PTSD…And Cash

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Army illustration/Mindy Campbell, Douglas DeMaio

The Army removed Colonel Dallas Homas, commander of Madigan Army Medical Center in Washington state, on Tuesday from his post because of an investigation into whether post-traumatic stress disorder (PTSD) diagnoses were reversed solely to reduce medical costs on his watch.

An ombudsman’s investigation last fall shows that officials from Madigan’s forensic psychiatry team — a group created in October 2008 to review the behavioral health diagnoses of soldiers being considered for medical retirement due to PTSD — encouraged behavioral health professionals to consider the long-term costs to taxpayers of a PTSD diagnosis.  A memo from that probe quoted a member of the forensic psychiatric team lecturing about how a PTSD diagnosis could result in a soldier earning $1.5 million in benefits over a lifetime, and how the hospital should be good stewards of taxpayer dollars. What’s going on here?

While I agree that every government institution should be a good steward of taxpayer dollars, driving such alleged cost-cutting initiatives down to the very physicians that are charged with taking care of our nation’s service members is unfair — to both the soldier and the physician. It’s also unwise.  How can anyone expect a doctor to serve two conflicting goals?

Medical professionals’ primary responsibility should be the well-being of their patients, not the government’s bottom line.  Just like the separation of church and state, there should be a bright line between physician care and financial mandates.  The focus of medical professionals should be providing the best possible care to their patients. Period.

Gutting services like disability payments, which are meant to take care of a veteran for the rest of his/her life, is a disservice not only to that particular service member, but also to the rest of society, whose responsibility it is to take care of its veterans.  Our disabled service members deserve better, as does our society.

While bearing in mind that the investigation remains open and therefore unfinished, it’s hard not to jump to conclusions here.  What’s certain is that this is going to be a PR nightmare for the Army. It echoes the incessant myth that haunts the VA suggesting that VA claims adjusters are given cash bonuses in direct proportion to the number of disability claims they deny.

Regardless of the facts at the end of the day, the real travesty here is how this story will undoubtedly add uncertainty to the fate of soldiers being medically discharged.  Service members quickly grow weary of telling their trauma stories to multiple layers of therapists, often to three or more counselors, before a final decision is made.  If at every stage of the process the service member is rightly questioning the ultimate motivations of the examiner, the process loses all credibility. Most critically, those who have served their country with distinction can get caught up in the insanity and be refused benefits they deserve.

Akin to a prosecutor’s ethics scandal that taints every case they ever argued, now the merit of every decision the forensic psychiatry team has ever made, be it to grant or to deny benefits, may be justly scrutinized.  The entire benefits system at Madigan could be overwhelmed with requests from veterans to have their benefits decision reviewed. The Army Surgeon General has reportedly contacted the families of 14 soldiers that lost disability pensions because their PTSD diagnoses were changed by the Madigan forensic psychiatry team.  It remains unknown how many additional diagnoses the team adjusted.

Senator Patty Murray (D-Wash.), who chairs the Senate Committee on Veterans Affairs, wants to get to the bottom of this case.  “The most important thing is that these service members and their families are provided with answers on why cost was a factor in the treatment they sought for the invisible wounds of war,” she said, “and that the Army takes the right steps to fix it.”