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Army Looks to Ensure Consistent PTSD Diagnosis

By Rob McIlvaine
Army News Service

WASHINGTON, Feb. 9, 2012 - 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.

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