Looking through the State of Texas web site to document licensed psychologists, you will not find the name Norma J. Perez. Yet Perez, apparently unlicensed, is the post-traumatic stress disorder (PTSD) coordinator for the Department of Veterans’ Affairs (VA) facility in Temple, Texas.
Norma J. Perez is also at the center of a rapidly-growing controversy that raises questions, not only about how the VA diagnoses PTSD but, about who guides, or even controls, the diagnosticians.
On March 20, 2008, Perez wrote an email to her PTSD team, including psychologists, social workers, and a psychiatrist telling them: “…I’d like to suggest that you refrain from giving a diagnosis of PTSD straight out. Consider a diagnosis of Adjustment Disorder, R/O [ruling out] PTSD.”
The subject line on Perez’s email read: “Suggestion.” But, let’s get serious. In a government office when your superior makes a “suggestion,” you can rest assured that it really is an “order,” and it better be followed.
She then verifies this money-saving agenda at the end of the email by stating: “Also, there have been some incidence (sic) where the veteran has a C&P [compensation and pension examination], is not given a diagnosis of PTSD, then the veteran comes here and we give the diagnosis, and the veteran appeals his case based on our diagnosis.” What Perez is saying is this: By not diagnosing PTSD, then the VA’s assessment will coincide with the C&P examiner’s assessment and the claim for PTSD is denied, saving the VA the cost of disability compensation.
Now we know why Perez made her “suggestion,” but what does it really mean? Perez has told her subordinates to make a deliberate misdiagnosis. Perez’s actions are unethical, completely void of morality and could fall under the definition of malpractice.
Perez’s email also stated: “Additionally, we really don’t have time to do the extensive testing that should be done to determine PTSD.” This mind-set is a dereliction of duty. The job of Perez and her subordinates is to take the time to make a proper evaluation and diagnosis, whether that is PTSD or not. That is what they are paid to do. To suggest otherwise to her staff tells us Perez has no concept of the requirements of her position.
Strangely, Perez has her admirers. A diarist at the web site ePluribus Media dot com feels Perez has the best interest of veterans at heart. The diarist states that using a “provisional diagnosis” of Adjustment Disorder is proper because the veteran who has some PTSD symptoms may be having “…a normal reaction to stress and it resolves within 6 months.” However, the diarist overlooks the obvious. The job of Perez and her staff is not to wait “6 months” but to evaluate, diagnose and treat RIGHT NOW. Because the veteran needs help RIGHT NOW. If you went to a doctor with chest pains and he/she gave you a “provisional diagnosis” of heartburn and told you it could resolve “within 6 months,” you would find a new doctor, and rightly so. The diarist also ignores Perez’s opening and closing statements clearly referring to the costs of awarded PTSD disability claims, thus taking the diagnosis aspects of the email completely out of context.
Norma J. Perez has disgraced her profession. She, perhaps, has put in jeopardy the well being of many veterans. How many vets were misdiagnosed at Perez’s suggestion during the nearly two months between the date the email was written and the time it became public? We may never know.
But, there are those who do want to know. At least three U.S. Senators are calling for investigations into Perez’s email. Sens. Daniel Akaka (D-HI), Chairman of the Senate Committee on Veterans’ Affairs, Richard Burr (R-NC), Ranking Member on the Committee and Barack Obama, Member of the Committee, have all called for immediate probes. Perhaps the most interesting demand for an investigation comes from Obama who wants to know if the Perez email is just an “incident” or if it is a “trend.”
Obama’s question is right on target. Is this an isolated incident? Is Norma J. Perez a loose cannon who has caused the VA more unneeded bad publicity? Or, is Perez’s email indicative of the policies being implemented at VA facilities across the country? Anecdotal evidence suggests that a diagnosis of PTSD is more difficult to obtain as tens of thousands of older veterans, from conflicts going back to World War II, are coming forward to seek help with their mental health issues.
Off with her head? In a professional sense, this would seem a logical punishment for Norma J. Perez. If she does happen to be licensed, the State of Texas should examine this issue. If she is a member of the American Psychological Association, they should consider action. But, more importantly, the VA should act now to make sure veterans are protected from those who would seek to do them harm with a deliberate misdiagnosis.
Norma J. Perez should be fired for cause. Perez’s actions have caused veterans to question the medical integrity of the VA mental health care system. Vets will now be asking the questions: Have I received a correct diagnosis? Or, am I being shuffled aside in an attempt to save the VA money?
VA Secretary James Peake has stated that Perez has been “counseled” and is “apologetic.” This is no consolation to the veterans who may have been misdiagnosed or to the veterans who now fear the very system meant to care for them. Peake said that Perez’s suggestion has been “repudiated at the highest level” of the VA. What does that mean? Very little, because Perez is still employed by the VA.
Secretary Peake’s message to all veterans is very clear. Perez’s suggestion was repudiated by the VA not because it was wrong, but because she got caught.
