Investigation: Culture of shortchanging soldiers on PTSD didn't exist at Madigan hospital

Tacoma News TribuneMarch 18, 2013 

A 100-page Army investigation into patient complaints at Madigan Army Medical Center reveals a hospital under siege, where tearful discussions about doctors allegedly misdiagnosing post-traumatic stress disorder took place a year ago while Congress and the Pentagon kept watch.

It concludes in part that the hospital commander who temporarily lost his job never meddled with PTSD diagnoses, and that whistle-blowers who drew attention to the South Sound hospital were misinformed in their criticism.

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

The endorsement runs counter to the PTSD investigation’s publicly known impact across the Army.

In April, it led the Army to adopt new, soldier-friendly guidelines for diagnosing PTSD. Doctors later reviewed 431 patients who passed through Madigan, and re-diagnosed 147 of them with PTSD, implying they didn’t get a fair shake from the hospital.

The Army this month also released a service-wide behavioral health task force report that calls for structural reforms in PTSD programs that were partly rooted in the Madigan complaints.

Sen. Patty Murray, D-Wash., didn’t waver from her criticism Friday and pointed to the reforms that were put in place as proof that Madigan needed to make changes.

“The fact that the Army had to bring in new doctors to reinstate hundreds of PTSD diagnoses for local service members and that they have implemented major behavioral health policy changes nationwide in the wake of the Madigan cases are clear evidence that problems existed on base in properly identifying the invisible wounds of war,” she said Friday.

The latest report suggests Homas and Madigan were treating their patients fairly before the complaints came to light in late 2011. He was suspended from his command in February 2012 and reinstated in August.

The report was completed in April. The News Tribune filed Freedom of Information Act requests for the documents and others related to the Madigan inquiry beginning in September, but the Army rejected the appeals. Army spokesman Lt. Col. Stephen Platt did not know whether more Madigan reports would be disclosed.

For Homas, there was vindication in Friday’s public release of the investigation.

“Madigan Army Medical Center is a wonderful healthcare system, manned by superb professionals, delivering safe, quality care to America’s finest,” he said in a statement. “I am pleased that the released investigation verifies these facts.”

Nonetheless, the report shows a tense environment throughout the hospital in early 2012, the period when Murray called on the Army to investigate the complaints into reversed PTSD diagnoses.

It showed that Homas at that time was ruffling feathers at the base trying to control costs because the hospital was running deficits into the tens of millions of dollars every year. Some doctors appreciated his messages, believing the hospital needed a greater sense of accountability; others felt he was being too brash, according to statements from more than two dozen service members.

Homas in September 2011 called a meeting with a patient advocate whose name kept coming up in conversations about whether doctors were being too critical in evaluating soldiers with PTSD.

The advocate had spoken with several patients who came to Madigan with PTSD diagnoses from their primary caregivers, but lost them in their final review by Madigan’s forensic psychiatrists. Those reversals sometimes cost them disability benefits.

The advocate, known as a hospital ombudsman, appeared “vocal, tearful and frustrated” to the hospital commander. She was “obviously very passionate” about patients who felt their diagnoses were unfairly reversed.

The ombudsman, by turn, considered Homas too skeptical of PTSD. To her, he seemed to convey that certain patients were scheming to get that diagnosis so they could boost their disability benefits.

“He didn’t come out and say the soldiers were liars and malingerers but my perception was that he just felt that they were all in this together trying to get something out of the military,” she told the same investigator.

The ombudsman found evidence that doctors were shortchanging patients that month. She heard a forensic psychiatrist urge his colleagues to be mindful of the long-term costs of disability benefits. He pegged the cost of a PTSD diagnosis at $1.5 million.

“As I was hearing this I realized it is all about the money. Never before had I heard anyone talk about money,” she told the Army investigator.

Homas said he told the ombudsman the forensic psychiatrists were experts who dedicated their careers to behavioral health. He is a plastic surgeon by training, and he said he trusted the psychiatrists to make the correct conclusions.

Doctors who spoke to the Army investigator soundly rejected the suggestion that they changed diagnoses to save money. But they maintained that psychiatrists should feel free to consider whether a patient is falsely presenting certain symptoms to gain a PTSD diagnosis.

“I don’t perceive that financial consideration or disability ratings have anything to do with it,” the surgeon at Madigan’s Warrior Transition Battalion told the investigator. “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.”

The investigator found that the ombudsman did not understand the expertise of a forensic psychiatrist, nor the amount of work that those doctors put into making their diagnoses.

Homas instantly found wide support across the Army when he lost his command. Fellow officers knew it was a signal that the West Point graduate and combat veteran could be driven out of the Army.

Three full colonels at Lewis-McChord spoke favorably to the investigator about improvements Homas made to soldier health care on the base.

Homas also received a letter of support from retired Maj. Gen. Eric Olson, with whom Homas served in Afghanistan as the top doctor in the 25th Infantry Division.

“I truly believe that what is happening is a travesty unbefitting a democracy or the military which (Homas) selflessly serves,” Olson wrote.

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