Marines treated at Camp Lejeune for post-traumatic stress had to undergo therapy for months in temporary trailers where they could hear bomb blasts, machine-gun fire and war cries through the thin walls, according to servicemen and their former psychiatrist.
The eight trailers were used for nearly two years, until a permanent clinic was completed in September in another location on the base, said a Camp Lejeune medical spokesman, Navy Lt. j.g. Mark Jean-Pierre.
The noise from training exercises "shook me up real bad. I couldn't take it. I almost ran out of there a couple of times," said a Marine patient who spoke on condition of anonymity because he is not authorized to talk to the media. "My mind couldn't focus on the treatment. I couldn't tell the difference between the combat zone and the non-combat zone."
The allegations became public after the dismissal of Dr. Kernan Manion, a civilian psychiatrist who says he was fired for writing memos to his military superiors complaining of shoddy care of Marines returning from Iraq and Afghanistan with PTSD, a condition that can make patients jumpy, fearful of loud noises and prone to flashbacks.
"These guys are saying, 'I'm fried and I can't get out,'" Manion said in an interview. Referring to the Fort Hood shooting rampage in which an Army psychiatrist who counseled PTSD victims allegedly killed 13 people earlier this month, he said: "Is there potential for another blowup? Yes, indeed."
In e-mails shown to The Associated Press, Manion complained, among other things, that the military was not dealing with PTSD properly and that the trailers were infested with bugs and noisy.
"Given that PTSD is the most frequent diagnostic group we see, one would question the sense of locating a clinic in such close proximity to the booming of bombs that shake the trailer, the ratta-tat-tat of machine gun fire and the almost daily occurrence of grunts yelling war cries," Manion wrote.
In an interview with AP, Manion said the military should have rented a building off base.
Manion was fired in September after working for eight months for a company that has a contract with the military to provide mental health care on the North Carolina base. He said that when he asked the contractor why he was being fired, he was told it was ordered by the Navy.
Tom Greene, a regional manager with the contractor, Spectrum Healthcare Resources, said in an e-mail statement to the doctor that Manion "did not meet the government's requirements in accordance with the contract." Greene offered no specifics and did not respond to e-mails seeking further comment.
The inspector general for the Navy's Bureau of Medicine is reviewing the allegations of inadequate care, a military official said Friday on condition of anonymity because he was not authorized to speak about it.
Jean-Pierre said artillery fire can be heard nearly everywhere on the 240-square-mile base, which has 80 live-fire ranges.
In an e-mail, the spokesman said: "We are confident that our medical services are of the highest quality." He would not comment directly on why Manion was fired, but said that civilian doctors have to adapt to the "rapid evaluation and short-term treatment" that the military offers.
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Three of Manion's patients told the AP that being so close to the sounds of gunfire made it hard to concentrate and made them jumpy and nervous. The patients, who spoke on condition of anonymity because they are not authorized to speak to media, said they were making progress and were shocked when Manion was fired. All three patients said they trusted Manion after months of treatment and now found it hard to get help from other doctors.
Manion, 59, has 25 years of experience as a psychiatrist with a specialty in traumatic brain injury, or TBI.
He told the AP his Marine patients told him they were ostracized and sometimes punished by superiors for seeking treatment. He said one unit at the base made all of its soldiers suffering from PTSD sit in a room and read infantry manuals.
"How do we help a guy make sense of all that and heal from that when the Marine Corps is saying to get treatment means you're weak?" Manion said.
In an April memo to his superiors, Manion described episodes in which one Marine punched a telephone pole and another slugged a table in Manion's office. Manion said the clinic had no procedures for committing outburst-prone Marines for more intensive psychiatric care, and no safeguards for protecting therapists from violence.
Rep. Walter Jones, a North Carolina Republican whose district includes Lejeune, wrote to Defense Secretary Robert Gates about the situation.
"At this point, I only have one side of the story. However, based on the number of cases reaching my desk involving PTSD and TBI I am absolutely convinced there are serious problems with how mental health care is being delivered in my district," the congressman wrote in a Nov. 16 letter.
A Washington Post expose in 2007 on shabby treatment of soldiers at Washington's Walter Reed Medical Center led to a shake-up in which three top-ranking military officials, including the secretary of the Army, were ousted.
Manion said his patients have been traumatized by seeing friends killed and living for months under constant stress. When they come home, Manion said, they often have trouble sleeping, abuse alcohol and become anti-social.
Manion said that on June 24, a supervisor for the contractor warned him to stop sending e-mails to his superiors. But Manion said the problems continued and he filed a complaint about safety and quality of care to the inspector general of the Navy. Manion also wrote to President Barack Obama.
He said he was fired two days later and escorted from his office by an armed MP in full view of his incredulous patients.
Jones, who met earlier this week with Manion in Washington, said: "From listening to him and reading the letter he wrote to the president, I feel that he is a caring and true professional that wants to help those who have PTSD or other type of mental wounds. If we're going to call on these soldiers and Marines and their families to keep going on these deployments, we better be prepared to help them when they come back."
Associated Press writer Pauline Jelinek in Washington contributed to this report.