Army to stop using forensic psychiatrists to evaluate soldiers diagnosed with PTSD


From The Seattle Time

By Hal Brenton

The Army no longer will use forensic psychiatrists to evaluate soldiers diagnosed with post-traumatic stress disorder and under consideration for medical retirement, a change resulting from an investigation of a screening team at Madigan Army Medical Center.

“What we found is that the forensic methods are not the right ones for the United States Army disability evaluation system,” Gen. Lloyd Austin, the Army’s vice chief of staff, said in a statement Tuesday. “We learned MAMC (Madigan) officials acted in accordance with the standard of practice for civilian disability evaluations. But we also learned that while the evaluation may be fair and appropriate, it’s simply not optimal for the unique cases that the Army diagnoses and reviews. We’ve fixed that.”

The Army on Tuesday also reinstated Madigan’s commander, Col. Dallas Homas, who was suspended this year as the investigation got under way at the medical center on Joint Base Lewis-McChord, south of Tacoma.

Austin said Homas, who came to Madigan in 2011, did not exert undue influence on PTSD diagnoses and is back on the job.

“Col. Homas began his tenure … at a critical juncture, as the hospital faced a massive deficit, declining numbers of patients served, and other organizational problems,” Austin said. “His leadership was important to improving (Madigan).”

The Army investigation of Madigan focused on the conduct of the forensic team, whose screening of patients under consideration for medical retirement once was touted by Madigan leaders as a “best practice.”

Forensic evaluations often are used in legal proceedings and typically include administering tests such as the Minnesota Multiphasic Personality Inventory, which at Madigan was used sometimes to assess the severity of PTSD symptoms or whether a soldier might be feigning symptoms.

The Madigan forensic team ended up overturning the PTSD diagnoses of more than 300 service members who were under consideration for a retirement that would qualify them for a pension and other benefits.

The Madigan forensic team’s work triggered complaints from patients, some of whom were tagged as possible malingerers.

These complaints drew scrutiny from an Army Medical Command ombudsman. The ombudsman, in a memorandum, noted that a forensic team member gave a talk during which he cited the need to be good stewards of taxpayer dollars because a medical retirement provides up to $1.5 million in benefits over a soldier’s life.

U.S. Sen. Patty Murray, D-Wash., who chairs the Senate Committee on Veterans Affairs, also fielded complaints from soldiers.

In February, the Army surgeon general, Lt. Gen. Patricia Horoho, announced an investigation of Madigan’s mental-health screening, suspending the forensic team from its evaluation duties and putting together a new group to re-evaluate the claims of patients whose PTSD diagnoses had been overturned.

Army investigators also were to examine why Madigan closed an intensive outpatient PTSD program.

The Seattle Times has requested a copy of the Madigan investigation of the forensic team under the federal Freedom of Information Act, as well as other investigations launched this year at Madigan.

The Army has not released these reports. A spokesman from Murray’s office said the senator has not obtained them.

The progress of the Madigan re-evaluations of patients also was not disclosed in the statement released Tuesday.

A source with knowledge of that review said the Army has completed 229 re-evaluations of patients screened by the forensic team and that more than 50 percent of those patients ended up receiving PTSD diagnoses.

Army officials have said Madigan was the only Army medical center to use a forensic team to screen PTSD patients. Murray pressed for a broader examination. In June, Defense Secretary Leon Panetta announced a review of PTSD diagnoses of all branches of the service in the post 9/11 era.

“I’m pleased the Army has put an end to the use of forensic psychiatry and the practices that were at the core of the misdiagnosis of hundreds of soldiers,” Murray said in a statement Tuesday. “… I also hope that it encourages more service members to come forward and seek help, knowing they won’t be treated unfairly or accused of lying about their symptoms.”

PTSD diagnoses long have been surrounded by controversy.

The Army has been waging a campaign to help reduce the stigma that some soldiers may feel if they seek treatment for PTSD.

But some medical professionals believe that PTSD is being overdiagnosed.

Since the passage of 2008 congressional legislation, a service member deemed unfit for duty due to PTSD generally qualifies for a medical retirement that offers a pension and other benefits.

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