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Army report stemming from Madigan complaints recommends overhaul of psychiatric programs

Post by Adam Ashton / The News Tribune on March 8, 2013 at 6:26 am with No Comments »
March 8, 2013 4:09 pm

Army Surgeon General Lt. Gen. Patricia Horoho on Friday announced reforms to behavioral health programs.
Army Surgeon General Lt. Gen. Patricia Horoho on Friday announced reforms to behavioral health programs.

The Army did not find a systemic bias against diagnosing post-traumatic stress disorder in a deep review of its psychiatric programs that was prompted by complaints about doctors at MadiganArmyMedicalCenter.

In fact, the review of nearly 150,000 cases since the start of the war in Afghanistan shows doctors were as likely to upgrade diagnoses to PTSD from less serious, less expensive conditions as they were to “reverse” them for soldiers seeking medical retirements.

The Army launched the investigation last year amid complaints that Madigan doctors were downgrading PTSD diagnoses to save the Army money it would owe in disability benefits.

The Army did not discover any nefarious intent among the Madigan doctors, known as forensic psychiatrists. It found that they changed behavioral health diagnoses at about the same rate as their counterparts in the rest of the service.

“There was no intentional malice, nor was there wrongdoing,” at Madigan, said Army Surgeon General Lt. Gen. Patricia Horoho.

Nonetheless, the Army in a dense, 57-page report concludes that inconsistent understanding of behavioral health resources and poor planning for surges in psychiatric needs continue to plague the service as the Afghanistan War comes to an end.

The report by Lt. Gen. David Perkins’ produces 24 findings and 47 recommendations to improve psychiatric care for service members and their families. It was based on interviews with 750 people as well group discussions with thousands more.

It maps out comprehensive reforms to disability evaluation programs, such as standardizing them, finishing a long-awaited effort to coordinate military records with systems at the Department of Veterans Affairs, and offering more resources to Reserve and National Guard soldiers in remote places.

It also seeks to make the Army’s behavioral health programs easier to understand by calling on each Army installation to designate a single director of psychiatric health. The intent is to help commanders untangle the service’s myriad and sometimes duplicative support programs.

Sen. Patty Murray, D-Wash., pushed the Army to investigate Madigan and to expand its review across the service. She received a briefing on the report this week from Army Secretary John McHugh, and called it a “good starting point to make real changes for our soldiers.”

Her remarks revealed a sense of frustration that the Army is still working out its psychiatric programs so late in the war.

“This isn’t an issue of not having the resources to make changes. Instead, it is simply a matter of problems that have been allowed to persist while far too many soldiers fell through the cracks. That is unacceptable,” she said in written remarks.

Army doctors reviewed 146,000 diagnoses for soldiers who received medical retirements since October 2001. It found about 6,400 behavioral health diagnoses were changed late in the medical retirement process.

The review showed that doctors were about as likely to change a diagnosis to PTSD as they were to adjust from PTSD to a less serious condition, such as anxiety disorder.

The scrutiny at Madigan led the Army to review more than 400 case files of service members whose behavioral diagnoses were changed as they moved through the hospital. Of them, 147 were later diagnosed with PTSD.

However, the new diagnoses came under different standards than Madigan used in the period from which the complaints originated. The Army in April released new criteria for diagnosing PTSD, moving away from a standard that requires patients to express having felt overwhelming fear or helplessness in a single moment.

That condition is not compatible for trained service members who suffer the symptoms of PTSD but cannot admit to feeling helpless in combat.

“A lot of them don’t experience shock and awe,” said Horoho, a former Madigan commander.

Madigan no longer uses forensic psychiatrists in considering medical retirements. Horoho said the Army decided to eliminate that service because it could not be replicated across the military, not because the Madigan forensic psychiatrists did something wrong.

Two Army hospitals, one at FortPolk in Louisiana and one at FortIrwin in California, had a greater degree of diagnostic variance from the service’s overall trend. Madigan’s was within the norm since 2001, though slightly higher during the period when the forensic psychiatry program was at full force, Horoho said.

Disclosing the report and its supporting documents completes a pledge McHugh made when he visited Joint Base Lewis-McChord last month. The Army has yet to release its local investigations in Madigan despite from Freedom of Information Act requests from The News Tribune and other Puget Sound news outlets.

Deputy Secretary of the Army Samuel Retherford said those reports would be distributed soon.

Releasing the reports helps clear the air at Madigan. Last year, the Army suspended hospital commander Col. Dallas Homas and two other doctors during the investigation.

It has since reinstated Homas and the two doctors, and it extended Homas’ time in command through the end of this summer.

“There is no higher priority or privilege for me than ensuring they all receive the best, highest quality care our team of providers can deliver,” Homas said. “Army task forces, such as the one on behavioral health, are helpful and support Madigan’s efforts to constantly improve our delivery of care to our service members.”

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