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On June 10, 2006, Phillip Baldwin was shot in the back and foot while trying to help a wounded comrade during his second deployment in Afghanistan. He spent three weeks at Walter Reed Army Medical Center, where, he recalls, his treatment was good.
The 35-year-old army staff sergeant from Roxana, Illinois, says his wife and three kids were permitted to pass the days in his room. His doctors were attentive, the facilities clean and modern. But Baldwin never had to spend time in the rodent-infested outpatient Building 18, which the Washington Postexposed earlier this year, sparking national outrage.
Baldwin, who was then unable to walk, met a fellow St. Louisan with a similar injury who arrived for surgery at Walter Reed. He remembers dismissing the veteran's cautionary tale about the John Cochran Division of the St. Louis Veterans Affairs Medical Center.
"I thought, well, maybe he was a problem patient," says Baldwin.
Vets with spinal-cord injuries like Baldwin's receive rehabilitation, psychiatric and long-term care at the VA's Jefferson Barracks Division in south county. The specialized ward is a peaceful, roomy place with ample parking for visitors, not to mention a squad of career nurses who get to know many intimate details of their patients' lives.
For anything else, like acute medical attention, lab work and specialized procedures, vets must go to Cochran, a full-service hospital on North Grand Boulevard.
"If you've got a spinal-cord injury and you can get into Jefferson Barracks, that's the place to go," says Dr. John McGarry, the ward's former director. "It's better than anything I've seen in the private sector. But the John Cochran center seems to be quite busy and quite frightening for these folks."
Back at home nine months later, Phillip Baldwin agrees. Paralyzed in one leg and forced to walk with a cane, Baldwin was first admitted to Cochran late last summer with a urinary tract infection and high fever.
"It was as if I had disappeared," he recalls. "I went long periods of time without seeing a nurse. My IVs would run dry, and there would be nobody there to swap them out, and nobody to empty my catheter bags. The facilities were dirty, and at that particular time the air conditioning wasn't working and it was incredibly hot."
Baldwin says his wife and child were not allowed in his room to deliver medication that nurses had promised him but hadn't supplied. After a hemorrhoid surgery, the hospital, he says, forgot to call the pharmacy with his pain prescription.
At other times the VA sent Baldwin appointment-reminder cards, and he took off time from work as a train dispatcher for the Terminal Railroad Association of St. Louis, only to arrive at Cochran and find that his visits weren't on the hospital's calendar.
After nearly a dozen trips to Cochran, Baldwin is ready to issue his own warning to fellow service members: "Veterans, if you're coming back from war and you're supposed to be treated there if you have any other options, don't go to John Cochran hospital. Find another solution."
Veterans' hospitals have long been regarded in the medical community to be better than private institutions especially for spinal-cord care. But Cochran, even with its many Washington University and Saint Louis University physicians, earned a different distinction entirely.
Four years ago it became only the second veterans' hospital in the nation to be placed on probation by a Chicago-based hospital accreditation group, for noncompliance in 14 of 45 performance areas.
A military veterans' medical center since 1954, Cochran regained full accreditation eleven months later and maintained it in a 2004 followup. It faces its next unannounced inspection later this year.
In its own quarterly patient surveys from 2006, Cochran consistently ranked lower than the other six medical centers in the VA's Midwestern network, and "significantly worse than the national average" in eight of the nine categories polled.
"These numbers are an agenda item at every meeting," says Dr. Florian Thomas, director of the VA's spinal-cord service and a neurology professor at SLU. "We're very worried about them. And we have newly created positions task forces and workgroups that are looking at the data to see how we can improve."
It's a common notion among paralyzed veterans that they leave Cochran sicker than when they arrived.
"I left with a sore on my butt, and now I've been here at Jefferson Barracks almost five months trying to heal it," says Bernard Carr, a paraplegic.
A number of paraplegics and quadriplegics interviewed by Riverfront Timescomplained of being abandoned for hours without a nurse available to change their catheters and help perform bowel-management programs. Others offered stories about the lack of nurses available to feed them or turn them over to prevent the gaping pressure sores that result from prolonged immobility. Some say they were left in their own feces and urine for hours on end.
"This last time I came back from Cochran was the worst ever," says Jerry Ray, an amputee. "My catheter was leaking urine, so I was laying in urine for a long time, and they weren't changing my dressings or my bedding. My skin broke down, and then my sores were leaking a lot of fluid. I ended up with another sore on my scrotum and all the rest of the skin on my buttocks was damaged."