A former psychologist at the Southeast Louisiana Veterans Healthcare System, or the VA hospital that serves New Orleans, has blown the whistle on a pattern of severe underdiagnosis of Traumatic Brain Injury (TBI) between 2009 and 2019. Dr. Frederic Sautter, the head of the family mental health program at the hospital, retired in October and spoke to CBS News on November 12 about the misconduct he claims to have witnessed during his time at the VA. Sautter said that he became suspicious of veteran TBI diagnosis rates at the VA in 2017 when he noticed that the New Orleans VA’s TBI diagnosis rate was far lower than the national average among other VAs.
Sautter explained that while Post Traumatic Stress Disorder (PTSD) and depression are psychological issues, TBI is a physical wound. Suicide rates for those with TBI are twice as high than for those without it. TBI is often caused by head trauma or proximity to explosions. Many veterans who worked with explosives during their service or were injured by enemy explosive devices develop TBI from the experience.
Upon first visiting a VA hospital, all Iraq and Afghanistan veterans are screened for TBI with a four-question test. Nationally, 60 to 80% of veterans who are flagged for TBI by the preliminary screening are ultimately diagnosed with TBI. At the New Orleans VA hospital where Sautter worked, the rate of ultimate diagnosis was just 18%. Sautter was shocked at the difference and said, “It was so deviant a number.” Sautter discovered that one doctor in particular at the New Orleans VA had an even lower rate of diagnosis for TBI in patients that screened positive for TBI, at only 9%. Multiple veterans said that retired neuropsychologist John Mendoza “didn’t believe in traumatic brain injury.”
Before retiring in 2017, Mendoza assessed decorated Army Sergeant Daniel Murphy, a veteran who had been diagnosed with TBI in the field after his humvee was hit with an improvised explosive device (IED), according to the article. He told Murphy that there was no evidence that he had TBI despite his field diagnosis and history of working with and around explosives. Two months later, Murphy took his own life.
After discovering the extremely low rate of TBI diagnoses, Sautter began working with Priscilla Peltier, a nurse in the department of the New Orleans VA hospital that treats TBI. They compiled a list of hundreds of veterans who had screened positive on their first visit but had not been diagnosed with TBI. Peltier said that “It was a list compiled of veterans who basically just slipped through the cracks. There was absolutely no treatment being provided to them.” When Peltier took the list to her boss and proposed a plan to get in contact with these veterans, the chief of the Pain Management and Rehabilitation division told her to drop the inquiry, according to the article.
Sautter has pushed the VA to further investigate his allegations of misconduct and under-diagnosis. The Office of Special Counsel released a report in 2019 that although they had not identified a “specific danger to public health and safety,” they determined that “New Orleans failed to provide appropriate care … to those veterans with positive initial screening for TBI.” Although the report requested that the VA contact veterans that had screened positive for TBI but had not received a full diagnosis, an anonymous veteran recently told CBS that they had not yet been contacted.