Senator Calls For New Evaluations; Army investigating screening process
By Hal Bernton, Seattle Times staff reporter
The Army Medical Command has identified some 285 Madigan Army Medical Center patients whose diagnoses of post-traumatic stress disorder were reversed as they went through a screening process for possible medical retirements, according to U.S. Sen. Patty Murray.
Last month, Madigan's screeners for PTSD were removed from that duty while the Army Medical Command investigates why diagnoses were changed.
Soldiers diagnosed with PTSD as they prepare to leave the military can qualify for a medical retirement that offers a pension and other benefits.
The soldiers were screened by Madigan's forensic psychiatry team over a five-year period dating back to 2007, and will be invited to undergo new reviews at Madigan or other military facilities, according to a release Wednesday by the Western Regional Medical Command, which has oversight over Madigan.
Soldiers eligible for review were identified from a review of 1,500 soldiers screened by the forensic team for all types of mental-health conditions, the command said.
The Army did not provide the total number of PTSD evaluations done by the team during that period. Release of that information would be "premature" while those records are under review by investigators, the Western Regional Command said in a statement released to The Seattle Times.
PTSD is a condition that results from experiencing a traumatic event, such as a battlefield casualty. Symptoms can include recurrent nightmares, flashbacks, irritability and feeling distant from other people.
Some people recover from PTSD. For others, it may be a lifelong struggle.
The investigation at Madigan was triggered, in part, by complaints from soldiers who had previously been diagnosed with PTSD but were later accused by the screening team of exaggerating symptoms and sometimes malingering.
Earlier this year, 14 soldiers underwent new mental-health reviews at Walter Reed National Military Medical Center. Six had their PTSD diagnoses reinstated.
The investigation also was spurred by concerns that Madigan doctors involved in the screening were unduly influenced by worries about the escalating costs of paying benefits to those who qualify for medical retirements.
Murray said, "The only fair thing to do is to go back and find those service members who've also had their PTSD reversed by this unit in order to give them clear and unbiased re-evaluations. Our service members and their families deserve nothing less."
Murray was briefed this week on that effort by Lt. Gen. Patricia Horoho, the Army Surgeon General.
Madigan staff involved in the screening deny there was command pressure to limit disability awards.
The Madigan investigation has attracted national attention, triggering a broader Pentagon review of how the military medical staff diagnoses PTSD.
At the Western Washington medical center, some staff are embittered by the February decision to remove Col. Dallas Homas, Madigan's commander, during the investigation.
"We really believe that he has been scapegoated," said one senior Madigan employee who spoke on condition of anonymity. "Many of these diagnoses were made long before Col. Homas came on board."
Homas, who became commander less than a year ago, earned a reputation among some for trying to improve patient care.
"He said we need to treat patients like they are family members," said a Madigan staffer. "Like they are your son, your father, your mother."
The Army has been waging a campaign to help reduce the stigma that some soldiers feel if they seek mental-health treatment.
But some medical professionals have alleged that PTSD is being over-diagnosed. Patient medical records reviewed by The Seattle Times indicate considerable disputes both within the Army, and between the Army and the Department of Veterans Affairs, over how to diagnose PTSD.
As soldiers fought in Iraq and Afghanistan, there was considerable concern that the condition was being underrated as soldiers went through the medical retirement system.
Within the military, the financial stakes of PTSD screening dramatically increased after a 2008 congressional overhaul of the disability system resulted in a 50 percent disability rating for anyone leaving military service with that diagnosis. That rating is well above the threshold required for an Army medical retirement.
After the law changed, several soldiers attempted to make false or exaggerated claims of PTSD for personal financial gain, according to a Feb. 16 memorandum by Dr. Paul Whittaker, a Madigan physician who serves on the medical board that examines soldiers under consideration for medical retirement.
Whittaker wrote Madigan psychiatrists used objective testing to determine which soldiers had "significant mental illness that was compensable. ... "
If other Army medical facilities used this process, it is likely that the diagnosis rate would decrease below the rate of those based solely on the personal history provided by the soldier, Whittaker wrote.
The forensic program was in place when Horoho, the surgeon general, previously served as Madigan's commander.
As first reported by The Tacoma News-Tribune, a written copy of a March 2009 briefing she presented to senior Army leaders called the forensic program "an innovative solution to meet increased demands."
Horoho is now presiding over the investigation of the team.