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The number of tips to Afghan National Army and Afghan National Police units has tripled in the last five months, from 17 a week in November to 60 a week in March, said Army Lt. Col. David Oclander, commander of Task Force 1 Fury, the unit that oversees U.S. forces in Zabul.

“We want the villagers trusting the ANA and the ANP enough to come forward,” Oclander said.

Much of the information has led to arrests and the retrieval of major weapons caches throughout Zabul, which borders Pakistan and serves as a key transit route for the Taliban.

Oclander pointed to the spike in tips as proof that American troops are continuing to bring down the enemy even though their own numbers have been cut nearly in half since November, when 800 soldiers with the 5th Stryker Brigade Combat Team left to join coalition forces for the fight in Helmand province. Today, there are roughly 1,000 U.S. service members in Zabul.

“We have seen an aggregate reduction of attacks and an increase in tips provided to the Afghan National Army and Police,” Oclander said. “You can draw your own opinions from that.”

The ANP chief of the Mizan district, who arrived about a month ago, has never seen such a level of cooperation with the Afghan government in his six years with the unit.

“As we prove ourselves, we gain the trust of the people,” police Chief Badamgul Qalamyar said.

The 15 police officers often patrol the nearby villages with U.S., Romanian and Afghan soldiers. U.S. paratroopers, from 1-508th Parachute Infantry Regiment, help the police investigate improvised explosive devices and arrest suspected insurgents.

On March 12, Qalamyar received a tip that Taliban fighters had buried an IED in an orchard about two miles from here. The next day, a villager led Qalamyar to what first looked like a Chinese rocket.

The police chief then radioed Sgt. 1st Class Victor Delvalle, who was leading a patrol of a coalition soldiers nearby. The men met in the orchard.

“It looks like a Chinese rocket to me,” Delvalle told the soldiers and police officers standing in the orchard. A rocket had exploded about 800 meters outside the FOB four nights earlier.

When Delvalle moved closer, what he saw was a green tube buried under loose soil.

When Delvalle looked closer, he didn’t see any wires coming from the tube and he noticed that it was buried next to a wall, which few people would walk past.

“It looks like it is being cached,” Delvalle told Pfc. Alan Nutt, his radio operator, who sent the report to Mizan’s tactical operations center.

Delvalle then walked back to the tube, set down his M4 and started digging.

“This is too long to be a rocket,” Delvalle told a couple of his soldiers.

In one motion, Delvalle lifted the tube out of the ground, then looked inside and took a deep breath, trying to smell any powder.

“Something was fired out of this,” Delvalle said to Sgt. Jonathan Dean. “Smell it.”

Dean took a whiff and nodded. Delvalle told the Afghan police officers to bring the tube back to the FOB for inspection.

“I didn’t see any wires and saw it wasn’t in a place where people would be walking by, so I figured it wouldn’t go off,” Delvalle said when asked why he didn’t wait for an explosives ordnance team.

The tip was the third to come in to the ANP in four days. Villagers also had told the Afghan police officers to watch for a red truck mounted with explosives and an IED dug into a road three miles from here.

At a meeting a few days later, local elders promised the police chief and the local Afghan National Army commander that they would continue to report when Taliban fighters traveled through their villages.

The elders, however, told the officials that they worry the insurgents will hurt their people for cooperating with the government.

“Security is good now, but the Taliban have come in the night and kidnapped our family members for working with you,” the elder from the nearby village of Mokarak told Delvalle.

First Lt. Sean Snook, the platoon’s executive officer, told the elders that the only way troops could expel the Taliban fighters was with the villagers’ help.

“We can’t do it by ourselves,” he said. “Without you, we can’t be successful.”

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Often, they have cobbled together meals on their own from permissible foods, such as salami, canned tuna, fresh fruit and matzoh, said Army Reserve Col. Bonnie Koppell, a Phoenix rabbi and command chaplain with the 63rd Regional Support Command.

“People functioned as an Army of one, as it were,” she said.

But when Passover, which commemorates the Israelites’ exodus from Egypt, begins March 29, many Jewish soldiers, sailors, airmen and Marines will have access to special rations supplied by the Defense Logistics Agency.

These are not the only rations tailored to support religious observance. Year-round, the DLA’s Defense Supply Center Philadelphia ships thousands of halal and kosher rations for Muslim and Jewish troops, as well as detainees and foreign militaries.

In 2009, the center distributed 204,000 kosher meals and 1.32 million halal meals, according to Jim Lecollier, chief of DSCP’s individual rations branch. For this Passover, it has distributed more than 7,500 Passover meals and a number of related kits used to conduct a ritual feast called a seder. The kits are full of Passover-specific foods and religious materials.

Kosher and halal meals cost the Pentagon roughly the same as other MREs, $86 per case of 12, Lecollier said. The kosher-for-Passover meals cost more, $126 for a case of 12.

This year, the Army ordered 341 cases of the meals, the Navy and Marines ordered 213, and the Air Force ordered 72.

Koppell said that providing specialty foods is an important way to support diversity and troops’ free expression of religion.

“It gives them a sense that their religious observance is respected, that they’re understood for who they are, they’re supported and respected,” she said.

Kosher and halal rations have been available since Operation Desert Storm, and rations adhering to kosher-for-Passover rules — which are more restrictive than normal kosher rules — were first offered in 2004.

Although the process varies by service, personnel in need of such meals should request them through their chaplain, Lecollier said. Often, units pre-purchase kosher and halal meals to have on hand, but kosher-for-Passover meals must be ordered three to four months before the holiday, he said.

While halal and kosher standards both prohibit some items, such as pork, the two standards are not interchangeable. Halal foods cannot contain alcohol, and kosher foods cannot contain shellfish or mix meat and dairy.

My Own Meals, a Deerfield, Ill., company, manufactures Glatt kosher MREs and — under its JŸ&ŸM Food Products division — Dhabiha halal MREs, company President Mary Anne Jackson said.

But the meals are not always easy for the troops to locate when their unit is deploying rapidly and has no inventory. In some cases, soldiers and their relatives have contacted Jackson directly to locate or order meals.

“For the most part, there are kosher and halal meals in theater at all times,” Jackson said. “If someone tells you there aren’t, they’re wrong. They’re in Kuwait, they’re in [United Arab Emirates], Iraq, Afghanistan. They’re everywhere.”

My Own Meals, which has contracted with U.S. military since 1996, also makes its kosher and halal meals for grocery stores, universities and prisons.

To produce kosher meals, workers under the supervision of a rabbi must painstakingly dismantle, steam-clean and inspect the company production machinery and utensils. Each of the ingredients — including kosher meat from Minnesota and New Jersey — are certified kosher, assembled, cooked and packaged under rabbinical supervision.

Abdenour Moussawi, an inspector with the Islamic Food and Nutrition Council of America, certifies halal food at JŸ&ŸM facilities. Moussawi inspects equipment for cleanliness and supervises production.

JŸ&ŸM purchases meat from halal butchers in California, Washington, Iowa and New Jersey, where Muslim butchers must invoke the name of Allah as the animals are slaughtered.

A Muslim has no choice but to eat, dress and live according to halal — meaning permissible — standards, Moussawi said. Lack of access to halal food could harm a soldier’s job performance.

“It has to do with his psyche,” Moussawi said. “If he’s not comfortable with what he’s eating, he’s not going to be a comfortable soldier. You have to make everything proper for him.”

Kosher company LaBriute, of Lakewood, N.J., is supplying Passover meals this year. Two entrees, bone-in chicken and beef stew with vegetables, are complemented by matzo crackers, coffee, tea, dried fruit, nuts, macaroons, canned salmon and gefilte fish (a pungent carp patty).

A sense of community

This Passover, Koppell is one of many chaplains with plans to conduct a seder for troops. She will travel to Kuwait and use a government-issued seder kit, which includes a plastic seder plate, a box of matzo, religiously significant foods and a Passover prayer book called a Haggadah.

“It builds a tremendous sense of community,” Koppell said. “You have a private sitting next to a captain at the seder table, where under normal circumstances they wouldn’t have that kind of peer relationship. It’s an opportunity to freely be who they are in a place they might not feel that freedom.”

Abe Halberstam, president of LaBriute, said that when the government awarded him the contract in late January to provide kosher-for-Passover meals, not all his suppliers had begun producing kosher-for-Passover items. He had to wrangle the food from suppliers, assemble the meals and ship them — all in time for the holiday.

“The minute I get that contract, I start pulling all my resources together, and start nudging and making sure everyone is in sync,” Halberstam said. “We go into high gear, and it’s a big challenge.”

The orders went out via Army Post Office and Fleet Post Office on March 5.

“I believe we all have to take care of our troops one way or the other,” Halberstam said. “The most rewarding part of that is, when there are troops out there that need meals, I get these kits out to them on time.”

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Now she believes her surgery, the first hand transplant performed at a Defense Department hospital — Wilford Hall Medical Center here — will give hope to service members who have lost limbs in Iraq and Afghanistan.

Retired Master Sgt. Janet McWilliams, 59, cradled her bandaged left hand March 3 as military and civilian doctors declared her surgery a success.

“Two weeks ago I received a gift, a hand,” McWilliams told reporters. “Hopefully this will provide hope for [wounded service members] as well as receiving something back that is priceless, and that is our dignity.”

Doctors said the ground-breaking procedure, performed here, could pave the way for future hand transplants for wounded service members.

“This is an exciting day and … this is a tremendous opportunity,” said Army Col. Dr. James Ficke, chairman of the Wilford Hall and Brooke Army Medical Center integrated departments of orthopedics and rehabilitation.

Almost 1,000 troops wounded in Iraq or Afghanistan have undergone major extremity amputations, and about 50 of them could qualify for a hand transplant, said Ficke, who also is the orthopedic surgery consultant to the Army surgeon general.

McWilliams’ surgery signals great potential for other service members, but “what really happens in the future, time will tell,” Ficke said. “This is an additional choice for patients.”

McWilliams has undergone 29 surgeries since July 31, 2001, the day she noticed a package on her desk at Lackland. At the time, McWilliams was a first sergeant for the 342nd Training Squadron.

As soon as she opened the package, it exploded, severing her left hand and fingers from her right. The explosion also tore into her torso, damaged her right eye, blew out her eardrums and left powder burns all over her body.

A former airman assigned to McWilliams’ old training squadron, the 344th, sent the bomb because he was angry that he had been medically discharged from the Air Force. McWilliams had recommended a mental health evaluation for Brandon Walters, who was convicted of sending the bomb and sentenced to more than 90 years in prison.

As McWilliams recovered, she tried various prosthetics, but none seemed to work or fit right.

“I used all different types of devices to make my quality of life as good as it can be, but in the back of my mind I always wanted a hand, and this wonderful [donor] family gave me that gift,” she said.

In August 2009, McWilliams was put on the waiting list for a donor hand, said Maj. (Dr.) Dmitry Tuder, the lead surgeon on the transplant surgical team.

The search for a donor hand is complicated by factors such as skin color, race, gender and blood type, said Dr. Joe Nespral, director of clinical services for the Texas Organ Sharing Alliance.

On Feb. 16, a match was found, and McWilliams was in surgery the next day.

Since the surgery, McWilliams has healthy blood flow to her new hand and she already has some feeling in her thumb and fingers, Tuder said.

He estimates she will gain feeling in the hand in about six months and in about a year will have recovered enough feeling and function to complete daily tasks. She also faces months of vigorous occupational therapy and will rely on immunosuppressive medications for the rest of her life.

“I’m prepared for the next six months or years,” said McWilliams, who wore a blue robe with her rank and her former squadron patches.

“ ‘No’ is not part of my vocabulary. This beautiful new hand will certainly become a part of my body.”

McWilliams also thanked the donor family for their generosity despite their deep loss.

“At night, in the quiet, I marvel, I absolutely marvel at what has happened here,” she said. “And at the same token, I think of the family.”

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Perhaps more important in the minds of many was the ongoing wait for final results from the country’s second nationwide parliamentary election. The milestone will determine who will oversee Iraq as U.S. forces go home, but could also point the direction the fragile democracy will take down the road — deeper into the sectarian divide that followed Saddam’s fall, or toward a more secular, inclusive rule.

“Now we have democracy and freedom, but the cost was dire and Iraqis have paid that price,” said Raid Abdul-Zahra, 38, a technician in Najaf.

Prime Minister Nouri al-Maliki’s coalition appears to be ahead in the tight race. With almost 90 percent of the vote counted as of Thursday, his coalition was leading in seven of Iraq’s 18 provinces compared to five provinces for his closest rival, the Iraqiya coalition led by secular Shiite and former prime minister Ayad Allawi. Al-Maliki’s coalition also has about 40,000 votes more in the overall vote count.

Many, especially among the country’s Sunni-minority that dominated Iraq during Saddam’s rule, blame the U.S. for the sectarian violence that erupted after the invasion.

“Failure is the word that should be linked with the U.S war. The Americans brought people to power, but those people are specialized in reprisals, blackmail, inflaming sectarianism and robbing,” said Mohammed Thabit, a retired teacher from Saddam’s hometown of Tikrit.

While violence has plummeted since the height of the bloodshed in 2006 and 2007, attacks continue, although in much smaller numbers.

On Friday, at least five people were killed across Iraq.

Three people died when a bomb exploded in the Sadr City slum in east Baghdad; gunmen killed an Iraqi soldier in Baghdad; and a roadside bomb in the northern city of Mosul killed an Iraqi soldier, police and hospital officials said. All spoke on condition of anonymity because they were not authorized to speak to the media.

Many Iraqis view the U.S. withdrawal plans with mixed feelings — pride that their country is regaining its full sovereignty but also concern that the lull in violence may break and bloodshed return.

“If the forces leave speedily, there will be a power vacuum and more problems will erupt because Iraqi forces are not loyal to Iraq but to their party affiliations,” said Abdul-Karim Moussa, 55, in Baghdad.

Others think the violence will dissipate after the U.S. pulls out.

“I think the violence will vanish after the American withdrawal because they are causing the violence. They entered Iraq to steal its natural resources,” said Ahmed Abdul-Hussein, 55, in Kut.

In Sadr City, the stronghold of anti-American cleric Muqtada al-Sadr, Sheik Suhail al-Akabi described the anniversary as the “ominous day of the invasion,” and called for a demonstration April 9, the anniversary of Baghdad’s fall, “to call for the departure of the occupying forces.”

Al-Sadr’s followers have been some of the most adamant voices calling for U.S. troops to immediately leave Iraq.

The U.S. military said there were no ceremonies or special events to mark the anniversary.

At least 4,386 U.S. military personnel have died in Iraq since the war began, according to an Associated Press count.

Those numbers have tapered off significantly as violence has dropped and U.S. forces have limited their operations as part of the U.S.-Iraq pact under which American forces pulled out of Iraqi cities.

Last year, 152 American service members died in Iraq, compared to 314 a year earlier, according to figures compiled by The Associated Press using data from the Pentagon.

The number of troops in Iraq has also dropped significantly since the height of the war in October 2007, when the U.S. had about 170,000 troops in the country. About 95,000 remain, and that number is expected to fall to 50,000 by the end of August under President Obama’s plan to remove all combat troops from the country. All American troops are scheduled to leave by the end of 2011.

According to figures compiled by Iraq’s Human Rights Ministry and released last fall, 85,694 people were killed from the beginning of 2004 to Oct. 31, 2008, and 147,195 were wounded. The figures include Iraqi civilians, military and police, but do not cover U.S. military deaths, insurgents or foreigners, including contractors. And it did not include the first months of the war after the 2003 U.S.-led invasion.

However, those figure are widely considered a minimum because many deaths went unreported.

The war in Iraq has cost more than $712 billion, according to the National Priorities Project.

———

Associated Press writers Bushra Juhi, Sameer N. Yacoub and Katarina Kratovac contributed to this report.

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The pilots, both mid-’90s graduates of Georgia Tech, flew over Bobby Dodd Stadium in downtown Atlanta at just a few hundred feet above the stadium, under the 1,000 feet minimum required by Navy rules.

Multiple videos of the flyover, posted on YouTube, show the planes screaming low over the stadium.

“I can confirm the incident did happen,” said Lt. Cmdr. Phil Rosi, spokesman for Naval Air Force Atlantic. “But it would be inappropriate to comment further as these are not public figures and have an expectation of privacy.”

But documents obtained by Navy Times and authenticated by a senior Navy official familiar with the investigation name the pilots as Lt. Cmdr. Marc Fryman and Lt. Cmdr. Christopher Condon. Both were assigned to non-flying jobs through an administrative process called a Field Naval Aviator Evaluation Board, the results of which are not released by the Navy.

In the documents, Rear Adm. R.J. O’Hanlon, commander of AirLant, was unforgiving in his assessment of the incident and in Fryman and Condon’s future in naval aviation.

“Fryman failed to provide effective [crew resource management] for his flight lead and allowed an unsafe flyby to occur with nearly tragic consequences,” O’Hanlon wrote of the mission commander. “Despite his spotless record, his complacent, passive response to a major altitude transgression is unforgivable in my view.

“Continued aviation service involving flying is not in the best interest of Lt. Cmdr. Fryman or the United States Navy.”

O’Hanlon’s judgment of Condon was equally tough. The admiral wrote that Condon ignored low-altitude warnings and didn’t “keep altitude in his scan” and that the incident could have ended “tragically.”

O’Hanlon dismissed the conclusion by some of the reviewers of the board’s results that the altitude error was unintentional.

“The arguments written by prior endorsers that Lt. Cmdr. Condon’s actions were an honest mistake are not persuasive,” he wrote. “He is a senior, very experienced department head who placed his aircraft and wingman in a very dangerous position.”

Both will stay in the Navy, but O’Hanlon recommended both have a “warfare transition” to another officer community.

The pilots reported the low pass themselves upon landing and the Navy convened the evaluation board immediately to determine if the officers violated Navy rules.

Navy records show that Condon was reassigned to AirLant on Feb. 12, but Fryman’s record still shows him at VFA 136. However, sources say that he, too, is at AirLant.

“The results are tough for sure, but they broke the rules and got a proper punishment for what they did,” said the senior Navy official, who asked not to be named because he was not authorized to speak on the matter. “It may seem tough, but it’s a safety issue and the admiral made the right call.”

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• View the flyover

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Gen. John “Jack” Sheehan, who commanded Atlantic-based NATO forces in the 1990s, told the Senate Armed Services Committee that European militaries — many of whom allow open service by gays — were weakened in the wake of the collapse of the Soviet Union.

Nations such as Belgium, Luxembourg, Holland and others, he said, believed active combat capability was no longer needed and, as a result, those nations made conscious decisions to “socialize their military.”

The focus, Sheehan said, became peacekeeping operations.

“That led to a force that was ill-equipped to go to war,” he said.

At the 1995 massacre of 7,000 Bosnian-Muslim men at Srebrenica, he said, the Dutch battalion on station “was understrength, poorly led, and the Serbs came into town, handcuffed the soldiers to telephone poles, marched the Muslims off and executed them,” Sheehan said.

“Did the Dutch tell you it was because there were gay soldiers there?” asked Sen. Carl Levin, D-Mich., the committee chairman.

“Yes,” Sheehan said. “They included that as part of the problem. … A combination of the liberalization of the military — a net effect, basically, of social engineering.”

Levin waited until the end of the two-hour hearing to vigorously push back on Sheehan’s contention.

“I think we all remember Srebrenica,” Levin said. “Any effort to connect that failure on the part of the Dutch to the fact that they had homosexuals … is totally off target. I see no suggestion of that. It’s no more on point than the fact that they may have allowed African or Dutch-African or women” to serve.

“My comment was that the liberalization … ” Sheehan said.

Levin interrupted. “I agree with that,” he said. “They weren’t good in that respect. They were trained to be peacekeepers, not peace enforcers. … But to slide over from that into a suggestion that it had something to do with the fact that homosexuals were allowed in the Dutch army suggests that somehow or other homosexuals are not great fighters. … I think that is totally wrong.”

Sexual assault report

Sheehan also cited statistics from the Pentagon’s fiscal 2009 report on sexual assault that he said showed 7 percent of the 3,230 incidents recorded were male-on-male, though the actual figure in the report is closer to 5 percent. And in arguing that repeal of the military ban would undermine good order and discipline, he told the story of a male-on-male foxhole sexual assault in his unit during the Vietnam War, and its divisive impact.

Testifying in favor of repeal were two former officers who were discharged under the law and the military’s “don’t ask, don’t tell” policy.

Michael Almy, an Air Force major at the time, said he was kicked out despite never making a public admission of his homosexuality. A member of the unit that replaced his in Iraq did a routine search of computer files, found personal e-mails and forwarded them to his commander back in Germany.

“ ‘Don’t ask, don’t tell’ failed me despite the fact that I upheld my end of this law by never disclosing my private life,” Almy said. “Never once in my 13-year career did I make a statement to the military that violated ‘don’t ask, don’t tell,’ despite pressure from my commander to do so.”

Almy, who would like to return to active duty, said the Air Force’s decision to separate him disrupted unit cohesion — because he was replaced by a far more junior and less experienced officer.

“This had a negative effect on morale and unit cohesion, and the mission suffered as a result,” Almy said.

The other former officer, Jenny Kopfstein, decided to tell her commanding officer on the cruiser Shiloh that she was a lesbian and while he reported her, as required, he allowed her to continue serving openly.

“I expected negative responses,” said Kopfstein, a former lieutenant junior grade. “I got none. Everyone I talked to was positive, and the universal attitude was that ‘don’t ask, don’t tell’ was dumb. I served openly for two years and four months.”

In a fitness report, she said that her commanding officer wrote that her sexual orientation “has not disrupted good order and discipline onboard.”

She noted wryly that the ban on open service by gays often has been defended as necessary to preserve those qualities.

“It seems to me that the captain of a ship in the United States Navy is the most qualified judge of good order and discipline among his crew,” Kopfstein said.

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It had something to do with Read’s gallbladder operation. Something had gone horribly wrong, Jessica Read managed to say.

The master sergeant rushed to David Grant Medical Center at Travis Air Force Base, Calif.

Read had lost almost two-thirds of his blood and his legs were blue. At least a dozen doctors and nurses crowded around him.

He received ultrasounds and an angiogram. He was moved from the intensive care unit to a radiology suite, then back to the ICU.

Hours went by before Read was transferred to the University of California-Davis Medical Center, some 40 miles north. There, doctors amputated his legs to save his life.

“My husband almost died … because someone took eight and a half hours to get him to U.C. Davis,” Jessica Read later told Air Force investigators. “I’d like to see how they would feel if it was their son or their husband or wife because there was no compassion whatsoever.”

The investigation

Jessica Read was one of 54 witnesses interviewed by the investigators in an effort to detail the events that unfolded July 9, the day that her husband chose to have the laparoscopic surgery so he could deploy. Maj. Gen. Winfield Scott, then commander of the 18th Air Force, which oversees Travis, ordered what is called a commander-directed investigation.

A colonel, assisted by a lieutenant colonel and two majors, conducted the investigation in about two weeks, from July 24 to Aug. 6. Lt. Gen. Robert Allardice, the 18th’s current commander, approved the findings Sept. 8 and has determined no disciplinary action or punishment is warranted under the Uniform Code of Military Justice, said Capt. Shilo Weir, a spokeswoman for the command.

Weir confirmed the two surgeons involved are still on active duty but would not say if they were still at David Grant or where they might be assigned, citing privacy concerns.

Col. Lee Payne, commander of David Grant, defended his staff to investigators.

“I am proud of my people, and I am proud of the work that we do here,” he said. “In the middle of this, what is a horrible, horrible outcome for Airman Read and his family, we understand that, but I want, in the aggregate, to show people that this hospital has been, I think, focused in the right direction and we will learn from this and grow from it, but it is part of the whole institution. I don’t think this is a bad institution.”

Air Force Times obtained a heavily redacted copy of the investigators’ report through a Freedom of Information Act request. In it are gripping details of what happened to Read from the time he entered pre-op at 6:50 a.m. until he arrived by helicopter at U.C. Davis at 5:17 p.m.

The Reads, who now live in San Antonio, received the report in November.

Jessica Read made clear in her interview with investigators how angry she is with the surgeons.

“Are [the doctors] going to keep their licenses and keep practicing? Whoever made that bonehead decision to keep him there, what’s going to happen?” she said. “It was their pride that kept them from sending him somewhere else because they thought they could fix him … so then they finally send him somewhere else. Somebody’s pride took my husband’s legs.”

The couple has hired Darrell Keith, a medical malpractice attorney based in Fort Worth, Texas. Keith did not respond to telephone or e-mail requests for comment.

In a December interview, Keith told Air Force Times that he is conducting his own investigation because he “strongly” disagrees with the investigators’ findings. He described the Air Force report as inadequate and incomplete because the interviews with the doctors at David Grant were not detailed and the civilian surgeon at the university hospital was not interviewed.

The civilian surgeon declined to be interviewed by the investigators, according to Keith. Read, however, would have turned over his medical records from the university hospital if the investigators had asked for them, Keith said.

“The U.C. Davis hospital records relating to Colton are critical to understanding what happened,” Keith said. “It is glaringly incomplete without that investigation. Also, the statements that they took were woefully inadequate of the doctors and health care providers involved [at David Grant] to determine what happened and to determine if there was any criminal misconduct.”

The purpose of a commander-directed investigation, Weir said, is to gather, analyze and record relevant information and identify possible problems within a command.

“The purpose of this CDI, however, was to collect and present a releasable record [to Airman Read] of the facts surrounding the medical incident for accountability and identification of issues of command concern, not to provide conclusions, opinions or recommendations,” Weir said. “The report illustrates the care that Airman Read received and shows that Air Force medical personnel were consistently engaged in the diagnosis, treatment and medical care of Airman Read from the moment he arrived at [David Grant] to the time he was airlifted to U.C. Davis.”

Any conclusions or recommendations would come from three medical investigations, protected by federal law and not for review even to the patient or the doctors, Weir said. The investigations — a root cause analysis, a quality of care review and a medical incident investigation — have been concluded, she said.

The operation

Read, who analyzed full-motion video from MQ-1 Predators and MQ-9 Reapers flying over Iraq and Afghanistan, decided to follow the advice of Air Force surgeons to have his gallbladder removed to stop his stomach pain. If he didn’t opt for the elective surgery, he wouldn’t be deployed.

Then 20, Read went into David Grant early in the morning as an outpatient. In fiscal 2009, the doctors at David Grant — the Air Force’s largest hospital on the West Coast — saw 303,707 outpatients and performed 2,724 surgeries, delivered 503 babies, cared for 5,025 inpatients and treated 21,641 emergency room patients.

By 6:50 a.m., Read was being prepped for surgery, one performed through four small tubes or ports inserted into his abdominal wall. Less than two hours later, the surgeons — a male resident with the rank of captain and the female attending staff surgeon with the rank of major — started their work. Their names are redacted in the report.

The surgery went wrong immediately.

The resident started to insert the first port with a 7-inch surgical tool, called a trocar, by applying “firm and continuous pressure” but did not see or feel the instrument go into the abdominal wall.

“I asked if I was applying enough pressure, and [the attending surgeon] said to keep applying firm and gentle pressure and rotate it,” he told investigators.

The attending surgeon then became “concerned about how quickly the trocar went into the abdomen and the amount of pressure [the resident surgeon] was applying … and told [him] to stop,” according to the report.

She took over and noticed blood in Read’s abdominal cavity, but both doctors noted “no large or sustained accumulation of blood,” the report states. “Both presumed the bleeding was coming from a source somewhere in the connective tissue that attaches the intestines to the abdominal wall.”

The attending surgeon continued to look for the source of the bleeding, inserting four more ports into Read’s abdomen.

Eight to 10 minutes later, she still could not find a “definitive bleeding source,” according to the report.

By this time, the attending surgeon decided to cut open Read to look for the bleeding source and called for additional surgeons and anesthesiologists.

As the surgeons worked, the anesthesia staff began pumping blood products, intravenous fluids and medication into Read to stabilize his blood pressure.

Read continued to bleed.

Staff members rushed to get O-negative blood, the universal donor. They did not know Read’s blood type because blood-typing is not a standard pre-operative test for the laparoscopic gallbladder surgery, according to the report.

By this time, Jessica Read returned to the hospital from the base exchange, where she had gone to pass some time. She walked by the operating room on her way from the elevator to the waiting room.

“A nurse runs out and was like, ‘We need blood now,’ and she rounds the corner and she says, ‘We can’t wait for that cross type,’” Jessica Read told investigators.

A few minutes later, an anesthesiologist found Jessica Read and asked for her husband’s military identification card.

“I said, ‘Why do you need his ID card?’ And he said, ‘Well, there was a little problem during the surgery. He lost a little more blood than we thought he would, but everything’s OK,’” Jessica Read said, “because at that point, I started to cry, I was really upset. And he was like, ‘But everything’s OK; he’s doing great, ma’am, everything’s fine. I just need his ID card to see what blood type he is.’”

Unlike an older version of the military ID, however, Read’s ID did not include his blood type.

The anesthesia staff ended up giving Read 3 liters of IV fluids, three units of packed red blood cells, one unit of fresh frozen plasma and 1 liter of colloid, which is a special IV fluid that contains proteins to help maintain the density of a patient’s blood plasma.

The surgeons continued their search for the source of the bleeding. With Read’s abdomen open, they could see a “large contained collection of blood/bleeding located at the back of the abdominal cavity” that indicated injury to an artery or vein, the report states. As described to investigators by one of the doctors, the injury looked like a blood-filled balloon 5 to 7 inches long and 3 to 5 inches wide. Staff members suctioned 2½ liters of blood, about half the body’s blood volume, from Read’s abdomen.

As the seconds ticked by, doctors determined the trocar had nicked Read’s aorta, the body’s largest artery.

There was a 9- to 11-millimeter laceration to the lower section of the aorta, just above the point where it splits into two common iliac arteries that take blood to the legs.

The attending surgeon repaired the aorta with sutures.

At 10:42 a.m., more than an hour after the surgery started, the attending surgeon removed the clamp to test her repair and noticed a “little bit” of continued bleeding, according to the report. She added more sutures and noted “measurable blood flow with a pulse in both common iliac arteries,” according to the report.

“The repair appeared hemostatic [the bleeding stopped],” the surgeon told investigators. “I opted to leave the patient open … with the intent on bringing him back to the operating room another day to reassess the abdomen, address his gallbladder issues and close him later.”

Read’s abdomen was packed with gauze and temporarily sealed with a vacuum dressing.

At 11:07 a.m., the surgery finally came to an end. Read had lost an estimated 3½ liters of blood — the average man has about 5 liters of blood — but was in stable condition.

After the surgery, a colonel acting as the hospital’s deputy commander told investigators that Read’s surgeon was “clearly, visibly shaken by the events.”

“We asked how she was, how the other staff members were and if there was anything that we could do,” the colonel said.

The waiting

Two doctors went to the waiting room at 11:15 a.m. to update Jessica Read.

Back in the operating room, a registered nurse could not find a pulse in Read’s feet and noticed his toes were white. A surgical technician with the rank of staff sergeant examined Read with a Doppler, an instrument that uses high-frequency sound waves to translate blood flow into sound, but also could not detect a pulse in his feet and found them “very cold to touch,” according to the CDI.

“When we went to go turn him,” the technician told investigators, “I saw a bruise on the back of his right leg. It was a purplish color, and I had said that it didn’t look right.”

Still concerned, the staff sergeant touched Read’s feet again, “then I touched up a little higher to see exactly how cold because it was just weird. But I’ve been in trauma situations overseas and that’s why I did it. And I made the comment that it was unusually cool. … Everyone is a jumbled mess with the exception of a few.”

One after another, staff members checked Read’s feet and legs, looking for a pulse.

One doctor found a faint pulse in his left foot. Another had trouble finding a pulse in the femoral arteries in the groin area and upper portions of the legs. Even with an ultrasound, the doctors had difficulty finding a pulse.

Finally, a staff member found “continuous, non-pulsatile flow” in the femoral arteries with the Doppler.

The staff members attributed Read’s weak pulse to the blood loss or the medication to boost his blood pressure.

When the attending surgeon returned to the operating room from talking to Jessica Read, “no member of the OR staff told her about a possible change in [Colton Read’s] lower extremity pulse exams,” according to the report.

“His whole body was white,” the surgeon said. “And that would have to do with the fact that he had lost an estimated three and a half liters of blood volume, which is almost 60 to 65 percent of his blood volume.”

At 11:25 a.m., Read was taken to the intensive care unit in critical but stable condition and Jessica Read was allowed to see him.

“I went back and he was asleep,” she told investigators. “He didn’t look great, no one does after surgery, but they assured me everything was OK, and I was like, ‘All right.’”

Read’s vital signs improved in the ICU, but staff members there had trouble finding a pulse in his legs, which some described as being “cool, pale and mottled,” the report states.

Doctors became concerned there was a complication from the aortic repair and requested a bedside ultrasound for Read.

The technical sergeant conducting the exam could not see Read’s aorta or his pelvic and leg arteries because of his open abdomen, so she called on her boss — a female radiologist with the rank of major — for help.

When the radiologist arrived, she too could not see the aorta. An exam of his iliac and femoral arteries showed sluggish, low velocity, non-pulsatile flow, suggesting abnormal blood flow in both legs caused by blood clots nearly blocking the arteries and a separation of the layers in the aortic wall that fills with blood and causes a blockage, according to the CDI.

“I said, ‘This is totally abnormal,’” the radiologist told investigators. “Your normal blood vessel, when you look at it on ultrasound, the lumen is black. … His vessel is gray. It has little speckles all throughout it.”

By 12:30 p.m., the doctor had finished the ultrasound and reported that neither leg appeared to be getting blood.

The decision

After the radiologist’s pronouncement, the doctors, including Col. (Dr.) Thomas Dye, then the medical surgical operations squadron commander with the 60th Medical Group at David Grant, began debating whether to transfer Read to the university hospital or continue treating him at David Grant.

“Ultimately, the group decided that if they could treat [Read] at [David Grant], they would treat him there,” according to the report.

The doctors ordered an angiogram, a special X-ray exam that uses dye injected into the arterial system.

After being briefed on Read’s condition, the doctor who was going to perform the angiogram suggested moving Read to a hospital with a vascular surgeon on staff. The other doctors countered by requesting the doctor to perform an urgent angiogram to see if the problem was treatable. The doctor agreed.

During this time, about 12:45 p.m., doctors brought Read out of sedation to examine him.

“He began to move his head, his neck, his arms,” one of the anesthesiologists, a major, told investigators. “I asked him to open his eyes, and although he could not open his eyes, he tried to open his eyes. His eyebrows raised, but his eyelids did not open.”

Read could move his arms but couldn’t squeeze the doctor’s hands or hold up one or two fingers, the doctor said.

“We asked him to move his legs and his feet and his toes. He didn’t. We gave him a painful stimulus to his foot to see if he would move his toe. He did not, either of his feet or his legs,” the anesthesiologist told investigators.

Jessica Read too had noticed her husband’s feet looked blue but didn’t receive any information from doctors.

“Everyone was just kind of not telling me what was going on, like you kind of felt like there was something going on because there were so many people in there [in his room] but no one had said anything,” she said.

At 1:20 p.m., staff members took Read for the angiogram. Again, two nurses in the radiology suite could not detect a pulse in Read’s feet and found his legs cold to the touch. The two doctors who conducted the angiogram confirmed the nurses’ findings. One of the doctors noted discoloration in both legs with a mottled appearance below the knees, “a definite demarcation,” according to the CDI.

The angiogram found blood flowing into the left leg but not into the right leg and possible narrowing of the aorta or a clot near where the attending surgeon closed the artery. The doctor, however, could not provide a definitive diagnosis, according to the CDI.

Again, the question of whether to transfer Read came up. One doctor told investigators she believed Read needed a vascular surgeon, a specialist that David Grant didn’t have at the time. Another doctor lobbied for Read to stay at the Air Force hospital if doctors there could treat him.

An anesthesiologist assigned to Travis who also worked at the university hospital told investigators “there was a discussion about whether or not this was a fixable problem that we could do here [and] … someone said that they thought that maybe it was an aortic dissection, another person said ‘No, I don’t think that that is what we are really dealing with here, and if this is fixable we should go into the operating room and fix it now.’”

Three doctors who overheard the discussion told investigators “it appears there was a disagreement” between at least two of the doctors about the next course of action for Read.

By this time, more than four hours had passed since the resident nicked Read’s aorta.

At 2:30 p.m., the doctors finally decided to move Read, setting off a flurry of activity to arrange for air ambulance and a bed and a doctor at the university hospital.

The transfer

Jessica Read learned about the transfer 15 minutes after the decision was made. Accompanying her was the master sergeant whom she had called and other members of her husband’s unit, the 9th Intelligence Squadron at Beale Air Force Base, Calif.

According to a second lieutenant with the 9th, doctors told Jessica Read that a patient could lose his limbs if he goes without blood flow for about six hours, but they “were not concerned because [Read] had some blood flow so he had more than six hours.”

When Jessica Read asked how long it would take to move her husband, doctors told her it was a 20-minute flight and a helicopter was on its way.

“Col. Dye spoke with Jessica, apologizing for what had happened,” the second lieutenant told investigators. “He said they were doing what they could to correct the situation. He was very nice, however avoided answering any questions. It was obvious he did not know the full extent or story of what had happened and he did not want to comment on anything he was not sure of. He was mainly there, I think, to show his concern.”

At 3:36 p.m., the helicopter and the aircrew began preparing to move Read, who was still in critical condition. Jessica Read and the master sergeant started driving to the university hospital.

At 5 p.m., David Grant received a call from U.C. Davis: “The doctor is here waiting. Where is he?”

The helicopter departed at 5:01 p.m. and landed 16 minutes later.

After the civilian doctor assessed Read, he went to talk with Jessica Read. He was blunt, describing Read as “a very sick boy.”

The doctor “plainly told me things don’t look good, and he was most likely not going to survive the surgery,” Jessica Read told investigators. “He said, ‘People don’t survive this.’”

The master sergeant told investigators that he was shocked when he heard the doctor’s words.

“Nobody gave any impression of exactly how sick Colton was at that point,” he told investigators. “There was never any sense of urgency, never any sense of ‘Hey, this guy might lose his legs or his life.’ That never came into anybody’s mindset until we got to U.C. Davis and we actually found out the truth.”

Read went into surgery again. The university doctors repaired his aorta and restored blood flow to his legs. Under the pressure of the returning blood, Read’s legs swelled and circulation stopped at his knees because the tissue below had already died.

At 2 a.m. July 10, doctors delivered somber news to Jessica Read.

“They came out and said they were going to have to remove the bottom portion of his right leg, and it was removed by 2:45,” she told investigators. “He had a drain on the left leg and then Friday evening is when they took his left leg.”

Now, Read’s left leg ends above the knee and his right leg at mid-thigh. He is still in the Air Force, promoted to senior airman in December.

The service will not make any decision on Read's status until he finishes his recovery and rehabilitation at Brooke Army Medical Center in San Antonio, an Air Force spokeswoman told Air Force Times shortly after Read lost his legs.

Jessica Read told investigators she often thinks about what she could have done differently.

“The first red flag should have been when [the doctor] had told Colton … ‘You might be here overnight, you could be here as long as five days if I cut the wrong thing.’ That should have been my first red flag.”

Read the entire report (55 pages)

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