Iraqi insurgents wounded Gerald Cassidy in the deafening blast of a roadside bomb just outside Baghdad on Aug. 28, 2006. But it took more than a year for him to die from neglect by the Army that had sent him off to war. When Cassidy returned to the U.S. last April, the Army shipped him to a hospital in Fort Knox, Ky., to get treatment for the excruciating headaches that had accompanied him home. For five months, he made the rounds of Army medical personnel, who couldn't cure a pain that grew steadily worse. Unable to make room for him in a pain-management clinic, the Army increasingly plied him with drugs to dull the torment.
At summer's end, the headaches had grown so intense that Cassidy pleaded once more for help, and his doctor prescribed methadone, a powerful narcotic. The next day, calls to Cassidy's cell phone from his wife Melissa went unanswered. After two more days without word from her husband, she frantically called the Army and urged that someone check on him. Nine hours later, two soldiers finally unlocked the door to his room. They found Cassidy slumped in his chair, dead, his laptop and cold takeout chicken wings on his desk.
The "manner of death" was summed up at the end of the 12-page autopsy: "Accident." But when he died, Cassidy had the contents of a locked medicine cabinet coursing through his body, powerful narcotics and other drugs like citalopram, hydromorphine, morphine and oxycodone, as well as methadone. The drugs--both the levels that Cassidy took and "their combined, synergistic actions," in the medical examiner's words--killed him.
Horrifyingly, it appears that Cassidy lived for up to two days after falling into a stupor. Forgotten and alone, he sat in his room until he died. "My God, he was there for three days, and no one even found him. That's a huge scandal," says Dr. William Kearney, Cassidy's Army psychiatrist. Regulations that require a soldier to show up for formation three times a day or be tracked down were widely ignored, say soldiers who stayed at Fort Knox. "You could easily linger for two days in a coma," Kearney says, "and if anybody had opened his door, they would have found him unconscious and they would have called 911."
Soldiers fall through the cracks in every war. But the death of Sergeant Gerald (GJ) Cassidy, a cheerful 31-year-old husband and father of two, highlights the tragic and persistent shortcomings of Army medicine. The same Army that spends $160 billion on tomorrow's fighting machines is shortchanging the shell-shocked troops coming home from war in need of healing. Cassidy was promised world-class health care. But he didn't get the simple help--quick treatment, pain-management classes, knowledge of his whereabouts or even a roommate--that could have saved his life.
Cassidy grew up playing army games with cousins and re-creating Civil War battles on a Ping-Pong table covered with fake grass and tiny trees in the basement of his Carmel, Ind., home. He joined the Army Reserve in 1992, and the Indiana National Guard in 2003, intending to serve 20 years, get a pension and then retire to teach junior-high history. He served in Bosnia in 2004. And in April 2006, when the Army called, Cassidy left his landscaping job for Iraq. "Some guys had gone to Iraq three times at that point, and he hadn't gone," Melissa says. "He felt if he volunteered, someone else would get to stay home."
In Iraq, Cassidy's job was to protect the serpentine convoys that carry food, fuel and mail to and from Kuwait. On a routine mission in August 2006, a roadside bomb blew up 10 yds. (9 m) from his armored humvee. There was no apparent damage to the humvee or the four men in it. But for two to three minutes after the attack, Cassidy lost his hearing, and he quickly developed a bad headache. The next day medics diagnosed a minor concussion. "Since that time," he wrote in a January 2007 statement, "I have been plagued with migraine headaches every seven to 10 days."
Melissa was grateful when Cassidy finally came home. "I felt like I could breathe again," she says. But because of the continuing head pain, the Army decided to send him to Fort Knox, 150 miles (240 km) from his home in Indiana. It was a strange choice. Cassidy was apparently suffering from traumatic brain injury (TBI) compounded by posttraumatic stress disorder (PTSD), which should have required treatment by neurologists. But there are none at Fort Knox's Ireland Army Community Hospital.
Just as the Pentagon failed to anticipate the duration and cost of the Iraq war, it has been woefully unprepared for the waves of wounded who return home needing care. Earnest, hardworking medical personnel haven't been able to handle the deluge. At Fort Knox, Cassidy and more than 200 other soldiers were placed in a newly created Warrior Transition Unit (WTU). The Army is spending $500 million this year on such units, in which troops operate as a military detachment and continue to be paid. After a 2007 Washington Post series focused attention on poor conditions at the service's flagship Walter Reed hospital in Washington, the Army created the units to streamline the care of Army outpatients. There are currently 8,300 soldiers in 35 WTUS. One in 5 suffers from TBI, PTSD or both.
Mild TBI is the "signature wound" of the Iraq war, afflicting up to 250,000 troops. It nearly doubles the chance of developing PTSD, according to a recent study in the New England Journal of Medicine. While severe TBI cases are easily identified by bloodied and broken craniums, disorders in which brains are rattled inside intact skulls by IEDS (improvised explosive devices) are harder, and sometimes impossible, to diagnose.
During his first month at Fort Knox, an MRI of Cassidy's brain revealed no "hemorrhage, edema, mass effect or midline shift" that would clearly indicate TBI. Nonetheless, his case manager made a note in his file that "headaches are gradually worsening." Cassidy tried a slew of prescription pain relievers without success. Because there was no physical evidence of an injury, a civilian neurologist working for the Army who examined Cassidy in late April concluded that the headaches were most likely "posttraumatic migraines." The doctor prescribed two more kinds of drugs. It was the soldier's lone visit to a neurologist during his 13 months of headaches.
"He Was Getting Worse"