The Forgotten Casualties: Falling through the Cracks in the U.S. Army’s Duty of Care
It was just another tragic headline in a Florida newspaper, “Area woman killed in Iraq—Father confirms his daughter is third casualty in past three months.” The article went on to describe how Army SPC Oprah Nestling, aged 24, (for reasons of confidentiality—not her real name or age), had been killed in combat overseas in January 2006. She was the third service member from the newspaper’s catchment area to become a fatality in as many months. No details were provided by the Department of Defense and her father declined to make any further comment.
Nestling’s name also briefly appeared as one of sixty-two service fatalities listed during the month of January 2006 on the website of the Iraq Coalition Casualty Count (www.icasualty.org), along with the names of a number of marines who had been killed in the same IED (Improvised Explosive Device) attack.
However, a few days later her name was removed from the casualty list altogether and no further information appeared in the local paper. In the months that followed there was desultory “chatter” on the Internet speculating that there had been some sort of army cover-up. At the time lurid rumors were widespread about unexplained deaths of female military personnel both overseas and on bases in the U.S. Further investigation revealed that SPC Nestling had not been killed on active service in Iraq but was supposedly found slumped dead on the floor of a barrack room (not her own) at Fort Bragg, North Carolina.
Delay and obfuscation by military authorities
Fast-forward a year-and-a-half and the Army was still refusing to make available any information about Nestling’s death following requests submitted through the Freedom of Information Act (FOIA). The reason given was that an active investigation of the case was still in progress.
A second request for details under the FOIA submitted in January 2007 indicated that the U.S. Army Criminal Investigation Command had finally assigned the application a case number. In June 2008, that’s two years and five months after Nestling’s death, a partial report was released by the army. Withheld from the report were key pieces of information:
• The Emergency Medical Service Pre-Hospital Report made out when the paramedics responded to the 911 call after the body
was discovered
• SPC Nestling’s army medical/psychiatric records
• The Autopsy Examination Report determining the manner and cause of death (which was not actually completed until over four months after the autopsy itself took place)
• The Report of Toxicological Examination which was completed within a fortnight of the fatality
• Information on the contents of about a dozen prescription pill bottles found either with the body or in her room at the time of death
• The contents of letters and journals written just prior to her death
• Evidence of completion of any Army Suicide Event Reports. These are mandatory and must be completed by a credentialed behavioral health clinician within 30 days of an evacuation/hospitalization due to suicidal behavior or within 60 days of an actual suicide
• Evidence of a completed psychological autopsy. Also mandatory when the manner of death is uncertain.
• Swab test results of red and brown stains found on the floor next to the body
The original death certificate, signed January 19, 2006 and filed five days later, listed the cause of death as “pending.” It claimed that an autopsy had already been performed and its findings were available prior to completion of the document. This is totally untrue; the autopsy report was not actually completed until the May 15, 2006 which happened to be the same date as the Supplemental Report of Cause of Death Certificate was completed. This now listed the cause of death as “undetermined.” So how did an active 24 year-old female soldier die alone in a total stranger’s barrack room on a U.S. Army base? How come three years after the event the manner and cause of death are still undetermined? Why have the authorities failed to come to a satisfactory conclusion concerning her demise? Why are they still withholding vital information?
Prescription drug cocktail—an accident waiting to happen?
From the scant and heavily censored details in the partial report released by the army it is still possible to piece together some of the history leading up to the death of SPC Nestling. What it reveals is the tragic story of a young woman with chronic psychological problems including severe depression and anger management issues, a track record of heavy drinking, abusing prescription drugs, bulimia, self-harm including cutting, overdosing, and failed suicide attempts, relationship problems, and questions about sexual orientation.
It begs the question, how did such a person with so many psychological problems come to be accepted into the military in the first place? A military life exposes soldiers to high stress situations which would be traumatic enough in the ordinary civilian world but in combat can result in deadly serious consequences for both individuals and their colleagues. It could be argued that such personnel need to be very carefully selected, well-balanced, and best able to cope with difficult circumstances.
Was her psychological entry-screening really so inadequate or has the desperate need to put boots on the ground meant that psychological standards had been lowered to such an extent that severe depression and bizarre self-destructive behavior are no longer seen as being a disqualification for entry? Once in the service was this same behavior condoned or just overlooked as long as it didn’t interfere too much with prosecuting the war in Iraq? How was Nestling treated once in the army, what counseling did she receive, what drugs was she prescribed, and where was the duty of care to look after this young woman? All questions the military authorities have so far failed to answer.
You don’t have to dig far into the army documents to find that Nestling had been diagnosed and medicated as a manic-depressive with bi-polar disorder from the age of 13. Her brother and mother both had similar problems. Prior to joining the military she had been institutionalized for six months due to depression. Evidence also suggests a chaotic childhood, broken home, family drinking problems, and even the possibility of sexual abuse.
The released army documents are surprisingly light on information as to Nestling’s subsequent performance and experience in the army. She appeared to do well, liked service life and working with helicopters but continued to have chronic mental and relationship problems. She was described as being a “good soldier, she only had problems in her time off.” It was noted she (unusually) didn’t have a cell phone of her own and often borrowed others. She was seen as a “loner with no close friends.” Even prior to being sent overseas she was mixing prescription anti-depressants with alcohol and was once rushed to the ER to have her stomach pumped in what may have been a failed suicide attempt.
It’s not clear if Nestling was actually posted to the war zone in Iraq but we do know that while she was stationed in Egypt she was cutting herself, drinking and abusing prescription drugs, before again attempting suicide. She was evacuated to a medical center in Israel for evaluation and put on a 24-hour watch for about two weeks, before being sent to the Landstuhl Medical Center in Germany where she was diagnosed with a borderline personality disorder and medicated for depression.
An Army Mental Health Counselor who knew her during this period later incongruously commented to investigating officers that Nestling was “chronically suicidal, but at the time had no desire to kill herself,” but “based on her history and our conversations I felt she would kill herself within a year.” The same person said Nestling had been warned of the potential for liver damage if she continued to drink alcohol while taking prescriptions for the drug INH to combat a TB infection. Interestingly, the investigating officer also asked if Nestling had ever been prescribed the anti-malarial drug, Lariam1, which carries warnings that it should be used with caution in patients with a history of depression. This interview appears to have been completed the day after the autopsy, and prior to the completion of the toxicological examination and a full review of her medical records.
The counselor said she did not know if Nestling had taken Lariam. We still don’t know for sure as the army has so far failed to release details on the cocktail of medications regularly taken by Nestling for physical or psychological problems, what was in the dozen or so prescription pill bottles found at the time of her death, or the results of the toxicology report.
Conspicuously absent from the evidence/property custody document listing those same pill bottles was any information as to what drugs they actually contained. However, the partial army report did inadvertently reveal the use of several drugs including sleeping tablets. Others mentioned by name were INH (see above), “Zolft” (probably the antidepressant Zoloft), “Colodpyn” (probably Klonopin used for the treatment of panic disorders), and Quetiapine (an anti-psychotic) all of which should not be mixed with alcohol and need to be carefully monitored. All these drugs can have serious side-effects. The last one is particularly noted for increasing the sedating effects of other drugs such as Klonopin and ethanol, and even a potentially fatal complex called neuroleptic malignant syndrome (NMS) has been reported.
After returning to the mainland U.S.A., Nestling visited her mother who was concerned at her daughter’s excessive drinking and her difficulty sleeping due to nightmares and crying bouts which she claimed were brought on by her experiences (incidents and deaths of fellow soldiers) while stationed overseas.
Not long after this, Nestling again took a cocktail of antibiotics, decongestants, and alcohol, and was reported by the MPs as making suicidal gestures. She was taken to the ER for treatment and held for observation. She also spent about two months at Walter Reed Hospital where she signed a Suicide Prevention Agreement and a doctor recommended she be “at a stable location where she could meet friends and socialize.”
The exit strategy—or not?
At some point, which is still not clear, the army decided that Nestling would be chaptered out of the service and was sent to Fort Bragg, N.C. for processing and discharge. In early December 2005 she was again drinking in barracks and later hospitalized for cutting herself, and held for yet another psychological evaluation. She was by now probably seeing a base psychiatrist regularly about three times a week.
In early January 2006 she failed to turn up for duty or attend a scheduled hospital appointment and was subsequently reported absent without leave. A few days prior to this it is known Nestling was found asleep on a couch in the barrack-block day room she shared with fellow soldiers. She awoke for an incoming phone call and asked them to leave so she could hold a private conversation. On their return the door was locked and despite banging loudly for quite a while they had to resort to using a credit card to slip the lock and gain entry. Nestling was passed out on a couch with the phone still pressed to her ear. She continued to sleep most of the day and when the soldiers eventually left at about 9:00 p.m. they nudged her but it was clear she just wanted to be left alone.
This was the last time she was seen alive. About midday five days later her fully-clothed body was found slumped on the floor of a barrack room by a soldier returning to collect some personal possessions from a billet he no longer occupied (as he was lodging off the base). The soldier did not know Nestling but evidence suggests she had been living in his room (instead of her own) for a couple of days.
Nestling’s own room had been checked for her whereabouts the previous late afternoon after she was posted missing. An unmade bed covered with pill bottles and odd journal entries/letters were found which mentioned a “monster” and other strange writings about pain. However, the notes were not thought to be suicidal.
Some witnesses said there was no evidence she had been drinking on the last day in question but others contradict this and claimed “she was last seen drinking an unknown amount of alcohol.” One witness commented that she would normally “drink whenever she could get her hands on (it),” and had pleaded she “wouldn’t know what she would do without (her girlfriend) in her life.”
Although, to date, the toxicological report has not been released, the partial report suggests it came back “negative for all tests” except for “a minor amount of Benzodiazepine in the urine,” and “there was no alcohol present.” This would appear to be highly inconsistent with her chronic alcohol and prescription drug problems, recent history, and some witness statements.
Cock-up or conspiracy?
Nestling’s death may or may not have been suicide. It is now over three years since her demise and we will probably never know the truth. Authorities continue to refuse the release of all the relevant documents that reveal the manner and cause of this young soldier’s death. What’s certain is that the number of army suicides has doubled in the past few years and is symptomatic of an organization in severe crisis.
Stories from families of servicemen and women who have died non-combat related deaths also reveal a pattern of deception and obfuscation by military authorities. At an interview with a CID investigating officer nearly 11 weeks after the fatality, Nestling’s own mother revealed she was “upset with the military in that they did not notify her of her daughter’s death,” and that she “found out from a friend and if she did not find out that way, she still would not have known that her daughter had died.”
The mainstream U.S. media continues to shy away from awkward questions about the lowering of mental health entry standards into the military and the subsequent medication of personnel with severe psychological problems. The side-effects of mixing various psychotropic and non-psychotropic drugs in an environment which appears to ignore a culture of heavy drinking is also not on the agenda despite clear manufacturer’s warning labels.
What is very obvious is that SPC Nestling’s death was totally unnecessary; her calls for help were largely ignored by a military establishment who no longer saw her as an asset but a liability that needed to be shown the exit door. The military authorities have failed get to the bottom of what really happened or are covering up. This suggests a basic lack of respect for low-ranking personnel and their families in a system which is clearly stretched beyond capacity.
SPC Nestling was dumped alone into a decommissioning facility with total strangers, where odd behavior like sleeping all day, locking oneself inside a shared day-room, binge drinking and abusing prescription drugs were ignored, or worse, accepted as normal behavior. A place where she did not make friends or socialize and where fellow soldiers forgot the first rule drummed into them during basic training i.e., you look after each other—that’s what keeps you alive in combat.
Was Nestling’s death just another avoidable cock-up or is there something more sinister going on here? Either way, plenty of people in the military appeared to be aware that she had serious psychological problems and its leadership clearly failed in its basic duty of care by allowing a vulnerable confused young female soldier to slip thru the cracks.
—This article was submitted to Socialist Viewpoint May 19, 2009 by the author.
1 Since September 2002 warning labels on the drug Lariam, state:
Mefloquine (Lariam) may cause psychiatric symptoms in a number of patients, ranging from anxiety, paranoia, and depression to hallucinations and psychotic behavior. On occasions, these symptoms have been reported to continue long after mefloquine has been stopped. Rare cases of suicidal ideation and suicide have been reported though no relationship to drug administration has been confirmed. To minimize the chances of these adverse events, mefloquine should not be taken for prophylaxis in patients with active depression or with a recent history of depression, generalized anxiety disorder, psychosis, or schizophrenia or other major psychiatric disorders. Lariam should be used with caution in patients with a previous history of depression.