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Originally published February 11, 2012 at 8:00 PM | Page modified February 11, 2012 at 9:52 PM

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Expanded review looking into why Madigan closed PTSD program

The Army surgeon general will look into the closure of an intensive treatment program for soldiers with PTSD at Madigan Army Medical Center as part of an investigation into psychiatric care and diagnosis at the military hospital.

Seattle Times staff reporter

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The Army surgeon general is looking into why Madigan Army Medical Center closed an intensive treatment program to help soldiers cope with post-traumatic-stress disorder (PTSD).

At a congressional hearing last Wednesday, the Army surgeon general, Lt. Gen. Patricia Horoho, said the review was included in an ongoing investigation of PTSD diagnoses at Madigan.

A PTSD rating can qualify a soldier leaving the Army for medical retirement, which brings considerable financial benefits. At the Wednesday hearing of a U.S. House Appropriations subcommittee, Rep. Norm Dicks, D-Bremerton, expressed concerns the intensive treatment program at Madigan ran into trouble because its staff diagnosed too many patients with PTSD.

Horoho, responding to Dicks, said the program has not gone away but was merged with other behavioral-health programs at Madigan, according to a transcript of the hearing.

"Having said that ... we are going to investigate to make sure that's actually true, and that we're providing the best possible care to our service members," Horoho testified.

Horoho said the review would examine the reason for the closure, whether there was undue command influence in closing it and if the demise of the program had "any negative impact on our patients," according to a transcript of the hearing.

Ombudsman memo

Dicks was informed that the program was closed in 2010. That was a year some 18,000 soldiers were returning from Iraq and Afghanistan to Joint Base Lewis-McChord, near Tacoma, where Madigan is located. Because of the pending investigation, Madigan officials declined to comment on the date the program stopped operating.

PTSD is a condition that results from experiencing a traumatic event, such as a battlefield casualty. Symptoms can include recurrent nightmares, flashbacks, irritability and feeling distant from other people. More than a dozen soldiers under consideration for medical retirement who believed their PTSD diagnosis was unfairly dropped by a forensic psychiatric team have had their cases reviewed by doctors at Walter Reed National Military Medical Center in Bethesda, Md.

The Army surgeon general also is investigating an ombudsman memo detailing remarks made by a member of the forensic psychiatric team at a September 2011 lecture.

During the lecture, the psychiatrist reportedly said that a soldier rated with PTSD could cost the Army $1.5 million over a lifetime, and that medical personnel needed to ensure they weren't just "rubber-stamping" PTSD diagnoses. While that investigation is under way, the leader of the forensic psychiatrist team has been suspended.

Classes and care

The PTSD intensive-treatment program was opened in 2003, according to Madigan officials.

The program provided patients with PTSD and other stress-related disorders up to four weeks of care, according to former staff members.

The program offered classes on stress management, group and individual counseling, yoga and other relaxation techniques. At the end of the day, patients would return to their barracks or homes. Later in the program's development, evening sessions were added for patients and spouses.

The Madigan program was similar to another intensive program that opened at Walter Reed, as the Army dedicated more resources to PTSD treatment.

Dicks, in an interview Friday, said he recently became aware of the closure of the Madigan PTSD program after being briefed by three sources who were involved with the treatment effort. And he wants to know why it was ended.

"Apparently, this was a really good program," Dicks said.

"We added a lot of money (in the federal budget) for PTSD treatment — big money. So it's never been about a lack of money," he said.

"Decrease redundancy"

Madigan officials said the services once offered by the intensive-treatment program have been "nested" within the medical center's Department of Behavioral Health.

They said the action was taken to "decrease redundancy" and improve health-care delivery, according to a statement released Friday.

"They (patients) absolutely deserve the best care possible," said Col. Dallas Homas, who has served as Madigan's commander since March 2011. "We welcome the opportunity to show investigators our procedures and practices and are committed to doing so with the utmost transparency and cooperation."

Two former staffers at the intensive outpatient-treatment program said current services are organized differently and do not provide equivalent treatment opportunities.

They said some Madigan PTSD patients who could benefit from intensive treatment are now referred off base to private programs or a PTSD program offered by the Department of Veterans Affairs, the former staffers said.

"Our motto was to create a safe place where people could make positive changes in their lives," said one former staffer, who spoke on the condition of anonymity. Jennifer Ferguson, a licensed counselor and therapist who worked at the program for about a year, said: "I really thought it was a great program, and I was furious when it closed."

The Army has launched extensive campaigns to persuade soldiers to overcome the stigma of seeking mental-health care and reach out if they have symptoms of PTSD.

Some medical professionals say PTSD is overdiagnosed.

At Madigan, the forensic psychiatric team that screened soldiers under consideration for possible medical retirement sometimes disagreed with PTSD diagnoses made by other health-care providers and changed some of those diagnoses. During the congressional hearing, Dicks, citing his sources, said the Madigan program ran into resistance from a member of the forensic psychiatric team because its patients were frequently diagnosed with PTSD.

In her testimony, Horoho said concerns about the Madigan intensive-treatment program came to her attention earlier last week.

She said she immediately expanded the Madigan investigation "so we can understand ... why it was actually closed."

Hal Bernton: 206-464-2581 or hbernton@seattletimes.com

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