Trouble at all turns in Hasan training

WASHINGTON (AP) - Often teetering on failure during his medical training, Nidal Hasan hit a particularly rough patch in 2007 when his Army superior cited him for unprofessional behavior, inappropriately discussing religion, underperforming in his residency program and being too fat.

Yet the same supervisor who meticulously catalogued Hasan's problems suddenly swept them under the rug when graduation arrived that year for the man now charged in the Nov. 5 massacre at Fort Hood, Texas, government documents show.

Hasan, then a captain, was rated "Outstanding Performance, Must Promote" by that supervisor, Maj. Scott Moran, and as "Best Qualified" by another, Col. John Bradley, shortly after he barely escaped the punishment of administrative probation.

Reached by telephone, Moran declined to comment. Calls to Bradley's office were not returned.

And in direct contradiction with the record about the psychiatrist in training, Moran reported after Hasan's graduation that there was no documented evidence of unprofessional behavior or other problems in his academic past.

Defense Secretary Robert Gates last week released an internal Pentagon review that found several unidentified medical officers failed to use "appropriate judgment and standards of officership" when reviewing Hasan's performance as a student, internist and psychiatric resident.

Gates withheld details, noting that the findings had been referred to Army Secretary John McHugh for possible disciplinary action against the officers.

But the disjointed picture emerges through information gathered during the internal review and obtained by The Associated Press.

The information reveals a pattern of sanitized performance appraisals -- praise piled into the official record by officers who seemed determined to advance Hasan's career despite knowing he was chronically late for work, saw few patients, disappeared when he was on call and confronted those around him with his Islamic views.

The material exposes concerns about Hasan at almost every stage of his more than decade-long Army education.

It also reveals that the Army either goofed in applying the physical fitness test he needed for graduation or fudged the numbers to help him pass. After failing an initial test because he was overweight, he passed a second one even though he then weighed more.

Two congressional oversight committees were holding hearings in Washington this week to review the Pentagon's investigation.

Nothing in the record points specifically to a risk that Hasan would turn violent.

But after Hasan moved to a fellowship from his residency at Walter Reed -- where he once appended "Allah willing" to a patient's medical chart -- one instructor, Lt. Col. Donald Lundy, thought Hasan was at risk of developing a psychosis, according to the documents. No follow up mental-health evaluation was done. Lundy did not immediately respond to telephone calls seeking comment.

It wasn't the first time people around him thought the physician needed to heal himself. Nor was it the last. By the time Hasan completed his fellowship and showed up for work at Fort Hood, at least two of his new bosses knew they were getting a poor performer with a religious preoccupation.

The documents do not address why the variety of officers who kept Hasan's academic career moving on a glide path did so despite all his known deficiencies. The Army's review is expected to examine those issues.

Was it incompetence? Or was the shortage of Army psychiatrists -- especially one who could connect with Muslim soldiers -- so acute that they were willing to overlook bad work and strange traits? Or was it a case of leaders worried the failure of a subordinate would reflect poorly on them?

Whatever the answer, investigators found a sharp disconnect between close-up performance reports that noted a multitude of deficiencies with Hasan and a higher level of reports that make up the subject's permanent career record.

Those higher reports didn't accurately reflect his history of problems, even though several were prepared by the same officers who raised red flags about his behavior.

The documents trace erratic behavior that began early and grew over time, with a few intervening episodes of normalcy. They disclose many new details about Hasan's rocky path to the huge Army base in central Texas, where he allegedly killed 13 people and wounded dozens more.

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After two years as an enlisted soldier, studies in community colleges and a biochemistry bachelor's degree from Virginia Tech, Hasan rejoined the Army in 1997 to attend the Uniformed Services University of the Health Sciences, the military's medical school in Bethesda, Md.

He struggled academically, taking six years to complete the four-year program. But while his academic record was marred, his separate military record was clean enough to get him into Walter Reed for a four-year psychiatry internship and residency.

Hasan's first year at Walter Reed was largely uneventful, apart from a memo noting "inappropriate interactions with patients."

That changed in the 2004-2005 academic year, when a potentially suicidal and homicidal patient of Hasan's walked out of the emergency room without authorization.

Confidential minutes from a January 2005 meeting held by a policy committee that oversees Walter Reed's psychiatry program assert: "Dr. Hasan exhibits poor self-monitoring, judgment and cognitive abilities. He has shown a failure to progress."

His supervisor, Col. Douglas Waldrep, "met with him regarding professionalism, religious conflicts, etc.," according to minutes of a meeting the next month. Waldrep has retired from the military. The AP made several telephone calls to Waldrep's office in North Carolina, but he could not be reached.

Then on June 1, 2005, the committee knocked Hasan for "a continuous trend of poor performance" and said it is "difficult for him to involve completely with Army processes because of his religious issues." Remediation or probation was considered.

Weeks later, he received a glowing review covering the same period.

His officer evaluation report -- the official assessment that determines promotions and future assignments -- credited him with "Outstanding Performance," and both officers who rated him recommended him for promotion with his peers. One, Col. Stephen J. Cozza, called him a "fine military physician officer."

It was one of several such reports that ignored documented problems.

Cozza has since retired and is an associate professor of psychiatry at the Uniformed Services University. A call to his office was referred to the school's public affairs office, which had no comment.

In his third year, Hasan's conflicts as a devout Muslim and an Army officer became more visible, the material shows. Yet his work improved, despite a month on administrative probation, and minutes from a September 2005 policy committee meeting indicate he was happier.

In December 2006, he was selected for a two-year research fellowship for which he had been the only applicant. It would begin after his graduation the next year.

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Starting in March 2007, Hasan began going sharply downhill.

Maj. Scott Moran, who replaced Waldrep as director of the psychiatry residency program at Walter Reed, proposed a remediation plan because Hasan was seeing less than one patient a week and acting unprofessionally. As well, Hasan failed the fitness test required to graduate; he was nearly 20 pounds overweight.

Moran leaned on him hard. From March to June, Moran:

--Reprimanded Hasan for being out of reach when he was on call.

--Cited concerns about Hasan's professionalism and work ethic and his inappropriate discussions of religious issues. "I do not recommend him for further training, unless there are demonstrated improvements," Moran wrote on May 11, 2007.

--Criticized Hasan's scholarly research presentation for being unfocused and too loaded with verses from the Quran.

On June 1, Hasan was weighed again and passed despite gaining a pound. This was because his neck was measured as much bigger than before -- a difference of more than 2 inches. In the test, waist size is compared with neck size.

Hasan's magically expanding neck created a body fat ratio within the Army standard. But the accuracy of the measurements is in question, according to the documents.

Moran went on to write a letter of reference saying Hasan had completed the residency program despite "documented evidence of unethical or unprofessional behavior" and serious concerns about his performance.

That was on June 30, 2007.

Less than two weeks later, Moran wrote to the American Board of Psychiatry and Neurology, a professional organization that certifies psychiatrists. This time he ignored the record and his own history of upbraiding Hasan. He closed the letter saying Walter Reed's records contain "no documented evidence of unethical or unprofessional behavior, nor any serious question regarding clinical competence during his residency."

And in Hasan's officer evaluation report from that time, Moran rated him as having "Outstanding Performance." Another rating officer suggested Hasan's promotion to major as soon as possible and praised his "thoughtful" approach to Islamic issues in the armed forces.

Moran declined to comment.

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During Hasan's fellowship, split between Walter Reed and Uniformed Services University, fellow students repeatedly raised concerns about his preoccupation with Islam, including that the war on terror was "a war against Islam."

They said he appeared to justify suicide bombing and had declared Islamic law took precedence over the Constitution -- an assertion that should have prompted a review of his security clearance.

"He at least should have been confronted about these beliefs, told to cease and desist, and to shape up or ship out," one of those classmates, Dr. Val Finnell, said in a prior interview with AP.

His by-now familiar pattern of sub-par performance continued -- a few missed exams, a physical fitness test avoided, laziness observed. Still, he got by. He was promoted to major in May 2009. Two months later he reported for duty at Fort Hood's Carl R. Darnall Army Medical Center.

The decision to send him there was made by Col. Carroll Diebold, a senior officer who advises the Army surgeon general on the service's psychiatry programs. Diebold reasoned that Hood, one of the Army's largest installations, would give Hasan the support he needed. Sending him to a smaller facility where he would be the sole mental health provider was not an option.

Hasan's reputation preceded him. When he arrived, Col. Kimberly Kesling, Darnall's chief for clinical services, laid down the law. Shoddy work and bad behavior wouldn't be tolerated, she told him.

Through their respective public affairs offices, Diebold and Kesling declined to comment.

There, in the wilting Texas heat, Hasan suddenly proved a diligent worker in the months before his scheduled deployment to Afghanistan at the end of November. Patients seemed to like him. Colleagues found him cordial.

His last officer evaluation report was to be his best. On the morning of Nov. 5, he called a superior to ask about it and was told it was ready for him to see and sign.

Instead, authorities say, he went on a killing spree.

Click here to access a copy of the Hasan review from the Department of Defense.