ARMY CLAIMS THEY ARE NOT DELIBERATELY

MISDIAGNOSING PTSD -- Even though soldier taped

Army doctor telling of pressure not to diagnose PTSD.

This is part two in a series.  The first part is here...
http://www.vawatchdog.org/09/nf09/nfapr09/nf040909-2.htm

Today's story here... http://www.salon.com/n
ews/special/coming_home/2009/04/09/ptsd/

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Tale of the secret Army tape

After a soldier taped a psychologist saying he'd been pressured not to diagnose PTSD, the Army launched an investigation. Read the details of how the Army declared itself innocent.

By Mark Benjamin and Michael de Yoanna

In a story published yesterday, Salon reported on a surreptitious tape recording of an Army psychologist telling a patient last June that he had been pressured not to diagnose soldiers as having post-traumatic stress disorder. The soldier, whom Salon dubbed Sgt. X to protect his identity, recorded the Fort Carson, Colo., psychologist, Douglas McNinch, twice describing pressure to label soldiers with "anxiety disorder" instead of PTSD. The diagnosis of anxiety disorder could result in improper treatment and lower disability payments if the Army discharges a soldier from the military. "It's not fair," McNinch said on the tape. "I think it's a horrible way to treat soldiers."

But neither the U.S. Senate nor the Army apparently agrees with McNinch's assessment of the treatment that returning soldiers are receiving. By early July, news of the tape recording had made its way to both the Senate Armed Services Committee and the upper reaches of the Pentagon. Despite prodding from Sen. Kit Bond, the Senate Armed Services Committee declined to investigate the tape's implications. A veterans' advocacy group then had a combative July 14 meeting at the Pentagon with the Army's vice chief of staff, at which the vice chief was reportedly dismissive. Two weeks later, the Army issued the results of an internal investigation and absolved itself of any wrongdoing.

Today's article describes the contentious meeting at the Pentagon, how the tape got to the Senate and the secretary of the Army in the first place, and which Senate aide determined it was not worth investigating. It also details how the individuals assigned by the Army to investigate the tape were connected both to the individual who had allegedly pressured McNinch not to diagnose soldiers as having PTSD and to earlier questionable in-house investigations of Army medical care.

Salon dubbed the soldier who made the tape "Sgt. X" because he is still in the process of being put out of the Army and he fears that if he is identified, it might affect the process meant to gauge his disability. He made the tape during a visit to McNinch's office in June so he could remember what the psychologist told him -- a traumatic brain injury suffered in Iraq has affected his short-term memory. When she heard what McNinch said about PTSD diagnoses on the tape, Sgt. X's wife handed the tape over to Georg-Andreas Pogany, an investigator with a group called the National Veterans Legal Services Program. The NVLSP is a group of lawyers who take on difficult medical entitlement cases for soldiers, free of charge.

Pogany told Salon that he found the tape shocking. On July 2, he handed it over to the Fort Carson's post commander, Maj. Gen. Mark Graham.

In a telephone interview, Graham refused to name Pogany as the man who gave him the tape, but confirmed that he had received it and that it set off alarms. "Anytime anyone brings me information regarding the health and welfare of our soldiers, I take it very seriously, as I did this," Graham said, adding that he has not yet seen the results of Army's internal investigation.

After receiving the tape, Graham forwarded it up the Army chain of command, where it ultimately wound up in the hands of Gen. Richard Cody, then the Army's vice chief of staff.

At about this same time, Sen. Kit Bond, R-Mo., a longtime champion of veterans' issues, also became aware of the tape. Bond's staff attempted to prod the Senate Armed Services Committee into an independent investigation of the implications of the tape, but were ignored.

Salon has learned that Gerald Leeling, a majority counsel to the Senate Armed Services Committee, was informed of the tape and its contents. Leeling reports to Sen. Carl Levin, D-Mich., the chairman of the committee. However, there is no evidence that Levin's committee ever launched an investigation or did anything to check whether the Army's investigation was thorough and unbiased.

Leeling did not respond to a request for an interview. A committee spokeswoman released a statement, essentially deferring to the official Army line: "The Army conducted an investigation into whether mental health providers at Fort Carson were being pressured by the Command to change diagnoses from PTSD to Anxiety Disorder. The investigation found that that there was no command pressure to influence diagnoses."

While the Senate was declining to act last July, there was building pressure within the Army to do something about the tape. (Heat would come from the outside as well -- though the timing of the contact is unclear, a spokeswoman for Sen. Bond confirms that the senator personally contacted Army Secretary Pete Geren to express alarm about the implications of the recording.)

On July 10, the Army initiated an investigation. In addition, Gen. Cody, the Army's second-most-powerful officer, contacted the NVLSP to arrange a meeting at the Pentagon.

The Pentagon's sprawling parking lot shimmered with heat as Bart Stichman, a co-executive director for the NVLSP, arrived for a face-to-face meeting with Cody last July 14, flanked by fellow co-executive director Ron Abrams and investigator Andreas Pogany.

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It was already halfway through a year that would mark the highest suicide rate in Army history. And Stichman, Abrams and Pogany were aware of the Army's apparent pattern of misdiagnosing troops, often leaving them without access to the best care for their war-related mental injuries and possibly no care at all. "We have seen other cases like this, where diagnoses are changing over a short time frame," Stichman's investigator, Pogany, said in a recent telephone interview. "We are seeing what is described on the tape."

The three were hopeful, however. If anybody had the power to recognize the real problems and start fixing things, it would be Cody.

The three entered a conference room deep inside the Pentagon to meet with Cody and an A-list of Army power players: Lt. Gen. David Huntoon, director of the Army staff; Maj. Gen. Bernard Champoux, chief legislative liaison; Brig. Gen. Gary Cheek, director of the Army's wounded warrior transition program; Cheek's chief of staff, Col. Jimmie Keenan; Lt. Gen. Scott Black, the Army's top lawyer; Brig. Gen. Jeffrey Phillips, deputy chief of public affairs; and Col. James Polo, assistant deputy for health policy.

Stichman and his colleagues felt somewhat optimistic simply because Cody was the one who had called the meeting. But in person, Cody set a cold, browbeating tone early. "Are we tape-recording this meeting?" Cody joked icily. "Do you advise your clients to tape-record meetings?" To Stichman, it seemed Cody was trying to imply that Sgt. X and his tape were part of a setup and that the NVLSP was involved.

Stichman started with a discussion of some of the problems identified by his organization. "We were going to go over what the problems we saw were and what could be done about it," Stichman recalled to Salon. He hoped the tape might spur the Army to launch an independent probe to see whether Army doctors elsewhere also felt pressured to issue misdiagnoses for combat veterans.

But when the discussion came to the subject of the tape, Cody cut Stichman off. The tape should stay private, Cody argued, citing a "moral obligation to protect this soldier." Cody then suggested that the psychologist, McNinch, might have felt "pressure" to make timely disability payment decisions for soldiers, rather than pressure to misdiagnose soldiers, although on the tape the psychologist clearly stated he was pressured "to not diagnose PTSD and diagnose anxiety disorder."

Stichman was stunned. "Look, we can understand English," Stichman said to Cody. "I don't know if you heard the same thing we heard, but the guy clearly says he's pressured not to give diagnoses of PTSD."

Cody seemed unconcerned, Stichman recalled. "To our surprise, when we came into that meeting, he no longer seemed to be disturbed by that tape. He said there was going to be an investigation, but that he didn't see anything wrong and felt that the Army is doing well by soldiers. It was clear that they weren't taking it seriously. It was very disheartening. I was in disbelief."



Stichman's NVLSP counterpart, Abrams, recalled that Cody avoided talking about the specifics of the tape or discussing how a thorough investigation of the tape might ultimately improve Army mental health care. Instead, Abrams remembered Cody describing Army initiatives to improve mental health care, including efforts to deal proactively with suicide risk through "chain teaching" -- commanders supporting commanders to get soldiers help. In other words, Abrams said, Cody seemed reluctant to explore whether the tape was a representation of specific abuse and possibly wider problems. Instead, Cody merely spoke in broad terms about how the Army's existing healthcare system operates. Cody's tone, Abrams said, was "insulting."

Cody told Stichman and his associates that an internal investigation of the tape would be conducted. To Stichman's surprise, Cody then suggested what the not-yet-completed investigation would reveal.

Cody denied that the Army was pressuring doctors not to diagnose PTSD in soldiers. "There is no one in leadership telling doctors to do this," stated Cody. "This is not Army policy." Cody called the evidence on the tape "anecdotal."

After the meeting was concluded, Stichman never heard from Cody again. None of the other officers in the room contacted Stichman, either. Just three weeks after the meeting, Cody retired from the Army. Last September, the former general joined L-3 Communications, a defense contractor, as corporate vice president. Salon described this article to an L-3 spokeswoman and requested an interview with Cody, but was told Cody was "not interested" in talking. "He has retired and moved on," the spokeswoman said.

On July 28, a week before Cody's retirement, the Army completed its internal investigation, an informal review known as an "AR 15-6."

Salon requested a copy of the investigation in November through the Freedom of Information Act. The Army finally produced a copy in March, after it became apparent that Salon had obtained the recording and planned to write about it. Large portions of the report are blacked out, including several entire pages of the "analysis of evidence" and the explanation of the conclusions. The Army even blacked out some references to "PTSD."

What is not blacked out is that the Army Medical Command, which investigated itself, determined that none of the medical workers under its watch did anything wrong. "This investigation," it states, "does not find that any level of [the Army Medical Command] staff and leadership have attempted to coerce or otherwise influence the outcome of clinical evaluations."

What also escaped the black pen was the name of the man who presided over the review: Brig. Gen. James Gilman, who commands Great Plains Regional Medical Command, which oversees several Army hospitals, including the one under scrutiny at Fort Carson. Gilman assigned Col. Bruce Crow, the clinical psychology consultant to the Army surgeon general, to supervise the actual investigation.

Almost the entire investigation consists of questionnaires handed out to a handful of healthcare providers. There is no interview of Sgt. X, the soldier who made the tape, or any review of his case.

The copy of the investigation ultimately obtained by Salon shows that the Army reached almost exactly those conclusions that Cody had predicted it would reach: "This investigation does not find that any level of [the Army Medical Command] staff and leadership have attempted to coerce or otherwise influence the outcome of clinical evaluations."

Yet the investigation found "potential systemic pressures" that could cause a misdiagnosis. Those pressures "may lead providers to avoid making a diagnosis of PTSD ... contrary to their clinical judgment." The Army says it fixed those problems last December by removing a requirement that soldiers produce "credible supporting evidence" that they faced trauma in war in order to receive benefits.

In addition to relying almost exclusively on questionnaires to a handful of Army healthcare officials and failing to interview Sgt. X or scrutinize his medical records, the Army also did not interview the NVLSP's Pogany, who has documented several cases that support what was said on Sgt. X's tape. And there is no evidence the Army went back to see how many soldiers might have been refused benefits to which they were entitled during the years since the nation began its wars in Iraq and Afghanistan.

Gilman, the general who ordered the Army's investigation, defended the Army's response to the tape. "We were very, very concerned about what we heard on the tape," he said in an interview. "We felt that an investigation was warranted and we moved out on that as expeditiously as we could." He also supported the idea of limiting the investigation mostly to questionnaires sent to healthcare providers. "The thing that concerned me was that internal to the hospital … somehow people were getting the word that people should use something other than good clinical practice and clinical judgment to assign diagnoses," Gilman said. To investigate that, he added, "you go talk to the people who are involved in those processes."

It appears, however, that investigators did not question the Army officer who Douglas McNinch said had pressured him not to diagnose PTSD. In an interview with Salon, McNinch said the pressure to misdiagnose soldiers came from the psychiatrist who used to head the Department of Behavioral Health at Fort Carson. "His name was Steve Knorr," McNinch said. When asked if he told Army investigators this information, McNinch responded, "Yes, I did." Though the extensive redaction makes it difficult to say for certain, there is no sign in the report that Knorr was contacted or interviewed by Army investigators.

McNinch also said he was afraid to talk. He himself suffers from medical issues and, as a civilian employee of the Army, is going through the process of getting government benefits. "I am going through a disability process right now," he said, "and quite frankly, I would not put it past the Army to, you know, fuck me over, to be blunt."

McNinch's naming of Knorr is particularly intriguing, given that Knorr's name has come up before in connection with internal investigations of possibly questionable Army medical care. In a 2007 article for the Nation, journalist Joshua Kors documented a shocking coverup of Army misdiagnoses. The Army was apparently diagnosing soldiers as having "personality disorders" instead of combat-related stress. Since "personality disorders" supposedly preexist military service, they cannot be attributed to combat, meaning veterans are potentially ineligible for proper benefits. Kors reported that Knorr conducted a review of cases on behalf of the Army's acting surgeon general and determined that no one in the Army had done anything wrong. Within a year, in response to the Nation article, the Government Accountability Office, the investigative arm of Congress, released a report questioning why 2,800 war veterans had been diagnosed as having "personality disorders."

Contacted by Salon, Knorr said, "I don't talk with media. Good day," and hung up.

Salon has learned that one of the officers conducting the investigation of the tape is a junior officer to Knorr at their shared Army post. Lt. Col. Kris Peterson, chief psychiatrist at Madigan Army Medical Center at Fort Lewis, Wash., assisted Col. Bruce Crow in the investigation of the tape. Knorr is now a health consultant at Madigan.

Crow, meanwhile, was also implicated in the "personality disorder" scandal. As Knorr was writing up his review back in 2007, the Army dispatched Crow to Congress to "set the record straight," as he told the House Committee on Veterans' Affairs on July 25, 2007. Crow said the Army would study soldiers dismissed with personality disorders but suggested the Army was doing nothing wrong. He said soldiers with a diagnosis of personality disorder only "feel" they have been wrongly separated from the Army. "I want to assure the Congress that the Army Medical Department's highest priority is caring for our warriors and their families," he told the panel.

In a statement to Salon, Col. Catherine Abbott, an Army spokeswoman, reiterated Gilman's defense of the Army's internal investigation of Sgt. X's tape. "They did do an investigation into it," said Abbott in a phone interview. "There was indeed no pressure and no coercion to make any diagnosis other than the correct ones,."

"This story," Abbott said, "is over and done with."

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posted by Larry Scott
Founder and Editor
VA Watchdog dot Org
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