Put your hand on Doyle Stanley's head -- a stretch of skin that slopes awkwardly back from his eyebrows -- and you are one touch from killing him.
His forehead, bereft of bone, moves like an underinflated beach ball. Underneath the skin floats spinal fluid; beyond that is brain. What was meant to be covered with skull has been reshaped by man and made vulnerable. And so has life for Petty Officer 1st Class Stanley, a 12-year Navy man who two years ago underwent surgery in a Navy hospital for a benign bone tumor.
Since then, the weapons expert and former instructor, now 29, has battled a virulent staph infection and lost a major part of his skull to a series of operations. He has sought help at four Navy and Army hospitals and appealed to private doctors who he believes saved him from inept care by the Navy.
Last September he learned that he was recommended -- against his wishes -- for retirement with a 50 percent disability. A retirement hearing is scheduled for tomorrow.
Navy doctors will not comment about Stanley's case because it is under review by the inspector general's office in the Department of Defense. Representatives from the inspector general's office also declined to comment. This story was compiled mainly from medical records obtained from Stanley's private doctors, his own account and naval records from a congressional office.
Stanley and one of two private doctors who would talk about his case say it raises serious questions about medical care in the Navy -- some of the same questions that congressmen and Department of Defense authorities have raised about the quality of medical care throughout the armed forces.
Sen. James R. Sasser (D-Tenn.) has called for a special investigation of Stanley's problems and in a letter to the inspector general described the reports submitted to him by the Navy as "more self-protective than a factual representation of the events that occurred."
Last week, Sasser described Stanley's case as one that "shows a pattern of inadequate record keeping and . . . a pattern of cover-up of evidence of malpractice that showed up in his record." Stanley, whose legal residence is in Crossville, Tenn., was one of several constituents whose questionable medical care from the armed forces prompted Sasser to ask six months ago for an audit of military medical care by the General Accounting Office.
That request came after audits of the quality of care in the Navy, Army and Air Force medical centers around the world had been ordered by Defense Secretary Caspar W. Weinberger. The GAO has begun audits as well, to look at how military hospitals handle incidents leading to malpractice claims.
Sasser received some internal audits in January from the Defense Department that, taken together, are critical of medical controls in all branches. The more wide-ranging audit, compiled by the Department of Defense, will be reviewed in the next few months.
That report may comfort Stanley, an active serviceman who finds he has no legal recourse for the care he received. Because of a 1950 Supreme Court ruling known as the Feres Doctrine, active service personnel are not allowed to sue the Army, Navy or Air Force for any injuries that occur during service. So Stanley, who says he wants to remain in the Navy, makes phone calls and writes letters in an effort to ensure the kind of care that he believes he needs.
His days are quiet ones, spent with his wife Sandy and their two small children in a ranch-style home, tucked into the Virginia Beach countryside of open fields and winding roads.
Once athletic but now plagued with daily headaches, Stanley cannot roughhouse with his 4-year-old daughter, Amber, or risk playing ball with his 7-year-old son, Joey. An opened cabinet door could be deadly, a darkened room is a menace. He must wear an uncomfortable plastic cap, a medical records. Stanley was admitted for surgery on April 21 after Richardson found that the infection had reccurred and the repair was decayed, records show. Richardson consulted with a second doctor, Dr. John Drummond, an expert in infectious diseases who called the staph infection "severe."
Richardson last week described Stanley's as a "complicated case that under the best of circumstances is not a black-and-white situation. These kind of things . . . can go on for years and years."
But Drummond, first a consultant and later the physician to whom Stanley would appeal when he was "scared of the care from the Navy," said the infection he saw in April was a festering one that should have alerted Navy doctors three months earlier.
"The symptoms that Doyle had should have been a red flag to a sophomore medical student, let alone a staff surgeon, that there was the possibility of a staph infection," Drummond said last week. Drummond said that spinal fluid leaks are a well-known complication of sinus surgery. The time between January and March 1983 was a "critical period during which the postoperative sinus infection developed," he said, adding that Navy doctors should have conducted a test on the fluid or a bone scan after the operation.
"Was the Navy negligent? Hell, yes, they were in February 1983. There is no question of it," he continued. "Doyle Stanley was a good sailor with limited means who put his trust in the Navy medical community. Not only did they screw him up, but they've tried to sweep him under the carpet."
Drummond has not kept his criticism to himself. In a letter dated Oct. 23, 1984, Drummond responded to a request from the inspector general saying, "In my opinion, his symptoms of headache and nasal discharge were either ignored or at the very least grossly underestimated by the Navy physicians during this period of time. Prompt attention to the possibility of a leakage of spinal fluid, with hospitalization and aggressive intravenous antibiotic therapy, may have prevented any further complications."
Drummond also has expressed frustration with the Navy's record keeping. Stanley, who checked his Navy medical file and noticed that records about the Atlanta operation were missing, notified Drummond. Drummond said he has had to send at least three copies of one report to the Jacksonville hospital since May 1983. Stanley said he has replaced the same records -- seven times.
No one, both men said, could explain why the reports were missing.
Rish, contacted at home in Bethesda, would not discuss Stanley's case. "The Navy Department has asked me not to talk to you," Rish said. "I have mixed emotions because I don't have anything to hide . . . . But I'm still in the Navy and they told me not to talk to you." Requests to speak to other naval doctors were refused by the Navy Office of Information.
Stanley continued to receive care from Richardson and Drummond until July 7, when they said he could return to restricted duty with oral antibiotics, according to records. On July 8, Stanley returned to Jacksonville, where doctors refused to fill his prescription because it was not ordered by a Navy doctor, Stanley said.
Stanley continued having postnasal drip and headaches. He received treatment at the Jacksonville center but then was referred for treatment to the Bethesda hospital, where Rish had been transferred. Stanley balked at the assignment, told doctors at Jacksonville he did not want to be treated again by Rish and then wrote a letter to Sasser's office for help.
Stanley remained under order to report to Bethesda and arrived there Aug. 5.
According to Stanley's diary, he was told that there was no room for him at the hospital and he would have to wait in the lobby until personnel at the medical center could find space for him. Three days later, on Aug. 8, the hospital found him a room. Stanley, who was still experiencing severe headaches during this time, said he had decided to pay for his own hotel room rather than wait, without a bed, in the lobby. Sasser's office later intervened and helped him get reimbursed for the cost, Stanley said.
On Aug. 8, Stanley was told he would be examined by Rish. Panicked, he called Sasser's office for help. On Aug. 9, Stanley said he was examined by another physician. On Aug. 18, Bethesda doctors prepared a history of the previous operation in Jacksonville which they put in Stanley's file over his objections and later sent to Sasser. At that time, Stanley also received the go-ahead to return to Jacksonville to begin six months of limited duty at Cecil Field.
From August 1983 through Febuary 1984, Stanley continued under doctors' care at Jacksonville. His diary, as well as medical reports completed by the Naval doctors, show he was treated for constant headaches and bloody drainage.
Despite his medical problems, Stanley continued to be ranked favorably for duty. An evaluation completed Nov. 30, 1983, said, "He has maintained military bearing and personal conduct in spite of adverse experiences and austere hardships upon his family. His loyalty and professional performance are diminished only by his physical impairments."
On Feb. 21, 1984, doctors at Jacksonville told Stanley his case was being transferred again. He had the choice of the naval hospitals in Bethesda or Portsmouth, Va. The Navy would pay to move him and his family while treatment continued, they said. Stanley asked to be transferred to Portsmouth.
Upon arrival in Portsmouth, he was examined and told an operation was needed because the infection in the sinus passage had spread. On March 10, doctors removed the frontal bone of his skull.
A letter to Sasser's office from the Naval Medical Command, dated April 10, 1984, states that Stanley was an inpatient at the naval hospital and receiving antibiotics for an "unspecified inflammation of the bone."
The report, which chronicled Stanley's care since January 1983, does not mention the removal of the skull bone on March 10.
On April 30, Stanley was discharged. He went home to sell his house in Jacksonville and buy a home in Virginia Beach. He said he continued to suffer bloody drainage and a dizzying heart rate through May. On June 3, after collapsing at church, he was taken by ambulance to the Naval Hospital in Portsmouth. A few days later, doctors said they would have to operate again.
The staph infection had eaten closer to the brain. They might have to remove more of the skull, doctors told him. He consented, and the operation took place June 13. In July, a blood clot developed above the right eye. A staph infection was found in the clot, and that too was removed. In August, doctors determined another operation was needed. This time, half of his left sinus was taken out.
Weeks later, when the swelling had disappeared and Stanley could open his eyes, he touched his forehead. For the first time, he realized that he could die.
"They told me I might have to wear some kind of protective covering, but I really didn't know what it would all mean," he said recently.
Stanley was sent home but returned to the hospital every few days, complaining of headaches and sleeplessness. Upset and scared, Stanley said, he told staff doctors in late August that he wanted to leave Navy care. On Aug. 29, Stanley and his wife were told in separate conversations with officers at the hospital -- including Dr. Theodore W. Fetter, head of the ear, nose and throat department -- that he should remain under Navy care.
Fetter, contacted recently at Portsmouth, described Stanley's case as "difficult and very complicated." Fetter said he would discuss the case if the Navy would give him permission. Stanley's "is a good case, and he makes us look good at Portsmouth," Fetter said. The Office of Naval Information refused to discuss the case or to allow Fetter or other naval doctors to comment.
Stanley said he agreed to continue with the Navy because the doctors assured him he would get checkups twice a week and counseling to help his family adjust to the strain of the past year. They also asked if he would submit to an evaluation by a staff psychiatrist. He agreed.
"The psychiatrist told me I had a lot of suppressed anger," Stanley said, shaking his head and smiling ruefully. "I could've told them that."
While recovering at home, Stanley learned that the Navy wanted him to retire with a 50 percent disablity -- a level that would cut the $1,600 take-home pay Stanley now receives every four weeks to $625. Stanley, who does not want to leave the Navy, has appealed the retirement. He also appealed the disability level, which would give him $300 less a month than full disability.
Stanley said the doctors at Portsmouth never followed through on the promises for family counseling and twice-weekly appointments. Since then he has asked the Navy to allow him to go to a civilian doctor or to Walter Reed Medical Center. The Navy sent him to Walter Reed. He said he has been pleased with the care there.
Doctors at Walter Reed who have seen Stanley since last November believe that "his prognosis for rehabilitation and return to line duty status is not very good," according to a Jan. 3 letter Dr. William Dichtel of Walter Reed sent to Portsmouth doctors.
In that letter, Dichtel pointed out that Stanley is an unlikely candidate for a protective plate on his skull, unless he can be free of pain and infection for a year.
"This is a significant problem which in its present state is fully disabling him from further employment," the letter said.
Stanley has been on active duty with convalescent leave since his last operation. A hearing is scheduled Tuesday to discuss his forced retirement. But in a confusing turn of events two weeks ago, the Navy ordered Stanley to work at the naval base in Norfolk. When he asked why he had to return to work -- days before the Navy was trying to force him to retire -- Stanley said he was told he should not have been on convalescent leave that long. Then last week Stanley was told not to show up for work but simply to call in every morning.
Attempts to discuss the latest decision with naval officers at Norfolk and with Navy information personnel were refused.
"I know I've changed because of this," Stanley said quietly. "I know I show more anger about little things because of the bigger anger that is there inside of me . . . . Who am I more angry at -- the doctors or the Navy? I don't know.
"But I'm sure I have enough anger for both. One was the institution that allowed the others to be the way they are."