Army Surgeon General defends PTSD diagnostic method
April 3, 2012
By J.D. Leipold
WASHINGTON (Army News Service, March 30, 2012) -- The Army's surgeon general last week told Senators that all military services use a standard method to diagnose post-traumatic stress disorder.
Lt. Gen. Patricia D. Horoho testified March 28 at a Senate Appropriations Committee, Defense subcommittee hearing on military health and said military hospitals use the same method as the civilian sector to diagnose post-traumatic stress disorder, known as PTSD.
"It's the one standard that's out in the civilian sector as well as the military. It's the best standard out there for diagnosing PTSD," she said.
Sen. Patty Murray of Washington state said she was aware there were Soldiers at Madigan Army Medical Center at Joint Base Lewis-McChord, Wash., who were diagnosed with PTSD but then a forensics psychiatry team changed the diagnosis. She asked if Soldiers elsewhere had been misdiagnosed.
Horoho said the Army had just completed its own investigation at Madigan, which is under review by Army attorneys. She said the Deputy Surgeon General's Office under Maj. Gen. Richard A. Stone had initiated the investigation to look into the forensics used in the evaluation of PTSD.
"Then there's another investigation that was launched by the Western Region Medical Command to look into command climate and Madigan Army Medical Center," she said. "I initiated an IG assessment, not an investigation, but an assessment that looked at every single one of our military treatment facilities and the provision of care to see whether we had this practice of using forensic psychiatry or psychology in the medical evaluation process."
Horoho said that since becoming surgeon general, she has focused on care for PTSD, brain injuries and behavioral health.
"Since I took over as surgeon general on the 5th of December, what I've done so far is we're pulling behavioral health up to the headquarters level so that we have one standard of care across all of Army Medicine, and we're able then to shift that capability where the demand is," she said.
She said a Behavioral Health Service Line is being established and officials explained this will standardize best practices in behavioral health Army-wide to provide state-of-the-art support and optimize care.
The surgeon general said that her office is pulling behavioral health up to the headquarters level to ensure one standard of care across all of Army medicine.
"I've got a team that has developed clinical practice guidelines for the use of forensics as well as clinical practice guidelines for the implementation of behavioral health capability across Army medicine," she said. She added that an Army-wide standard for the Integrated Disability Evaluation Process would be sent out in April.
Horoho told the subcommittee the Army was really looking hard at how to ensure it focuses on the "mind, body, spirit and soul" of not only Soldiers, but of their family members as well.
"We've learned over this 10-year conflict that we just can't treat our warriors, that we absolutely have to treat the family, because it impacts on both. So we've started with the platform of having patient centers, medical homes, of really focusing on continuity of care and wellness in managing their care," she said. "We've also stood up community-based clinics and pushed health care to the areas where patients live," Horoho said.
Horoho also addressed the pain management task force that was stood up two years ago to look into alternatives to the use of pain medications after officials determined more than 35 percent of wounded Soldiers were addicted. Former Special Operations Command deputy and now retired Lt. Gen. David Fridovich in December 2010 admitted publicly that he'd been a narcotics addict for five years as the result of the pain caused by a shattered vertebra.
"I do believe we're on the right track," Horoho said. "We've seen a decrease in the reliance of polypharmacy -- multiple drugs, and many of our warriors have used yoga, acupressure, acupuncture, mindfulness and sleep management vice narcotic pain medicine we're seeing better patient outcomes."
Chair of the committee Sen. Daniel K. Inouye (Hawaii) asked Horoho and her service counterparts if the funding for health care was adequate, to which each surgeon general replied "absolutely."
Horoho voiced a concern that the Army needs continued funding for scholarship programs that "allow us to bring in the right talents, physicians, dentists, nurses and social workers, to care for our warriors in the future."
She added that it was also critical to ensure the Army has the continued funding for care of the nearly 10,000 Soldiers who are in Warrior Transition Units.
"As we draw down as an Army, we will continue to have large numbers of patients who we will need to care for their psychological wounds as well as physical injuries that have occurred over the last 10 years," she said.
Inouye said it was assumed there would be a fiscal year 2013 savings of $423 million based upon new Tricare enrollment fees and increases in co-payments for prescription drugs. He noted that the House of Representatives had announced "this will not pass muster in the House, it will not see the light of day - what are your thoughts?"
"Senior leaders who are retired have been very supportive of this, in wanting to ensure that our military benefit continues, and so their feedback has been in support of the fee increases," Horoho said. "I think what's really at stake is the need for all of us to be critically looking at all our programs and processes, and figure out where we have redundancies so we can look at saving dollars in other areas to offset some of the rising costs of health care."