The military's standard for
reporting problem doctors to a National database
is less strict than that or civilians.
By Russell Carollo and Jeff Nesmith Dayton Daily News
Published: October 9, 1997
Series - Part 5 of 7
The U.S. Army from 1994 through 1995 was accused of medical malpractice in
more than 900 incidents, and paid out $66 million to settle malpractice
claims.
But the service in those years reported only one practitioner to the
National Practitioner Data Bank, a national registry of health care workers
linked to medical malpractice.
Federal law requires civilian hospitals,insurance companies and HMOs to report all payments made on behalf of doctors in malpractice cases.
 RICK MCKAY / COX NEWS SERVICE Sandra Bean had a miscarriage after surgery performed by a military doctor who removed a fallopian tube. |
The military employs about 18 of even 1,000 doctors in America, yet it accounts for just two of every l,000 malpractice reports in the database. Those who leave the service for private practice are also likely to leave behind any links to malpractice lawsuits.
Not a single doctor was reported for a malpractice case at more than 75 military hospitals and clinics, a Dayton Daily News examination found. Since the database went on-line in September 1990, those 75 facilities were targeted for claims alleging more than 1,000 incidents of medical malpractice, hundreds of cases resulting in payments.
Not all of those 1,000 cases should have resulted in reports. But roughly 43 percent of all military claims are paid, and civilians must report all payments made on behalf of a doctor.
"We understand the military's health care systems' sensitivity to reporting practitioners who are career personnel," says a July 1996 report from the U.S. Department of Health and Human Services, which runs the database.
"(The) Department of Defense has informed us that if practitioners do not feel supported by the system, they will consider leaving the service."
Department of Defense officials said they are "reviewing further" policies on reporting to the database.
John F. Mazzuchi deputy assistant secretary of defense for clinical services, said he has asked the Department of Defense inspector general to audit reports be each service.
Lt. Gen. (Dr.) Ronald R. Blanck, the Army's Surgeon General, said the service reports all legitimate claims. 'I would argue that for those that we do report you know that there was a problem," he said.
An Army spokeswoman said 800 Army malpractice cases are awaiting action before the serv ice can decide if any need to be reported.
Fairchild Air Force Base hospital near Spokane, Wash., is one of the more than 75 military facilities that never had a doctor reported for malpractice to the database.
Since 1990, claims filed at the base alleged at least 25 separate incidents of malpractice.
The Air Force refused to provide information on how the claims were resolved.
In one of the Fairchild cases, the government paid a settlement to a woman who blamed Dr. William M. Lindel in the death her child.
Lindel acknowledged that the case was never reported to the National Practitioner if Data Bank. He also said that had he been a civilian, he would have been reported "whether I was responsible or not." Federal law requires civilian hospitals and insurance companies to report payments made on behalf of doctors, regardless of the amount.
When Lindel left the military in 1994 for civilian practice, records connecting him to that case remained with the military.
Kim Tank, the wife of an airman, accused Lindel of negligence when he delivered her baby in 1991.
Tank alleged in her lawsuit that she was having trouble delivering her baby. Instead doing a cesarean section-removing the baby through an incision in Tank's abdomen-the doctor used forceps to pull the child from her womb. The baby died four days later at a civilian hospital in Spokane.
`Childbirth is supposed to be something beautiful and natural," Tank said. "It was the most horrible thing I've ever been through."
Lindel said the forceps did not injure the child.
Military often blames system, not doctors
One reason cases like Tank's are not reported to the national database is that the military has different reporting rules than civilian hospitals and clinics.
And those rules help shield the identities of doctors in the military.
Under Public Law 99-660, insurance companies, HMOs and hospitals are required to report all malpractice payments involving civilian doctors.
The law excludes the military from the mandate. Instead, the military reports through a ''memorandum of understanding" with the Department of Health and Human Services.
Money changing hands doesn't mean a military doctor will be reported. Not
only does the claim have to be settled, the doctor must also have violated
the"standard of care." And the military decides what that prescribed standard
is and when it is violated.
Lindel said the Air Force determined he met the standard of care in the Tank case, even though the baby died and the service agreed to an out-of-court settlement.
A committee of military medical experts also found the standard of care was met in the Aug.19, 1993, operation of Cleophus M. Wade at Walter Reed Army Medical Center.
Wade suffered a heart attack after a surgeon mistakenly cut a vein during gallbladder surgery, records of a claim filed against the hospital show. Wade died the same day.
The surgeon, Dr. John Owen Colonna II, an Army major, was a trainee not yet credentialed at the hospital for that procedure. Colonna had served as primary surgeon at the hospital on that type of operation only once before-at least when a human was a patient. Before that, he performed the surgery in animal lab experiments. "I don't remember if it was pigs or dogs," he said in a deposition.
Colonna said he has no indication that he was ever reported to the database.
The Army argued that Wade died when a gas bubble entered his artery. A lawsuit by the family alleges that Wade lost large amounts of blood after his vein was cut.
Colonna, in a letter to the newspaper, said that he was licensed and board certified at the time of the operation and that he had performed a similar type of operation 200 times before.
The animal lab operations were required for credentialing a Walter Reed for labaroscopic procedures, he said.
The Army settled the case. The families's attorney said the service paid a six-figure amount.
Even if the Army decided the case fell below the standard of care, Colonna
likely would not have been reported. Doctors identified as trainees during a
procedure usually are not reported under military rules. All civilian doctors
with state licenses or registration, even trainees, can be reported.
Walter Reed, the subject of: claims alleging at least 100 incidents of medical malpractice since the National Practitioner Data Bank went on-line, has never had a doctor reported for a malpractice case to the database.
"That doesn't surprise me . . . There was a reluctance to find the standard of care not met . . There were those who would bend over backwards to avoid criticizing," said John Caldwell, who until a year ago was the Army's chief claims attorney for the western half of the United States.
Denver attorney Stephen A. Justino, who once served on an Army hospital committee responsible for reporting doctors to the database, said, "They (the Army) went out of their way to say there was no negligence."
The military's own computer examination of nearly 3,000 malpractice claims found that the standard of care was considered breached in 28 percent of the cases. That means only paid cases among that 28 percent are eligible for reporting under the military's rules. Civilians must report all payments made on behalf of a doctor.
But the real gap between the military and civilian systems is wider.
Some doctors go unreported even when the claim is paid and the military decides the standard of care is not met. That's because even though a patient may have died or been crippled for life and the standard of care wasn't met, the military can place the blame on system problems rather than on a problem directly linked to a doctor. "In the military, they're a lot more likely not to report,' said Robert E. Oshel, research director for the database. "They would say this is a system problem. They wouldn't report it."
A 1996 Department of Health and Human Services report found: The military "has said that a large percent of medical malpractice events have been interpreted as system problems. This situation also occurs in the civilian sector when payments are made for a hospital or HMO rather than an individual. This is usually referred to as the corporate shield."
Report can follow doctors for life
Doctors named once or twice on the National Practitioner Bank aren't necessarily bad doctors, but several reports can alert employers to possible problems.
In September 1990, the Department of Health and Human Services began collecting two categories of information on health care workers. The first category includes malpractice payments to people who accuse health care workers of negligence or incompetence. The second category : involves adverse actions: sanctions by stab medical boards or disciplinary actions by employers, such as loss of hospital privileges suspensions or firings.
The Daily News examination found more than 75 military facilities never had a doctor reported for an adverse action. Records from the services show that at least 40 facilities never had a doctor reported for either an adverse action or a malpractice payment.
Data bank officials have criticized civilian hospitals, too, for not reporting adverse actions. But, unlike military facilities, civilian hospitals, insurance companies and county prosecutors often are required to report doctors, a report to the database can be the only sanction they face.
In 1996, Dr. Forrest D. Lanchbury was convicted at an Army court-martial in Bosnia of drug use and of stealing 119 small containers of morphine and more than 60 other drug tablets. In the state where he is licensed, Alabama, state law requires prosecutors to report such cases to the medical board, but the state has no power to force the Army to make such reports.
Lanchbury, who now works at an Indian reservation in California, said he submitted at least two requests to the National Practitioner Data Bank to search Or any reports naming him, and the response in both cases confirmed that he had no record.
He voluntarily disclosed his conviction to medical boards in Alabama and Wyoming, where his license application is under consideration.
Reports to the National Practitioner Data Bank can follow a doctor for life.
Every time l apply for new insurance, it comes up. Every time I get privileges at a new hospital, it comes up," said Dr. Orion A. Rust, a former military doctor. "They say please explain this."
Rust is one of the cases the military did report.
In 1990, a pregnant Pamela Shelton twice went to the hospital at the now-closed Castle Air Force Base in California bleeding and worried she was losing her unborn child. Twice doctors telephoned Rust about her condition, and twice he recommended sending her home, Air Force courtmartial records show.
She eventually was taken to a civilian hospital, but the baby died hours after birth. Days later, Merced, Calif., police found Shelton and the baby's father dead, apparently the victims of a murder-suicide. They were lying on a bed, a blanket pulled up across their chests. At the foot of the bed, officers found photographs of the dead newborn on top of the blanket.
The Air Force convicted Rust at a court-martial of criminal charges of lying and dereliction of duties in connection with the case. He was fined $5,00(), reprimanded and dismissed from the service.
"I have to answer for it every time I talk to somebody about a job," Rust said.
The under-reporting by the services doesn't mean the military thinks the information is useless.
Since 1988, the Department of Defense has kept a confidential database on malpractice cases linked to its doctors, including cases not reported to the National Practitioner Data Bank. Though the military has access to the NPDB, state medical boards aren't necessarily aware of the military's database.
Dave Thorton has been an investigator or supervisor for 23 years with the California medical board, which licenses more Navy doctors than any other state. He never heard of the military database.
"I didn't know they had anything like this," he said.
The military's own database has about 3,900 reports-more than nine times the number it reported to the National Practitioner Data Bank. And its own database includes not only cases withheld from the NPDB because the services determined the standard of core was met, it also includes The names of doctors involved in cases not resulting in payments.
`There may be something learned from denied cases, even if the person wasn't paid," said Dr. Rich Granville, deputy chairman of the Armed Forces Institute of Pathology's Department of Legal Medicine. "The (National Practitioner) Data Bank only takes paid cases. Ours is much more complete."
The Dayton Daily News requested the Department of Defense database in April 1996, supplying the name and telephone number of the person in charge of operating it. Last month, almost a year and a half After the request, lawyers representing the military acknowledged for the first time they knew . Die database existed, but so far Stave not released it.
Military reports can take years
The military can take years to report doctors, even after finding the standard of care was not met.
The Army took nearly two years to report Dr. Arnold C. Evans, who retired in August after serving as chief of gynecology at Kimbrough Army Community Hospital at Fort Meade, Md.
Evans, previously employed by a prison in Texas, was hired to work in the outpatient clinic at Kimbrough in 1992.
Complaints soon followed.
A Nov. 18,1992, Army record noted that Evans "scheduled several patients in the operating room in the past that were outside the parameters of his credentialing."
Then, on July 27, 1994, the Army gave the hospital commander a list of complaints involving 27 cases. The Army alleged Evans performed needless operations on women, didn't get a patient's consent before doing an operation, caused at least one woman to face additional surgery and didn't document pap smears on several patients.
One of the patients who complained was Sandra Bean, the wife of an Air Force sergeant.
In April 1994, a pregnant Bean went to Kimbrough complaining of pain and bleeding.
Evans, she said, told her he would do a simple exploratory procedure involving two small incisions.
"The next thing I know, I'm on the operating table getting my tube removed," she said. "He told me he was afraid my tube was going to rupture."
Evans told her she had lost her baby, she said, but she demanded a transfer to another Army hospital, where she learned she was still pregnant. She had a miscarriage days later. . A biopsy on the fallopian tube Evans removed, she said, showed it was healthy and normal.
"Even after my body healed physically, I didn't heal mentally. The doctor screwed up he took this baby from me and left a scar behind that will remind me for the rest of my life," she said.
On Aug. 3,1994, the Army suspended Evans' privileges, an action reportable to the database under civilian standards. The Army concluded that 70 percent of the cases reviewed "failed to meet acceptable standards of care," and the service found that Evans ' needs additional basic experience in management of patients."
But there was no report.
Several written evaluations the Army did on Evans rate his skills as "excellent" An evaluation in January 1996 says Evans had "excellent technique" and his skins and knowledge had "improved significantly."
In February 1996, Evans filed suit against the military, asking the court to review his suspension and the limitations on his practice. Three months later-nearly two years after his privileges were suspended-the Army reported him to the National Practitioner Data Band.
In June 1996, a federal judge ordered his name removed pending the outcome of the lawsuit. But the Army reported him again n January of this years
Washington, D.C., attorney Shelley Hayes, who represents Evans said the Army didn't start investigating him until he wrote to Congress complaining of racism at the hospital.
"I would say it is fairly clear that had he not filed the lawsuit," Hayes said, "he would not have Ben reported."
Part 6 - The Man In The White Coat Was No Doctor
The military cuts costs and fills doctor shortages in hundreds of clinics and hospitals by allowing staff members without medical degrees or licenses to provide the same care civilians often get from licensed doctors.