Sgt. Elder Fernandes (U.S. Army)

AUSTIN, Texas — Within minutes of learning that Sgt. Elder Fernandes was missing from his unit at Fort Hood, Texas, Army investigators began making calls and identifying leads to locate the soldier. However, Fernandes had been missing for 48 hours before anyone contacted the Army Criminal Investigation Command, setting agents far behind in the race to find Fernandes, who had spent the previous week hospitalized for contemplating suicide.

Upon his release Aug. 17, the soldier’s chain of command knew that he had been sleeping in his car, acting out of character and preparing to file for divorce and had recently reported he was the victim of unwanted sexual contact. Yet, he was dropped off at the home of a friend, without confirmation that he made it inside. When he missed a medical safety check the next day, no one alerted authorities, allowing precious time to slip by as his family called the unit for help and got none.

The 23-year-old Fernandes was found dead Aug. 25 in Temple, Texas, about 30 miles from the central Texas Army base where he served as a chemical, biological, radiological and nuclear specialist in the 1st Cavalry Division’s sustainment brigade. An investigation by the Temple Police Department and autopsy results show he hung himself from a tree near the railroad tracks about three days after he left the hospital.

“It’s appalling,” said Lenny Kesten, an attorney working with Fernandes’ family to gather information on the soldier’s death. “He’s a high-risk individual, they know it. He needs support, and he’s dropped off on the curb, and when he doesn’t show up the next morning for work, his sergeant is not connected to any network to say, ‘Red alert.’”

Fernandes had spent a week at Fort Hood’s Carl R. Darnall Army Medical Center, where he checked himself in for suicidal ideations. He asked his leadership for permission to go home to his family in Brockton, Mass., to recover, but the request was denied, and he was told to return to his Army life, Kesten said.

Maj. Gen. Jeffery Broadwater, commanding general, 1st Cavalry Division, speaks at a press conference held Aug. 26, 2020 at Fort Hood. (U.S. ARMY)

“There’s an absence of any evidence of coordination as they let him out,” Kesten said. “He said he was living in a parking lot, so what did they think was going to happen?”

On the afternoon of his release, a staff sergeant from Fernandes’ company drove him from the hospital to his car, which was parked at the motor pool. The BMW, a loaner from Fernandes’ brother, wouldn’t start, so the staff sergeant drove Fernandes, at his request, to a friend’s home in Killeen.

Fernandes never made it inside and was not heard from again.

AWOL or missing

The Fernandes family recently received the investigative file from Army Criminal Investigative Command, known as CID, which confirms what they previously said — from the time Fernandes was dropped off at 3 or 4 p.m. Aug. 17 until CID was notified of his absence around 4:45 p.m. Aug. 19, little was done to locate the soldier.

All names, except for the names of members of the Fernandes family, were redacted from the 166-page investigation file, which included interviews and summaries, results of vehicle and phone searches and a timeline of paths investigators followed to try and find Fernandes between Aug. 19 and when a railroad employee found him dead Aug. 25.

When Fernandes didn’t show up for morning formation Aug. 18, the staff sergeant who had dropped him off said he called Fernandes’ phone, which went to voicemail, and drove to the Killeen home several times. A sergeant first class who was acting as the company’s first sergeant said he took the same measures. The CID documents do not state whether either noncommissioned officer knocked on the door or spoke to anyone in the area.

When Ailina Fernandes, the soldier’s mother, called Aug. 18, the unit told her he was listed as AWOL, and they wouldn’t begin looking for him for 30 days, according to the documents and Kesten. Dissatisfied with the response, she flew to Texas next day to ask for help in person.

However, an Aug. 23 press release from the 1st Cavalry Division stated, “Within hours of Sgt. Fernandes’ disappearance, soldiers from his unit on Fort Hood initiated a thorough search for him, both on and off post, which will continue until he is located.”

“That’s obviously not true,” Kesten said. “What the family has said was always true, which is that when they got there that nothing had happened.”

Lt. Col. Chris Brautigam, spokesman for the 1st Cavalry Division, disputes that claim. He said the top priority was to find Fernandes from the first missed formation.

“In addition to the initial attempts to reach Sgt. Fernandes by phone and through visits to his home to attempt to locate him, the unit conducted exhaustive searches of the unit area and coordinated with local law enforcement,” he said. “Additionally, the unit immediately attempted to reach out to his spouse, his brother-in-law/roommate, and his close friends to try to locate him.”

When Ailina Fernandes arrived, she went first to the Fort Hood Military Police station, which sent her to the Killeen Police Department, Kesten said. Eventually, CID was notified.

Within 45 minutes, CID investigators made their first call to a company commander within the 553rd Combat Support Sustainment Battalion, who was preparing to deploy to Kuwait the next day. The captain had the wrong hospital release date for Fernandes and was “not sure” whether he had been assigned to rear detachment.

Efforts increased the next day with Fernandes’ unit assisting CID with searching the base, calling local hotels, businesses and homeless shelters before expanding farther to Waco, Dallas and San Antonio, according to the CID report and the division.

After days without much progress, the soldier’s father, Eugenio Fernandes, the national director of police in the country of Cape Verde, pleaded on a call for investigators to find his son.

“I ask with all of my heart that you take good care of this case because I want to know the truth about what happened to my son,” he said through a Spanish translator. “I trust that you [REDACTED] will do a good job so that I feel better. I am very ill with the news of my son. I’m not doing well.”

Changing policy

In December, the Army announced changes to its policy and protocols for missing soldiers that focus on acting within the first 48 hours. The new directive included “clear expectations and responsibilities of unit commanders and Army law enforcement authorities,” then-Army Secretary Ryan McCarthy said.

The service created the designation of “absent-unknown” as a 48-hour transitory duty status. In that time, commanders must determine whether a soldier’s absence is voluntary and therefore classify them as AWOL, or if the soldier is missing. If the latter, the Army will simultaneously initiate a “duty status whereabouts unknown,” known as DUSTWUN. Opening a DUSTWUN casualty case provides the family with a liaison officer while attempting to locate the missing soldier.

These changes were announced alongside the release of a report by the Fort Hood Independent Review Committee, a civilian-led review board that found at Fort Hood that “no one recognized the slippage in accountability procedures” and there was an “unwillingness or lack of ability of noncommissioned officers to keep track of their subordinates.”

Without any formal protocols for soldiers who fail to report, leaders and military police at Fort Hood took “an ad hoc approach to effectively address instances of missing soldiers during the critical first 24 hours, again with adverse consequences.”

McCarthy appointed the committee in July to review Fort Hood after the disappearance and death of Spc. Vanessa Guillen. The 20-year-old was killed by a fellow Fort Hood soldier on base. It took investigators more than two months to find her body buried along a river miles from the base.

The committee arrived at Fort Hood to begin its work five days after Fernandes was found dead.

The Fort Hood committee reviewed all case files of the 53 suicides recorded at Fort Hood between fiscal year 2018 and August 2020. Of those, 34 soldiers died off base and “these files were generally sparse,” stated the report. Only one file for an on-post suicide death included a postmortem behavioral assessment.

“The case file review also revealed that off-post suicides and deaths were not fully investigated by CID to determine whether there were contributory causes such as lifestyle issues, locations or other influences that would inform the command about certain activities, people and places off-post that may be higher risk for their soldiers,” the report stated.

The Army announced Friday that CID policy now requires “a full investigation of all suspected soldier suicides occurring on or off the installation.” Before that, CID conducted joint investigations with local law enforcement or collected the information from civilian agencies for CID files.

The Fort Hood committee said it was not clear why CID didn’t conduct these postmortem assessments.

“Failure to perform and refer to a postmortem behavioral assessment is a wasted opportunity to learn more about soldier suicides that can help lead to better prevention strategies,” the report stated.

Missed safety check

Kesten said if the Army did a postmortem review of Fernandes’ case, it would show that the medical system at Fort Hood also failed him and that someone should be held accountable.

As part of the routine to release soldiers from in-patient care, Fernandes’ chain of command met with the soldier and his medical providers during his hospitalization to develop a care plan, according to the CID documents. In that meeting, the unit informed Fernandes he was being involuntarily separated from the Army for a “pattern of misconduct.”

“All service members are discharged with a plan articulating how the commander and unit leadership can support the soldier’s treatment plan to maximize recovery and ensure soldier safety,” officials said.

Someone “dropped the ball,” Kesten said.

“Somebody was in charge of releasing him,” he said. “I mean, you guys are getting together to make a plan for his care once he gets out, what happened?”

The day after his hospital release, Fernandes was supposed to have a safety-check appointment with his unit’s embedded behavior health team, according to the CID documents. Investigators were first told that Fernandes checked in at 7:43 a.m., but upon following up, they learned Fernandes never checked in.

If a high-risk patient is a no-show for a scheduled appointment, clinic personnel “must attempt to contact the patient the same day,” according to the statement from Fort Hood health officials. If they don’t reach the soldier, they “should contact the unit commander to help arrange contact and create an appropriate follow-up plan.”

For Fernandes, that didn’t happen.

Two more investigations looking into the Fernandes case are pending. The House Committee on Oversight and Reform’s subpanel on national security and the House Committee on Armed Services’ subpanel on military personnel announced a joint investigation in September to review the policies and practices at Fort Hood with a focus on seven soldiers, including Fernandes and Guillen, who died there last year. The oversight committee hopes to make its findings public by the end of the year, according to a congressional aide.

The Army also has an administrative investigation, which is standard process following any soldier’s death, and those results also are pending release. Information gathered in that investigation will be provided to the Fernandes family through the casualty assistance process.

“You’re not going to solve the problem without analyzing what went wrong and the effects of it,” Kesten said. “That’s important to our service men and women, so that something like this never happens again.”

Paranoia and distrust

In the months leading up to his death, the CID investigators found that those around Fernandes noticed increasingly erratic behavior. Beyond alcohol abuse treatment in June and July, the report doesn’t show the soldier ever received any other behavioral health care. Fernandes reported in June as having drank alcohol four days out of the previous 30 and that he never drank more than six beers.

His personality shifted around April, then his odd behavior escalated a month later after Fernandes reported being sexually assaulted by a supply sergeant, Kesten said. CID used a polygraph to clear the accused sergeant of wrongdoing.

In June, Fernandes became angry at a tire store on base and poured soda on a computer keyboard, according to CID. Later that month he encountered the supply sergeant he’d accused of sexual assault at a convenience store on base. Fernandes stood behind his car, blocking him in until police were called.

People interviewed by CID described Fernandes during this period as paranoid, believing that he was being followed by the FBI. He thought people wanted to poison him or put a bomb in his car. He would place baby and dog toys in the doorways of the friend’s home where he was staying in Killeen, one of the many reasons the two argued and Fernandes moved out.

Fernandes married his friend’s sister in April to be able to move off base and collect a housing allowance, not because they were in a real relationship, according to CID. The couple did not have a relationship and, at the time, Fernandes was living with his friend. He did not live with his wife.

He signed a lease to move into a Killeen apartment Aug. 14, but he never picked up the keys. The marriage license and paperwork to start his housing allowance were found in Fernandes’ car, but had never been filed with the Army, according to the Temple Police Department’s investigation.

In early August, Fernandes’ unit went to the field for a week. At one point during training, the unit took his weapon from him, according to CID. When they returned Aug. 9, Fernandes refused orders and walked away.

His leaders caught up with him near the post exchange, where Fernandes threatened to go AWOL. Police and emergency medical personnel were called but determined that there was nothing they could do for Fernandes, according to the investigation.

He went missing from his unit for the next two days. He was labeled as AWOL until Aug. 11, when he called his leadership to report he had checked himself into the hospital. Fernandes said he’d spent the past two days wandering around Killeen and hanging out at a Walmart. As he walked busy streets, he said he visualized himself walking into traffic.

“The Army totally failed Sgt. Fernandes in giving him any support,” Kesten said. “To tell him that, ‘You’ll be able to get out of the Army eventually. Now go back to work and go live somewhere, we don’t care where you sleep.’ How’s that’s supposed to make him feel?”

thayer.rose@stripes.comTwitter: @Rose_Lori