U.S. Army Looks to Ensure Consistent PTSD Diagnosis

WASHINGTON — The Army is inves­ti­gat­ing how post-trau­mat­ic stress dis­or­der is diag­nosed to ensure con­sis­ten­cy at all hos­pi­tals, the service’s sur­geon gen­er­al told Con­gress yes­ter­day.

Army Sur­geon Gen­er­al Lt. Gen. Patri­cia D. Horo­ho and the sur­geons gen­er­al from the Air Force and Navy tes­ti­fied at a hear­ing of the House Appro­pri­a­tions Committee’s defense sub­com­mit­tee.

Hon­cho addressed con­cerns over clo­sure of the inten­sive out­pa­tient cen­ter at Madi­gan Army Med­ical Cen­ter on Joint Base Lewis-McChord, Wash., report­ed­ly because the staff con­clud­ed too often that patents suf­fered from PTSD. She said she has launched an inves­ti­ga­tion to look into the vari­ance of behav­ioral health diag­noses at Madi­gan, and to inves­ti­gate why the inten­sive out­pa­tient cen­ter was closed, whether undo com­mand influ­ence con­tributed to the clo­sure, and whether patients were neg­a­tive­ly affect­ed.

A foren­sic psy­chi­a­trist there who screened patients for PTSD and alleged­ly made inap­pro­pri­ate remarks was removed admin­is­tra­tive­ly from clin­i­cal duties until the inves­ti­ga­tion is fin­ished, Horo­ho said.

The center’s capa­bil­i­ties have not gone away, Horo­ho said, explain­ing that 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 said. She denied that the Army is press­ing med­ical per­son­nel to ensure sol­diers return to duty.

“Absolute­ly, the Army is not putting pres­sure on any of our clin­i­cians,” she said.

Horo­ho said she has asked the Army’s inspec­tor gen­er­al to eval­u­ate and inves­ti­gate the sit­u­a­tion at Madi­gan, not­ing a vari­ance there that involved patients going through the Inte­gra­tive Dis­abil­i­ty Eval­u­a­tion Sys­tem who had their records screened with­out face-to-face diag­no­sis.

When the dis­abil­i­ty eval­u­a­tor was unsure of whether the patient suf­fered from PTSD, she explained, he would refer the case to foren­sic psy­chi­a­try, and the diag­no­sis would then be made using admin­is­tra­tive data with­out a patient encounter.

That’s not the way PTSD diag­noses are made across Army med­i­cine, Horo­cho said, and she wants to ensure no Madi­gan patients were put at a dis­ad­van­tage.

“Our com­mit­ment,” she told the sub­com­mit­tee, “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 recent merg­er of the for­mer Wal­ter Reed Army Med­ical Cen­ter and the Nation­al Naval Med­ical Cen­ter in Bethes­da, Md., was anoth­er top­ic at the hear­ing.

Navy Sur­geon Gen­er­al Vice Adm. (Dr.) Matthew L. Nathan, who com­mand­ed the for­mer Navy facil­i­ty at Bethes­da and then the con­sol­i­dat­ed Wal­ter Reed Nation­al Mil­i­tary Med­ical Cen­ter, thanked the sub­com­mit­tee mem­bers for their sup­port and pledged con­tin­ued high-qual­i­ty care as bud­get con­straints loom.

“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 warfight­er sup­port that has been evi­dent over this last decade, result­ing in the great­est sur­vival rates and the low­est dis­ease non­bat­tle injury rate in mil­i­tary his­to­ry,” Nathan said.

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)