Inconsistency in Medical Care

Inconsistency in Medical CareAlessandra Armstrong

Question & SignificanceWhy is the military held to a different standard when it comes to comparing the civilian and military sector in medical care?Understanding why the military has a different way of handling medical situations would take an expert to explain. The reasoning expressed in the upcoming slides comes from personal experience, research, and course experiences that allow for the cross examination of military medical system.

Military Medical CareThe lack of antiquate care has caused the active duty hospitals as well as veterans affairs medical care to be put under careful observation. The failure to uphold military medical personnel to the same standard as civilians may be one reason why discrimination continues to take place in the armed forces.

Feres Doctrine, United States, 1950, Supreme Court made it illegal for military faculty to be sued due to malpractice/mistakes.

The reason why this ruling is still in place is because some individuals believe if the opportunity to sue medical personnel became warranted, it would alter the current practice of veterans being medically covered for a lifetime (Shane).

Many mishaps have made its way to the publics knowledge. The doctrine continues to protect military medical personal.

According to Ryan & Brown P.A. attorneys at law, The only group of individuals that can sue are military dependents, and active duties dependent, retired members who were injured after being retired, and veterans injured at VA hospitals.

Case 1

Sgt. Rodriguez, 1997, Marine Corps veteran passed away from terminal cancer. Sgt. Rodriguez noted melanoma eight years prior to his terminal illness. The cause was pointed to the neglect of military providers due to the failure to correct the problem. Medical providers were aware of the skin condition but failed to express concern until the cancer had taken over his body

Case 2

TSgt Cindy Wilson, 2007, went to Langley Air Force Base to deliver her child. A c-section was needed, the medical team initiated and a healthy baby was delivered. During the procedure, providers lacerated the uterine artery during the procedure. Attempts to stop the bleeding failed and two surgical sponges were left in her body. She died twelve hours later leaving behind a son she did not have the opportunity to hold (Innes).

Case 3 A1C Read, 2009, went in for a gall bladder removal. During the surgery, a medical professional damaged an artery in the leg. The leg was removed piece by piece to find the retracted artery (McGuirt). This surgical malpractice caused a young man to go in to have a simple surgery and then wake up to lose his leg.

Case 4

Air Force nurse was charged with giving patients a lethal dose of medications to cause death. Not only did he disobey doctors orders he illegally changed patient medical records.

Capt. Michael Fontana verdict was not guilty. This was because of the vague orders given by doctors as well as other events that occurred during trial (Military Nurse Acquitted of Euthanasia). It is out of my scope of practice, but I believe with a civilian case, this individual would have been charged with murder for altering the amount of drug used for the patient.

The military falls under different judicial rules, I can confidently say that two crimes can be committed by two different individuals and depending on rank, amount of time served, and other pertinent information will determine the verdict of an individual.

Some of the decisions that Ive witnessed are ethically inappropriate. One example is intentionally not following a doctors order. Having been exposed from previous classes during my undergrad journey as well as working in the hospital has educated me about decisions that must be made carefully.

Some of the ethical aspects that must be reported are reporting impaired, incompetent, or unethical colleagues.

Incompetence should be reported to the proper clinical authority who would be empowered to assess the potential impact on patient welfare and to facilitate remedial action (Opinion 9.031- Reporting Impaired Incompetent, or Unethical Colleagues).

I do not recall ethics, moral and immoral studies being covered. It is apparent that the majority of this type of training is not covered because it reflects in the military medical care system. But, it is also dependent on the individual to educate themselves and leadership holding them accountable. Since the lack of medical care has been exposed to the public. Leadership has taken a stand on educating military personnel about the importance of unethical behavior and working as a team. Education has also made it clear that regardless to an individuals position, it is important to express concern if something is not right.

Working in a military facility as well as a civilian facility has allowed me to compare the two different sides of medical care.

Ive worked at different facilities including civilian hospitals. The military bases include Wilford Hall medical center, Fort Sam medical center, San Antonios Saint Francis Pediatric Unit and the Air Force Academy Hospital. First three hospitals stated are trauma one hospitals. Ive also been deployed twice. This gave me the opportunity to work on US military German hospitals as well as native German hospitals. The level of care, in comparison, stands far from similar. The entire medical team, on the civilian aspect, are held accountable for their actions. One of the main things that I noticed were that everyone had to have a credential to practice. Some flexibility is allowed for the medical personnel. For example, temporary respiratory licenses are allowed in Texas up to a year until individuals test for the board.

The main difference, as stated previously, are the laws that protect medical personnel. If a civilian makes an error, they are liable. If a military doctor does the same thing, he is liable to an extent.

By examining one area of practice, respiratory care, Im able to point out the differences in care. The military offers Respiratory care in all branches of service. One difference is the Air Force sector. The Air Force requires two extra areas to be studied prior to graduation. Those areas are pulmonary and cardiology.

The Navy and Army focus their entire program on Respiratory care. The Army and Navy also require students to have certain prerequisites accomplished prior to applying to the program.

Also, all of the medics that become respiratory therapist choose to do so. Service members from the Navy and Army are required to have a certain rank and prior career.

The Air Force requires certain prerequisites to be accomplished prior to joining the career field as well. The difference is, the individuals are allowed to come enlist with the career prior to any other career field.

After the army and navy complete their training course, they are able to challenge the board and receive their credentials. It is a requirement to the course, not passing the board results in washout in the career field.

In the Air Force, individuals are not able to sit for their boards until all required classes have been accomplished as well as the receiving of a certain skill level. The skill level that is required is received after the nine month tech school has been completed and then six months to a year after that when they have gained the next skill set. In order to test, a CoArc number is needed and that is only given to the student after the completion of on the job training, or as stated previously, the next skill level is achieved.

Could this be one reason that the level of care varies throughout the different medical career fields?

The difference in education has been expressed throughout the branches for respiratory care.

One way to improve the inconsistency in care is to change the program to replicate what the army and navy are doing. Perhaps having a mature group of individuals as well as individuals that want to do the job will change the attitude towards the career field.

Developing a reason as to why military medical personnel fall short of acceptable care cannot be explained from one point of view. What can be explained is that the individuals that are in the medical field need to be reexamined.

The way that individuals are being qualified in the Air Force to become a respiratory therapist may not be the best route to go. It is evident that changes need to be made because those exact changes have been implemented. One of those changes being that enlisted individuals wanting to join as an RT need to have certain sciences accomplished prior to having the ability to become a therapist.

ConclusionTeam strategies

Team Huddles

Continuing Education

Holding Individuals Accontable

ReferencesFAQs. Ryan & Brown P.A. Attorneys at Law. Web July 31 2015.Innes, Wendy. Medical Malpractice in the U.S. Military Shockingly Underreported. IVN. Web 31 July 2015.McGuirt, Mary. Airman Loses Legs After Gall Bladder Surgery. abcnews. Web 31 July 2015.Military Nurse Acquitted of Euthanasia. CBSNEWS. Web 31 July 2015.Shane, Leo. Supreme Court Deals Devastated Blow To Feres Doctrine Opponents. Stars and Stripes. Web 31 July 2015.Opinion 9.031- Reporting Impaired Incompetent, or Unethical Colleagues. AMA. Web 31 July 2015.