The 28-year-old Navy man from Honolulu lost his hand in an accident under the flight deck of an aircraft carrier as it sailed off Hawai'i.

He was medevaced to Tripler Army Medical Center, where a team of surgeons was able to reattach the hand, said the sailor's mother, C.L. Chong.

But the reattachment started to fail, the head surgeon went on a monthlong trip, and Chong's son became discouraged and depressed. He stopped going to Tripler, and no one bothered to call, she said.

An Air Force surgeon eventually was flown in from San Antonio to take care of the hand, which by then had to be amputated, Chong said. The surgeon did treat him well and fought for him to get a prosthetic, she said.

Chong was one of 30 people who responded to an invitation by The Advertiser to share their Tripler experiences following news of poor conditions at a Walter Reed Army Medical Center outpatient facility in Washington, D.C.

The accounts help illustrate some of the issues facing the largest military medical facility in the Pacific Basin.

Of those who responded, 17 were satisfied with Tripler's services and 10 were not. Three people made neutral comments. The survey was not scientific and only represents the opinions of those who chose to participate.

The readers' comments show some strong support for Tripler, some complaints about bureaucracy and excessively long waits, and a few worrisome actions. The Advertiser asked hospital officials to review the responses that have been printed in connection with this story.

Tripler's commanding general, Maj. Gen. Carla Hawley-Bowland, said she believes the quality of care provided at the hospital, which has 176 beds, is on a par with private hospitals, "and at times I think it's better."

There was no shortage of responders willing to stand up for the quality of care they've received at Tripler.

"I was not wounded in combat but it was discovered that I had skin cancer while deployed to Iraq," wrote Dan Fullerton. "The doctors here in Iraq set up my surgery so I could have it at Tripler while on my mid-tour leave. ... The doctors and staff both here in Iraq and at Tripler were very professional and everything with the surgery went better than I had expected."

Veteran care is closely linked with Tripler, and the Spark M. Matsunaga VA Medical Center is located on the grounds of Tripler.

Dick Loutzenhiser of 'Ewa Beach, an 81-year-old retired veteran of World War II, Korea and Vietnam, said he has been cared for at several veterans hospitals, and without them, "I would be long gone."

"Tripler has taken me for emergencies, even called back a few hours later to see how well I was doing," Loutzenhiser said. "My wife, who won't let me go alone, tells me this is the most friendly hospital of all we have had to visit."

SERIOUS CONCERNS

The reader responses received by The Advertiser also pointed to some serious concerns over treatment received at Tripler.

Nanci Handleson, who lives on the Big Island, said her husband, Pete, received a hip replacement at Tripler. Different teams of doctors came into his room and added a painkiller to his intravenous drip, she said.

But it was too much — Pete Handleson overdosed and was rushed to the emergency room, she said.

"He came very close to dying that day, due to the neglect and uncaring attitude of the doctors at Tripler," Nanci Handleson said.

Cheryl A. Gray has had her own close call with her father at Tripler, but as a registered nurse has a broader perspective on hospital care.

Her father, a retired Special Forces lieutenant colonel, was being treated at Tripler and was about to get a "very toxic" antibiotic intravenously without a pump — which could have been a life-threatening issue, Gray said.

Gray corrected the nurse, she said, who came back with a pump and a supervisor who was very apologetic.

For the most part, her father's care has been very good, said Gray, who runs an assisted living facility.

"In my position, one of the first things I tell my residents and their families is that my staff and I are not perfect. We make mistakes," she said. "We will always strive to do the right thing. We will always notify family and (doctors) in any instance where an error needs to be reported, but we are all human beings."

News that war veterans had to endure moldy walls, rodents and other problems at a Walter Reed facility stunned the public, outraged Capitol Hill and forced three high-level Pentagon officials to step down.

The president subsequently established commissions to look into the problems facing military personnel who come off active duty and are moving into veteran status.

The Defense Department's independent review group is to report back by the middle of next month with recommendations on how to improve conditions at Walter Reed.

Veterans Affairs Secretary Jim Nicholson is leading an interagency task force to find gaps in federal services received by wounded troops.

A bipartisan commission, chaired by former Sen. Bob Dole, R-Kan., and Donna Shalala, former President Clinton's secretary of health and human services, will complete its report this summer.

Tripler is one of 11 Army hospitals being examined as the service looks at the care provided to active-duty service members on "medical hold," and National Guard and Reserve troops on "medical holdover." Medical hold and holdover means the service member isn't able to return to his or her everyday job.

INSPECTION LAST WEEK

A team of Army inspectors visited Tripler last Monday and Tuesday. The results won't be known for some time.

There remain highly publicized cases of malpractice and often perceptions of inferior care, impersonal bureaucracy and sometimes very long waits at Tripler.

Malpractice cases like that involving newborn Izzy Peterson, who was given carbon dioxide instead of oxygen at birth at Tripler in 2005, tend to stigmatize the entire hospital, instead of an individual doctor as is usually the case at a private hospital.

"Some of it (perceptions) are how the suits are filed," said Hawley-Bowland, the head of Tripler. "With the military, because you sue the U.S. government, it all gets lumped into one number. The (private) hospitals, you never have the visibility of that lump number because it's the individual doctor that gets sued. So they may have the same number of cases at their hospitals, but it's all individual doctors."

The hospital's own recent customer surveys show a 97 percent overall satisfaction rate and a 77 percent satisfaction with access to appointments.

One issue that officials acknowledged was long waits for care in the emergency room. Hawley-Bowland said that across the country, emergency rooms are crowded with patients who show up there instead of waiting for an appointment.

She acknowledged some patients at Tripler wait up to seven hours, but that's because workups like X-rays, CAT scans and laboratory work also are being done.

All of O'ahu is experiencing a doctor shortage, Hawley-Bowland said, but with wartime deployments, which include doctors and other medical personnel, Tripler is even more short-handed.

Fourteen out of 350 doctors and 22 out of 565 nurses are deployed, the hospital said.

Hawley-Bowland said there are "extensive performance improvement programs" going on throughout the hospital.

One is to improve customer service. In November, meanwhile, a Rapid Response Team of clinicians who bring in extra expertise was started to change hospital culture in part by improving communications with families.

Only 28 active-duty and 48 National Guard or Reserve soldiers were at Tripler recently as "medical hold" or "medical holdover" patients — the patient category over which concern was raised at Walter Reed. By comparison, Walter Reed recently had about 600 such soldiers, Hawley-Bowland said.

TWO WITH NO COMPLAINTS

Two at Tripler, Special Forces Master Sgt. Tim Friedrich, 44, and Pvt. Stephen Schwartzengraber, 18, both had good things to say about their care and accommodations.

Friedrich, who is with the 39th Special Forces Detachment in South Korea, was ambushed in a war zone he declined to specify when a roadside bomb hit his pickup and a bullet ricocheted through his knee. He recently was exercising a titanium replacement in a physical therapy room at Tripler. His surgeon is "world-renowned" in the military healthcare system, the San Antonio man said.

"You look on the Internet, he's the man who does knee replacements. There's probably no one better," Friedrich said.

Friedrich said at "Walter Reed, that's pretty unfortunate what's going on."

He wouldn't call the facility he's staying in at Tripler a luxury hotel, Friedrich said, but "it's clean and the maid staff there does a superb job."

Friedrich has been in the Army for 23 years and experienced a number of military hospitals.

"I think the problem isn't the medical care. They aren't complaining about doctors and nurses," he said. "It's the other stuff. It's administration and times for medical boards (to be reviewed for disability)."

Schwartzengraber turned 18 in September, went to Iraq and got hit by a sniper's bullet in Ramadi in December that ricocheted into his pelvis.

The 6-foot-7 soldier nicknamed "Too Tall" was based out of Colorado but moved to Tripler for rehabilitation to be closer to his family on the Big Island.

"Honestly, I can't complain. I really like the care I've gotten here," Schwartzengraber said in a room with weights, machines and blue-topped rehab platforms.

He's staying in the med-hold barracks, which is "an older building, but the rooms are really nice."

QUOTES FROM TRIPLER PATIENTS

I was not wounded in combat but it was discovered that I had skin cancer while deployed to Iraq. The doctors here in Iraq set up my surgery so I could have it at Tripler while on my mid-tour leave. I was also allowed to have extra days of leave at home in Hawai'i with my family while my surgery healed. I have since returned to duty in Iraq. The doctors and staff both here in Iraq and at Tripler were very professional and everything with the surgery went better than I had expected. I have had other procedures while stationed in Hawai'i done at Tripler and was always very impressed with the staff and the facility. I felt terrible when I read about my fellow servicemembers getting such poor care after the wounds they had received in combat. I can only hope that the services will standardize the care and every servicemember will be afforded the same high standard of care that I received at Tripler. They have definitely earned it.

—Dan Fullerton

I have repeatedly read articles in your paper denigrating Tripler Army Hospital and its staff. However, I am writing to share my personal experiences as a military dependent which have been nothing but wonderful. In the last three and one half years I have undergone four surgeries and numerous procedures for osteoporosis related injuries. During this time I have been cared for by two exceptional orthopedic surgeons, Dr. Joseph Orchowski and Dr. Kurt Wohlrab. The staff at Tripler is both caring and professional. They have my utmost gratitude and thanks for piecing my aging body back together again.

— Kathleen Vesely

First, let's keep in mind that Tripler is a teaching hospital NOT Walter Reed. Secondly, let us also keep in mind that it is a hospital, that continues to receive funds for upkeep, unlike the section of Walter Reed spotlighted that was in terrible shape. That section of Walter Reed was put on the BRAC (Base Realignment and Closure) list over five years ago. The minute the facility went on the BRAC list, all funds were reallocated to other facilities immediately thanks to Congress. Our entire family receives care from Tripler. I've given birth to one child there, had surgery performed another time, and all our routine visits are through their family practice clinic. I am the mother of two boys and therefore am familiar with the emergency room as well. It's clean, efficiently run, the medical staff is thorough and even their cafeteria food is good. What is NOT good, is there parking availability. ... It is important to remember that Walter Reed is an enormous hospital and also that it is moving into a new location (and ) brand new facility while the section that has been spotlighted was BRAC'd and wasn't moving anywhere!

— Allison Stanton

We've been silent for too long .. it's time to speak out about the treatment my son received at Tripler a few years ago. My son served the Navy well for nine years and was in a supervisory position when the accident occurred. He was assigned to an aircraft carrier (during the Afghanistan conflict) that was about an hour outside of Hawaii when the accident happened under the flight deck, causing his right hand to be severed. Fortunately, they were able to medivac him to Tripler where a team of surgeons was able to reattach his hand.

He started physical therapy and everything seemed to be going fine. One Friday, as they bandaged his hand after his treatment, my son questioned if the bandage was not too tight. Nothing was done and when he returned on Monday and the bandage was removed, his hand was purple, indicating that there was no circulation and thus, the reattachment failed. This seemed to be the turning point as he went in for a second plastic surgery and while in recovery, learned that three of his fingers were severed. He was not informed that this was going to happen and did not sign a contract authorizing it. He was very devastated and asked to go home. He was released.

Meanwhile, the head surgeon who performed the reattachment went on a trip and was gone for more than a month. No contact was made with my son and he was not informed that the surgeon would be gone. Another surgeon kept tabs on my son and made an appointment for him to meet with the head surgeon when he returned from his trip. When he met with the surgeon, he was told that a prosthesis was being recommended and that they would call him as soon as they receive the video they requested. They called him when the video came in and told him to view it and let them know when he made a decision regarding a prosthesis ... very cold hearted and no compassion. The doctors didn't seem to care once the reattachment failed. My son was very, very discouraged and depressed. He stopped going to Tripler and would change his bandages at home .. and no one bothered calling him.

He stopped checking in at Pearl Harbor and got a call that if he didn't check in, he would be AWOL. He then told the Chief (who he was reporting to at Pearl Harbor) all that had happened. He was assigned a case manager and an Air Force orthopedic surgeon was flown in from San Antonio to take care of his hand, which was eventually amputated. This surgeon treated him well and also fought for him to get a prosthesis.

— C.L. Chong

I'm a retired Navy man and this is what happened at Tripler Army Medical Center. This story is not combat related, but pretty interesting. I took my wife to Tripler Army Medical Center Emergency Room, after she was complaining of severe stomach pains on or about 29 June 2006 at 11:30 p.m. They took her vitals, (blood pressure, temperature, height, weight), and told us to wait out in the lobby. My wife could not hold anything down. I told them that I think that it is her appendix.

After sitting out in the lobby for over three hours, they finally called us in at about 2:30 a.m. 30 June 06. All the while, my wife is in severe pain and vomiting. There was only four people in the emergency room. They called us in and put us in a small room in the emergency area. After sitting in there for almost forty five minutes, I looked out the door and saw the personnel that worked there, talking and laughing.

I went out and told them to give me the I.V. and I'll start it myself. They finally came in and started helping my wife. They gave her an I.V. and they gave her a shot of morphine and my wife started to feel a little better. I told the emergency person working on my wife, that I think that it's her appendix again. This person was a doctor. She told me that I can't diagnose things like this.

I did over twenty years in the Navy and have seen this before. After the I.V., they sent us home at approx. 4:45 a.m. and wanted us back at 7:30 a.m. in the morning for my wife to get an ultra-sound. I took her there and the appointment paper said "Don't forget to keep your appointment at 7:30 a.m."

We get there and waited while other people were getting called around my wife. It's now past 8:30 a.m. and I had to jump up and said that my wife is next. The person there said that my wife was an "Add-on", I ask her if she could read, she stated she could, I ask her if this appointment paper said, "Don't forget to keep your Add-on appointment, or your appointment at 7:30 a.m.?" At this time, my wife is shaking very badly. We went into the ultra-sound room and they began checking my wife's stomach area.

I asked them to check her appendix, the lady stated that they think it's her gallbladder. I said that I didn't think so. So now they make an appointment for her at family practice at 10:45 a.m. We get over there at 09:15 a.m. and I ask them to help her. She now can't keep anything in and is shaking very badly.

They didn't call us in till 10:45 a.m. Then they put us in a room for over an hour and nobody came in to help us. I finally had enough and went out to the office and I wanted somebody to get in there and help her. They finally gave her a shot at about 1:30 p.m. It knocked her out. They took her back down and did a cat scan on her and low and behold, her appendix is now busted.

They didn't get her into the emergency room until after 6:30 p.m. After they operated on her, she didn't want to come-to (breathe on her own that is), so they had to re-intubate her three to four times (shove the tube back down her throat). They scratched her throat, she caught pneumonia while coming out of the operation, found out that she got gangrene from the appendix busting (rupturing) and then being put in the intensive care unit for five days.

She then was treated bad in there. She wasn't getting enough oxygen (86%) and I had to tell them, that I didn't think that she was getting enough oxygen, they only had the "nose-hose". They had to give her a big face mask to get the right amount of oxygen. They didn't put any ointment on her lips that were cracked and bleeding from the oxygen being blown directly into her face. I had to ask them to give her a bath, because they weren't even doing that. After all that, then she spent another 4 days in a regular room to heal.

Something that should have only took two days, took over a week in the hospital and the personnel in Family Practice said, "Your husband was right, it was your appendix."

— William Shawl

While I do have issues with some of the care that (Tripler Army Medical Center) provides my decorated, Purple Heart recipient, Retired Special Forces, (Lieutenant Colonel) father...I want to begin by saying that I get the feeling there is a feeding frenzy about to begin regarding military hospitals and I want to make sure that appropriate information is not only gathered but also reported.

(Tripler) is a federal armed forces facility. It must disclose all risk managed events that occur. Other, nonprofit, hospitals in the state of Hawai'i make the same errors but are not required to disclose to the public when they occur. Their nonprofit status protects them (not to mention payments made to those who have suffered by poor outcome care).

My son (who is now 15) was born at Tripler. My father, loyal always to the service, will only get medical care at Tripler. As his daughter, I have activated the (Interactive Customer Evaluation) program in the hospital to report issues that have occurred over the years as my father became more and more ill.

For the most part, his care has been very good. Several doctors have gone above and beyond the call with their thoroughness and time spent with my father. Where I feel Tripler has a very large problem is how they address family concerns and advance directives. The family is not part of the case management team. The doctors are not social workers, in many cases they do not know how to connect with families.

Because of this, my father who is dying, had to wait almost a year to get a wheelchair through the channels of outpatient social services. I was on the floor one day when a nurse was going to start a very toxic IV antibiotic on my father who had a central line. She was going to run the IV without a pump. This could have been a life threatening issue.

I corrected her, asked her to check with her supervisor. Needless to say, she came back with a pump. The supervisor came also and was very apologetic.

One time my father was in the medical (intensive care unit) and his oxygen had not been reconnected after an updraft treatment. His oxygen saturation level was in the 60's when I walked in. I promptly attached the tubing and watched his saturation climb back into the low 90's. My father was intubated at this time and was not aware of any problem.

... To be very fair, the reason doctors, nurses and other health practitioners are leaving the field at a time when the aging population is growing, is because the public expects perfection, which is completely unrealistic. In my position, one of the first things I tell my residents and their families is that my staff and I are not perfect. We make mistakes. We will always strive to do the right thing, we will always notify family and MD in any instance where an error needs to be reported...but we are all human beings.

Medication errors occur at every level of patient care. Falls cannot always be prevented. I am old enough to remember when families came to the hospital with their loved ones and made the bed, walked their loved one, helped them dress and groom. Now days, hospital staff are treated like servants and the expectations are unrealistic.

— Cheryl A. Gray

I am a disabled veteran on Big island. Since the 1990s, I have had my dental needs taken care of by the Dental Clinic at the VA Facility at Tripler. The care has been excellent. The staff under the leadership of Dr Larson and Dr Yamashita are totally dedicated professionals. The equipment is state of the art. The facility is modern. Emergency dental needs are taken care of promptly while routine regular appointments are made at the Vet's convenience. Vets in Hawai'i are fortunate to have such excellent care.

—Lester C. Brandt

I am retired Navy. My wife and I have used Tripler as our primary care facility under the TRICARE Prime program since 1998. While on active duty in 1993, I had major shoulder surgery at Tripler, the orthopedic surgeon was exceptional, he spent two hours just sewing me up in order to minimize the scar I would have! Since retirement, my wife and I get prompt, courteous and personal care. Our current caregiver, Dr Yost, is among the finest caregivers we have ever had. We both consider Tripler a world class caregiver, in all respects and all categories of medicine.

I am sure there have been some mistakes, like the recent one with the newborn, however these mistakes happen just as frequently at civilian hospitals. I think the media minimizes those incidents and instead focus' on the military hospitals. Why, I am not sure. Thank God for Tripler and the people who serve and work there!

—James and Lorrie Roller

I am a Reservist who returned from Iraq May 2006. I did not have anything combat related but I had other medical issues that were dealt with through June, July , and August. The care I received was excellent. My appointments were timely and everyone was very efficient and courteous. My son who is a nurse has told me that during his training he was at Tripler and they have a lot of the latest equipment etc. Since returning I have retired from the Reserves and I am using tri-care and am very satisfied and happy with my care.

—Bob Bretschneider

I have used Tripler Hospital of and on from 1973 till 1977, and as my primary health care facility from 1987 until the present. My wife has used Tripler since 1999 until the present.

In all of that time, I have had problems with only one doctor, two nurses and one corps man. The rest of the time, my treatment has been exceptional.

I have had three occasions when I or my wife have been admitted to civilian hospitals and would NEVER EVER send my DOG back to any of them.

I am handicapped and in a wheelchair and have been shown every courtesy imaginable while in the hospital, both as an inpatient or an outpatient.

I understand that there have been accidents and poor treatment for some patients, but I have never witnessed and poor or bad treatment. In fact, in several cases, I have witnessed poor and bad actions by patients. The staff still treated them with respect and patience. If they had treated me like they treated the hospital staff, I would have tossed them out on their ears!

—LaVerne R. Galbraith

In my view (Tripler Army Medical Center) is one of the finest facilities in the military medical system. The care I and my family have received at Tripler has been excellent. Most folks who complain about the service at Tripler do not realize Tripler is a teaching hospital ... Yes there are long waits at the emergency clinic and the family medical practice clinic, however, if you need treatment in the major clinics the care is wonderful, the wait is relatively short, and the personal attention provided by the staff is outstanding. The fiscal conditions at Triple meets or exceed any hospital in Hawai'i (have you been to radiology at Straub or Kaiser lately). I am a 100 percent disabled Vietnam vet and I would not be alive today without the outstanding care provided by Tripler. One more point, most people do not know that the surgeon general of the Army sends out letters to patients requesting info on the care received at Tripler.

—Jim Warman

I know this is not combat related but an indication of care in general at (Tripler Army medical Center). In 1984 I went in for a biopsy of a lump in my right breast. While in the process of obtaining tissue for that the surgeon decided he might as well excise it right there and then-all under local anesthesia.

Two weeks later the results from pathology said the lump was benign. After being told for two years that the scar was keloiding the third year my civilian gynecologist finally decided I should see a surgeon who did a biopsy and subsequently a modified radical mastectomy removing a golf ball sized tumor that I could have sworn he deemed stage 4.

At the same time all lymph nodes were removed as at least 7 were positive for cancer. The surgeon, a civilian doctor told me I had the cancer when they did the biopsy 3 years prior and I should consider suing.

I told him I needed to concentrate my energy on getting well and would tell my husband to sue if I should die within a certain period of time since our children were not yet adults.

In retrospect I was probably lucky it happened that way and that I found a good surgeon and oncologist under my health insurance from work rather than trust my care to Tripler. It is now almost 20 years and I deem myself very very lucky.

—Chris Rosa

Reach William Cole at wcole@honoluluadvertiser.com.