Madigan Review Finds 150 More With PTSD


A wide-ranging review of behavioral health diagnoses at Madigan Army Medical Center closed in September with Army doctors changing more than half of the cases they evaluated, giving 150 servicemembers new diagnoses of post-traumatic stress disorder.

The review followed complaints early this year about a team of Madigan forensic psychiatrists who sometimes adjusted PTSD diagnoses, removing the diagnosis for reasons patients could not understand.

All together, 431 servicemembers were given opportunities for new diagnoses, according to a summary released by Sen. Patty Murray. A total of 74 servicemembers declined to have their cases reviewed and 261 re-evaluations are considered complete. Dozens are still outstanding.

Of the completed local cases, 107 servicemembers received new diagnoses in addition to the 150 who learned they have PTSD. Anxiety was the most common new diagnosis other than PTSD.

The diagnoses are important both for assigning care to servicemembers leaving the military, and to make sure they receive appropriate disability payments and benefits. Servicemembers with PTSD receive at least a 50 percent disability rating, which enhances pensions indefinitely unless a they are handed a new diagnosis from the Department of Veterans Affairs.

"This was a process that righted a very critical wrong," Murray said in a statement. "Because of the scrutiny we put on the Madigan forensic process, there are now hundreds of servicemembers who have the proper diagnoses for the invisible wounds of war and are getting the care and treatment they deserve."

Sharon Ayala, spokeswoman for the Western Regional Army Medical Command, said the Army has closed the "fusion cell" of doctors from around the country that reviewed cases at Madigan. Their work ended in September as the number of patients seeking reevaluations declined; the unit had opened shop at Madigan in March.

She said former patients can still have their diagnoses reviewed by contacting Madigan. They would be referred to the hospital's Integrated Disability Evaluation System. They also can call an Army Medical Command hotline at 800-984-8523.

"The Western Regional Medical Command remains committed to ensuring that all soldiers who undergo, and have undergone, the medical evaluation board process receive the most clinically accurate information regarding their diagnosis," she said.

Complaints at Madigan took off last winter when an Army inspector general obtained PowerPoint slides that suggested doctors think of themselves as stewards of taxpayer dollars when they consider PTSD diagnoses. It noted that a PTSD diagnosis could cost $1.5 million over time.

The slides drew attention to a Madigan program once held up as the gold standard of behavioral health diagnoses.

The forensic psychiatrists were responsible for reviewing behavioral health diagnoses in medical retirements, and their scope had grown since their unit was created in 2007. No other Army hospital used forensic psychiatry as extensively as Madigan.

Scrutiny on the program led the Army in February to restrict duties for two doctors and Madigan commander Col. Dallas Homas. The Army in August restored Homas' full authority as commander. It announced it would no longer use forensic psychiatry as extensively in the medical retirement process at any Army hospital.

The News Tribune has filed a Freedom of Information Act request for the Army's investigations into the Madigan complaints. The Army has not released the reports.

Murray last month wrote a letter to Defense Secretary Leon Panetta asking for an update on a service-wide review of PTSD diagnoses that Panetta had requested following Murray's advocacy at Madigan. Panetta has not responded to her letter, she said Thursday.

The Rand Corp. in 2008 estimated that about 20 percent of combat veterans would show signs of post-traumatic stress or major depression. About one in seven Iraq and Afghanistan veterans has sought treatment for PTSD at VA hospitals.

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