A 100-page Army investigation into patient complaints at Madigan ArmyMedical Center reveals a hospital under siege, where tearfuldiscussions about doctors allegedly misdiagnosing post-traumaticstress disorder took place a year ago while Congress and the Pentagonkept watch.
It concludes in part that the hospital commander who temporarily losthis job never meddled with PTSD diagnoses, and that whistle-blowerswho drew attention to the South Sound hospital were misinformed intheir criticism.
The report emphatically backs Madigan commander Col. Dallas Homas. Italso supports the way the hospital carried out forensic psychiatricevaluations before doctors were accused of “reversing” PTSD diagnosesto save the Army money in disability benefits owed to retiringveterans.
The endorsement runs counter to the PTSD investigation’s publiclyknown impact across the Army.
In April, it led the Army to adopt new, soldier-friendly guidelinesfor diagnosing PTSD. Doctors later reviewed 431 patients who passedthrough Madigan, and re-diagnosed 147 of them with PTSD, implying theydidn’t get a fair shake from the hospital.
The Army this month also released a service-wide behavioral healthtask force report that calls for structural reforms in PTSD programsthat were partly rooted in the Madigan complaints.
Sen. Patty Murray, D-Wash., didn’t waver from her criticism Friday andpointed to the reforms that were put in place as proof that Madiganneeded to make changes.
“The fact that the Army had to bring in new doctors to reinstatehundreds of PTSD diagnoses for local service members and that theyhave implemented major behavioral health policy changes nationwide inthe wake of the Madigan cases are clear evidence that problems existedon base in properly identifying the invisible wounds of war,” she saidFriday.
The latest report suggests Homas and Madigan were treating theirpatients fairly before the complaints came to light in late 2011. Hewas suspended from his command in February 2012 and reinstated inAugust.
The report was completed in April. The News Tribune filed Freedom ofInformation Act requests for the documents and others related to theMadigan inquiry beginning in September, but the Army rejected theappeals. Army spokesman Lt. Col. Stephen Platt did not know whethermore Madigan reports would be disclosed.
For Homas, there was vindication in Friday’s public release of theinvestigation.
“Madigan Army Medical Center is a wonderful healthcare system, mannedby superb professionals, delivering safe, quality care to America’sfinest,” he said in a statement. “I am pleased that the releasedinvestigation verifies these facts.”
Nonetheless, the report shows a tense environment throughout thehospital in early 2012, the period when Murray called on the Army toinvestigate the complaints into reversed PTSD diagnoses.
It showed that Homas at that time was ruffling feathers at the basetrying to control costs because the hospital was running deficits intothe tens of millions of dollars every year. Some doctors appreciatedhis messages, believing the hospital needed a greater sense ofaccountability; others felt he was being too brash, according tostatements from more than two dozen service members.
Homas in September 2011 called a meeting with a patient advocate whosename kept coming up in conversations about whether doctors were beingtoo critical in evaluating soldiers with PTSD.
The advocate had spoken with several patients who came to Madigan withPTSD diagnoses from their primary caregivers, but lost them in theirfinal review by Madigan’s forensic psychiatrists. Those reversalssometimes cost them disability benefits.
The advocate, known as a hospital ombudsman, appeared “vocal, tearfuland frustrated” to the hospital commander. She was “obviously verypassionate” about patients who felt their diagnoses were unfairlyreversed.
The ombudsman, by turn, considered Homas too skeptical of PTSD. Toher, he seemed to convey that certain patients were scheming to getthat diagnosis so they could boost their disability benefits.
“He didn’t come out and say the soldiers were liars and malingerersbut my perception was that he just felt that they were all in thistogether trying to get something out of the military,” she told thesame investigator.
The ombudsman found evidence that doctors were shortchanging patientsthat month. She heard a forensic psychiatrist urge his colleagues tobe mindful of the long-term costs of disability benefits. He peggedthe cost of a PTSD diagnosis at $1.5 million.
“As I was hearing this I realized it is all about the money. Neverbefore had I heard anyone talk about money,” she told the Armyinvestigator.
Homas said he told the ombudsman the forensic psychiatrists wereexperts who dedicated their careers to behavioral health. He is aplastic surgeon by training, and he said he trusted the psychiatriststo make the correct conclusions.
Doctors who spoke to the Army investigator soundly rejected thesuggestion that they changed diagnoses to save money. But theymaintained that psychiatrists should feel free to consider whether apatient is falsely presenting certain symptoms to gain a PTSDdiagnosis.
“I don’t perceive that financial consideration or disability ratingshave anything to do with it,” the surgeon at Madigan’s WarriorTransition Battalion told the investigator. “Maybe it was a poordecision by (redacted) to give an example of what a wrong diagnosiswould end up costing the government, but I certainly do not think itproves a conspiracy to save the tax payer money.”
The investigator found that the ombudsman did not understand theexpertise of a forensic psychiatrist, nor the amount of work thatthose doctors put into making their diagnoses.
Homas instantly found wide support across the Army when he lost hiscommand. Fellow officers knew it was a signal that the West Pointgraduate and combat veteran could be driven out of the Army.
Three full colonels at Lewis-McChord spoke favorably to theinvestigator about improvements Homas made to soldier health care onthe base.
Homas also received a letter of support from retired Maj. Gen. EricOlson, with whom Homas served in Afghanistan as the top doctor in the25th Infantry Division.
“I truly believe that what is happening is a travesty unbefitting ademocracy or the military which (Homas) selflessly serves,” Olsonwrote.