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Forensic approach dropped from disability reviews

Strategic Communication and Executive Services Western Regional Medical Command

Published: 04:44PM August 8th, 2012
Forensic approach dropped from disability reviews

Scott Hansen/Northwest Guardian

Maj. Gen. Richard Thomas, commanding general, Western Regional Medical Command and chief of the Army Medical Corps, left, Lt. Gen. Robert Brown, commanding ceneral I Corps JBLM, middle, and Col. Dallas Homas, commander of Madigan Army Medical Center, conduct a joint press conference Aug. 2 to address questions about the ArmyÕs recent changes to how PTSD cases are processed.

Last week, senior leaders from I Corps, the Western Regional Medical Command and Madigan Army Medical Center participated in a press conference to address questions regarding the Army’s recent announcement about changes to how PTSD cases are processed, the reinstatement of Col. Dallas Homas as commander of Madigan, and the way ahead for the base’s medical community.

Lieutenant General Robert B. Brown, commanding general, I Corps, opened the Aug. 2 press session by reiterating that his top priority as the senior mission commander is to ensure service members and families are getting access to the care they need, and reduce the stigma associated with seeking behavioral health care.

“It is critical as leaders that we reduce the stigma of seeking behavioral health care,” Brown said. “There is a stigma out there and it’s in our society and the Army. I’ve seen a big improvement over the years, but we still need to get after this one.”

The Army wants Soldiers to know they can trust their leaders when they seek help for any issue, he said, but especially behavioral health issues.

“As a commander, your No. 1 concern is always taking care of Soldiers, Airmen and Families — a promise we take very seriously,” Brown said. “A key part of that is providing access to world-class medical care. That’s why we do what we do, because we know we’re going to get world-class health care.”

Discontinuing forensic techniques at Madigan formed an important part of the disability evaluation process discussion, a change resulting from a comprehensive review of Madigan’s disability evaluation system as directed by Secretary of the Army John McHugh, and Army Chief of Staff Gen. Ray Odierno, following concerns that some Soldiers diagnosed with PTSD had that finding changed during a subsequent evaluation at Madigan.

Earlier this year, approximately 425 Soldiers who had their initial PTSD diagnoses changed, received notification letters inviting them to be re-evaluated at Madigan or another military treatment facility. More than half of those individuals have gone through the re-evaluation process.

Serving a beneficiary population exceeding 100,000, Madigan is one of the premier hospitals and institutions for higher learning in medicine in the DOD inventory. The medical center is an esteeemed educational facility with 34 graduate medical education programs, equipped with many resident capabilities not available at other military treatment facilities. This introduced variability in how medical evaluation board cases were evaluated throughout the Army Medical Command, said Maj. Gen. Richard Thomas, commanding general, Western Regional Medical Command and chief of the Army Medical Corps.

“What we found is that while patients were able to see forensic psychiatrists here (at Madigan), they didn’t always have access to that service at the smaller installations,” Thomas said. “So it introduced some variance in how Soldiers were evaluated for their medical evaluation boards.”

In the Army’s July 31 press release, General Lloyd Austin, Army vice chief of staff, emphasized that Madigan officials acted in accordance with the standard of practice for civilian disability evaluations, but added that while the evaluation might be fair and appropriate, it’s not optimal for the unique cases that the Army diagnoses and reviews.

Thomas told reporters that the Army Medical Command is a learning institution, and in learning how to do things better, it discovered that although a valuable tool, forensic psychiatry was being used to evaluate the regular types of cases for disability evaluations, which is really appropriately done by the general behavioral health practitioner.

“Forensic psychiatry is a valuable tool. They do insanity hearings, disability evaluations, and a lot of other specialized areas of focus for us,” Thomas said, who used a surgical instrument as an analogy to forensic psychiatry.

“You don’t want to use a surgical instrument in all cases, because it’s not necessary,” he said. “We have to be consistent in our application. As Army doctors, there’s one thing we must do to take care of Soldiers — we have to make sure it’s fair and equitable, and we’re taking care of them. That’s why we’re here.”

During the last 10 years, Army Medicine has made tremendous strides in pain management and traumatic brain injuries, which have significantly improved the health of the force, their family members and retirees.

During the press conference, Thomas said that PTSD and the emerging science behind diagnosing and treatment of those injuries is what Army Medicine is all about.

“We’re advancing the science and our capabilities of making sure our Soldiers get the best medical care possible, especially when it comes to those invisible wounds, such as post-traumatic stress. Eighty percent of Soldiers who have a diagnosis of PTSD are not in a hospital; they’re working in our offices and in our formations,” Thomas said. “These are Soldiers who are working every day and doing a good job.”

During the Army’s three-month review, Madigan’s commander, Col. Dallas Homas, was administratively removed from his command position, as a routine part of the investigational process. However, the press release announced that Homas had been reinstated in command.

“Colonel Homas was temporarily suspended so that we could do a thorough investigation,” Brown said. “There was nothing that he did wrong. He’s the right leader and we’re very excited to have Dallas back in command of Madigan.” Thomas echoed Brown’s sentiments, “This is a great day for Army Medicine. It’s also a great day for Soldiers and Dallas Homas and his family. He has my complete faith and confidence and he’s the right man to take us forward and to the next level.”

Homas said that he is honored and humbled to return to command at Madigan, and is very excited to be back taking care of Soldiers, Airmen, families and retirees. He also thanked Col. Michael Heimall for his leadership as acting commander during the last five months.

“Colonel Mike Heimall did a great job in my absence and the team is ready and poised to move forward,” Homas said. “My pledge to all of you is that I will work tirelessly to ensure that Madigan is delivering the finest care that we are capable of delivering.”