Army looking to ensure PTSD diagnosis consistent
February 8, 2012
WASHINGTON (Army News Service, Feb. 8, 2012) --The Army's surgeon general told members of Congress that the service is investigating how post-traumatic stress disorder is diagnosed to ensure consistency at all hospitals.
Lt. Gen. Patricia D. Horoho and the surgeons general from the Air Force and Navy testified Feb. 8 to members of the Defense subcommittee of the House Appropriations Committee.
Norman D. Dicks (D-Wash.), ranking member of the subcommittee, questioned Horoho about the Army's closure of a program at Madigan Army Medical Center on Joint Base Lewis-McChord, Wash.
"I wanted to ask Lieutenant General Horoho, who had served as commanding officer at Madigan Army Medical Center in Tacoma, Washington, about one of the things I heard about in the last few days," Dicks said. "A program, created at Madigan was extremely successful, but it was cancelled and I am told by my sources that it was cancelled because it came up with too many recommendations that the patients had post-traumatic stress disorder."
Horoho said she has launched a 15-6 investigation to look into the variance of behavioral health diagnoses at Madigan, and to investigate why the Intensive Outpatient Center was closed, if there was undo command influence in closing it, and if the patients were negatively impacted.
A forensic psychiatrist there who screened patients for post-traumatic stress disorder, known as PTSD, and allegedly made inappropriate remarks was removed administratively from clinical duties until the investigation is finished, Horoho said.
Capabilities of the Intensive Outpatient Center have actually not gone away, Horoho said, explaining they have been merged into other behavioral health programs at Madigan.
"Having said that, we are going to investigate to make sure that's actually true and that we're providing the best care to our service members," she told Dicks.
Dicks replied, "Isn't the Army saying, 'return to duty is our number one priority,' and are putting pressure on these doctors to come in with decisions?"
Horoho responded, "Absolutely the Army is not putting pressure on any of our clinicians."
Horoho said she has asked the Department of the Army Inspector General to do an evaluation and an investigation. She said the practice that was a variance at Joint Base Lewis-McChord involved patients going through the Integrative Disability Evaluation System who had their records screened without face-to-face diagnosis.
"When they had a diagnosis that the disability evaluator was unsure of, whether or not it was PTSD or not, he then would refer the cases to forensic psychiatry and then what they do, it's all administrative. It's not a patient encounter, and what they would do is they look at all sorts of administrative data and they make that diagnosis."
She said that's not the way PTSD diagnoses are made across Army medicine and she wants to ensure that no patients at Madigan were put at a disadvantage.
"Our commitment," said Horoho, "is to ensure we optimize the delivery of health services to ensure our medical support to each of our services while reducing redundancy, by maintaining unity of effort, and focusing on health."
The hearing also discussed the merger of Walter Reed and Bethesda and the quest for efficiencies in health care.
Vice Adm. Matthew L. Nathan, surgeon general of the Navy, who had been commander at the National Naval Medical Center and then the Walter Reed National Military Medical Center, thanked the Defense subcommittee members for their support.
"I recognize that we are in somewhat unchartered waters, as we say in the Navy, as we look for new footing and a new landscape to find a governance structure that will accommodate these efficiencies and these transparencies and at the same time preserve the amazing combat war-fighter support that has been evident over this last decade, resulting in the greatest survival rates and the lowest disease non-battle injury rate in military history," Nathan said.
C.W. Bill Young (R-Fla.), chairman of the Defense subcommittee, told the surgeons general that he wanted to do an overall governance hearing, and then do a separate hearing for the merger of Walter Reed and Bethesda.
But he said he realized that this wasn't feasible because it all works together.
"We need to look at a number of options as to how we should proceed at this merged facility," Young said. "This is the most complex, largest merger of medical facilities anywhere and I can understand that because Walter Reed, in my opinion, was a world-class medical facility that took great care of our Soldiers.
"I think I witnessed miracles at Bethesda and at Walter Reed -- people who lived when I don't think anybody believed they would," Young said.
The Joint Task Force, National Capital Region Medical has oversight over Walter Reed National Military Medical Center in Bethesda and the new Fort Belvoir Community Hospital in Virginia, testified its commander, Vice Adm. John M. Mateczun.
Young questioned the size of the task force, citing 119 full-time members and additional contractors, but he added that "the Army and Navy commanders are really working things out fairly well."