Imagine being a healthy 25 year old. In the best shape of your life. Fighting for your country as a proud military Staff Sgt. Imagine going to your local military hospital with abdominal pain, only to find out you need emergent surgery for acute appendicitis. Imagine an incredible array post operative gross negligence. Understaffed anesthesia. Unavailable supplies. Deadly dosing of medication administration. The result was a vegetative state on life support. Three months later, removal of life sustaining therapies resulted in death.
This is a true story.
Now imagine having no recourse in the court of law for damages suffered as a result of gross negligence. Internal reports stated, "This medical incident was due to an avoidable error." According to an obscure Supreme Court ruling over 60 years ago, military hospitals and their staffs are immune from malpractice claims, even for the most egregious lapses, if the victim is an enlisted man or woman on active duty. The 1950 court case was Feres vs United States
Defenders of the doctrine, say it is necessary to protect the military from costly, time-consuming trials that could compromise military discipline. James Smith, a New Jersey attorney who served as a military judge during a 30 year service career, said the theory behind Feres is that because the military provides full medical care for members and life long veterans benefits, there is little practical need for financial damages for malpractice. "The military is already providing for you, and that's your sole remedy," Smith said.
I sat in complete dismay after reading this article. The above excerpt came pretty much word for word from the complete story at the LA Times here. Imagine going in for a left knee arthroscopy, and coming out with a right leg amputation. Or going in for sinus surgery, and coming out with a total thyroidectomy. No recourse at all. Extrapolate to VA medicine for our active duty soldiers and it's easy to see how medical care could be provided on the cheap when you know you can't be sued for missing the what if of diagnosis. Imagine if John Ritter was active duty, and presented to a military hospital. The whole disgusting public propaganda about bad doctors missing a rare deadly condition would have never happened. Mrs Ritter would not be 14 million dollars richer because the hospital failed to support their doctors, who by the way, won their lawsuits.
The military hides under a cloak of security in the national interest. We can't be bogging down our military discipline in costly lawsuits. Extrapolate to Medicaid/Medicare what Mr. Smith says above. Instead say, "The Government is already providing for you and that is your last sole remedy." How about your work. Let's imagine your work provides you health insurance for free. Let us say that the boss fires you because you refuse to provide sexual favors. Using Mr. Smith's line of argument, one could say, "Your work is already providing for you and that is your last sole remedy."
I fail to understand how getting something for free removes recourse for gross negligence. If national interest was really at the heart of complete immunity for gross negligence, I would argue that all physicians who see Medicare/Medicaid patients should be granted complete immunity from all legal recourse, including gross negligence. Failure to do so has resulted in hundreds of billions of dollars a year in defensive medical spending that threatens the financial security of our nation. With future unfunded mandates of 34 trillion dollars, the Medicare National Bank threatens to destroy our economy. In the interest of national security, all physicians should be granted full immunity from gross negligence for the care of government funded insurance plans.
Who's with me?
Tuesday, April 22, 2008
We Fuk'd Up. Sorry 'Bout That
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12 Outbursts:
As an entering MS1 and going to college in the DC/Virginia area, I've had a lot of military persuasion towards going to med school at USUHS or taking the HPSP scholarship. It's all great incentives for young'ns like me who realize that we're going to need a leg up to help foot the bill when we get out. I even applied to USUHS dreaming of free med school and a salary to go with it.
I later dropped the USUHS application and went with the HPSP scholarship. The reason? Because private hospitals and practices view someone with a military training in medicine with disdain. Grads from West Point and the Naval Academy are revered for the leadership and experience, but someone who went to med school at USUHS versus a number of civilian schools is, from what I've read, considered second best. And I think this is the reason. By going through all of your education with no recourse for mistakes, a person is more likely to be less careful.
I'm hoping that by going to a civilian school and helping our country's finest afterwards will both teach me the responsibility and care I will need to avoid such mistakes, as well as drop the unwanted bias the military may or may not have on my future medical career.
I wonder a lot about your post, because, working in the VA (I'm a newbie), it's hard to figure out why they keep the idiots.
We got plenty of RNs spreading nosocomial infections because they're so darned smart (only in their own minds, of course).
Well, I figured I had to point out that the very premise of the post is wrong. Of course people can sue. It happens all the time. I, as a Navy physician, work at a Naval hospital. My wife is a civilian physician at a hospital in the same city. The Naval hospital has a roughly proportional number of lawsuits ongoing as the civilian hospital. So to say that the patients have no recourse is, well, wrong.
The difference is that the physicians cannot be sued. This is generally true across the board, related to government. You can sue the institution, but not the individual. So the hospital gets sued, but the physician is not. Fair? Tough question, for sure. But the idea is that I am an agent of the Navy. You cannot sue the agent, but you can sue the agency. Happens all the time. Witness the Naval hospital in Jacksonville--lawsuits out the wazoo. It is the Navy equivalent of the hospital in your town where you don't want to go...
Anyway, you can debate that point. But it's best not to post on things about which you are clearly not well informed. Bad form.
@ Ken Jr: I also went the HPSP route, and am glad primarily because in 2 months I am finished with the Navy and can move on. But I don't think that your impressions of military training are accurate. I've done both civilian and military, and I can tell you that my military medical training is held in high esteem. It helped open doors in the civilian world that probably would not have been open otherwise. Most normal people don't want to have to deal with the military crap while going to med school, and this is perhaps why I think most USUHS grads are a bit weird, but they tend to be good physicians. There are some pretty damn smart people teaching up there.
From nolo.com:
Feres doctrine
A legal doctrine that prevents people who are injured as a result of military service from successfully suing the federal government under the Federal Tort Claims Act. The doctrine comes from the U.S. Supreme Court case Feres v. United States, in which servicemen who picked up highly radioactive weapons fragments from a crashed airplane were not permitted to recover damages from the government. Also known as the Feres-Stencel doctrine or the Feres rule.
The last time a I checked a a Navy Hospital and all their employees is Uncle Sam.
I stand by me statements.
Ken jr, I have a relative who just finished 7 years of post residency service with the military, in orthopaedic surgery. He was so bored, professionally he was frustrated. Given my experience as a resident in VA hospitals, it doesn't surprise me that slow and stop are two common modes of communication and interaction in any government operated medical facility.
I think we need to keep in mind that the majority of damage awards in medical malpractice are for future medical care. Now, if you are in the military and the military is paying for all of your care then you already have most of your damages (that would be claimed) paid for by continued military health care. Now, I understand there may be some pain and suffering or punitive damages that a plaintiff may want to claim, but unfortunately you signed a contract barring this recourse. Is this fair? Well, that depends upon "what your definition of is, is." My point is not to say that this is warranted, but I believe the idea is that the patient will receive continued care. The military also takes internal action to decide on negligence and the physician can be held accountable and punished. Also, this Feres doctrine applies to individuals in military service. Many family members are cared for by the military medicine and these individuals can in fact file suit, it is the servicemembers that cannot.
In regard to VA and Military Hospitals you must keep in mind that these are mutually exclusive entities run by the different governmental bodies. The VA may not be the most exciting place to practice but they are currently a model of efficiency in monetary terms and the current leadership has done wonders since the 80s.
PS: I am also a HPSP student and I have found that military medicine is held in high regard in the civilian sector. Some military residencies are also consider to be the top in the nation, but you will not find them ranked among private residencies. If anyone is considering an HPSP scholarship, they should first decide if they want to serve their country and practice medicine in the military on our soldiers and sailors. Deciding anything solely on money will always end in regret, practice where you are happy and the money will be there if you can walk in everyday with a smile. - I think the Happy Hospitalist would agree.
-Best wishes
Sir, your knowledge on the subject is apparently limited to Wikipedia entries on a subject not related to military medicine. Lawsuits against military hospitals are a matter of public domain. You can look them up. As I mentioned, NMC Jacksonville recently paid a large sum as a result of a suit involving a death (unnecessary) from sepsis. But you have clearly made up your mind, and I am sure I waste my breath (so to speak, as I type). I suspect you are not one for evidence-based medicine, either...
Your comment about your relative in ortho also speaks volumes. Do you regularly form conclusions so haphazardly, or is this just a peculiar topic for you? In any case, how an orthopaedic surgeon is bored in the military is beyond me. I have deployed with several, and I thank God for being an internist, because they did not sleep. And at home, their caseload is just phenomenal. Further, I echo "anonymous" who points out, correctly, that the VA and the military health system are entirely separate. To draw conclusions on one from experience with the other is simply not valid. Heck, even a Wikipedia search would tell you that... (Please God that you do better research in making medical decisions?)
Patrick,personal insults are a sign of character flaws. That said, if you can present to me an example of an active duty military personal who is injured or killed by a military hospital and successfully sued them for damages, I will write a retraction. I shall put the proof of my ignorance in your hands. Prove away wise one. I researched your hospital. And numerous settled lawsuits at that facility. But I have been unable to find one successfully litigated for harm or death from an active duty personal
As far as the difference between a military hospital and a VA hospital, I am well aware of the differences between them. Its the similarities, the government owned and operated style that I am quite familiar with. Taking 2-3 days to get an echo. Or waiting a week to get a biopsy an an inpatient. Or having my attending physician 300 miles away doing attending phone rounds on a saturday morning. That is my lasting opinion of the striking operational inefficiencies of government owned facilities with government employees who have limited fear of losing their jobs
Regarding the attack on my character: I make no personal insults. I do imply that you are a bit reckless with facts to make a sensational point, and that I hope you are a bit more rigorous in your "day job." But you are a blogger, and of course you may say as you wish. It is your blog, after all. So I'll take your initial statement about character flaws to be a non-sequitur, and assume we're still having a friendly chat.
Active duty personnel have been compensated for gross negligence on several instances I am aware of. One recent (sort of) case in Jacksonville, related to an allergic reaction. You are correct, however, that they cannot sue. I did not say that you were incorrect in this regard. Your argument was that because benefits are provided to military personnel, the physicians/institutions cannot be sued. But they are sued all the time--even though family members/retirees/veterans all get benefits, they can all sue.
Active duty personnel cannot sue, but there are other recourses for compensation. In a case of gross negligence, court martial charges could be brought against the physician (and have been), and compensation directed for the victim.
In other words, your initial statement of fact is true. But you take that to absurd conclusions. Your logic is flawed, and that is all I meant to say.
Again, I mean no disrespect. I recognize you are a blogger and not a news outlet, so I am not saying I would hold you to the same standard. But perhaps you may wish to keep in mind that the LA Times and Wikipedia don't tell the whole story. And I'm sorry your VA experience sucked. I've worked at 2. One was terrible, and one was excellent (Birmingham, AL--truly an excellent hospital). You seem to be quick to draw generalized conclusions based on limited experience/data. Fine for blogging, bad for medicine. I have no doubt you separate the two admirably, however.
patrick, my facts hold their own. Nothing I wrote was inaccurate. If you chose to interpret the facts to your own liking, feel free to do so. As for your assertion that:
Your argument was that because benefits are provided to military personnel, the physicians/institutions cannot be sued.
That is not my argument at all. Anyone can sue anyone anytime for any reason. That's why private sector medicine wastes hundreds of billions of dollars a year in defensive medicine. The LA Times accurately reported that the guilty parties are immune from lawsuits.
You've raised some good points, HH. As the old saying, "There's the right way, the wrong way and the Army way."
You make some excellent points, Happy. I think you are right on track, except I would argue that the military recipients of medical care are not getting it for "free." As much as I think the present war in Iraq is a monumental error based on a host of outright lies, the people who enlist in the military certainly EARN their health care benefits (well, maybe not all of them, but you know what I mean). I think serving your country and putting your life on the line certainly entitles you to at least the same standard of care and protection from negligence as we civilians.
Found this page via Google. I am looking for advice on finding good clinical negligence solicitors in the UK. I don't want to go with just the first one I find, ideally I want some reviews.