Military quacks.

• Author: Carollo, Russell
• Position: Analysis of military medical system

It's time to repair the military medical system

Leigh Clark, 16, was to undergo a 45-minute laparoscopic procedure to provide physicians with pictures of the inside of her abdomen, where she had complained of sharp pains. But something went wrong and a surgeon's mistake caused her right femoral artery to be severed. Clark was on the verge of bleeding to death when a second surgeon, summoned from his home, saved her life. Loss of blood caused her right leg to wither.

Emily Houck was only a few days old when her mother became concerned about small blisters that had appeared on her head and took her to a clinic. A pediatrician who examined the infant acknowledged later that he suspected a herpes infection. A few days later Emily's temperature rose and she began to lose weight, so her mother took her back. She'll be fine, the mother recalls the doctor telling her. But Emily will never be fine. A herpes infection caused her temperature to rise even more, damaging her brain. Today, a six-year-old, she cannot see, hear, talk, or walk.

Donald McKinley, 67, complained repeatedly to his doctor of chest and shoulder pains, sometimes so severe they kept him awake at night. At the time, McKinley had a medical record that included high blood pressure, diabetes, angina, high cholesterol, an abnormal heart beat, a history of heavy smoking, and a severely occluded aorta. His doctor thought the pains may have come from muscle soreness, even though McKinley could not recall any recent exertion. The doctor prescribed an anti-inflammatory drug. A few weeks later, McKinley's wife found him lying face down in the backyard. He had died of a heart attack.

Leigh Clark, Emily Houck, and Donald McKinley were not unlike victims of medical accidents and misjudgments that occur every day in hospitals, doctors offices, and clinics throughout America, except in one respect: In all three cases, the doctors involved worked for the U.S. military. That meant the patients were treated in an environment not governed by some of the most significant safeguards that help protect civilians from bad medicine.

None of the doctors was licensed in the state where he practiced, and in the Clark surgery, which took place at Fitzsimmons Army Hospital in Denver, the surgeon had been specifically rejected for a medical license by the Colorado Board of Medical Examiners. The doctors did not have to obtain medical malpractice insurance or to maintain a practice record that enabled them to keep it. They were virtually immune from malpractice suits, because in such claims, the government is the defendant. The doctor who treated McKinley was practicing in Texas with an Alabama medical license, and although he has never been sued in either state, the government has quietly paid claims in three different cases in which he failed to correctly diagnose illnesses and the patients subsequently died.

The pediatrician who would later admit he failed to treat Emily Houck with a toothpaste-sized tube of ointment that might have prevented the brain damage that today confines her to specially-built, $5,000 wheelchair, was licensed by the State of New York, although he was practicing in Georgia. The government paid $4.2 million to settle the malpractice claim brought by Emily's mother. But under Defense Department rules, the incident would not be reported to the National Practitioners Data Bank, a nationwide registry created by Congress in the 1980s to track malpractice in the United States. A civilian doctor would have automatically been reported.

Because of hundreds of cases like these, even the people in charge of the military health care system now say their system must be reformed if it is to provide the top-notch medical care every recruit is promised for himself and his family.

License to Kill

Though one would assume that the military would ensure that the men and women who serve in this country's armed forces receive the best medical care available, in many ways the system seems to work toward the opposite effect.

Among other things, the licensing process for military doctors is less stringent than for civilian doctors. Understandably, since military physicians are frequently transferred from one installation to another, it would be unworkable to require them to obtain a new license every time they landed in a new state. As a result, military doctors may practice anywhere so long as they hold a valid license from any state. But so broad was this licensing rule that it encompassed even doctors holding "special licenses" from the State of Oklahoma. These licenses do not require physicians to pass the medical exams Oklahoma and other states require for most licenses. Holders of special licenses are not authorized to practice medicine on civilians in the state, but can practice in prisons, on Indian reservations, and in the military, as well as work in laboratories that handle human organs for transplant purposes. One doctor flunked various state exams 30 times between 1973 and 1992 before obtaining a special license that enabled him to become an Air Force doctor. Another military doctor had failed 14 times; yet another had taken licensing exams 18 times, in Louisiana, Arizona, Alabama, Tennessee, and Oklahoma, before obtaining the Oklahoma special. In previous jobs he had delivered pizza, worked in a furniture store, and made sales pitches as a telemarketer. All told, in our reporting for the Dayton (Ohio) Daily News, we found that at least 77 Army, Navy, and Air Force physicians (out of the more than 15,000 total) held...