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Wednesday, Feb. 15, 2012

Army seeks consistent PTSD diagnosis

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WASHINGTON — 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 Wednesday 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 Lt. Gen. Horoho, who had served as commanding officer at Madigan Army Medical Center in Tacoma, Wash., 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 canceled … 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 undue command influence in closing it, and if the patients were negatively impacted.

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.

Capabilities of the Intensive Outpatient Center have actually not gone away, Horoho said. They have been merged into other behavioral health programs at Madigan.

Horoho said she has asked 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.

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.

“We need to look at a number of options as to how we should proceed at this merged facility,” said C.W. Bill Young (R-Fla.), chairman of the Defense subcommittee, who questioned the size of the task force, citing 119 full-time members and additional contractors. “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.”

The Joint Task Force, National Capital Region Medical, has oversight of Walter Reed National Military Medical Center in Bethesda and the new Fort Belvoir Community Hospital.

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