Many of the military hospitals treating our 1.35 million active-duty service members and their families are small, and their lack of traffic as compared to larger military or civilian hospitals compromises the ability to diagnose and treat serious illnesses.According to recent reports, about two-thirds of the smaller military hospitals serve 30 or fewer inpatients per day; this is about one third less than the average civilian hospital serves per day and contributes to the decline of quality offered at these medical facilities. The more inexperienced nurses, physicians and medical personnel aren’t getting enough practice in these smaller military service hospitals.
Also, the fast-track promotion policy common in the military can put patients’ health and safety at risk, especially at the smaller military hospitals. Inexperienced doctors are taking on extensive responsibilities because military policy encourages more experienced and driven doctors to become hospital administrators, removing them from direct patient care. This, coupled with the rigid rotation of military assignments, causes concern about the continuity of hospital staff, which is crucial to success in patient care and safety.
Every two years, army hospitals are appointed a new commander. “You are constantly losing momentum and traction, and that relates directly to patient safety and quality of care,” said a former hospital commander, who spoke on the condition of anonymity for fear of retaliation. “What civilian health care organization rotates their CEO every two years? There is no consistency, no continuity and no institutional memory.”
As seasoned military doctors assume administrative positions, inexperienced junior physicians who have just completed their residency are prematurely promoted to head clinical departments. Another issue is that many skilled nurses and doctors are being utilized in the wars in Iraq and Afghanistan rather than in the United States. The various wars have spread military medical professionals thin. Without consistency, there is a lack of available experienced medical professionals who can provide mentorship and critical expertise in a crisis in our nation’s many small military hospitals.
Pentagon’s System Review of All Military Medical Hospitals
Since May, the Pentagon has conducted a system-wide review of the quality of care, patient safety and access to treatment for all military medical facilities, partly in response to the inquiries from the New York Times. Defense Secretary Chuck Hagel ordered a review of all military hospitals; unfortunately, the review has its flaws and is limited. The Pentagon does not rigorously analyze some crucial data nor does it collect all applicable data on military medical malpractice errors. In addition, some hospitals have too few patients to be measured against the appropriate benchmark of care. The military hospital system reached its peak size during World War II and has been shrinking ever since.
The New York Times has examined the Pentagon’s studies and court records, analyzed thousands of pages of data, and interviewed current and former health officials and workers to compare military hospitals to civilian hospitals. The results demonstrate that military hospitals do not perform as well in patient health, care and safety. “Root-cause analysis” reviews unforeseen deaths or permanent harm of patients while in the care of medical professionals. In some cases the smaller military hospitals lack these reports or any explanation as to why a tragic event occurred. In 2003, a Pentagon audit revealed medical workers had reported 80 cases of severe harm or death in the preceding year, but only 32 root-cause analyses had been performed. In 2011, 50 unexpected deaths occurred, but only 25 analyses were submitted. The following year, 110 deaths were reported, but only 25 analyses were submitted.
Since 2001, the Defense Department has required military hospitals to conduct safety investigations. The object is to expose and fix systemic errors in the most routine procedures that lead to dire consequences as a result of medical malpractice. When a root-cause analysis is never performed, there is no way to determine the problem, so it is unlikely to ever be fixed.
A few examples:
- Patient Irene Smith underwent surgery to correct a hiatal hernia. Due to a botched surgical procedure at Winn Army Community Hospital, she lost her health, her job and any sense of normalness in her life. Dozens of corrective surgeries later, she lost her entire stomach in what should have been a routine procedure. She filed a lawsuit, which settled for about $1 million.
- In Lemoore Military Hospital, a retired officer died of appendicitis in 2007, two days after having the incorrect diagnosis of a hernia.
- Raquel Bradshaw lost her six-year-old son, Kristian, to gastrogenesis and dehydration. The misdiagnosis of his condition was found to be a direct cause of his death. The government paid out $250,000 for malpractice, the maximum allowed by California law.
Military Bureaucracy Placed Above Patient Care and Safety
Lemoore Military Hospital is the only hospital to convert to an outpatient clinic. Health care bureaucracy and other factors are preventing similar conversions from happening in other underperforming military hospitals. Military officials’ agendas and policies are being placed ahead of the quality of care and services that military patients receive in these smaller hospitals. “The patient-safety system is broken,” says Dr. Mary Lopez, a former staff officer for health policy and services under the Army surgeon general.
According to reports last year, the government paid 21 military patients more than $500,000 each in malpractice settlements against military hospitals. The quality and consistency of safety measures used in smaller medical facilities do not compare to those in civilian hospitals. Patient-safety reports show that the lack of communication can lead to deadly misdiagnoses. In 1999, the Institute of Medicine estimated that medical errors killed between 44,000 and 98,000 patients at hospitals nationwide every year. Experts agree that it is difficult to accurately access the military medical industry because of various factors like the inability of an active military member to sue, so many errors go unreported. There is also a lack of data available since only the 17 largest military hospitals are reviewed, and many fail to report the root-cause analysis of a catastrophic event due to medical error.
It was only a requirement beginning last October for the Army, Navy and Air Force to identify the military hospitals where patients were severely harmed due to negligence. There is still more work that needs to be done after the startling revelations from the Pentagon’s initial investigation. It is time to consider closing the smaller military medical facilities and utilize more appropriate and advanced resources of larger nearby hospitals. Military members and their families who dedicate their lives to protecting us should have their quality of health care protected.
For more information about how we can help you determine if you or a loved one has suffered a severe injury or even wrongful death due to military medical malpractice, contact Slack Davis Sanger today at 800.455.8686 or www.slackdavis.com.