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Army investigation finds Colonel Homas did not use position to influence PTSD diagnoses

An Army investigation glowingly endorses the Madigan Army Medical Center commander who temporarily lost his post this year amid complaints about inconsistencies in the hospital’s post-traumatic stress disorder diagnoses.

The report found that Col. Dallas Homas “did not exert any undue influence over PTSD diagnoses, and that he acted appropriately enforcing standard medical guidelines,” according to a summary The News Tribune obtained through the Freedom of Information Act.

The Army relieved Homas from his command from February until August as part of its investigation into the forensic psychiatry program at the Army hospital south of Tacoma. Madigan’s forensic team had the last say on behavioral health diagnoses in disability evaluations, and patients couldn’t understand why the team’s psychologists sometimes changed other doctors’ PTSD diagnoses to other conditions.

Concerns about the program reached Homas’ level in part because one doctor in a staff meeting suggested psychologists be mindful of long-term costs to the government in making their diagnoses. PowerPoint slides from the briefing estimated the cost of a diagnosis at $1.5 million over time.

The Army has since given fresh PTSD diagnoses to 150 patients who had passed through the Madigan team over the past four years; all those patients previously were given a clean bill of health or a different diagnosis. Others who want their cases reviewed still can get new opinions.

An Army lawyer wrote to The News Tribune that a broader inquiry is still under way, and the military is declining to release more documents until it adopts a “corrective action plan.” The News Tribune requested copies of all Army investigations stemming from the complaints about forensic psychiatry.

Homas’ suspension brought potentially career-killing scrutiny to the West Point graduate, a veteran of both the Iraq and Afghanistan wars. Homas’ supporters throughout the Army feared he was being scapegoated for criticism of a forensic psychiatry program that was created years before he took his command in March 2011.

Madigan’s forensic psychiatry program in 2009 was endorsed to the highest levels of Army medicine as a “best practice” because it was thought to achieve a higher degree of accuracy.

“I know all the persons described in the news reports. They are fine soldiers and dedicated doctors, who have devoted their lives to treating patients, both in the United States and in Iraq and Afghanistan,” Elspeth Cameron Ritchie, a retired Army psychologist, wrote on Time magazine’s Battleland blog just after Homas’ suspension in February.

Lt. Gen. David Perkins carried out the review of Homas’ command climate. Perkins found widespread support for the commander and recommended that Homas be reinstated. Perkins stressed that Homas did not intervene in any forensic psychiatry cases except to encourage doctors to “use established medical standards to make accurate diagnoses.”

Civilian and military employees “stated that Col. Homas was one of the finest hospital commanders ever assigned to (Madigan),” Perkins wrote in his July 31 report. The general praised Homas for conveying clear goals for the hospital and motivating employees to improve access to health care.

His “vision was accepted, endorsed and engrained through the command and was one of the driving factors behind the significant improvements at (Madigan) during his command,” Perkins wrote.

Homas said at an August news conference: “I am thrilled, excited to be back, to get after it again.”

Perkins’ otherwise ringing endorsement of the Madigan commander faulted Homas for his interactions with congressional lawmakers. Perkins wrote that Homas’ written responses to lawmakers in the investigation could have been perceived as “inappropriate in tone.”

Sen. Patty Murray, D-Wash., drove the calls for the inquiries because her office received some of the initial complaints about the Madigan doctors. She pressed Defense Secretary Leon Panetta to expand the reviews and look at all Defense Department standards for PTSD diagnoses.

That review is not complete.

Homas met Murray in summer 2011 when Lewis-McChord opened new apartments for wounded and sick soldiers. Their meeting took place during a month when the base saw a sudden spike in suicides, and Murray posed a number of questions about Army behavioral health programs. Murray spokesman Matt McAlvanaugh declined to answer questions last week about Perkins’ critique of Homas’ relations with lawmakers.

“Clearly, based on the fact that there were hundreds of service members who had their PTSD diagnoses incorrectly changed, there were serious mistakes made at Madigan,” McAlvanaugh said. “Sen. Murray is pleased that the Army responded to her concerns over these mistakes, and that many of those that were misdiagnosed have since had their cases reviewed, are now properly diagnosed, and are getting access to the appropriate care.”