Military Doctors’ Case Records Will Undergo Civilian Reviews

In what amounts to a revolutionary change for military medicine, the Pentagon moved Thursday to subject the performance of military doctors to systematic civilian review.

The Defense Department announced that it had awarded the Commission on Professional and Hospital Activities, a nonprofit organization based in Ann Arbor, Mich., a $4.63-million contract to oversee monthly “peer reviews” of doctors at the nation’s 168 military hospitals.

Over the next year, the records of about 15%, or 150,000, of the 1 million patients admitted to military hospitals worldwide “will be reviewed after discharge, and the care given measured against standard criteria to be developed by the contractor and Department of Defense,” the Pentagon said.

“This unprecedented external peer review of military medicine, similar to the one for Medicare patients, will dramatically complement the quality assurance programs we have put in place in the past two years,” said Dr. William Mayer, assistant defense secretary for health affairs.

Expresses Confidence

“I am convinced that the overall quality of care in military medicine is equal to, if not better than, care overall in the civilian sector, despite a relatively small number of highly visible tragic instances of medical mischance,” he said.

The military medical system has been buffeted over the last year by reports of substandard practice. In the most publicized case, a Navy heart surgeon, recruited despite questionable qualifications, is being tried on charges that he bungled operations and his mistakes caused the deaths of five patients.

The new civilian review groups will work independently of the peer review committees already active in military hospitals.

Mayer said Thursday that the actual reviews of patient records would begin “no later than April.”

The contract awarded the Commission on Professional and Hospital Activities is for one year and carries renewal options.

Double-Screening Plan

The military records initially will be screened by health professionals who are not doctors, the Pentagon said, and any case that suggests questionable care will be referred immediately to “board-certified physicians.”

The reviews will include all deaths that involved surgery, all cases of brain damage related to anesthesia, all cases of organ failure and all post-operative complications or readmissions of patients within 14 days of their first discharge from the hospital.