this kind of a record," says Judith Broder, who runs the Soldiers Project, an award-winning private therapy program for troops in Southern California.

Broder says that soldiers seeking therapy may be falling apart, filled with rage and a distrust of authority. What those soldiers need, she says, is a psychiatrist they can trust completely — not a therapist who fails to show up and abandons his patients.

"This kind of behavior could, in fact, set off a stress reaction" in a patient, she says. "It could be a trigger to a post-traumatic stress reaction."

Moran and Pentagon spokesmen declined NPR's requests for interviews for this story. Officials at Fort Hood would not comment, either.

But sources say that when the Army sent Hasan to Fort Hood earlier this year, Walter Reed sent the damning evaluation there, too. So commanders at Fort Hood would know exactly what they were getting.

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Memo:
http://www.npr.org/documents/2009/nov/hasanletter.pdf
[Editor's Note: NPR has obtained a copy of the original memo; this is a transcript of that
memo, not a photographic reproduction, to help protect the source.]

National Capital Consortium
Psychiatry Residency Program
Borden Pavilion, Walter Reed Army Medical Center
Bldg.6, Rm. 2059, 6900 Georgia Ave, NW
Washington DC, 20307-5001
XXXXXXX

Consortium Participating Instructions: Uniformed Services University of Health
Sciences, Walter Reed Army Medical Center, National Naval Medical Center, Malcolm
Grow USAF Medical Center

May 17, 2007

Memorandum for: Credentials Committee

Subject: CPT Nidal Hasan

1. I am the program director for NCC Psychiatry Residency Training Program. I
took over as PD in MAR 2007 and was Assistant PD from July 2006. I have been
a faculty member of the residency since July 2004.
2. This memo is based on my personal knowledge of and the documented incidences
in CPT Hasan’s Resident Training File.
3. The Faculty has serious concerns about CPT Hasan’s professionalism and work
ethic. Clinically he is competent to deliver safe patient care. But he demonstrates
a pattern of poor judgment and a lack of professionalism. In his PGY-2 year, he
was counseled for inappropriately discussing religious topics with his assigned
patients. He also required a period of in-program remediation when he was
discovered to have not documented appropriately an ER encounter with a
homicidal patient who subsequently eloped from the ER. He did successfully
remediate this problem. At the end of his PGY-2 year, he was placed on
administrative probation by the NCC GMEC for failure to take and pass USMLE
Step 3 and to obtain an unrestricted state medical license by the end of his PGY-2
year; as a result he was not promoted to PGY-3 on time. He did eventually
complete step 3 and get a license and was promoted to PGY-3. He was counseled
for having a poor record of attendance at didactics and lower than expected
PRITE scores. One year he failed to show for his PRITE examination at all.
During his PGY-3 year, he was counseled for being consistently late to NNMC
morning report. During his PGY-4 year, he was discovered to have only seen 30
outpatients in 38 week of outpatient continuity clinic. He was required to make
this missed clinic time up using his elective. He failed his HGT/WGT screening
and was found to be out of standards with body fat % and was counseled on that.
Lastly, he missed a night of call for MGMC ER and then did not respond to
numerous pages by my office the next day.
4. Take together; these issues demonstrate a lack of professionalism and work ethics.
He is able to self-correct with supervision. However, at this point he should not
need so much supervision. In spite of all of this, I am not able to say he is not
competent to graduate nor do I think a period of academic probation now at the
end of his training will be beneficial. He would be able to contain his behavior
enough to complete any period of probation successfully. My purpose in writing
this letter is to give the credentials committee the benefit of full disclosure and the
opportunity to modify CPT Hasan’s plan of supervision following initial
privileging.
5. I did discuss this memo with CPT Hasan and informed him I would be adding it
to his initial credentialing paperwork.
6. POC is the undersigned and may be reached at 202-XXX-XXXX or email at
XXX/

Sincerely,

Scott Moran, MAJ, MC
Program Director
NCC Psychiatry Residency Training