The head of the Army’s Madigan Healthcare System, one of the largest military hospitals on the West Coast, has been temporarily relieved of command amid an investigation over whether the Army has avoided diagnosing returning combat soldiers with post-traumatic stress disorder to save money.
Col. Dallas Homas, a West Point graduate has been administratively removed from his position near Joint Base Lewis-McChord in Washington state, Army officials announced Monday. Homas had headed the busy medical center since March 2011.
Meanwhile, 14 soldiers who complained about their initial PTSD reviews were scheduled Tuesday to begin receiving the results of a new round of medical evaluations.
“While the evaluations are complete, this is one step in the process of ensuring our soldiers are receiving the most accurate clinical diagnoses to ensure optimal lifetime care,” Gen. Philip Volpe, chief of the Western Regional Medical Command, said in a statement.
The Army said it is investigating a wide range of complaints about the handling of PTSD claims at Lewis-McChord, which has one of the nation’s most active combat rotations to Iraq and Afghanistan. The base has been plagued, as have many bases with large numbers of multiple deployments, with soldiers suffering from nightmares, unpredictable rage, trouble reconnecting with their families and drug and alcohol abuse.
Some cases have been so severe that the Army has granted disability payments or even medical retirements, offering an elevated level of financial support to veterans who may be unable to hold down jobs.
The PTSD claims process has been riddled with controversy, with complaints on the one hand that some soldiers may be trying to get PTSD diagnoses to collect extra cash and to avoid going back to battle.
Some veterans advocates say the problem is just the opposite: Large numbers of soldiers are troubled by combat stress but are ostracized if they seek help and are sometimes denied legitimate benefits as a result of the military’s cost-cutting mentality.
The 14 soldiers who were the subject of the Army’s announcement on Monday complained about their initial PTSD evaluations at Madigan and were granted re-evaluations by doctors at Walter Reed National Military Medical Center. Additional reviews are likely in the coming weeks, Army officials said.
An Army ombudsman reported in November -- in a memo obtained by the Los Angeles Times -- that an Army physician at Madigan cautioned colleagues at a forensic psychiatry lecture that a PTSD diagnosis could cost the Army up to $1.5 million over the lifetime of a soldier.
"He stated at the rate we are going that the Army and the [Veterans Administration] will be broke," the ombudsman wrote. "He stated we have to be good stewards of taxpayers' dollars and we have to ensure we are not just 'rubber stamping' a soldier with the diagnosis of PTSD."
The room was "exceptionally quiet," the ombudsman wrote, adding that he was unsure whether it was because listeners were surprised at the $1.5 million estimate "or why we were talking about dollars in relation to our soldiers."
The existence of the memo was first reported by the Seattle Times. Since then, members of Congress have demanded to know how big a role cost-cutting is playing in decisions to provide treatment to stressed combat veterans.
Matt McAlvanah, who has investigated the issue for U.S. Sen. Patty Murray (D-Wash.), who chairs the Senate's veterans affairs committee, said the senator has received reports of "derogatory language" used by Madigan physicians about PTSD complaints.
"They were making comments about them not having PTSD, or sort of faking it. They used the word malingerers," McAlvanah said in an interview.
William Keppler, head of Madigan’s forensic psychiatric team, and another unnamed Army doctor have both been suspended from clinical duties pending the outcome of the new investigation, Army officials said.
“The Army has a long history here about being more concerned about money, frankly, than the soldiers,” U.S. Rep. Norm Dicks (D-Wash.) complained at a Feb. 8 subcommittee hearing in Washington, D.C. At the time, he raised pointed questions about Madigan's handling of PTSD complaints to the Army’s surgeon general, Lt. Gen. Patricia Horoho, a former Madigan commander.
“We’re not very interested in … characterizing the people who had been diagnosed with post-traumatic stress disorder as malingerers, which I find offensive,” the congressman said.
Horoho said the Army is investigating a practice, apparently unique to Joint Base Lewis-McChord, in which doctors who were unsure about a PTSD diagnosis referred their case files to the forensic psychiatry team, which decided on a diagnosis, without seeing the patient personally.
“They look at all sorts of administrative data and then they make that diagnosis. So that's why there wasn't a face-to-face encounter with it because it's actually not treatment. But that variance is not how we handle the disability process across all of Army medicine,” Horoho told the committee, adding that the process “was an unfair disadvantage to those service members, so we've suspended that.”
She said the Army is also investigating the decision to close a high-intensity stress treatment program at Madigan and fold it into another mental health program.
“You know, we can’t be getting rid of an Intensive Operations Program because it came up with too many diagnoses,” Dicks complained.
"I actually expanded the investigation to include the intensive outpatient center, so that we can understand why it … was actually closed; was there undue command influence in closing of it; has it had any negative impact on our patients,” Horoho said.
Jorge Gonzalez, head of a service members’ advocacy group near Lewis-McChord, said the investigation reflects a longstanding problem with combat veterans gaining access to mental health services.
“We have people coming in here, they have the symptoms of PTSD, every symptom you can think of, and then they get ‘anxiety disorder’ instead. And it’s definitely to save money,” said Gonzalez of the group G.I. Voice. “It’s definitely to bring down the numbers of PTSD, especially at this base, which has such a high number.”
Madigan has seen a substantial increase in soldiers seeking help with mental health issues, with “behavioral health” visits exceeding 100,000 a year since 2010.
Sharon Ayala, spokeswoman for the Army's Western Region Medical Command, said the Army has scheduled appointments through Thursday with the 14 soldiers whose diagnoses have been reevaluated.
"This is going to be a very thorough and compassionate notification process," she said in an interview. "We've allocated one hour for each soldier. We want to take our time in providing them with this information, and we want to be able to answer any questions that they have."