Thursday, March 22, 2012

'Cost-savings' on the backs of veterans, service members and their loved ones

Senator Patty Murray is one of Washington state's two US Senators. She is also Chair of the Senate Veterans Affairs Committee. In her home state, there has been a problem with some veterans and service members diagnosed with PTSD being re-diagnosed at Madigan Army Medical Center and suddenly not having PTSD -- it's apparently a 24-hour kind of condition -- and these re-diagnoses came up after it's been documented that administration at Madigan Army Medical Center was discussing the financial costs PTSD had on the government. Yesterday morning, Hal Bernton (Seattle Times) reported on the latest. Of the re-diagnosed as not having PTSD who have been examined (this would be after they were told they didn't have it), over 40% have been found to in fact have PTSD.

Meaning? That the original diagnoses was correct. So why did it change?

Yesterday, Senator Murray questioned Army Secretary John McHugh about this issue during a Defense Appropriations Subcommittee hearing.

Senator Patty Murray: Secretary McHugh, as you and I have discussed, Joint Base Lewis McChord in my home state is facing some very real questions on the way they have diagnosed PTSD and the invisible wounds of war. And today, unfortunately, we are seeing more information on the extent of those problems. Mr. Secretary, this is a copy of today's Seattle Times. In it is an article based on the most recent review of the Forensic Psychiatry Department at JBLM which -- as you know -- is under investigation for taking the cost of mental health care into account in their decisions. And what this article shows is that since that unit was stood up in 2007 over 40% of those service members who walked in the door with a PTSD diagnosis had their diagnosis changed to something else or overturned altogether. What is says is that over 4 in 10 of our service members -- many who were already being treated for PTSD -- and were due the benefits and care that comes with that diagnoses -- had it taken away by that unit. And that they were then sent back into the force or into their own local communities. Now, in light of all the tragedies we have seen that stem from the untreated, invisible wounds of war -- I'm sure that you would agree that this is very concerning. Not only is it damaging for these soldiers, but it also furthers the stigma for others that are deciding whether to seek help today. So in light of all the other issues you and I have had a chance to talk to this generally but I wanted to ask you specifically today, why was this highly controversial unit set up originally at Joint Base Lewis McChord and whose decision was it to do that?

Secretary John McHugh : Do you mean the forensic department itself?

Senator Patty Murray : Correct.

Secretary John McHugh : Well for every base where you demobilize soldiers it is practice to have that kind of capacity. The concern, as you noted, Senator, is that at least statistically -- and the numbers are changing every moment, they've changed since that newspaper went to print --

Senator Patty Murray: Do you have the most recent numbers?

Secretary John McHugh: I don't have them exactly but --

[cross talk]

Senator Patty Murray: But it is over 40%?

Secretary John McHugh: -- cases of re-evaluation is some what over 300 now.

Senator Patty Murray: But it is over 40%?

Secretary John McHugh: I haven't done the exact math but I think that's a pretty accurate figure. So-so the question for us is why in this one unit were those kinds of re-evaluations and change in diagnoses achieved? It's not totally unheard of that a psychiatric or mental health condition will change. So I don't want to say all of those diagnoses and changes were inappropriate but clearly when you have those kind of data, we want to make sure that everything is appropriate. And, as you and I have discussed, to the Army Surgeon General's credit, [Lt] General Patti Horoho, she has immediately stepped forward has-has asked and has had that particular unit step down and has conducted a wholesale re-examination that has begun with 14 soldiers and will periodically, methodically go through all them to make sure that the changes were not in fact inappropriate.

Senator Patty Murray: Do you know who made the original decision to step up that unit?

Secretary John McHugh: To actually form it?

Senator Patty Murray: Yes.

Secretary John McHugh: I-I couldn't tell you the officer's name.

Senator Patty Murray: And can you tell me is this an isolated incident or are there other Army medical centers that are changing --

Secretary John McHugh: Well --

Senator Patty Murray: -- PTSD diagnoses --

Secretary John McHugh: That --

Senator Patty Murray: -- at this rate?

Secretary John McHugh: I'm sorry. That's what we have to be sure of. The Surgeon General has asked the Inspector General of the Army to go and examine all of the similar facilities and locations. To this point, we don't see any evidence that of this being systemic but as you and I again -- you and I have discussed, we want to make sure that where this was inappropriate, it was an isolated case and where it was not, we address it as holistically as we're trying to address it.

Senator Patty Murray: Okay, have you examined similar statistics for all the other installations?

Secretary John McHugh: All re-evaluations are being looked at and re-evaluated.

Senator Patty Murray: Okay, so that is being done? Can you provide us with that information?

Secretary John McHugh: We'll certainly keep you up to date on that.

Senator Patty Murray: Well, as you know, the review by that forensic psychiatry at Madigan was a change from the standard disability process used across the military. The integrity of the disability evaluation system depends on each and every service member being subject to the same process. Across the Army, what will be done to improve the oversight of the disability evaluation system to make sure that the same process is being applied system wide?

Secretary John McHugh: Well as I said, the Inspector General along with the Surgeon General were examining the application of all diagnostic procedures. You noted correctly, we have a very standardized system. It's a system that is utilized really in the VA evaluations, really in civilian evaluations [. . .]

Please note, the above is from Wally's notes.

Murray is pointing out -- and McHugh is agreeing -- that the diagnostic test is a standard one. It is standard, meaning the same diagnosis should be arrived at for Service Member X whether Service Member X is seeing doctors at a Florida Army facility or a Washington one, a California one or a Rhode Island one. That's the point of standardization.

Which is why the fact that 40% (or even 5%) of the re-diagnosed as not having PTSD have been found to have PTSD.

This doesn't just happen. And there's no answer as to why this happened, no answer the Army or the administration wants to offer at this point.

Is it happening elsewhere? I know in California, it's being looked into currently.

But on another level, it's already happened.

This is a cost-cutting measure. And we've seen that before.

In yesterday's joint-hearing of the House and Senate Veterans Affairs Committees, Wounded Warrior Project's Dawn Halfaker raised the issue of the Caregivers and Veterans Omnibus Health Services Act of 2010. For those who've forgotten, the Congress wrote that legislation and passed it. They consulted with the VA while writing the legislation. They made very clear what the legislation was intended to do.

And yet this legislation meant to aid the loved ones taking care of a wounded veteran did not get implemented the way the Congress intended.

The Senate Veterans Affairs Committee's March 2nd hearing (covered in that day's snapshot and Kat covered it in "Burr promises VA 'one hell of a fight'" and Ava covered it at Trina's site with "The VA still can't get it together") called VA's out on its failure to implement the law that was writtne. Chair Patty Murray stated, "VA's plan on the caregivers issue was overdue and once submitted it hardly resembled the bill that unanimously cleared this Congress. Three weeks ago, my Committee staff requested information on how that plan was developed and to date no information has been provided. Rather than following the law, the administration set forth some overly stringent rules, bureaucratic hurdles, that would essentially deny help to caregivers."

In yesterday's hearing, a veterans advocacy group expressed concerns that despite VA's apologies, mea culpas and promises to follow the letter of the law, it was still not being followed.
How does that happen?

How does an agency take it upon themselves to 'save' the federal government money in violation of the law?

That's the question to ask about the failures on the caregivers law and about the service members and veterans with PTSD who found themselves suddenly PTSD-free in what appears to have been a 'cost saving' effort.

I don't mean this as an insult to government employees, but the reality is that it's very unlikely that Madigan administrators reached a decision like that all on their own. What was in it for them? It is much more likely that they were 'encouraged' from higher up to reach new diagnoses. Government employees are overworked -- part of the reason the claims process is backed up at VA -- and underpaid so the idea that most government employees are looking for ways to save money is ludicrous (and I don't blame them for that). If someone's trying to cut costs, it's usually someone who's been ordered to do so or who is getting to use a percent of the savings for another program. These things don't just happen.

The following community sites -- Chocolate City, On The Edge, -- updated last night and this morning:

There will be a second entry this morning. I'm waiting for a hearing to start and using the iPad. I'll have to stop to take notes during opening statements by the chairs and ranking members (joint-hearing) but after that I'll rush to finish the second entry.

Wally took notes on Senator Murray's exchange yesterday. I was not at the hearing, I was at the joint-hearing of the Veterans Affairs Committees during that time. Thank you to Wally. And this wasn't the planned entry for this morning -- I'd started two (that I may combine) but one of our community members e-mailed about the caregivers issue and she states she doesn't believe her mother is getting the benefits outlined and asked if we could hit on that again.

The e-mail address for this site is