Malpractice suits look different when they originate at federal government facilities.
Physicians aren't sued individually at military medical centers; instead, the suit is against the federal government. The federal government also pays out the case.
Last month, a suit against Tripler Army Medical Center was settled for $29.5 million.
Tripler Army Medical Center in Honolulu, Hawaii, has paid out over $108 million since 1997 due to malpractice settlements and verdicts. This includes a recent case, decided this May, when a Hawaiian US District Court ruled against Tripler Army Medical Center in favor of a Honolulu-based military family who received care from the medical center in 2016. The medical care was for the family’s child, who was three months old.
John and Laura Warren, the military couple at the center of this recent case, took their young child to Tripler Army Medical Center when her stomach distended and turned blue below the navel. Their daughter stopped breathing after arriving at the medical center and was resuscitated. Medical staff attending the infant suspected she might have midgut volvulus, but tests for the condition were not run. The Warren’s lawyer alleged that it took 19 hours for action to be taken. By this point, the Warren’s daughter was near death and was transferred to Kapiolani Medical Center.
At Kapiolani Medical Center, it was found that 90 to 95% of her small intestine was necrotic. The infant required 14 surgeries and was in the hospital for five months. Today, she takes in most of her nutrition through jejunostomy tubing. Infections to her jejunostomy sites have caused heart and brain damage. After reviewing the case, Hawaii’s US District Court awarded the Warren family $29.5 million.
The Culture of Military Medical Centers
Military medical centers are an established part of the armed forces. The United States has had dedicated hospitals for military members since the Civil War. There were 140 military hospitals nationwide by America’s entrance into World War I.
Over many years, the United States Military Medical system has received praise and criticism. For instance, between 2001 and 2014, during the active years of Operation Enduring Freedom and Operation Iraqi Freedom, the United States Military Medical System’s approach to care allowed them to achieve the highest survival from battlefield wounds in warfare.
Tamara Green MD, MPH, an emergency physician who has worked in military medical centers such as Walter Reed National Medical Center and Andrews Air Force Base Medical Center, as well as private hospitals, says military medical centers also offer advantages when it comes to staffing.
“Staffing at these facilities was better than private hospitals, likely due to large labor pools available for staffing,” says Green. “In the emergency departments that I worked in, the labor pool consisted of government contractors, government employees, and military medical staff, so there were few instances of being ‘short staffed.’”
Despite accomplishments on this scale, the system has been called dysfunctional and has been at the center of investigations, lawsuits, and negative press.
Military hospitals serve a different population and have a different staff population than private hospitals. This can lead to a different culture and different set of expectations than private hospitals.
“One cultural difference is the chain of command, Green explains. “Having a sense of the chain of command is helpful for contractors when working at military facilities when you have to speak with patients and other providers.
Sometimes, this results in military medical centers being leaders in medical advancements and patient care, but in other instances, it can lead to military medical centers fostering cultures that can lead to breakdowns in communication, lack of teamwork, and gaps in patient care when the chain of command doesn’t work as it should.
In the summer of 2022, Col. Kenneth Bode, an orthopedic spine surgeon, resigned from a leadership position at Brooke Army Medical Center, the nation’s largest military medical center, with a social media post calling out the facility for a culture of what he called, “toxic leadership.” Col. Bode said he repeatedly tried to bring up concerns through the appropriate channels in his chain of command and that his concerns were dismissed, ignored, or downplayed. As a result of Col. Bode’s post, Brooke Army Medical Center is being investigated by the Army and Air Force’s inspector general and staff judge advocate offices.
Military Medical Centers and Malpractice
Malpractice suits against military medical centers can look very different. There are several reasons for this. A primary reason is that military medical centers are federal government facilities. When you work for a federal government healthcare facility, you cannot be individually sued for malpractice. The suit is always against the federal government, and the federal government always pays out the claim. You don’t need your own malpractice insurance in these facilities.
The other major reason suits against military medical centers are often very different from suits against private hospitals is that regulations prevent many suits from ever going to court. Active duty military members cannot bring suits for their own care and have them tried in court. Instead, they are required to file a claim with the Department of Defense (DoD). The DoD will investigate the claim and all evidence provided by the claimant. The burden of proof is with the claimant. The DoD pays approved claims under $100,000 and the Department of the Treasury pays approved claims over $100,000.
This means that not only are providers at military medical centers not individually sued and liable for malpractice, but they also will not have to appear in court if the malpractice claim involves an active-duty military member. Of course, something that results in an approved malpractice claim could lead to other professional repercussions, but this change in how the actual malpractice case is handled is significant.