The psychiatry staff at Madigan Army Medical Center was not encouraged to overturn diagnoses of post-traumatic stress disorder to save the government money, according to investigation documents provided to NBC News.
The Army previously said it found no evidence of wrongdoing at the Tacoma, Wash., hospital, but had not released the investigation documents until Friday. As recently as last month, the Army said it would not share the findings and denied Freedom of Information Act requests by local media.
The investigation, conducted last spring, sought to determine whether or not the commander of Madigan, Col. Dallas Homas, exerted any “undue influence” on PTSD diagnoses. Homas was reinstated last July and the investigation documents contain numerous glowing reviews of his leadership and no indication that he pressed the staff to consider the cost of diagnosing a soldier with PTSD.
That claim stemmed from a 30-minute presentation given in September 2011 by the hospital’s chief of forensic psychiatry, in which he noted that a PTSD diagnosis could cost the government over $1.5 million in disability payments over a soldier’s lifetime.
The 100-page investigation document contains several interviews with Madigan staff members who say the comment was made in less than a minute and taken out of context.
When questioned about the remark, the commander explained that forensic psychiatrists must take into consideration all factors “that could bear on an individual’s diagnosis,” including financial gain, the document showed.
“... It is clearly being blown out of proportion and used to attack [redacted] and his team,” Homas said. “I have not seen any evidence that concern over saving government money is a driver of arriving or not arriving at a diagnosis.”
In the fall of 2011, some soldiers had complained that their PTSD diagnoses had been switched to conditions like anxiety disorder, which could have affected their medical retirement rating and the amount of their disability payments.
Homas pointed out during the investigation that while 14 soldiers were not diagnosed with PTSD, at least 44 soldiers who entered the medical retirement process were ultimately given that diagnosis.
“If this were about saving money, this section has failed has failed miserably,” he said.
The investigation interviews also revealed that some staff faced tense situations when giving a diagnosis.
“Sometimes some soldiers can get so upset that they might act out in some manner, perhaps expressing threats," the chief of behavioral health said to the investigator. "The easy thing to do is just give the patient what they want. The (forensic psychiatry) clinicians work very hard to do what is right.”
Homas said in his interview that some soldiers made death threats against forensic psychiatrists.
The investigating officer wrote that only two individuals, who were ombudsmen, made “unsubstantiated allegations” regarding the forensic psychiatric process. Both were suspicious of changes to soldiers’ PTSD diagnoses, but did not believe Homas advised staff to consider the cost as a factor.
The investigating officer agreed with Madigan staff that the ombudsmen had misunderstood the context of the Sept. 2011 comment.
One ombudsman said soldiers whose diagnoses were reviewed by the forensic psychiatric team were very distressed upon being told they did not have PTSD. In some cases, medical professionals previously told them they had the disorder.
That ombudsman said their lives had been “turned upside down” as a result, and that some evaluations contained language insinuating that the solders were liars and malingerers.
Though the forensic psychiatry team was essentially absolved by the report, the Army has stopped the practice of using such teams to vet PTSD diagnoses; Madigan was the only Army hospital to do so.
“The fact that the Army had to bring in new doctors to reinstate hundreds of PTSD diagnoses for local servicemembers 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,” Sen. Patty Murray, D-Wash., said in a statement to NBC News. Murray pushed for the investigation into the PTSD diagnoses at Madigan.
As part of the investigation, a review of 431 Madigan cases — some of which had been overturned — led to PTSD diagnoses for 150 soldiers by last October. The Army recently said that Madigan’s variance rate for diagnoses was not outside the norm.
Rebecca Ruiz is a reporter based in the Bay Area.
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