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Army releases investigation into Madigan PTSD complaints. Read excerpts and full report here

Post by Adam Ashton / The News Tribune on March 15, 2013 at 6:33 pm |
March 18, 2013 1:24 pm

A 100-page Army investigation into patient complaints at MadiganArmyMedicalCenter reveals a hospital under siege a year ago, where “tearful” discussions about doctors allegedly misdiagnosing post-traumatic stress disorder took place under the scrutiny of Congress and the Pentagon.

It concludes in part the hospital commander who temporarily lost his job because of the investigation never meddled with PTSD diagnoses, and that the whistleblowers who drew attention to the hospital were misinformed in their criticism.

The report emphatically backs Madigan commander Col. Dallas Homas, and supports the way the hospital carried out forensic psychiatric evaluations before its doctors were accused of “reversing” PTSD diagnoses to save the Army money in disability benefits it would owe retiring veterans.

“The evidence shows that (Homas) played no direct role in the level of scrutiny (forensic psychiatrists) used to evaluate cases of PTSD, other than to provide positive guidance to providers: That they should do what is right and make accurate diagnosis based on the on the medical evidence,” the report says.

Here’s a link to my news story about the investigation in Saturday’s News Tribune. 

And here are excerpts from the investigation. The full report is posted below.

Question from investigator to Col. Dallas Homas: Did you ever issue any guidance to any of the bebavioral health providers in what you expected them to use as criteria for evaluating Soldiers they saw?

A: Absolutely not. I wouldn’t even pretend to have any knowledge or expertise in the practice of their specialty. I would never tell them how to do their business. Just as I would not expect them to tell me how to practice my specialty in medicine.

Col. Dallas Homas on the forensic psychiatrists who were criticized for “reversing” PTSD diagnoses:

I think it is very interesting that FPS has come under scrutiny for not diagnosing PTSD. I think that if we look at at the data, we would find that PTSD is actually the most commonly diagnosed condition coming out of our behavioral health department, by a fairly significant margin. At the same time that the 14 Soldiers were not diagnosed with PTSD, at least 44 other Soldiers that entered the disability evaluation system without a diagnosis of PTSD, were actually diagnosed with PTSD. If this were about saving money, this section has failed miserably. They made the diagnosis of PTSD in hundreds of cases even in dozens of cases where the Soldiers did not think they bad PTSD.

Question from investigator to Madigan chief of staff regarding a Sept. 1, 2011 presentation in which a forensic psychiatrist suggested a PTSD diagnosis would cost taxpayers $1.5 million over a soldier’s lifetime: What was your perception in introducing cost in his lecture?

Answer: l think it was just an icebreaker, something to catch your attention. It’s important for us to do the right thing because it’s the right thing to do. There are consequences to just rubber stamping a diagnosis and not doing good and proper medical evaluations.

 Do you have anything further to add?

Answer from Madigan Chief of Staff: There is a general feeling that there is pressure from outside of JBLM to make the diagnosis of PTSD even though it is not necessarily there.

Warrior Transition Battalion surgeon on Madigan forensic psychiatrists:

FPS is there to look at the record as a disinterested party, does the evidence support the diagnosis within the criteria? From my discussions with (redacted) he has this same attitude. I don’t perceive that financial consideration or disability ratings have anything to with it. Maybe it was a poor decision by (redacted) to give an example of what a wrong diagnosis would end up costing the government, but I certainly do not think it proves a conspiracy to save the tax payer money. I don’t believe that’s the case at all.

Madigan’s chief of behavioral heath on Col. Homas:

(Homas) is one of the best commanders I have ever worked for. The very concept that I would try to influence a diagnosis for any reason is ludicrous. Has he been a good steward of taxpayers’ dollars and directed the rest of us to do the same? Absolutely and he has done so under very public forums. He expects people to do their job and take responsibility for their actions. Bottom line, if I thought for a minute that if any diagnosis here at Madigan was being influenced by money I would not be getting my medical treatment here and I would not allow my family to get their medical treatment here.

Former Joint Base Lewis-McChord base commander Col. Thomas Brittain on Col. Homas. (Two other Army brigade commanders gave similar statements.)

He is a superior commander respected by all his peers, subordinates, and superiors alike. (Homas) has re-instilled military standards to the hospital in reference to customer service, reporting standards, and good order and discipline. He has enforced standards to do the harder right rather than the easier wrong. The greatest compliment I can pay to a peer is that I would work for him and I would work for (Homas) in a heartbeat.

Army Medical Command contracted ombudsman on Col. Homas’ guidance to staff:

I was aware of the meetings where he brought in the providers to the auditorium and was spitting mad, and discussing and cussing about the way we were doing business. About accountability, about appointments and quality of work, the whole nine yards. That first meeting was rather interestingly interpreted by several people. He was very angry with the way Madigan had been run, and talked about Madigan’s budget, and how terrible it was.

Contracted ombudsman on her reasons for determining forensic psychiatrists sought to reverse PTSD diagnoses to save money:

We had a couple of other meetings where cost was mentioned. It is not just that one lecture. It’s after a year of hearing soldiers saying “I’ve been an in-patient, I’ve been in combat medic for 32 months,” and then seeing those adjustment disorder [diagnosis from FPS] pop up after they have been in treatment for six years for something that is supposed to be short-term. Then turning around and watching someone say, “You do not have PTSD according to FPS so now we are going to administratively separate you for a personality disorder.”

Second hospital ombudsman on her September 2011 meeting with Col. Homas regarding her assessment that forensic psychiatrists were shortchanging soldiers:

He didn’t come out and say the soldiers were liars and malingers but my perception was  that he just felt that they were all in this together trying to get something out of the military.

Second hospital ombudsman’s take on the September presentation in which a forensic psychiatrist suggested PTSD diagnoses cost taxpayers $1.5 million over time.

I was stunned and I whispered to another person, “So that is what this is all about. This is all about money?” She looked at me and said, “Apparently so.” I stated, “You have got to be kidding me, I thought we were here to provide the best care for Soldiers.” As I was hearing this I realized it is all about the money. Never before had I heard anyone talk about money. He stated the money issue very competently. It was as if he was saying, “Look, this is supported by the higher up. This is the deal folks, pay attention to what you are doing, think about it every time you want to say someone has PTSD and think about the fact that it is now going to cost us $1.5 million dollars.” That’s what I took from it.

 Army investigator on hospital ombudsmen:

During the·course of my investigation, I could only find two individuals, the two MEDCOM Ombudsmen, who made unsubstantiated allegations of improper influence, by unknown persons, on the FPS evaluation process.  Specifically, the two MEDCOM Ombudsmen were suspicious that MAMC FPS was changing some Soldiers diagnosis of PTSD-yes to PTSD-no because the large financial costs to the U.S. government incurred (in the way of benefits) when a diagnosis of PTSD-yes was given to a Soldier. During questioning, both ombudsmen stated that they did not believe (Homas) improperly influenced the FPS  section nor was he the source of any guidance to use financial consideration when diagnosing PTSD. Additionally I could find no evidence to support the suspicions of improper influence of the two MEDCOM Ombudsmen. I do find that the source of the MEDCOM Ombudsmen’s suspicions of improper financial influence stems from their ignorance of the FPS evaluation process and a statement made by (redacted) at a 1 September briefing he gave on the FPS evaluation process that the Ombudsmen took completely out of context and used as confirmation of their theories of improper financial influence to explain why FPS downgraded some Soldiers PTSD diagnosis from PTSD-yes to PTSD-no.

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