RESPONSE

Officials defend military medicine system

Mobility of service members makes the military health care system unique

Military medicine isn't perfect but the system performs "exceptionally well" when measured against civilian health care standards, Pentagon officials say.

Reporters for the Dayton Daily News met in July with Pentagon officials and described findings of a yearlong examination of the armed services medical system.

In a nine-page response, Department of Defense officials said the quality of care delivered to military personnel and their families does not suffer simply because there are differences between the military and civilian health care systems.

"Because of the mobility of the armed forces and their families, there are some unique aspects to the operation of military medicine that differ somewhat from civilian medicine," said John F. Mazzuchi, deputy assistant secretary of defense for clinical services. "These differences, however, result in neither degraded quality of health care delivered nor lessened satisfaction with health care received."

No other health care system must prepare to deploy "with the U.S. Armed Forces to any corner of the globe, set up health care operations and keep soldiers, sailors, airmen and Marines healthy in order to carry out the national security missions of this nation," Mazzuchi said. "This is what military medicine does, and by all measures, it performs exceptionally well."

The military's system, like all health care in this country, is "neither an exact science nor a perfect art," Mazzuchi said. "Still, military medicine rates highly when measured against the variety of quality indicators used by industry to determine how well hospitals, systems of hospitals and health care organizations perform."

The department would not discuss individual cases or doctors involved in malpractice allegations.

In other responses the department said:

* The Feres doctrine, which bars lawsuits from active-duty personnel, is a ``legal issue rather than a health care issue.'' However, the fact that the military is protected from lawsuits involving malpractice on 25 percent of its patients does not affect the quality of care. ``It is not logical or reasonable to think military physicians would provide health care differently for the population that can sue than for the one that cannot sue.''

* Although the Defense Department does not report to a national government data bank every time the government pays a malpractice claim, it does report doctors when the military determines standards were not met. The mere payment of a claim does not necessarily mean standards were violated.

* Because of the mobility of the military population, it would not be feasible to require doctors to obtain licenses in the state in which they practice.

* The department is implementing "the most significant change in the practice of military health care in 30 years" in the form of a health plan known as TRICARE. The plan gives civilian patients a choice among three health options patterned after private medical insurance, allowing them to go to civilian doctors and hospitals if they choose. Improving continuity of care was a major consideration in setting up part of the TRICARE plan.

Although myriad differences between military and civilian health care make direct comparisons difficult, the Defense Department claims in annual reports to Congress that civilian physicians are sued for malpractice much more frequently than military doctors.

In its most recent quality management report, the Office of Health Affairs published a chart showing that malpractice claims were filed against military medical institutions in 1994 at the rate of roughly 7.8 claims per 100 physicians.

However, these figures were not adjusted to take into account the Feres doctrine. An Army spokeswoman said that when adjusted for the fact that medical malpractice lawsuits cannot be filed for injuries to active-duty soldiers, records show that between nine and 12 malpractice claims per 100 physicians have been filed against Army doctors in recent years.

A study by the Physician Insurers Association of America of approximately 150,000 private sector physicians between 1985 and 1995 showed that roughly 10 malpractice lawsuits were filed annually for every 100 doctors.