Missoula therapist fights human resources firm over confidentiality, PTSD treatment for soldiers

Outraged by a change in a counseling contract that provides mental health care to military personnel and their families, a Missoula therapist is waging a one-person war to defend soldiers' rights.

Taking on this battle is David Stube, a licensed clinical counselor who is fighting Ceridian, a global human resources firm that is contracted with the U.S. Department of Defense to provide psychological health services to soldiers.

The issue came to light in January when Ceridian sent a letter to counselors it contracts with in all 50 states. The letter asked those professionals to sign an addendum that not only waives doctor-patient confidentiality, but also forces counselors to agree not to provide counseling for post-traumatic stress disorder, depression, addiction issues, or violent or suicidal behavior.

Stube refused to sign the addendum and believes Ceridian's new requirements and the Defense Department's acceptance of those changes are unethical. Now, a few months into the fray, he's recruited and gained support from Sen. Jon Tester, D-Mont.

"If you are a soldier or in a soldier's family, this means you can no longer be counseled for these conditions, even though all military websites refer all soldiers to Ceridian MilitaryOne Source counselors for these exact issues," Stube said. "The websites neglect to tell the soldiers that the counselors have agreed to not treat PTSD, depression, addiction issues and problems with dangerous angry behavior.

"Furthermore, if the counselor does not post their clinical notes after each session on the Ceridian website within three days after seeing the soldier, the counselor will not be paid," Stube said.

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Jennifer Sewell, Ceridian's vice president of clinical and counseling services and the person who issued the addendum in the letter titled "Provider Network Services Quality Improvement Initiative," could not be reached for comment.

Cary Griffith, Ceridian's spokesman, refused to discuss the matter by phone with the Missoulian and would only respond to email questions with polite but opaque answers.

Regarding the issue of confidentiality and the sharing of counseling notes through email, Griffith wrote: "Everything Ceridian does, including getting copies of all session notes, is not only HIPPA compliant but in full compliance with all our Department of Defense and provider contract obligations."

Complicating things, Monica Matoush, public affairs officer with the DOD, gave the following contradictory explanation:

"Counseling is private and confidential, with the exception of mandatory state, federal and military ‘duty to warn' reporting requirements," Matoush said. "It is true that counseling notes are reviewed - this is for quality assurance purposes.

"It is important to point out that any personally identifying information is not shared except in a duty to warn situation," she said. "Also, in addition to the quality assurance step, the review is necessary to establish record of payment."

Despite Stube's long relationship with the two organizations and his frustrations with the changes in the counseling contract, both Ceridian and the DOD refuse to acknowledge any new standard for services.

"The scope for Employee Assistance Program services under our contract with the Department of Defense is for nonmedical short-term counseling," Griffith wrote. "For instances in which providers suspect their clients may suffer from PTSD, depression or similar illnesses, there is a medical referral in place - since these issues usually require more concentrated, sustained medical counseling than what's provided under the EAP process."

"Nonmedical counseling," Griffith further elaborated, is defined as short-term, situational and problem-solving counseling." Some examples for this kind of counseling, he said, include: deployment stress, marital couple issues, homesickness, well-being and family relationships.

"Consultants in the affiliate network are master's-level professionals trained to recognize the need for clinical treatment of medical issues such as PTSD," Matoush explained. "If counseling reveals clinical disorder, consultants will refer the individual to military medical mental health care providers, TRICARE or other providers for professional mental health care.

"While consultants may provide clinical services in their own private practice," she said, "that level of service is outside their scope of work as members of the affiliate network."

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