By Craig Whitlock
Washington Post Foreign Service
Monday, April 25, 2005
LANDSTUHL, Germany -- Faced with a shortage of neurosurgeons, the U.S. military's largest overseas hospital is becoming increasingly dependent on civilian doctors volunteering their time to treat troops who suffered severe brain and spinal injuries in Iraq.
Landstuhl Regional Medical Center, an Army-run hospital in southwestern Germany, began recruiting civilian neurosurgeons from the United States late last year after a rotation of active-duty physicians became stretched so thin that the hospital was left without coverage at times.
Karl Detwiler, a neurosurgeon in private practice in Tulsa, arrived in Germany in January for a two-week stint at the hospital. He said he found the experience so rewarding that he told Landstuhl officials he was willing to come back.
"I can't shoot a gun, but I can do this," he said.
During his stay, Detwiler said, he performed six or seven operations to treat brain and spinal injuries. Although he had never before treated patients with combat wounds, he said most civilian neurosurgeons had sufficient experience treating victims of car wrecks, shootings and other trauma to be able to handle battlefield injuries.
For now, there are no plans to increase the number of military doctors in this highly specialized field, military officials said. The lure of high-paying jobs in civilian medicine makes it difficult to keep them. So for the immediate future, the hospital in Germany will continue to draw on private volunteers.
About 200 troops who had served in Iraq were admitted to Landstuhl's intensive care unit last year with severe brain or spinal injuries requiring neurosurgery, hospital officials said. While the vast majority were seen by U.S. military doctors, a handful had to be transferred to neighboring German hospitals for treatment.
The problem became acute in December after a suicide bombing at a mess hall at a U.S. military base in Mosul, Iraq. At the time, no neurosurgeon was assigned to Landstuhl because of a staffing shortage during the holiday season, forcing the Army to rush a doctor to Germany from Walter Reed Army Medical Center in Washington, hospital officials said.
Since then, Landstuhl has relied heavily on the services of a half-dozen civilian neurosurgeons from the United States who have volunteered to fill rotations lasting one or two weeks. The military also continues to assign active-duty neurosurgeons to Landstuhl for temporary stints, but the hospital has needed the civilians to fill the gaps.
Col. Rhonda Cornum, commander of Landstuhl, said the civilian doctors have performed admirably and fit in well with the military, which has only about 40 neurosurgeons on active duty worldwide. Sixteen are in the Army, many of them already working in Iraq.
"There's no question that neurosurgery is a critically short specialty in all the services," Cornum said. "But I have a commitment from my surgeon general to send people here. As long as they are high-quality people, it doesn't make much difference to us where they come from."
But at times -- January 2004, for instance -- the hospital has had no neurosurgeon on duty, said Col. Kory Cornum, an Air Force orthopedist who oversees the civilian volunteer program. The month passed without any serious neurosurgery cases arriving from Iraq. But "we were one event downrange from being overwhelmed," said Cornum, who is married to the hospital commander.
He said the staffing problems persisted through 2004. "It was getting pretty acute," he said. "Frequently, I wouldn't know if somebody was coming until the week before."
Kory Cornum said the idea to recruit civilian doctors was developed last October, when he described Landstuhl's problems at a military leadership conference in Leesburg, Va. Afterward, he was approached by a general from South Carolina who said he was friends with a neurosurgeon from Charleston who might be interested in volunteering.
Since then, news of the volunteer program has spread quickly by word of mouth, and Cornum said he has had no problem finding willing recruits. The volunteers sign up through the Red Cross and receive free lodging, plane tickets and $26 a day in meal money, but no other compensation.
"People have been stepping all over themselves to help us out," Kory Cornum said. "We need neurosurgeons, and we don't care what kind of costume they wear. This gives the civilian volunteers a way to feel like they've contributed."
While Landstuhl officials said it was unclear how long they would continue to depend on civilian doctors, military leaders in Washington emphasized that they were confident the quality of care was undiminished.
"The volunteer neurosurgeons go through a credentialing process that assures they are capable surgeons," Lt. Col. William T. Monacci, a neurosurgery consultant to the Army surgeon general, said in a written response to questions for this article. "We are proud of their contributions."