Medical Malpractice Claims Against The Army

• Author: Colonel Frank W Kiel
• Pages: 01

1. INTRODUCTION

   Claims against rhe Goieinment am an indicatoi ofrhe qualiri of medical care This measure 11 a crude one. bur I[ does represent the unsatisfied parienr, suffmenrh disturbed 10 go through the effort m\ol,ed in actualh filing a claim Thus, I[ goes bqond the restire patient suffering ~n silence. or uriting letters IO the commander. OT seeking out rhe ornbudiman.z On the orher hand. L[also excludes rhe injured patient who assumes the mjun as a risk of the sstem, suffering silentl, or assuaged b\ good doctor-patient rapport.

   In 1973 a report published br the L' 5 Deparrmenr of Health. Education. and Welfare IHEW shoaed that malpractice claims in

   tnquin during consultant staff itsits LO Arm) medical facilities in1974 The purpose of the stud\ r a i IO determine what problems had mien at each medical rreaiment facilm and hou each commander \+as dealing wrh current cases e

   11. DESIGN OF STUDY

   The cases pertaining to each command r ~ e r e exrracted and given10 the commander of each medical treatment facilir\ of rhe US. Arm\ Health Senices Canimand (HSC) prior to rhe consulrani's iisit.' Anmers ro rhe follohing quemons rere sought. (I) Is the information in rhe extract correct? (2) Is mom information on the cases a\ailable localhi (3) Are there other claims cases not on the IN? (4) IYhat >+as the outcome of the claim: (5) \Vas correctiw BC-[ion forthcoming as a result of the incident? During the con~uliant's \m[, the cases were discussed with rhe mdmidual uham the commander considered to he most kno*ledgeable rtrh respect to each case and the consultant nar appiiied of the extent to which the hospital command group was kepr informed abour claims. The use of information filed with the Arm\ Claims Ser~iceuar intentionall> a\aided in the first !ear of the stud) because rhe main effort was IO dircoier ilhar the local commander knew and did about Clalmi

   111. KNOIVLEDGE OF MALPRACTICE CLAIMS AT LOCAL MEDICAL FACILITIES

   All iubotdinare units of the HSC %ere contacted during 1974 with the eiceprion of Vallm Forge General Hosplral uhch was m the process of cloimg. Inrelest in the subject of malpractice claims iaried from e-rrensive 10 none. although the increasing magnirude of rhe rnalpracrice claim problem was vel1 knoun IO all.

   '4.

   Because the claims had been hled beween 1968 and 1973, and some of rhe incidenrr anredared 1968, man, U ~ I E

   had difficulri confirming h e rxrracred case9 Clinical records on file in patient adminiwarion ~eciion~are ierired ar IJ+O iear\.l' and coniequenrl\ inam ot rhr cases were onfarn~lia~to local hospiral personnel. In (hose inirnncea irhere records were mailable. m lie re bas a high COP ielation hemeen the clinm.1 rec

   B ADDITlO.+~AL C.4SE DETAIL .41AIL(BLE LOCALL).

   If rhe clinical record aas aiailrhle. mnrideiable detailr iriuld br obramed. although frequenrlr rheie iias nu siiggrsrion tn the * , I t - ten record of ani unroi$aid e~enrrhnr uould foreshadow the late1

   c l a m ' I The ~ranaient nature of rite profess hospirali mmmized rhe OCCBILOIIS 111 nhich an

   3. OTHER CASES K.YOtV.\ LOCALLY

      At those ins~allatmni airh a Sraff Judge .Ad\ocare Claimr Off ere a long-rerm cii.iliari emploree was preir ained iemrdr mer the jeaii. 11 ilai n o ~ uncornm

      a1 cases added to the series These included a fen claims rhar liad been rerrled localli rrhich >>ere beneath thr mme-

      CORRECT.VESS OF THE I.\~FOR.MATlO.Y IS AFIP SERIES

      tary threshold limitation and also included other major cases that had eluded the list. At those installations with transtent clams offi.

      CUE and wirh no retention of clinical records mer two years, it xas uncommon to gain additional cases

   4. OUTCOME OF THE CASES

      Because of the time-consuming nature of the claims process, interest m the caie times. particularly ai the medical indiriduals mrohed mote away. Wxh fer erceptmnr, knowledge about the ourcome of Claims (or Imgaoon) was U ~ L U E U B I . hlosr units attempted to obtam these amhers for rhe con~ultsnt b) telephoning the Arm,

      Claims Senice.

      E CORRECTIVE ACTI0.T TAKE6 AS RESULT OF ISCIDEST The general lack of knoxledge about the claims filed reflects 11- self in the pauciry of cases ~n which any correctiw action vas mscituted Procedural manuals and standard operating procedures %,ere occasion all^ changed to counter defects m the witem. In answer to the question "Could the same incident occur tonight)" rhe response UPS often affirmatne So mcan~erof disciplinary action were found, and only one physician is knaun to ha\e had his opeiaring prlrl~egei cur~al~ed.13

      >* huthonr) has been delegated ID the commander or the riaffpdge adioiare 01 a m command aurhonred to e~errsse gencral ro~ri-rnari~alpmd#ir#on

      IO settle

      claim; up to 55,000 hrmm Reg Sa 2i-20, Legal Ser~ire~-Clairni para 4-15Wllinl (C5, 25 Yo\ 19il) Iheieinalter cited as AP. 27-201 For example. afier the birth af a brbr the rnorhei complained of a malodorous 'aginal dnchaige fox sejeral dais Exammation niter that tlme re-ealed a mrgxal sponge had been lefr behind ~n the 'agm after dehcri .\ clam far damage, ,+as settled lo call^ for 51.000 Cf Dobbins 1 Gardner Si7 S.SV2d 665 iTex Cn 40" 19641 In char

      F POLVT-OF-COSTACT FOR MALPRACTICE CASESThe mdi\idual designated as the knorledgeahle point-of-contact on medical malpracrice cases was found in a number of different adminisrrati\e poritionr Some large medical centers ha\e their own rraff judge adiocare, more commonl) the posrjudge adrocate was the contact. Ar certain hospirals, rhe chief of the patienr administration secrmn was the point-of-contacr, I\ hile in other horpiralr 11 \as the chief of professional SC~VICCI. the deputr commander or

      rhe commander himself Although the sraffjudge adiocate ~ I X P I I had some role m rhe claims mvestigarion process, he rareli %as sufficientlr m\al\ed in hospital affairs LO sene a role in rhe CO~TCC-tne action process desirable afrer a clam surfaced

   7. EXTE.VT TO WHICH HOSPITAL COM.LfA.VD IS I,VFOR,MED ABOCT CLAl.\IS

      Claims do no^ go through medical clianneli or command chan-nels, bur rhrough legal channels Claims need not men be filed ~n the localiu of rhe hospital canceined.l* Although bnfaimation could usually he found b, rhe local claims office if an inquiii were Initiated. information about new cases "as infrequently communicated to the hospital command group. and a recurrent report on the progress of the case uar rare.'*

      IV, MEDICAL MALPRACTICE CASES BY SPECIALTY AREASDi\idmg the cases among various caregone8 reienli that a major.

      I t ) of claims originated ~n the surgical fields.'8 hut no caregori

      hi the porr nanrhlr edu-

      immune."

      While the monetan aspects of claims are often disparaged. I t cannot be denied that the COS[ EO rhe federal fisc is considerable E\en rhough initial claim amounts are often inflared to a11011 lee-wa) for compromise, final claim settlements may also oienalue the clam inasmuch as they reflect the perceiied extent of goiernment exposure A major component of this eiporure is the chance that the case might T C S U I ~ in a berdicr against the Goiernment If it vent 10 Imgatmn. Man\ orher factors, such ai nona\ailabhry of defense ~,itnesses or uncertainti of the law concerning (he parttcular suhject. also influence the decision to settle a claim

      .4 SURGICAL TREATMEST Is

      As diagnostic and technical procedures ha\e imprwed. so also

      ha\e patient expectations Increased. A poor result still occurs OCCP-rionall). and if rhe patient xai not ruffmenth informed about the operation and its probable results, a disappointed parienr may he prone to file a claim against rhe Gmernmenr Failures of the medical system, whether results of mad%errent forgetfulness or o\er-reaching self-confidence. ha\e produced harm for patients and hate led to cases \fan) of rhe problems related ID surgical treat-

      menti cross iob-specialt) lines and uill be noted uirhour particular regard to the ripe of operation

      I . Fncluir to Dmgnosr

      DelaFed diagnosis of illness iiai parr~ularlj pretalent among rhe claims mvol>ing orrhopedic Is and gastrointestinal surger! Al-though an alleged failure of diagnosis of a patienr'r illness IS a ground for a proferrianal Iiabilit% claim, the failure IO correc~li diagnose doer not in and of itself constitute negligence The legal graiamen of ani claim 1) not that a diagnosis is Incorrect, but rather thar reasonable skill and care were not applied to rhe par-txuldr patient's sii~atmn s] In the orthopedic sub-specialiri. the failure to promprh diagnose spine factures or herniated disks proroked seieral claims. and almost half rhe cases iniolring gaitroinLestinal wrger) alleged delais in diagnosis Foirunareli rhe medical facilirier involved ofren iniriruted COTECIII.~ procedure, and rech-niques to preient recurrences of the delaii

      In one case. a delab in diagnosing a ruptured ichiller' rendon resulted in rhe neceis~n of correcttie iurger%. and the partent iubinirred a claim for SjO.000 which was settled for S5,OOO. As a resuh of rhe Incidenr, the hospital created a pre-opeiariie conference consisring of all the staff orrhopedic surgeons This group meets periodicall\ and re\ieai all pre-operati\e patients as *ell as all problem cases.

      Two cases inidring dependent children readd), suggest correc-ore procedures to avoid recurrences. One >oung girl was seen at a hospital on Saturday and Sunday but obtained no significant diag. nosir. On Monday, doctors diagnosed the condition as appendicitis and remowd a ruptured appendix The child died. No weekend clinical records could be found although the laboratory file copy nored an &bated white blood cell count. In this situation a $100,000 claim uas submitted and war eientually settled for $1,500. Corrective procedures which would upgrade the record-making or filing systems and impraw the weekend call procedures readilv suggest rhemselrer.

      In one case tn the eye-ear-nose and rhroat area, a three-year-old was examined for problems uith his wsion. Diagnosis ras rtrabiimur (cross-eye) and an ophthalmologist raw...