Despite official statements to the contrary, care in the military health care system is inferior to typical civilian hospitals, according to internal documents obtained by The New York Times.
The Times reported Sunday that an analysis of the military hospital system — which cares for some 1.6 million active-duty servicemembers and their families, and is entirely separate from the scandal-plagued veterans system — shows that reviews of practices are sporadic, and avoidable errors are chronic.
Since 2001, the Defense Department has required military hospitals to conduct safety investigations when patients unexpectedly die or suffer severe injury, the Times reported. Records indicate they often go undone: From 2011 to 2013, 239 unexpected deaths were reported, but only 100 inquiries were forwarded to the Pentagon’s patient-safety center, where analysts recommend how to improve care. Cases involving permanent harm often remained unexamined as well.
At the same time, the military system has consistently had higher than expected rates of harm and complications in two central parts of its business — maternity care and surgery.
The Times wrote that more than 50,000 babies are born at military hospitals each year, and they are twice as likely to be injured during delivery as newborns nationwide, statistics show. And their mothers were more likely to hemorrhage after childbirth than mothers at civilian hospitals, according to a 2012 analysis conducted for the Pentagon.
In surgery, half of the system’s 16 largest hospitals had higher-than-expected rates of complications over a recent 12-month period, the American College of Surgeons found last year. Four of the busiest hospitals have performed poorly on that metric year after year.
In late May, Defense Secretary Chuck Hagel ordered a review of all military hospitals, saying he wanted to determine if they had the same problems that have shaken the veterans system.
Hagel said the review would study not just access to treatment, the focus of investigations at the veterans hospitals, but also quality of care and patient safety.
The Times’ examination, based on Pentagon studies, court records, analyses of data and interviews with current and former health officials and workers, indicates that the military lags behind many civilian hospital systems in protecting patients from harm. The reasons, military doctors and nurses said, are rooted in a compartmentalized system of leadership, a culture of interservice secrecy and an overall failure to make patient safety a top priority.
Experience in civilian hospitals, and in the veterans system, has shown that stricter procedures and more sophisticated surveillance can limit errors, sometimes markedly, according to the Times. Among some in the military network, concerns about patient safety are longstanding, if rarely acknowledged in public. But calls for change have consistently foundered in the convoluted bureaucracy.
“The patient-safety system is broken,” Dr. Mary Lopez, a former staff officer for health policy and services under the Army surgeon general, told the Times. “It has no teeth. Reports are submitted, but patient-safety offices have no authority. People rarely talk to each other. It’s ‘I have my territory, and nobody is going to encroach on my territory.’”