MENTAL HEALTH CARE

Some staffers at alcohol clinic had minimal skills

* Some counselors were kept on the job while mentally ill themselves.

The 1993 court-martial of Navy Dr. William J. Forte produced volumes of records the military would rather keep secret.

Transcripts and other records of the case are filled with frank discussions about the quality of health care workers at a military alcohol rehabilitation clinic in California. Federal law prevents the public from seeing records about military health care workers, but the law doesn't protect criminal records.

Several of the counselors at the Alcohol Rehabilitation Department at Camp Pendleton, Calif., were unlicensed, didn't have college degrees or were in therapy themselves for mental problems.

Until 1993, Forte was director of the clinic, which had 34 beds and saw 247 patients a year. He failed licensing exams at least three times in North Carolina between 1989 and 1991, and he failed a `special' exam for a limited license in Oklahoma in 1991 - the same year he was named head of the Camp Pendleton clinic.

The Navy once suspended Forte's scholarship for two years, and a military prosecutor found `all kinds of inconsistencies' in the file listing his qualifications, including an entry listing a four-year period at a college. When the prosecutor asked about the entry, Forte answered, `I don't know.'

He was found guilty of failing to record drug prescriptions he wrote while serving as director of the clinic.

Forte, who still lives in California, denied failing state licensing exams three times. Told that the failures were listed on an application he filled out and signed, he said, "It was filled out so long ago. Unless I'm looking directly at it."

He said his scholarship was suspended at his request so he could take a leave of absence to work somewhere else.

Staffers had 'minimal and questionable skills'

Clinics like this one provide critical care to addicts, some repeat offenders. A 1996 report by the Naval Audit Service found that 25 percent of the enlisted sailors in intensive inpatient treatment had at least one prior treatment or had three or more alcohol-related incidents.

`Several of the staff members demonstrated minimal and questionable skills' and `members of the staff ... were impaired because of their own mental health issues,' Navy Commander Robert S. Bolshazy said in a 1993 statement made part of Forte's court-martial file.

One alcohol and drug counselor at the clinic testified that her qualifications included a high school diploma, `about a year' of total college credits that came from `various' places and some time in a Navy counseling school. The counselor was hospitalized for six weeks in 1992 for `a number of psychological reasons.'

Another counselor was `putting practically every spare moment into going into therapy' herself, says a 13-page statement from a master sergeant who worked at the clinic for five years. Still another was "close to a breakdown, confronted about her behavior and agreed to get into therapy again," Master Sgt. Robert L. Boswell of the Marine Corps wrote.

A woman who worked at the clinic as a therapist from 1988 to 1993 testified that she started as a clerk-typist from 1980-85. She was not licensed in any state to do therapy.

The problem was too many patients and not enough trained personnel.

In January 1992, the head of the clinic wrote to his commanding officer, `My latest conversation with Headquarters Marine Corps indicates that no trained counselors are available and that they might have to send three interns straight from school.'

Two months later, in March 1992, Boswell wrote to the hospital commander: `It was normal for groups to exceed directed size by four or five patients. The interns were facilitating groups that far exceeded the instruction or their capabilities.'

He noted that one counselor `needed further therapy to resolve her issues' before being allowed to counsel others, but she was allowed to oversee group sessions.

Boswell held no degrees to be a counselor and was not licensed, but he was certified by the military as an `advanced counselor' and was the senior military counselor at the alcohol clinic for two years, serving as assistant department head temporarily.

The master sergeant listed his qualifications as having been sent through `counselor's school' in 1976 and also having attended "several different types of schools."

Main Story:

Too Many Patients; Too Little Time
Understaffing, poor records management and the constant shuffling of personnel in military hospitals and clinics undermines continuity of care

WRIGHT-PATTERSON
DOCTORS CHANGE, RECORDS GO ASTRAY
* Continuity of care is often a luxury in military hospitals, and lack of it can be fatal.

MENTAL HEALTH CARE
SOME STAFFERS AT ALCOHOL CLINIC HAD MINIMAL SKILLS
* Some counselors were kept on the job while mentally ill themselves.

Special Licenses For Some Doctors
Despite a mandate that doctors in the military hold state medical licenses, at least 77 practiced without meeting the minimum licensing requirement.