The Army did not find a systemic bias against diagnosing post-traumatic stress disorder in a deep review of its psychiatric programs dating back to the start of the war in Afghanistan that was prompted by complaints about doctors at Madigan Army Medical Center.
In fact, the review of nearly 150,000 cases shows doctors were as likely to upgrade service members to PTSD from less serious, less expensive conditions as they were to downgrade them. At Madigan, patients charged that doctors were changing their PTSD diagnoses to save the Army money in mandatory disability benefits they would have received for certain behavioral health conditions.
Nonetheless, the Army in a dense, 57-page report concludes that inconsistent understanding of behavioral health resources and poor planning for surges in psychiatric needs continue to plague the service as the Afghanistan War comes to an end. It maps out comprehensive reforms to psychiatric programs, such as simplifying them and offering more resources to Reserve and National Guard soldiers in remote places.
“Perhaps the lesson best learned by the Army from this past decade of war is the importance of proactively preparing for and addressing behavioral health and (disability) concerns,” wrote Lt. Gen. David Perkins, who led the Army Behavioral Health Task Force.
The Army launched its behavioral health review last year in response to complaints about misdiagnoses of PTSD at Madigan Army Medical Center, where service members receiving medical retirements protested that doctors had “reversed” initial PTSD diagnoses to less serious conditions.
At the time, Madigan had a forensic psychiatry program that had the final say on behavioral health diagnoses. Its doctors sometimes changed diagnoses late in the process in such a way that confused service members or cost them disability benefits.
Perkins’ report does not shed any new light on what happened at the hospital, though it notes that doctors diagnosed 147 former Madigan patients with PTSD after the first complaints surfaced.
Sen. Patty Murray, D-Wash., pushed the Army to investigate Madigan and to expand its review across the service. She received a briefing on Perkins’ report this week from Army Secretary John McHugh, and called it a “good starting point to make real changes for our soldiers.”
Her remarks revealed a sense of frustration that the Army is still working out its psychiatric programs so late in the war.
“This isn’t an issue of not having the resources to make changes. Instead, it is simply a matter of problems that have been allowed to persist while far too many soldiers fell through the cracks. That is unacceptable,” she said in written remarks.
Perkins’ report produces 24 findings and 47 recommendations to improve psychiatric care for service members and their families. They include:
- Providing more resources to the Office of Soldier Counsel, a group of attorneys who advocate for soldiers receiving medical retirements.
- Streamlining health records so Army and Department of Veterans Affairs doctors can access them from a soldier’s enlistment through his retirement. The Defense Department has been working on this project since 2009, and it likely will not be complete for several more years.
- Requiring every Army post to designate a director of psychological health to counsel commanders on behavioral health programs. As is, Army commanders have trouble understanding myriad support services that sometimes appear to duplicate each other. The report further recommends that each state should create a similar office for National Guard and Reserve soldiers.
- Expanding “telehealth” resources so expert doctors can communicate with Reserve and National Guard soldiers in remote areas.
- Steering more resources services that support families of soldiers receiving medical retirements because relatives often care for loved ones with psychological or physical wounds of war.
- Coordinating medical retirement programs across the Army. Today, different military hospitals often use different processes instead of conforming to one standard.
Army doctors reviewed 146,000 diagnoses for soldiers who received medical retirements since October 2001. It found about 6,400 behavioral health diagnoses were changed late in the medical retirement process.
The review showed that doctors were about as likely to change a diagnosis to PTSD as they were to adjust from PTSD to a less serious condition, such as anxiety disorder.
Two Army hospitals had a greater degree of diagnostic variance from the overall trend. The report does not identify the hospitals. One of them presumably was Madigan.